“Do you want kids?”

It’s a question I’ve asked and instantly regretted asking at least once in the very recent past. Maybe I should know better—it’s not a small or easy decision to make. It’s a process, and often the honest answer is “I don’t know.” Sometimes, though, the answer is “I can’t” or “We’ve been trying for yearsor “I do—but not yet, not now, and I’m scared that by the time I’m ready it’ll be too late.” In short, it’s complicated… but aren’t complicated things made less so when we actually talk about them?

A new survey of millennial women suggests that we’re not doing that: not with our partners, not with our mothers, not with our friends, not even with our family doctors (who are definitely not invested in whether or not we give them non-canine grandchildren). It seems that fertility is a taboo that millennial women need to unpack. Like, now.

“We’ve gotten better about talking about postpartum depression [and] the challenges of raising children today with multiple demands on our time. We’re great at talking about contraception and STIs. But we’re still finding our voice and language — in mainstream media and in medical care — when it comes to talking about fertility,” says Dr. Carrie Schram, a Toronto family doctor with specialist training in women’s and public health.

“We’re a generation who is delaying childbearing longer than ever before. We’re hitting a point where 15 to 20 percent of women (or more) will have difficulty conceiving because we’re waiting. Yet we don’t know how to start this conversation. It does happen in fertility social media groups and on blogs but the only participants are those who’ve [already] run into trouble. That’s a great start, but it doesn’t reach the millions of women who need to start talking in order to understand their fertility.”

So… why aren’t we talking? Why is fertility one of the few remaining topics we get weird and shifty and awkward about? Is it because we assume that everyone wants children and is trying and we don’t want to add to the pressure? Or is it because we assume that everyone is super stressed about choosing among the zillions of options available to us at this point in our lives — kids being just one of them? Maybe it’s that we’re scared of admitting to wanting something that we’re not guaranteed to get. Or maybe we feel guilty about not wanting something that other people seem so desperate to have.

“Reproductive health is inherently connected with our mental health. The decision to have kids (or not) is one of the most life-defining choices we make, so when something ‘goes wrong,’ it can affect our sense of identity and well-being,” explains Piraye Yurttas Beim, the founder and CEO of Celmatix, a fertility-focused tech firm that has launched the #SaytheFword campaign and created a platform for women to share their experiences.

Beim points to a study cited by the Harvard Medical School, which found that women who experienced infertility felt as anxious or depressed as those diagnosed with cancer, hypertension, or recovering from a heart attack. “Women dealing with infertility often experience feelings of guilt and shame, and that leads them to silence — even when it comes to their partners or their doctors. And that silence is incredibly isolating and harmful.”

Previous generations didn’t have the same control that we have over our reproduction. Today, access to contraceptives and the option to terminate an unwanted pregnancy are available to more women than in the past (although still not available enough). But that idea of control is only half true when you consider the concept as a whole: Fertility is a key aspect of reproductive freedom, but our understanding of it and our willingness to talk about it doesn’t match our understanding or willingness to talk about contraception or abortion.

“When we open up about our experiences with the people in our lives, we’re sowing the seeds of a support network that can help us thrive despite the setbacks we may face,” says Beim. “There is great power and comfort in knowing you are not alone.”

If you’re ready to talk about your fertility, a smart first step is to bring it up with your doctor (who isn’t going to judge you or bring any emotional baggage to the conversation). It’s a good idea to make an appointment with the specific intention of addressing your fertility.

Dr. Schram explains why: “As a family doctor, I usually see people in 15 or 30 min time slots and I often address two or three or more things during this time. It’s much harder to say to someone who is 32 and single, ‘What are your thoughts about having children?’ [or] ‘What do you know about normal age-related fertility changes?’ than it is to ask ‘How are you feeling on this birth control pill? Would you like a renewal?’

“Family doctors like myself are increasingly pressed for time and although fertility conversations are necessary, they often aren’t always a priority in a busy visit. My colleagues and I do ask these and similar questions but the conversations they lead to aren’t simple or straightforward. They’re hard to initiate and often make our patients squirm and talk about things that they might not have the language to express in a way they feel safe and comfortable.”

Your doctor definitely cares about your fertility, says Schram, making it clear that her colleagues in family medicine are well-informed and always open to the topic (and that goes for everyone that wants children, no matter what community you belong to). It’s just that physicians too are still searching for the right language to use with patients in a way that doesn’t make them uncomfortable.

In the Instagram age where we’re all sharing the edited, filtered versions of our #bestlives, it can look like everyone around you has it totally together, from their cool careers to their perfect apartments to their not half-dead collection of succulents (I don’t understand; is it Photoshop?), to their joyful, perfectly-lit pregnancy pics. But a post on social media doesn’t tell us what the path to that pregnancy looked like, whether it was a struggle or was easy, whether it was planned or was a surprise, whether the baby will sleep through the night or turn its parents into zombies—it’s just a single moment. If we want to learn from each other’s experiences, we actually have to talk about them.

Do you feel comfortable talking about your own fertility? Let us know on Twitter.

(Images via Dakota Corbin, Daiga Ellaby/Unsplash)