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.
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.
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