Just last Monday, a woman sat across from me in my office and asked a question I have come to dread. Why had no one told her? She is 33, a therapist, married three years, and she has been to her gynecologist every year since high school. She was also on the brink of perimenopause.
She had assumed that when she was ready, her body would be too. No one in two decades of annual visits had ever explained that the most consequential decisions about her capacity to bear children were being made by her ovaries on a calendar she could not see, while her doctor took her blood pressure and refilled her birth control.
She is the patient I see several times a month. She is the most preventable tragedy in American medicine.
I am board certified in both obstetrics and gynecology, and reproductive endocrinology. There’s a fertility crisis happening right now in America—and a furious debate about who is to blame. The alleged culprits include housing, smartphones, and capitalism. One group is getting off lightly: ob-gyns.
In July, the Centers for Disease Control and Prevention (CDC) reported that the U.S. fertility rate had fallen to fewer than 1.6 children per woman—the lowest figure in our history—despite a 2025 survey of American Gen-Z women that found that nearly three-quarters intended to become mothers. American women are not opting out of building a family. They are running out of time.
