The F Word: Preventing the Fertility Freakout
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May 22nd, 2022

4 things to consider if you’re not thinking about kids yet but feel like you should be

by Erika Francks, Camille Berry, and Sujude Dalieh

Content warning: Fertility is a sensitive topic and we absolutely do not want to push a “doomsday” outlook on it, but we strongly feel that knowledge is power in understanding your options and keeping them open.

We’ve all heard the phrase ‘your biological clock is ticking, we get it as a concept, this graph made it real for us.
We’ve all heard the phrase ‘your biological clock is ticking, we get it as a concept, this graph made it real for us.

Are you pretty sure you want kids but feel like really thinking about it is a “later you” problem? Have you heard about IVF or surrogacy and thought, “I should probably actually understand what that entails,” but never followed up? Do you get a little pit in your stomach when someone mentions egg freezing and think, “should I be looking into that?”

If any of these ring true for you, no worries, we are totally with you. It is completely normal to put off thinking about this stuff when it doesn’t feel particularly relevant or pressing! That said, we focused our graduate thesis research on enabling women to make informed decisions about their fertility and family planning. In interviewing dozens of women ages 21–40 over the past year, we’ve started to realize that pushing off thinking about this stuff is leading to what we now call “Oh Sh*t” moments down the road, when suddenly options for having kids can feel a lot more limited and women ask themselves “when was I supposed to be planning for this?”

At the same time, women we interviewed who were not yet thinking about children reported feeling like they should be and asked us to share back with them what we found. There seems to be a general sense of “I should know more,” but not a lot of guidance on what to learn.

So, that said, we’re here to share a few things we’ve learned with you throughout our research so that we can all start clarifying our desires and understanding our options before we hit any sort of panic zone around fertility. This is in no way pushing anyone to have children, or to set hard-and-fast timelines, but just to help us all start having realistic conversations with ourselves around how our lives could play out, with a few guiding questions along the way.

1: The Disney Princess Complex and Preventing the “Oh Sh*t” Moment

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What is the “Disney princess” complex?

We’ll preface by pointing out that we didn’t come up with this term. It has been a headline before, but different groups have defined it in different ways. Some describe it as causing body image issues and an obsession with looks. Others (mostly male blogs) say it causes unrealistic expectations in dating. What we are calling the disney princess complex is the idea that we are socialized to believe once we fall in love, everything will fall into place in our lives and we’ll live happily ever after — a whimsical approach to dating and potential family-building.

Over the past few decades we’ve actually come a pretty long way in moving away from this narrative in how we think about relationships, since it’s obviously becoming more and more normal to be independent and career-focused and not just wait around for a man to save us. And beyond that, it’s way more accepted to be queer, not get married, or have different relationship structures like polyamory or open relationships.

But while narratives around what it means to be a woman in the world have shifted, our narratives around children have not. We’re still conditioned to believe that if we have a partner who loves us, kids will just work out when the time is right, like we see in fairytales. Or beyond fairytales, what we’ve seen with the generations before us. But as the “right time” for kids gets pushed due to later marriages, career aspirations, and financial constraints, for a lot of people it has become an experience far from a fairytale. The Disney princess influence on family “just working out” does not match our current reality, and provides a pretty unrealistic narrative of what to expect. We are not Disney princesses, nor do we want to be! But until we reconcile the disconnect and start planning within our current reality, “Oh Sh*t” moments will continue to happen.

What is causing these “Oh Sh*t” moments and how can we prevent them?

Need for reproductive assistance

One statistic to note is that the average age at which women had their first child in the US rose from 21.4 years old in 1970 to 26.9 in 2018. For fathers, it’s increased from 27 to 31. Obviously, this still sounds pretty young. I mean, we’re in our mid-twenties, but this age thing feeds into the fact that one in six couples today has trouble conceiving. And, in at least half of all cases of infertility, a male factor is a major or contributing cause. So, often, the “Oh Sh*t” moment in a heterosexual relationship could be getting to the point of being ready to have kids and then realizing you’re going to need some assistance if you want to have biological children–for queer couples this could be finding out how much it costs to utilize assisted reproductive technologies (ART) or realizing that you are not covered by insurance.

Author’s note: we believe everyone should have access to fertility benefits! And abortion! True agency is the ability to say no and to say yes (check out our website http://whohateswomen.com for more on this).

Shift in life circumstances

Another reason for the “Oh Sh*t” moment comes from life changes; we’ve heard from a lot of women in their 30’s or 40’s who went through breakups or encountered other life changes and suddenly their life circumstances around children were completely different. They’d been assuming things were going to work out when the time was right, and planning for a certain version of their life, but all of a sudden they’re asking themselves questions like, am I willing to have kids on my own? Should I have frozen my eggs years ago? How important are biological children to me?

Medical diagnoses

And finally, “Oh Sh*t” moments can come along with medical diagnoses. We have a really long way to go in the world of women’s healthcare to even understand what is going on with our bodies (we could do a whole separate book on that), but we’ve talked to a bunch of women who face an “Oh Sh*t” moment when they suddenly become aware of a medical condition, like endometriosis, PCOS, or an autoimmune disease that could affect their fertility and need to make decisions about how to handle that. This can also come about at the moment of transition for transgender folks in deciding how to handle preserving fertility if they’d like to do so.

What do I do with this information?

Right, so honestly, that’s kind of the whole point of this article! We know this stuff can be super overwhelming, and it’s way easier to just be like “I’ll deal with this later”. But we’ve heard from enough women now who kept moving the goalpost of “I’ll deal with this later,” and ultimately ended up in very stressful scenarios, that we really think there is value in starting to think about this stuff earlier on.

For a lot of people, this is honestly just getting clear with yourself on some possible scenarios for how your life could play out and thinking through what you might do in that situation. Here are some examples:

“I know I really want kids, so if I get to be in my early 30’s and I’m still really not feeling ready, maybe that’s when I get a fertility assessment to see if anything is abnormal that I should be aware of?”

“I’m not sure if I want kids yet, but if I decide to have them it would likely be in my late 30’s or even early 40’s, thus IVF could be necessary. Maybe I could consider freezing my eggs at a younger age in order for that to have a higher chance of success?”

“I’m queer and know I will want to use assited reproductive technologies to have children, but all of that can cost a lot of money. Maybe I could start saving or advocating for fertility benefits in my workplace?”

Again, none of this is personal or medical advice at all, but we think knowledge is power. If we can get educated on the options out there, understand the realistic costs and limitations that might exist, and reflect on how these options might fit into our own lives, then we have a lot more agency over our futures. We can avoid the “Oh Sh*t” moments, not miss out on options because we didn’t know or didn’t understand, and feel convicted in our decisions when it is time to make them.

2: The Paradox of Partnership

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What is the “Paradox of Partnership?”

When chatting with dozens of women between the ages of 21 and 40, partnership and lack of partnership are both used as reasons to delay thinking about family planning and fertility. We heard people in partnerships say “I’m not too worried about it, we’ll have these conversations once we get more serious about having kids” and people without partners say “I don’t have a partner so I don’t think about family planning yet.” Sound like you?

So, when are people planning for children?

In many cases, right before they start trying! Which, in our parents’ generation, made a bit more sense because marriage and children were essentially the default for everyone and timelines tended to move more quickly. Now, couples are waiting a lot longer not only to marry, but also to have kids. Many factors contribute to this, but according to a study by Sofi and Modern Fertility, 60% of respondents reported delaying childbearing due to not having enough money. Life costs more money nowadays, so getting to a place where we can fully provide for children is taking longer than for our parents, and we have pretty abysmal childcare support in this country to help us.

On top of that, there are higher numbers of women pursuing education and continued education, and more women working and advancing in their careers. Relationships and dating have changed, as well–in some ways it feels like we’re all slight commitment-phobes due to the rise of divorce rates we experienced with our parents’ generation.

So, all of this combined is pushing out the timeline for having kids. Which in some sense is awesome. It provides more opportunity to pursue other things outside of building a family. The only problem is that our ability to have biological children really does change over time. We can push out the timeline, but if the goalpost keeps moving back and back and back, eventually we could run into a situation where we just don’t have as many options as we did before. Most folks we’ve interviewed have pretty vague ideas of what it might look like to try to have kids at different stages of life given egg counts, fertility challenges, etc.

Hence, the need to plan ahead. We believe more forethought could go into what you want, outside of partnership. When you consider divorce rates averaging around 45–50%, the likelihood of raising children on your own or co-parenting from different households is actually quite high. This is not a fun statistic, but it was a reframe that helped us think through the realities of choosing to have children.

We also heard many stories of women experiencing a breakup at 35, 36, 37 with someone they thought they were going to marry and have kids with. That can’t be planned for, of course, but it’s a very real possibility–partnership is kind of a question mark! Doesn’t it feel a bit odd to hinge such a big decision on a question mark?

Yes! What do I do with this information?

We plan out almost everything else in our lives, so it’s interesting that we keep this sort of whimsical outlook of “it will fall into place!” Or “if it’s meant to be it will be” around having kids. We believe this is a conversation that is useful to have with ourselves, outside of partnership, so that we can handle possible changes in our lives with the grounding that we know what we want.

We’ve laid out some examples of guiding questions to think about with yourself, whether or not you have a partner:

“I don’t have a partner at this moment and I’m like 75% sure I want kids in the future, but definitely not 100%…would I be willing to spend money on getting a fertility assessment or freezing my eggs now so that I can have some extra buffer room to decide?”

“I definitely need to be on the same page about kids as my partner before marriage, but when I brought it up it kind of caught them off-guard. What do I really want kid-wise and what kind of timeline am I thinking about? What will I do if we don’t align?”

“Thinking about future partners — I’d want to ask myself if I would feel confident raising a child with them if we did not stay together romantically in the future?”

“What if I’m not even sure I want the 1:1 partnership model for the rest of my life? Would I consider having kids on my own? Would I want to be a “choice mom” (the new term for having children solo intentionally)?

“Do I want multiple partners or a larger family unit to raise children with as a community?”

Now, this is not to scare anyone or push folks to overplan. These are huge questions, and our answers can change over time. But knowing our options, being real about the various outcomes that could play out, and having a good sense of our own desires–detached from partnership–should set us up to have much more agency than if we put off thinking about children until we want to start trying.

3: False Confidence in Options and Fertility Unit Economics

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What is causing “false confidence” in fertility?

With rapid advancements in fertility technology and heavy investment in the space, it’s easy to believe that we will have plenty of options for conceiving when the time is right. There are some really exciting emerging technologies. However, due to high cost and mixed success rates of fertility interventions, our current options are actually less of a slam dunk than we think, and can lead to emotional and physical challenges.

We also seem to have a skewed understanding of the accessibility of these fertility interventions, partly from the influence of celebrity news and social media. In 2015, Gabrielle Union opened up about the shame she felt in prioritizing career over family building, leading her to pursue IVF in her 40’s. In 2016, Selena Gomez froze her eggs; her medical care team recommended considering the procedure before undergoing chemotherapy for Lupus. In 2018, Halsey froze her eggs at 23 due to her endometriosis diagnosis and related surgeries. In 2020, we learned more about Kim Kardashian’s fertility journey–during her first two pregnancies she experienced placenta accreta and gestational diabetes, a condition in which the placenta gets stuck inside the body during birth. Because of this, she chose to use surrogates for her third and fourth children. In 2021, we watched Heather Rae from Selling Sunsets document her fertility journey through IVF and embryo preservation on TikTok. And finally, in 2022, we learned Chrissy Teigen is using IVF to try for her third child and saw her share the all-too-common, but often private, pain of miscarriage.

On the one hand, this exposure is great. It’s passively trojan-horsing some of this fertility information to folks and normalizing conversations. But while exposure is good, it could also be giving us a false sense of security. We hear the ages of some of these celebrities and think “ah, I have all the time in the world.” However, for them, money isn’t an issue. They can afford as many cycles or procedures as it takes, and can seek out and travel to the best clinics in the world.

We also detected a lot of false confidence when speaking with women who use their mom’s story as an example of success. We heard things like, “well my mom had a kid at 39, so I’m probably good!” However, there are differences between our mothers’ generation and ours. Not only are we, on average, having kids later in life, there’s also more and more evidence that environmental factors like pollution affect fertility, and that fertility is generally on the decline.

Fertility struggles also are not limited to women. In fact, it’s a giant misconception and one that we need to set straight. In at least half of all cases of infertility, a male factor is a major or contributing cause. While researchers aren’t sure what exactly is causing male-factor infertility–they mostly blame environmental factors–it is clear that male fertility is decreasing. In 1992, a study found a global 50% decline in sperm counts in men over the previous 60 years. Multiple studies over subsequent years confirmed that initial finding, including a 2017 paper showing 50–60% decline in sperm concentration between 1973 and 2011 in men from around the world.

So what does this mean? We’re not trying to scare the shit out of everyone. But there’s no denying fertility is changing and the need for assisted reproductive technologies is increasing. We need to get real about how much different treatments cost and the likely success rates at different ages (because age matters here too) with assisted reproductive technologies like IUI, egg freezing, and IVF. With this information we can better plan, better save, and better prioritize when making life decisions, like potentially taking fertility benefits into account when job searching.

How much do fertility options really cost?

To begin, we need to make clear that most of these procedures are not covered by insurance, public or private. This is something not everyone knows. Unless it is deemed “medically necessary,” like in the case of women undergoing chemotherapy for cancer, it is not covered. And these guidelines are quite strict–we spoke with a woman undergoing chemo for an autoimmune disease who could not get egg freezing covered as “medically necessary” because it wasn’t cancer. This also typically excludes LGBTQ+ individuals who don’t meet the definitions of “infertility” that may qualify them for coverage. Even transgender individuals undergoing gender-affirming care may not meet the criteria for “infertility” that would cover them for fertility preservation (think: egg or sperm freezing).

So, most patients are paying out of pocket for these treatments, which can end up being well over $10,000, depending on the treatment. Let’s break it down. And shoutout to FertilityIQ — a super informative fertility education site that helped us source these numbers (this platform also costs money…nothing is free in this fertility world!).

IUI

IUI, which stands for Intrauterine Insemination, is a procedure to put sperm directly inside the uterus, helping healthy sperm get closer to an egg. It is usually a “first try” for unexplained infertility. You may explore this if you have endometriosis or low sperm count/quality. It would also be used for same-sex female couples using donor sperm, or single women using donor sperm. It averages between $500-$4000 per cycle or “try,” essentially. The range is so wide because it can vary by medication pricing, monitoring and bloodwork, and the insemination procedure, so it mostly depends on the clinic you go to.

IVF

IVF, which stands for In-Vitro Fertilization, is a procedure in which eggs and sperm are fertilized outside of the body in a test tube or petri dish, and then a viable fertilized embryo is put directly inside the uterus. It can be eggs and sperm from partners, or donor eggs / donor sperm. It is also often used with surrogates. This is often a next step in the unexplained infertility process, or for women who have fallopian tube damage/blockage, or other health concerns. IVF can cost well over $20,000 for one cycle when tallying the cost of treatment and medication–most women will average 2.1 cycles, bringing the total cost upwards of $40,000. Cost also depends on if you do genetic testing or other add-ons and is variable by clinic and by state.

Egg freezing

Egg freezing is the last one we’ll cover, although there are many more fertility options. Egg freezing is a procedure in which eggs are extracted and then frozen using cryopreservation. It is used as a preservation measure, so that you can use the eggs later. You can freeze embryos (fertilized eggs) for preservation as well. On average, egg freezing patients will spend $30,000-$40,000 on treatment and storage. The breakdown is around $15,000 per cycle (to extract the eggs) and most women do an average of 2.1 cycles. Storage costs depend on location, but average around $500 per year.

It becomes even more complex when assessing the unit economics of fertility treatments. Freezing your eggs at 32 is a very different financial decision than freezing your eggs at 38, or 43 like Kourtney Kardashian. For example, you might be able to get 40 eggs in one round at age 32 for $20,000 with longer-term storage costs, and 20 eggs in three rounds at age 38 for $60,000 with reduced storage costs. We should be thinking not only about which fertility options might make sense for us, but also when those options make sense in the context of our wants and needs. It’s not fun to have to think about unit economics when thinking about the magic of having a baby! But that is exactly the kind of psychological barrier we hope to help women overcome.

So, what could I be thinking about?

There are a few companies popping up to make fertility procedures cheaper, which is exciting. That’s essentially Kindbody’s premise–they’re improving user experience but also trying to drive down costs. But even at Kindbody, if you want to get a basic fertility assessment to find out where you’re at and if you should be worried, it can still be upwards of $300. In some states, insurance companies are required to cover a fertility assessment, so if you’re interested in getting a fertility workup done, talk to your OBGYN. They should be able to refer you to a clinic, and with that referral your insurance could cover it. But always ask upfront what your insurance will cover.

There are also companies like Carrot Fertility or Progyny that facilitate employers offering their employees fertility benefits. You could consider negotiating or advocating for fertility benefits in your current company or next job! And finally, there are companies like Sunfish offering financing and loans for fertility treatments.

Additionally, here are a few guiding questions you could ask yourself:

“How do I feel about assisted reproductive technologies in general?”

“Do I know what, if any, fertility coverage I currently have?”

“If I have a partner(s), have we mutually discussed our feelings about ART? Does my partner have fertility benefits?”

“I’m queer and would likely use ART to have a biological child with my partner, how might we plan for that?”

“If I’m diagnosed with a fertility issue (about 10% of women have PCOS and 2–10% have endometriosis) and struggle to get pregnant naturally, how much money, if any, would I be willing to spend on assisted reproductive technology?”

“Am I willing to start saving money (or advocating for benefits!) now to have a plan in place for if I might need ART?”

4: Why We Might Not Want Kids

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Let’s talk about this!

Obviously, it’s becoming increasingly socially acceptable to not want kids, but we don’t actually spend much structured time thinking or talking about the reasons why we do or do not want kids. We found in many cases in our interviews with women, it’s just referred to as a feeling. But where does this feeling come from? Is it subliminal social pressure? What your friends are doing? The next logical step in your relationship with your partner? Or, is it truly your own desire and intentional decision, one way or another?

So, let’s talk about why we might not want kids! Lack of a supportive partner, lifestyle and identity, climate change, and health concerns are all valid reasons for choosing not to have children and deserve some discussion to spark thoughtful reflection. And, even without children of your own, there are many ways to integrate children into your life if you still want to be around them.

Lack of supportive partner

Unfortunately, the ever-present influence of traditional gender roles feeds into considerations around lack of a supportive partner. According to happiness expert Paul Dolan, a professor of behavioral science at the London School of Economics, women who are single with no children are actually the happiest. Dolan explains that while men derive benefits from marriage, the same cannot generally be said for women. This statement is clearly very heteronormative and sweeping, and there are many really great marriages out there, but women are still typically the default for emotional and household labor within marriages, which gets exacerbated with children involved. Married heterosexual mothers notoriously take on more responsibilities than their male partners and very different responsibilities than their single women counterparts.

Lifestyle and identity

Here, we want to touch on the concept of “regretting motherhood” which is super taboo in our society to talk about.

Sociologist Orna Donath published a book called Regretting Motherhood, which is a study on women who self-report regretting becoming mothers. There are many different reasons they became mothers in the first place–avoiding divorce, meeting family expectations, fitting in with friends, or simply because they thought it was the “next step”–and some of them actually did have a strong desire to be mothers before having kids, but all of them ended up regretting it when faced with the reality of motherhood.

We always hear about women who choose not to be mothers being warned that they will regret their decision later in life, but we really don’t talk about the possibility that the opposite could also be true — that a woman who becomes a mother might regret it. This brings us back to women dealing with most of the emotional and household labor in heterosexual relationships–the burden of childbearing often does fall primarily on the woman, which is a very real factor to consider depending on your relationship. Looking at the realities of the lifestyle changes and identity changes that come along with having kids, you might just decide you are not down for that shift and really value your autonomy, which is a completely valid choice.

Climate change

Climate change is a very real consideration for a lot of folks in the decision of whether or not to have kids. In our parents’ generation, they still had plenty of societal issues going on that could make them wary of bringing children into the world (ex. war, economic stress, etc.), but it wasn’t at quite the same level of climate change–our world is fully on fire and not on track to stabilize.

Given the trajectory we’re on, there’s definitely questions of: “What kind of world am I bringing my kids into?” “Where should we live so that we’re not at constant threat of floods, fires, famine, etc., and can we even afford that?” For some, this feels more pressing than for others, but certainly we’re hearing more and more about people choosing not to have children due to climate change.

We are absolutely not trying to be doomsday here, and there’s an argument on the flip-side of all this where having children is actually a sign of sustained hope for the world, but we just want to validate the fact that you might have considered this and that you are not crazy for factoring climate into your decision-making.

Health concerns

Finally, health concerns are a valid consideration. Maybe you are already dealing with a health condition that meaningfully affects your life and you do not know how a pregnancy or the stress of having children might impact your own personal health. We spoke with a woman who has a very intense autoimmune disease and is worried about taking care of a child while also trying to manage her disease. Obviously, our society should have better resources for and access to childcare, which would solve many of these problems, but within our current reality this is a serious consideration.

Even the act of giving birth can come with serious health risks that are rarely talked about. 303,000 women die around the world as a result of complications of pregnancy and childbirth every year, and due to inequitable care, Black Women in the US have the highest maternal mortality rate, more than two times worse than that of any other racial or ethnic group.

Additionally, we are not told much about birthing until it happens to us. Even with more and more women opening up about the realities of childbirth on social media, we are still wildly uninformed when it comes to what happens to our bodies during and after childbirth. Even miscarriages are taboo, yet 10–20% of known pregnancies end in them. For some women, this might have a meaningful impact on whether or not they want to be a birthing parent and thus it should not remain a taboo topic.

What can I be thinking about?

So, there are a lot of reasons you might not want kids. We have a really strong narrative in society that parenthood will be the best thing that ever happened to you. However, we heard a quote recently that we loved along the lines of, “We are told parenthood will be the best thing that ever happened to you, but if you don’t become a parent or don’t want to,* something else *will be the best thing that ever happened to you.” You’ll always have a best thing! The best thing is not the same for everyone.

The status quo and cultural expectation is still to have children, but women are still sacrificing the most with having kids. So we hope that the decision of whether or not to have kids becomes more intentional– one you truly have conviction in. Also, experiencing the positive impacts of “nurturing” something does not have to be children. It could be nurturing your relationships, your community, the world in whatever way feels right to you. Or, if you are really inclined to nurture children, there are a million ways to integrate kids into your life even if they are not your own.

Here are some guiding questions to consider:

“Have I thought about all the ways my lifestyle would change if I were to have kids? Am I okay with that? “

“Do I want kids of my own or just kids in my life in general?”

“Do I feel like I would be taking on the role of primary caregiver in my relationship if we were to have kids, and if so, am I okay with that?”

“Do I feel that bringing a child into the world is something I’m comfortable with given my own personal feelings about the trajectory our world is on?”

“Does having the right partner meaningfully impact whether or not I would want kids?”

Final thoughts

Ultimately, the goal of this article is to help women avoid the “Oh Sh*t” moment we keep hearing about, where they get totally blindsided by fertility challenges. And again, you can have babies at any age and in a lot of different ways–we just want everyone to understand the options that are available to them and empower everyone to become their own advocate!

Please reach out if this brought anything up for you or if you have any questions!

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