The Four-Minute Fertility Conversation Most Of Us Never Got

Earlier this week, my co-founder Abby sent me this article by Dr. Brian Levine, along with a clapping hands emoji. Finally, someone had said it: at least part of the reason so many women and couples are flocking to fertility clinics — and why the "business of IVF" is booming — is because some (not all) OB/GYNs are falling short when it comes to fertility awareness and evaluations.

I lived this. As a teenager, my periods were irregular, sometimes showing up after 60 days, sometimes not at all. Nobody mentioned PCOS (or better yet, PMOS). I was put on birth control, which regulated everything beautifully, and stayed on it for the better part of a decade. When my husband and I were ready to start a family, I came off the pill and waited, but my cycle never came back. No period, no ovulation, nothing. My OB/GYN, to her credit, sent me straight to a fertility clinic — but that's not everyone's story. A lot of women in my position are told to wait and see, give it a few more months, relax. And those months matter in ways nobody warned them about.

Dr. Levine's argument is pointed: insurers reimburse a 15-minute well-woman visit the same whether it includes a real fertility conversation or not. There's no billing code for the four minutes that conversation actually requires, so it doesn't happen. Add in sex ed classrooms that taught us how not to get pregnant but never explained that fertility has a timeline, and you start to understand how a woman can do everything "right" and still end up blindsided.

We were never told the clock was running. We just assumed we had time.