The whole map
The medical facts a reproductive medicine specialist considers the minimum worth knowing, narrowed to 24. The full list is published here — nothing withheld. Because these rest on physiology and epidemiology rather than policy or pricing, they do not go out of date.
This knowledge is not only for you
The intended readers include parents of teenagers and students, people working in education and healthcare, and anyone responsible for workplace wellbeing — not only those trying to conceive. Facts 23 and 24 are not about the patient at all; they are about the people around them. One person understanding this correctly can spare someone else a great deal.
Fertility has two clocks — egg quality and egg quantity — and they set the frame for any life plan.
One in ten couples will face infertility
Infertility means a year of unprotected sex without conception. Simply continuing to wait does not restore the odds.
Egg quality declines from your thirties
The first clock. Pregnancy rates fall gradually after 33, and the decline steepens past 36.
One in a hundred women loses fertility in their thirties
Premature ovarian insufficiency affects 1 in 100 under 40 and 1 in 1,000 under 30 — potentially right after the average age of marriage.
Egg count falls silently
The second clock. AMH declines without symptoms, and — crucially — it does not correlate with age. The variation between women is enormous.
Time is limited
The career-building years (20–35) overlap with the fertile years. Because that window differs per person, knowing your own status comes first.
Periods, STIs and contraception: the silent problems that quietly erode future fertility.
Understanding your own cycle comes first
Changes in length, pain and flow are the earliest signals you can read yourself — and a shortening or lengthening cycle means something.
Chronic anovulation raises endometrial cancer risk
Without ovulation the lining never resets. Ignoring irregular cycles carries risks well beyond fertility.
Treat severe period pain as endometriosis until proven otherwise
Pain cannot be compared between people. Endometriosis worsens year on year and causes infertility — but effective treatment exists.
You can carry an STI without knowing
Chlamydia affects 1 in 10–20 women in their early twenties, blocking tubes silently. Testing is simple and treatment is easy.
HPV causes cervical cancer
50–80% of women acquire it; 90% clear it within two years. Vaccination plus screening every 1–2 years prevents almost all of it.
Unintended pregnancy is more likely than people think
Without contraception, 21% conceive within a month and 73% within six. The twenties are the most fertile years of your life.
The pill does more than prevent pregnancy
It regulates cycles and slows the progression of dysmenorrhoea — which is itself preparation for conceiving later.
How the fertile window actually works, and how long it is reasonable to keep trying on your own.
An egg loses its fertility within 24 hours
Sperm survive about a week — which is why the two days before ovulation, through the day itself, matter most.
If your cycle is regular, you can predict ovulation accurately
Your period comes about two weeks after ovulation, so you can count backwards from your next expected period.
BBT charting cannot predict your fertile days
By the time the temperature rises, ovulation has already happened. BBT confirms; it does not forecast.
If your cycles are irregular, no app can predict ovulation
Apps extrapolate from past cycles. When cycles vary, the maths cannot work — clinic monitoring is the faster route.
The first months of trying are the most fertile
50% by three months, 80% by six — but only 10 more points between six and twelve. Month six is the decision point.
Testing early widens your options
Finding a problem before you start means you can treat it first. The real benefit is the time you do not lose.
What treatment actually involves, and what it does to daily life. Knowing this in advance reduces the toll.
There are three kinds of fertility treatment
Those that use your own ovulation (timed intercourse, IUI) and the one that bypasses it (IVF).
All tests normal — and still not pregnant
Testing reaches as far as tubes and sperm. Fertilisation, embryo development and implantation all happen unobserved.
Freezing preserves the success rate of the age you froze at
Frozen eggs and embryos do not age, and can be used for a second or third child later.
Fertility treatment is schedule management
Visits follow your cycle, not your calendar: 3–5 visits in two weeks for a retrieval, with dates confirmed only days ahead.
Nobody around you can see what the visits cost
A loop forms at work: people stay silent because explaining feels futile, so the employer concludes nobody is struggling.
Assumptions about gender roles quietly shape the load
Only women can be pregnant, give birth and breastfeed. Everything else — cooking, laundry, sick-day pickups — is shareable, and where you draw that line decides the burden.
Read all 24 in order, with illustrations
View the book (Amazon)