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Waking Up From the Pill

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“There’s no reason for girls to have to worry about getting their period in gym class at school, or for women to be worried about wearing their white pants,” says Weschler. “There is no mystery here. If you take your temperature, you will know when you’ve ovulated and when you get your period.” She sighs. “Think about a woman who gets pregnant accidentally when she’s on the Pill, because she missed a few pills: How come she doesn’t know that if she feels a lot of fluid, which I like to call ‘egg-white cervical fluid,’ her estrogen is rising, and one of the eggs hasn’t been suppressed? In fact, she’s about to release it. For no other reason, all women should know that, so they can say, ‘Oh, dear, my estrogen seems to be rising, something is wrong.’ ”

You’re not going to find anyone, male or female, who isn’t a little grossed out by the words egg-white cervical fluid, but it’s just basic biology. “The egg-white stuff is just my body preparing for ovulation, which is the time to hop into bed,” says Barrie, 35, a FAM enthusiast. “It’s the glue that transports the sperm into my uterus.”

To arrive at the stage when one stops taking the Pill and starts timing one’s ovulations is to enter a new and anxious universe. After that, if you’re unlucky, you may enter a kind of medical and bureaucratic purgatory of doctors’ waiting rooms and insurance companies and worries that’s very far indeed from the freedom you enjoyed before.

On the Pill, it’s easy to forget the truths about biology. Specifically, that as much as athleticism or taut cheekbones are, fertility is a gift of youth. The body that you wake up with after fifteen or more years on the Pill is, in significant ways, not the one you started out with. With age, body rhythms change. Cystic conditions, endometriosis, and a whole host of complicated ailments are more common. And whatever “irregularities” a woman may have experienced in her teenage years before going on the Pill will likely be around when she goes off it. “Some women who come off the Pill in their thirties are surprised that it takes a few cycles to get their periods back, or that they may have very long cycles, or cycles without ovulation,” says Jill Blakeway, founder of acupuncture center Yinova near Union Square and a co-author of the cult book Making Babies. “The Pill didn’t create these problems: In most cases, the problems were there all the time, but because they were on the Pill, these women were never motivated to deal with them. And now they have a time issue.”

But the biggest issue for aging women, of course, is that over time, their stockpile of eggs becomes depleted, and the ones they still have are not of top quality. Fifty percent of women over 35 will fail to get pregnant over the course of eight months, and after that the odds keep dropping.

And as it turns out, it’s difficult to predict how hard it will be for any given woman to conceive. “We don’t completely know what determines who is fertile and who is not,” says Dr. Jamie Grifo, the compassionate, plainspoken program director of NYU Langone’s Fertility Center. “The only test is trying to get pregnant and getting pregnant. That’s it.”

For women who have spent so much of their lives pressing the off button on their bodies while on the Pill, it’s upsetting to learn that there’s no magic pill that causes instant impregnation. (The same is not the case for men: With the advent, in the nineties, of a technology that can fertilize an egg with a single sperm, almost every man can be a father.) In fact, fertility doctors have a surprisingly small suite of options for women who are having trouble conceiving—and very few that don’t involve the risk of multiple births. There’s Clomid, a neurological drug that encourages ovulation and can trick a woman’s body into making more than one egg a month; a bioengineered follicle-stimulating hormone, originally synthesized from the urine of postmenopausal nuns, which also makes the body produce multiple eggs; and in vitro fertilization (IVF), or test-tube babies, which has been the gold standard of infertility treatments since 1978 (the British doctor who pioneered it received the Nobel Prize this year).

IVF has never been more effective than it is today, but cycle by cycle, it still fails more than it succeeds. NYU has one of the best IVF programs in New York—the other is the Weill Cornell Medical Center, part of New York–Presbyterian—and its success rates put it near the top in the country. But a look at these rates should give one pause. In a single cycle of IVF, about 64 percent of 30-year-old women wound up with a child. At 35, 47 percent were successful; at 40, only 28 percent; at 43, only 13 percent; and at 44 and over, it’s 2 percent.


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