Clicking onto Slate this morning, a headline jumped out at me: “Max Levchin Wants You To Get Pregnant”. The subheading was even more attention-grabbing: “The Paypal Founder Will Pay Up if His New Fertility App Doesn’t Pay Off”. Naturally, because I’m interested in anything regarding fertility, and even more interested in anything regarding paying for treatment, I started reading the article.
I’ve concluded I sometimes don’t much care for the tone and editing techniques Slate uses for some issues regarding fertility or babies. While I recognize that Slate exists to get page views and one of the best ways of doing that is to edit so as to pull together the most inflammatory quotes or lines (as with the recent Kate Fridkis article) and top it all off with a very attention-grabbing headline. However, when it comes to a subject as deeply felt as fertility and babies, I really wish Slate editors and headline writers would show some basic decency and sensitivity. The article wasn’t too bad, however, and made some interesting points.
The article itself is about a fertility app with a twist. Glow, as the app is named, does all the normal things most fertility apps help with: tracking cervical mucus, basal body temperature readings, mood, weight, and all other fertility related charting anyone could come up with. However, if you pay $50 a month for ten months, chart and try to conceive diligently according to the terms, and can’t get pregnant, the app will pay for some costs associated with infertility.
Levchin states of developing the app: “I couldn’t live without [children]…This isn’t an optional thing. They are part of me. The fact that some people know every day that want to have this part in their life and they can’t have it, that’s pretty profound.” I really, really appreciate this as an infertile woman. It’s a balm after hearing over and over the tired statements we in the infertility community all know so well about how having children is a just a lifestyle choice, we’re simply out of luck if our bodies don’t function, and insurance shouldn’t have to pay for ‘optional’ treatments such as IVF (even though infertility is a recognized medical condition). I think most of us understand well how untrue and unfair those statements are regarding infertility. Levchin hits the nail on the head with this statement, acknowledging the terrible reality of infertility and the way society often dismisses those who can’t conceive.
The article does an excellent job of pointing out the overwhelming lack of insurance coverage for infertility treatment in the United States that is driving less-traditional means of financing, such as the Glow app. This, of course, is a huge problem for many infertile people and couples. Even where insurance does cover infertility treatments, there are often many restrictions and the maximum lifetime benefits laughably low when it comes to the more expensive treatments such as IVF.
One other very interesting aspect of Levchin’s app is the heavy reliance on data and analytics. Evidence-based practice is an enormous part of how modern medicine (and nursing) is shaped. I can also see some potential ways in which an app like this could be modified to allow for research collection with permission. Fertility, as Jean Twenge pointed out in a recent article in The Atlantic, needs new research badly (thank you to Mel from Stirrup Queens for pointing out the Twenge article). I also found interesting Levchin’s assertion that medicine should be more personalized; certainly no argument here.
Another good aspect of the article is noting ways to chart and examine fertility. The article encourages women trying to conceive to educate themselves about their fertility and cycles. It lists a few of the more basic methods of doing so. The article also points out one big problem with Levchin’s app: better ovulation tracking does not rule out potential male infertility.
Unfortunately, all of this was mixed in with some other things that had me sighing. First of all was Levchin’s assertion that “Twenty percent of women think they’re infertile, but the real number is more like two percent.” The article does note that the CDC rate of occurrence of infertility is around 11%, but Levchin also, the article states, believes that even many women who haven’t gotten pregnant after 12 months of trying can get pregnant with his app.
The last in particular seems a very, very misguided belief on Levchin’s part. I’d be extremely curious to see what a good, evidence-based, peer-reviewed study would say. However, in my admittedly personal and anecdotal experience, most women actively trying to conceive (as opposed to ‘not trying, not preventing’) start looking into charting basal body temperatures, tracking cycles, checking cervical mucus, and/or using ovulation predictor kits after several months of not conceiving. There’s also the fact that unless there is no regular sexual intercourse going on, while it’s possible that in a year there would be no conception and no medical problem, that’s still going against the odds pretty heavily since somewhere around 85% of couples get pregnant within one year.
I worry that what Levchin says about the rates of infertility, which he has skewed ridiculously low, as well as his supreme confidence that his app will get you pregnant, might push some people into putting off looking into infertility issues or doubting themselves. Having gone to the Glow website, it looks as though the app will begin to pay out for infertility testing if you meet the criteria and haven’t conceived within 10 months. For those under age 35, this is more or less within standard guidelines of when to seek testing (around one year). It isn’t within those for people 35 and older (around six months). In some of these cases, time matters quite a bit in seeking certain options for infertility treatments if they desire a genetic child, particularly for those who have diminishing ovarian reserve or are over age 35.
I’ll let one of my objections with the tone of the article speak for itself here:
“When I was trying to conceive a decade ago and it was taking longer than I hoped, I found my way to Toni Weschler’s seminal (sorry), life-changing manual Taking Charge of Your Fertility, originally published in 1996. It lays it all out there, the primordial but simple secrets of the female body that my comprehensive post-collegiate education had failed to elucidate. Somehow, in our collective pill-induced ignorance of all things cyclical, we’d missed the most obvious facts of our reproductive biology: Our temperatures go up, considerably up, after ovulation, and our—yes, ahem—cervical mucus changes rather drastically, if only we care to look.”
I entirely agree that education about fertility and charting is an excellent way to aid in conception (or non-conception). However, this paragraph has a certain expectation: women have no clue about their bodies. I think the assertion that people need better education on how the reproductive process works is indisputable, backed up by, ironically, the United States’ high unplanned pregnancy rates.
That being said, I couldn’t help but detect a whiff of “you’re not really infertile, you just don’t understand your body” in the paragraph. It’s frustrating to hear that as a woman who knew, five months in to trying to conceive, that something was dreadfully wrong with my body and cycle. I second-guessed myself continuously over whether or not to call the doctor’s office about my messy cycles and quotes like that don’t help.
In the end, I think Levchin’s on to some major, fundamental problems with the way American and western culture treat fertility. I especially applaud his willingness to see being able to build a family as something that is not a choice. However, we’ve still got a long way to go in working through how society sees both fertility and infertility.