How to make a baby

In our rush to embrace IVF, we’ve flown past the people who want help conceiving naturally.

How many of us truly learn how to make a baby? How not to make a baby, sure. But as we learn about sex, as we navigate our reproductive lives, as we have conversations about contraception, it seems that basic details about conception may be getting lost. 

A lot of people assume making a baby is as easy as trying. For some, it is. But a lot of people try and try and try to no avail. In between those who are lucky enough to conceive easily, and those who have committed to IVF, there is a vast and underserved space filled with people seeking a different kind of help.

To visit that space, open TikTok and meet Ashley, a jewelry maker from Kentucky. Standing in her kitchen wearing an oversized Guns N’ Roses t-shirt, she has a countertop of pill bottles below her. Ashley has been trying to conceive for years. 

Ultimately, buffeted by her own extensive research, she recounts the regimen that worked for her. She takes a prenatal supplement, fish oil, vitamin D3, Coenzyme Q10, Choline, and, most notably, the over-the-counter cold medicine Mucinex, every night of ovulation, 15 minutes before intercourse. Two months later she is eager to report she became pregnant. 

“Sobbing. This gives me so much hope,” one of the 432 commenters to Ashley’s video notes. 

If you type “mucinex” into the TikTok search bar, you will learn very little about nasal congestion. Nearly all of the suggested searches are fertility-related, leading to a rabbit hole of influencers and influencees. 

A video extolling Mucinex from Alexa Lemieux, a reality star from the third season of Love is Blind, has racked up more than two million views. Her commenters are effusive. One user says, “My Mucinex baby is taking a nap!” Another says, “My Mucinex baby is almost two after eight years of trying and three IUIs.” A third adds, “The one month I used Mucinex I got pregnant!” 

At this point, you might be wondering, Mucinex? Since when has an over-the-counter cold medicine become a fertility miracle drug? 

The post-coital test

The answer originates in the 1960s. Husband-and-wife research duo Dr. William H. Masters (a gynecologist) and Virginia E. Johnson (a sex therapist) conducted the first systematic studies on the physiologic mechanics of sex at the Masters and Johnson Institute—including investigations into the root causes of infertility. They were among a group of researchers striving to understand how to optimize and support conception.

This was the era when fertility cycles became more deeply understood, leading to the FDA approval of Clomid (clomiphene citrate), a now widely available and inexpensive medicine that makes ovulation more predictable and reliable. This was the era when scientists began analyzing the health of sperm and learning how simple lifestyle modifications could improve it. 

It was also the era that popularized something called the post-coital test.

For this test, a woman would go to the doctor to have her cervical mucus collected just before ovulation and shortly after intercourse. Under a microscope, the mucus was evaluated for consistency, presence of estrogen, and concentration of sperm. If it was deemed too thick and the sperm too few, it was read as abnormal–and for decades was treated with (you guessed it) the generic form of Mucinex. 

The logic behind Mucinex is simple. It thins respiratory mucus, making it easier to hack through your cold. In theory, it may also thin cervical mucus, making it easier for sperm to swim through your reproductive tract. 

In reality, cervical mucus is mercurial. Most of the time it acts as a barrier, but approximately once a month it transforms into a selective and temporary portal. During the menstrual cycle, hormone variations cause cervical mucus to change in texture, volume and color. And at the exact window when the egg is released into the fallopian tubes, it becomes permeable to sperm, while also filtering and preparing it for further transport. These changes are so profound and visually apparent that people can predict when they are ovulating by stretching the mucus between their fingers and simply looking at it. 

Known unknowns–and known knowns

That may be the bulk of what we know about how cervical mucus promotes (or impedes) conception. My friend Dr. David Sable, a reproductive endocrinologist and biotechnology investor, recently reminded me that cervical mucus is the only liquid barrier between the sterile inside of the body and the bacteria-contaminated outside world. Over the course of hundreds of millions of years, humans have presumably evolved to keep contamination out of the cervix but selectively let the most viable sperm in at key moments in time. Exactly how that works, let alone how medicine can support it, is still a mystery.

The post-coital test was never rigorously supported and was always known to be unreliable. In 1998, a randomized controlled trial found there was no statistically significant difference in the number of women who conceived with an abnormal result compared to a normal result. As for the treatment, there’s exactly one study on the effects of guaifenesin (the generic name for Mucinex) on fertility. It’s poorly conducted, and dates back to 1982. 

With the advent of assisted reproductive technology, we now had the ability to bypass cervical mucus in bringing the sperm and egg together. By the turn of the century, the utilization of IVF grew at an astonishing rate, ballooning from a rarely used procedure to hundreds of thousands of cycles per year. The medical community lost interest in modifying mucus to promote fertility. But on the Internet, the idea lingered.

In 2020, Google searches for “mucinex pregnancy” spiked after one Tik Toker took Mucinex for COVID-19 symptoms and claimed she saw her “fertility signs” increase.  Journalists following the thread—in the Daily Mail and Buzzfeed and Health and Yahoo—consulted doctors about Mucinex, who mostly dithered on the topic. The answer is a little bit complicated, so they kept it simple: there’s not enough proof to say whether Mucinex works, and patients shouldn’t expect anything to happen if they try. But, crucially, they don’t say it doesn’t work, even when thousands of commenters attest to the opposite. 

Minding the gap

An analysis of Google searches about Mucinex finds it is most sought as a fertility hack in states like Mississippi, North Dakota, Montana, Alabama, and Kentucky—a pattern that looks a lot like the March of Dimes’ maternal care desert map. These are places where reproductive health specialists, including fertility doctors, are very sparse. 

This indicates a real need among real people who need real help, and are looking for guidance on how to get pregnant without IVF. An internal analysis of Maven members who are trying to conceive showed that nearly 70% “don’t know what they don’t know” and are interested in education and expectation setting about conception. Across the country, 86% of women and 92% of men say they don’t receive preconception care from their primary doctor or gynecologist. 

We’ve made enormous strides in fertility technology, but often at the expense of a back-to-basics understanding of how to enable natural conception. As a society, we would benefit from deepening our scientific understanding of how babies are made, to unlock the mysteries of how cervical mucus and sperm interact—questions we left largely unanswered after the advent of ART.

In the meantime, we could also better deploy the knowledge we already have. For example, we already know how to reliably help people track their cycles and predict their ovulation window. We already know how diet, exercise, and other healthy habits can optimize sperm (without supplements!). We already know how to reliably induce ovulation with inexpensive widely available medication. 

At Maven, we find that for many people, applying this knowledge is challenging to do on their own without coaching and support. Changing habits and monitoring metrics are notoriously difficult without help. And in the brick and mortar health care system, there’s little incentive to spend time on holistic fertility education because, frankly, assisted reproductive technology is so lucrative. 

What everyone wants is the shortest pathway to a healthy baby. For many, enabling natural conception rather than bypassing it may actually be the best way to get there. 

What my team is reading, considering, and building against:

• Big news at Maven: we’re thrilled to welcome Dr. Rachel Hardeman as our newest visiting scientist! Preprint readers know we are big Hardeman fans. Dr. Hardeman is a towering, clarion voice, working to meticulously measure the impact of racism on public health outcomes. Her latest paper analyzes the most effective public health tools to measure structural racism as a multidimensional, multi-level determinant of health. We can’t wait to work with her. You can find more about her efforts to translate her work to real world impact at Maven Clinic here. 

• Why do Americans hate experts so much? Why is public health so hard to communicate, and science so uniquely unsuited for mass-consumption? These are just some of the questions Tom Nichols grapples with in his latest missive about the devastating blow COVID-19 dealt to public faith in science. A timely read as we celebrate four years since our first round of lockdowns. 

• A new piece in the Washington Post investigates a parallel story to our Mucinex tale: many young women, motivated by widespread internet misinformation, are choosing to stop taking hormonal birth control. It is true birth control is not without side effects (or value judgments). But the stories, and stakeholders at play in this recent movement are far more winding than you might expect. 

• The Peterson Foundation recently created a new institute for independent clinical and economic evaluations of digital health solutions. Their sweeping report on diabetes solutions concludes that evidence does not support further adoption of many of the most popular solutions. We can expect a similar analysis of the maternity space somewhere on the horizon.

• Some couples are supposedly opting to skip sex altogether—because of busy schedules, or known inheritable genetic conditions, or even gender preferences—and head straight to IVF, according to the NYT. It’s unclear how widespread this practice is, considering how pricey and inaccessible ART is for the average person. But for the many reasons discussed this week, it’s a trend we’re paying close attention to at Maven.