When Anna De Souza was in her early 30s, she asked her ob-gyn when she should start thinking about having kids. “When you were 26,” she remembers the doctor saying.
She was surprised. She’d had some sense that fertility decreases with age but didn’t know how significant the drop-off was. No doctor had ever told her, and she certainly didn’t learn about it in school. She took sex ed at her New Jersey high school in the late 1990s, but she said it focused mostly on trying to scare students out of having sex. She remembers little about the class besides watching a graphic VHS video of a woman giving birth.
De Souza, a journalist in Philadelphia, now wishes that class had included the basics of fertility and reproduction. A more robust sex-ed program, she thinks, could have prompted her to check her egg count or freeze her eggs when she was younger, or even try to have kids sooner. She ended up having twins at 36, after two rounds of IVF, and later a son, also through IVF. But if she’d known more about fertility earlier in her life, she might have tried for a family “the good, old-fashioned, fun way,” she said, “instead of the needles way.” Teenagers, she believes, should understand that just because they don’t want kids at 16 doesn’t mean they won’t want kids ever.
She’s far from the only person who feels this way. Fertility doctors and other experts told me that better sex education—with a curriculum that explains both how to prevent pregnancy and how to boost fertility—could help more families have the number of children they desire. This is especially essential as more people wait until they’re older to start trying to have kids. According to the doctors I spoke with, many patients arrive at fertility clinics filled with misconceptions about their own reproductive biology. “It’s been stunning how ill-informed so many people are,” Michael Zinaman, a reproductive endocrinologist in New York, told me.
The doctors I spoke with pointed to some things that they believe all women and men should know about fertility but in many cases don’t. Most obvious, getting pregnant is easier when you’re young. When women see stories in the media about female celebrities who have a baby at 50, Rashmi Kudesia, a reproductive endocrinologist in Houston, told me, they might assume it’s likely to happen for them, too. Additionally, Kudesia said some of her patients don’t realize that their being underweight or overweight can contribute to interfertility, as can untreated sexually transmitted infections. Or they don’t know that doctors advise women to take a prenatal vitamin containing folic acid—essential to the development of a fetus—even when they’re only thinking about getting pregnant. Men should know, too, that lifestyle factors, including alcohol and tobacco use, can affect their sperm quality, which in turn can affect their partner’s likelihood of getting pregnant.
Those who may end up trying to conceive later in life could benefit from even more information. Zinaman told me that many of his patients don’t know that a woman has a brief window each month during which it’s possible to get pregnant. Kudesia said that some of her patients come in with overly optimistic views of how well treatments such as IVF can work.
Surveys of women’s knowledge of fertility lend support to these anecdotes. A 2023 study of nearly 1,800 women ages 18 to 29 found that only 59 percent knew the phase during the menstrual cycle when they were most likely to get pregnant, and most erroneously thought that a woman’s ovaries continually make eggs until she reaches menopause. (Women are born with all of the eggs they’ll ever have, and the eggs’ quality and quantity diminish with time.) In a 2016 study of mostly low-income women, just over half knew what ovulation meant, and fewer than a third knew when it occurs. In a 2017 study, reproductive-age women correctly answered an average of only about 16 out of 29 fertility questions, covering topics such as the percentage of pregnancies that end in miscarriage and the lifestyle factors that decrease fertility. Women studying to become doctors fared little better, answering an average of only about 19 questions correctly, leading the authors to conclude that “fertility knowledge is low among U.S. women of reproductive age, including those with children and even among medical trainees.”
Even women who are actively trying to get pregnant tend to be underinformed: A 2021 review found that women who wanted to conceive had “low to moderate fertility knowledge.” In a 2022 study of women struggling to conceive, only a quarter correctly recognized the week during their cycle when they had the highest chance of getting pregnant. This lack of knowledge has real consequences: “A lot of the misunderstanding around fertility and reproductive health lends people to either not be able to have the family size that they desire,” Kudesia said, “or to have lost a lot of time along the way.”
That’s in part why Kudesia and some other doctors think that fertility should be taught as a standard part of sex ed in schools. Although doctors could try to give patients this information themselves, most doctors’ appointments are too brief for a long lecture on ovulation, and some patients don’t bring up fertility challenges until after they’ve started trying to have a baby. “What I hear all the time is people thinking that, Well, if my age is a concern with regards to fertility, my doctor will bring it up to me,” she said. “And that’s definitely not a fair assumption.” What’s more, doctors who specialize in fertility often have long wait times for appointments, and some don’t accept insurance, putting their counsel out of reach for many. Better sex ed in middle school and high school, including lessons on ovulation and fertility cycles, could help make people aware, earlier in their life, of the factors they need to consider if they eventually want to have children. Fertility education in school also has the potential to reach far more people than individual doctors can; not everyone goes to the doctor every year, but almost everyone goes to middle school and high school.
Fertility-education efforts haven’t been studied extensively, but the limited research that does exist suggests that they can be effective. Studies from Canada, Spain, and Japan found that exposure to information about fertility at least temporarily increased young adults’ knowledge of the topic. Conversely, the consequences of educators not broaching the topic in schools can be significant: In a 2019 study based on interviews with 54 American women experiencing infertility, several noted the “conspicuous absence of conversations about reproductive health and fertility from their schools’ sex education.” One 39-year-old woman told the study’s authors that if she and her husband had known more about fertility earlier, “we would not have waited so long before trying to conceive.”
Some places have already implemented more robust sex ed in their schools. California recently enacted a Know Your Period law, modeled after a similar law in Washington, D.C., which requires schools to teach all middle- and high-school students about the menstrual cycle and menopause. And about 500 school districts across the country use a comprehensive curriculum called Rights, Respect, Responsibility, which covers menstruation, the fertile window, and how an embryo implants in a uterus. Kudesia praised one lesson from the curriculum as “excellent,” saying it “seemed like an age-appropriate way of discussing things.” She told me, “When we’re in high school or younger, we often get the impression that if you just touch a boy, you’re going to get pregnant.” A more well-rounded sex-ed curriculum would show that it’s not quite that simple.
But these programs face the same headwinds that sex ed in general contends with. Attempts to expand sex ed in schools typically fail for a few reasons, among them that some school districts can’t afford to train teachers and develop or purchase additional curricula about sexuality, and anything having to do with sex and bodies can be highly contentious among parents. Kudesia noted that the Rights, Respect, Responsibility curriculum might not be popular in today’s political climate, because it includes discussions of gender identity, a fact that the curriculum has been scrutinized for in the past.
The Trump administration, too, is keen on the idea of fertility education, though not primarily through school-based sex ed: In April, The New York Times reported that a policy analyst at the Heritage Foundation proposed to the White House that it use government funds to educate women about their menstrual cycles. And in July, the Times wrote that the administration was offering a $1.5 million grant to start an “infertility training center” aimed at helping women conceive. But Robin Jensen, a University of Utah communications professor who has researched sex ed, points out that these programs seem as if they’re aiming to increase the U.S. birth rate and not to also help people prevent pregnancy, if they desire. “Fertility education is needed in sex education,” Jensen told me. “But it needs to be the kind that is designed to increase fertility awareness and knowledge across the board rather than the kind that offers only part of the story.”
Young people themselves seem to want to have this more expansive, impartial information about reproduction. The idea for California’s period bill came from a high-school student, Sriya Srinivasan, who had stopped menstruating for three years, didn’t understand why, and felt too embarrassed to ask her doctor. She told me that she thinks kids should have a place to learn about reproduction other than the internet—a place where, as she put it about a hypothetical student, “I can sit and listen to this, and I don’t have to feel that stigma or shame from searching it up online myself, or I don’t have to feel the stigma of my family shaming me.” Ideally, Srinivasan and other teenagers would come away from sex ed understanding both how not to get pregnant and how to get pregnant: basic information about the human body that the body’s owner deserves to know.
*Illustration by Vivian Dehning. Sources: VintageMedStock / Getty; Bettmann / Getty; Jeffry W. Myers / Corbis / Getty.
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