How Did I Get to Thirty-Five Without Really Understanding My Reproductive System?

I wanted to know more about my fertility because I thought it might help me prepare for a someday I wasn’t willing to give up on.

This is My Future, My Fertility, a monthly column in which Karissa Chen wrestles with her questions about fertility, motherhood, and future-planning after thirty-five.

The first time I saw my own reproductive system on an ultrasound, I was reminded of the evening my ex-partner and I had gone the top of Mauna Kea in Hawaii to stargaze. We’d spent the night watching the stars appear over us, the air so thin and clear that I couldn’t believe we weren’t inside a planetarium, the sky a perfect projection from a hidden machine. As I pressed my eye against the viewfinder of a powerful telescope calibrated toward Jupiter, I figured it would be more of the same—a round smudge, perhaps bright like a star, comparatively less spectacular than the glaze of world I’d been privy to all night. And maybe that’s really all it was; maybe it was merely a lesser sun; maybe I only imagined I could make out the shadow of its eye. But what I do know for sure: my chest seized. I was finally seeing, with my own eyes, this world I had heard so much about—and it was breathtaking.

On the ultrasound, my uterus looked like a staticky, bluish paisley shape. My ovaries were gray cavities, filled with clusters of tiny, shadowy boba. I could barely comprehend the images with my untrained eyes. And yet, when the technician pointed them out to me on the screen and explained what those fuzzy images were, I felt amazed, the way I’d felt when I saw Jupiter through a telescope. Except instead of a herculean planet, it was my body that was miraculous, this body I had carried around and lived in for the last three and a half decades. This was a universe that dictated entire swaths of my life—from my wardrobe decisions (no white pants today) to my understanding of my mental health (is this bad stretch hormonal or environmental or chemical?) to how I vote (stop legislating my womb). To be face-to-face with something so intimate, so essential yet still so mysterious—I couldn’t have predicted how much it would move me.

A few days later, over Skype, I told a close friend how empowered I’d felt. “How is it that I’m thirty-five and this is the first time I’ve ever seen these parts of myself?” I asked. “I wish we had all been given the option of an ultrasound at our first pap smear.”

I struggled to explain the feeling I had—that somehow, putting an image to the idea of my reproductive system helped me to understand myself better. It made all the other byproducts—my acne, my cramps, my hormonal shifts, my cravings, my sex drive, even my desire to be a mother—more concrete, more real, rooted in something I could claim and hold close to me. I had seen my uterine lining—the same lining that I soaked up with tampons every month. I had seen my eggs—one of which I hoped would someday become a real, living person.

My friend, who had been trying to get pregnant, agreed. “We just don’t learn enough about our bodies,” she said. She told me about a book she’d been reading, Taking Charge of Your Fertility by Toni Weschler, especially popular with those trying to get pregnant or looking for a natural form of birth control. My friend had been using the book to help her chart her monthly cycles and monitor her fertility. “Did you know that your cervical fluid is different depending on where you are in your cycle?” she asked.

No, I didn’t know. I had never given much thought to my cervical fluid, except that it was there (sometimes, anyway). It seemed random and messy, just another inconvenience I dealt with as a person with a uterus. I listened to my friend explain what she’d learned from the book, feeling at turns skeptical, intrigued, and confused. If what she was telling me was true, why hadn’t we been taught this when we were younger?

A few weeks after my thirty-fifth birthday, two months after my partner and I had split up, a package landed on my doorstep. Inside was a copy of the book, along with a note from my friend. Here’s to taking control of the life you want, in more ways than one.

*

I remember little of what I learned from the sex ed classes we started having in fourth grade. I mean, I remember having them—I remember being separated into two rooms, boys in one classroom with Mr. L and girls in another classroom with Mrs. M. I remember getting little booklets filled with scientific diagrams of uteruses and fallopian tubes, the drawings reminding me of the face of an alien ox. I remember someone asking Mrs. M about sex and how it happens, and how she brightly laughed and said you didn’t just fall into bed magically; you had to find a boy you really liked. I remember getting a pink box filled with brightly wrapped pads and pantyliners and a coupon for some tampons. I remember the boys in my class incessantly asking the girls, “What period is it?” as if it were an incredibly clever joke.

What I don’t remember is what I learned about my reproductive system. I knew this thing called a period would eventually happen to me; that it would involve blood (but how would it feel?). I knew that getting your period meant you could, theoretically, get pregnant. I learned that a fertilized egg can travel down and implant in your uterus. Perhaps, in middle school, there was some talk about luteal and follicular phases, about rising or declining levels of hormones, but if there was I don’t remember. None of it seemed to have any practical application. And so it all became relegated to hazy knowledge, somewhat familiar but without any certainty.

For the last two decades, the most visible—and therefore most important—part of my cycle had been the period itself. The other three weeks that came after it were a big empty mystery, marked in my mind as days I did not have circle with a red pen, days I took non-placebos when I was on the Pill, days of respite from the messy, uncomfortable days. They were the days I got to be “normal,” versus the state of suffering and inconvenience I had learned to associate with my period.

Paging through Toni Weschler’s book, I relearned—or perhaps learned for the first time—the details of how a menstrual cycle actually works. I read about how the follicular phase (the phase leading up to ovulation) is the one that can vary greatly due to stress, travel, or other environmental factors, while the luteal phase (the phase that comes after ovulation) rarely varies. I read about the different hormones and how they trigger each phase of the menstrual cycle. I learned that each month, many eggs begin to mature in the ovary, but only one is released, leaving the others to disintegrate. I learned the signs of ovulation: clear, egg-white-like cervical fluid; a spike in basal body temperature; a higher, softer cervix.

Different from the dry scientific knowledge that had been thrown at me in school, the knowledge I found in the book was eye-opening and intriguing. Again, I was left with the feeling of, Why didn’t I know any of this before? I suspected the answer had to do with how little women’s bodies are valued in society, except for when it comes to housing fetuses, and I was angry at the patriarchy for seizing control of our bodies even as it prevented us from truly understanding them.

But also, I thought: I can’t wait to implement all of this.

 For someone like me, who loves having a plan, knowledge makes me feel like I can make an educated choice.

For about a year, I followed the guidelines in the book and set an alarm for the same time every morning to take my temperature, recording the numbers in a charting app on my phone. I tried my best to familiarize myself with cervical fluid and note when I saw it, trying to figure out how what came out of my body correlated with the descriptors—“slippery like egg whites,” “creamy like hand lotion,” “sticky like paste”—so I could identify when I was approaching ovulation. I never got the hang of feeling for cervical position. I wondered if this was something that I could have learned better if a professional had guided me, and I couldn’t help but think that one of the reasons we don’t know how to physically feel for changes within ourselves is because it’s still often seen as shameful for women to touch themselves at all.

Over time, I began to see patterns. I began to correlate my body temperature spikes with other symptoms my body was producing: fatigue, moods, breast tenderness. Of course, I had noticed some of these things before, but now I could correlate them more precisely rather than wave them all off as “PMS.” I felt like I was doing something useful, important, even empowering. Sometimes I opened up my chart on my phone and just scrolled through it, because looking at it gave me the same click of satisfaction I felt when I planned out my week’s tasks in my calendar.

But even as I meticulously observed, charted, and reviewed my data, a small voice inside me asked: What’s the point? What did it matter how long my luteal phases tended to be, what my body felt like as I approached ovulation? Why track so carefully which days I was fertile, when I wasn’t going to use that information to get pregnant any time soon? Sometimes, thinking about the futility of it all, I couldn’t help but despair.

The truth is, at first I wanted to know more about my body because I thought it might help me prepare for a someday I wasn’t willing to give up on. It was a practice run, I thought, for when I wanted to get pregnant. If I was being forced to take this time, why not arm myself with as much knowledge as I could, so I’d be ready for whatever might come?

But over time, I became lazy. I’d sleep through my temperature alarm. I wouldn’t bother to check my cervical fluid. Occasionally I tracked symptoms like moods and cravings and oily skin, but I stopped double-checking my predicted fertile days. And it was okay. A relief, even, to not have to think about what my body was doing, every day, all the time. There’d be time for that later, I thought.

*

To accept that my reproductive system is in decline is to accept, at some level, that I have little control over it. When I was in the early phases of considering egg freezing, I talked to a doctor who told me that no lifestyle change would affect my eggs’ decline in quality. It didn’t matter if I exercised regularly or drank less alcohol—the eggs would continue to go bad, one by one, as time went on.

Even though I know I have no control over this, I keep reading other studies, learning other statistics, trying to understand the way my body works. This is still about control, of course: Knowledge offers a sense of agency, even when we don’t have much of it. It’s why a person checks WebMD when they have unexplained medical symptoms; why a person who has been cheated on wants to know all the painful details. When the future cracks open into a wide chasm of terrifying possibility, knowledge is often the only thing that offers us some footholds. For someone like me, who loves having a plan for the future, knowledge makes me feel like I can make an educated choice.

The things I want to know are numerous: I want to know why fertility dwindles with age; I want to know what, if any, options I have in the face of this. I want to know if acupuncture can be useful for the health of my womb. I want to know how the science behind egg freezing works. And yes, I want to know more about how my body works—a body that, I’m beginning to realize, I don’t know very well at all.

Nowadays, even without constant charting, I do know my body more intimately. I’m more attuned to its changes each month. Even when I don’t consciously look for signs or chart the data, I can say with a degree of certainty where I am in my cycle. I have a better sense of what factors are contributing to my overall sense of well-being. And I can picture for myself where all of this is happening—in that miraculous universe I’d once seen on screen. Maybe this knowledge isn’t useful for conception right now, and maybe there’s still much more I could learn—but what I know now is already so much more than I knew before. And that, in and of itself, feels empowering.

*

I want to end with a story from several years ago. One morning, I woke up to horrible cramps. I had just arrived in Beijing, where my mother lived, the day before, and I’d felt nauseous during the entire sixteen-hour plane ride. When I stumbled to the bathroom, I discovered thick, dark blood in my underwear. My period was a week early.

I put in an ultra tampon, the most absorbent kind on the market (up to eighteen grams of blood, versus nine grams in a regular tampon), and then lay back down. I’ve always had terrible periods, but this was particularly vicious, worse than any I had ever experienced. My uterus felt like it was being sheared from the inside out with a vegetable peeler. I finally took an Advil, and after twenty minutes, the fist of pain began to loosen slightly. By then I had fully soaked through my tampon. For the next several hours, I was in the bathroom every half an hour, the stash of tampons I had brought with me from the States fast dwindling. Four hours in, I pulled out another fully absorbed tube of cotton, and clots the size of silver dollars fell out of me. I stared in horror, fearing that something was terribly wrong.

Nowadays, I do know my body more intimately. I can say with a degree of certainty where I am in my cycle.

Three days before I’d gotten on that plane, I’d had a bit of spotting. It was two weeks too early for my period; unusual for my body, which typically ran like clockwork. I’d Googled and found a variety of possibilities—endometrial cancer, thyroid issues, a decaying womb—as well as the far more common possibility: implantation bleeding. I checked Clue, the app I used to track my period, and according to its algorithm, I’d probably been fertile the week before, when I’d last had sex. I hadn’t taken a pregnancy test, because my period was still too far away, rendering results unreliable, but the possibility that I was pregnant loomed large in my mind as I flew over the Pacific several days later, as unexplained nausea brimmed in my throat.

Now I wondered: What if I was having a miscarriage, and I didn’t know it?

The terribleness of that period lasted for two days. Two days of feeling like my uterus was going to push itself out. Two days of soaking through tampons at an alarming rate, though by the second day, the clumps stopped coming. Because I was in a foreign country, I didn’t call a gynecologist, instead hoping the period would resolve itself. On day three, the bleeding tapered down to more typical amounts, and a few days after that it finally stopped.

I still think about this period sometimes, wondering what it was or wasn’t. If it was simply a stress-induced atypical period, due to hormones gone awry, or if it was, indeed, something more. A clump of irregularly dividing cells. A potential life, unviable. I’ll never know, of course, and that’s mostly okay. The uncertainty is perturbing, though less upsetting than if I’d known for sure a miscarriage was happening.

I used to wish I had known more about my body before it happened. Maybe if I’d known more—about how to track for ovulation, of how to pay attention to my body’s ever-changing physical symptoms—I would have known for sure. Maybe if someone had taught me, from the moment I got my first period, how to understand my body’s unique signs, I wouldn’t have spent those two painful days oscillating between worry over the possibility that I had a serious medical condition, and sorrow that I was losing something I wasn’t even sure existed.

But maybe that’s not the point. Even armed with all that knowledge, maybe I couldn’t have known for sure, and I would have wished for even more—more knowledge, more certainty. Or maybe I would have known for sure that it was a miscarriage, and then irrationally blamed myself for something I’d been powerless to prevent. There’s always too much we don’t know, too much we can’t control. Now, all I can promise myself is this: I’ll do the best I can to prepare for what I can’t predict. But at some point, I have to let go of those footholds. Jump into the chasm and trust that I’ll be ready to face whatever I find there.