A Very Special Post-Roe Episode of Grey’s Anatomy

So Much for Escapist Entertainment

In the early days of Grey’s Anatomy, we got a lot of drama and a few political/educational messages. Christina Yang had an abortion. Dr. Stevens cared for a woman in the parking lot so as not to alert INS to the patient’s illegal status. Meredith almost lost her license for committing insurance fraud to help a kid who was also here illegally and had no health insurance of her own. The producers even partnered with the Kaiser Family Foundation on a storyline in which Izzie told a pregnant patient with HIV she didn’t have to have an abortion because medication could prevent transmission of the virus to her baby. Pre- and post- episode surveys showed the audience learned a lot. But all of this was happening amidst torrid affairs with McDreamy and McSteamy, long lost siblings, love triangles, and custody battles.  

In the last few seasons, there has been far more message than story. In addition to the pandemic storylines, we’ve had those devoted to “Asian hate crimes are rising,” “gay men still can’t give blood,” and “communities of color face health disparities.” Now we get the “post-Roe America is going to be really bad for women” episode. They brought back Dr. Addison Montgomery, our favorite ex-wife/OB/GYN/world-renown fetal surgeon to tell us how bad it is out there (even though she’s practicing in California which is going out of its way to protect abortion rights). Addie notes that she has teenagers asking for tubal ligation in case they go to college in a restrictive state and is worried young women are going to start resorting to coat hanger abortions.

While she’s in the hospital, one high school student happens to collapse in pain from ovarian cysts (The good doctor performs surgery to save her life and future fertility.), and she spots another crying in the stairwell over a pregnancy scare (The surgeon offers to do a confidential pregnancy test herself.). When the test comes back positive, the young woman and the audience get exact instruction on how to take mifepristone and misoprostol for a medication abortion and learn that in the state of Washington at least, parents don’t have to know. Apart from one funny line in which the girl says, “I’m in high school. I haven’t fed my fish since Tuesday. I can’t have a baby, he just needs a pinch of flakes, kids need to be fed like everyday,” it felt a little bit like being hit over the head with a message.

The episode was called “Let’s Talk About Sex,” a reference to the Salt-n-Pepa song that was already dated when I used it as the title of a pamphlet circa 2005. The high school students were all there to get sex ed from Dr. Bailey who is coming back after quitting due to post-pandemic burn out (another issue episode) to run a reproductive health clinic (despite the fact that she’s a surgeon and not an OB/GYN). She tells us, correctly, that the only thing to do in a world where teenager can’t get abortions is to educate them about how to not get pregnant. Then she recruits the interns to give a sex ed class (despite the fact that they’re surgical interns and not, say, sex educators).

Other than the idea that anyone with an ounce of medical education or sexual experience can do my job (which might be true), the depictions of sex ed were fine and, I suppose, even informative. In between shots of the doctors dancing, they got some good info in about contraception, STDs, porn, consent, and even orgasms. They used inclusive language (people with vaginas, etc.), and threw condoms at the audience Oprah style. My only objection was to suggestion that you can’t wear two condoms at once. In our article, “We’re Teaching About Condoms All Wrong,” Logan Levkoff and I point out that this is one of those factoids of unknown origin that keeps getting spread by sex educators but isn’t actually supported by research. There’s no reason to wear two condoms, one does the trick for STIs and pregnancy, but two are not less effective than one as is often suggested.

I should be glad that Shonda Rhimes and crew keep getting political and that ABC keeps letting them. Entertainment is a great vehicle for education and it’s possible that hearing beloved characters talk about these issues—instead of, say, pundits or politicians—could get some people past confirmation bias and closer to changing their minds.

But…

I’m living in Post-Roe America in real life, and it’s exhausting and depressing. I need some mindless entertainment. If I can’t find that in the halls of Grey-Sloan Memorial Hospital where impossibly good-looking interns are constantly screwing even better looking attendings, where can I find it? (Yeah, sure, the episode ended on a sex montage, but by that point I was so depressed about politics, I didn’t care.)

Don’t Say Anything at All, Ever Bill Introduced in the House

In a potential bid to out-dick their compatriots in “Don’t Say Gay” Florida, Representative Mike Johnson of Louisiana and 30 Republicans colleagues introduced a bill that would prohibit federal tax dollars from being used on any “sexually-oriented” programs for children under 10. Johnson, who is apparently horrified by Drag Queen story hours at local libraries, argues that “The Democrat (sic) Party and their cultural allies are on a misguided crusade to immerse young children in sexual imagery and radical gender ideology.” His solution? The Stop Sexualization of Children Act of 2022.

The act defines “sexually-oriented” as “any depiction, description, or simulation of sexual activity, any lewd or lascivious depiction or description of human genitals, or any topic involving gender identity, gender dysphoria, transgenderism, sexual orientation, or related subjects." This definition is wide enough to make institutions afraid to say, well, anything. Which is exactly how Johnson wants it.

He recently tweeted about Portland, Oregon’s new curriculum for young students telling parents to read it if they “could stomach it.” He’s right it’s truly over the top. It names body parts including elbows, vulvas, and knees. It even has lewd and lascivious drawings of bodies. (Okay they’re line drawings with almost no detail, but they include the urethra so they must meet the definition of  lascivious.) And the slide show has the audacity to tell kids, “When someone tells us a name they want to be called, we should use that name for them! That helps them feel safe and respected by us.” Stomach churning indeed.

I’d worry about the new bill more if I thought the Democratic Party and its cultural allies (me?) were actually providing federally funded sex education for the elementary school set. I would love to see that, but I’m pretty sure that Johnson used the only four examples across the country in his defense of the bill. They’re all Drag Queen story hours, and they’re all really tame. Yes, there is a man in a dress and heavy make-up who might have a punny name (that children won’t understand by the way), but they’re reading from The Cat in the Hat, not The Joy of Sex.  

Johnson doesn’t want to admit how tame they are. He’d rather insinuate that it’s all porn for kids and let his supporters use their Fox-News-fueled imaginations to come up with the rest. His Portland tweet ended with, “We’ve opted not to show you the most graphic examples from across the country.” Let me guess, there’s a school system in Albuquerque that reads the gay penguin book each year? That one does have some pretty racy pictures of birds sitting on eggs.

I shouldn’t make light of the law, however, because if it passes, parents will have the right to sue public and private institutions that federal funds for programs that they believe expose young children to sexually explicit material. If nothing else that could certainly make life harder for children’s librarians across the country, and those people are already saints in my opinion.

New Ovulation Test Gives More Information

Continuing my trend of talking to women who lead cool sexual health businesses, I sat down virtually with Amy Beckley, the founder of Proov. Her company has created new ways for people trying to get pregnant to understand and test their fertility. Amy is a pharmacologist and,  like so many femtech founders, was inspired by her own story to help solve problems for other women.   

“I had a career, got married, and decided to start a family, and it didn't come easy. Traditional health care was like, “Oh, well, you know, you just haven't tried long enough.” And then I had a miscarriage. I thought that at least it would be my golden ticket to getting some help. Nope. Traditional health care was like, “No, you haven't had enough losses.” It wasn’t until 12 months of infertility and three pregnancy losses that I was even allowed to get the tests that might give me a diagnosis. But the test didn’t show anything. The doctors told me they couldn’t find anything wrong with me. My diagnosis was “unexplained infertility.” Not very useful. They said I had two choices—keep trying on my own with a 5-10% chance of getting pregnancy each cycle or try IVF which has a 67% chance of success. I'm not crazy. We did that, and I have a 12-year-old son.”

Obviously, that was a great outcome, but Amy wanted another kid and was still not satisfied with the diagnosis of “unexplained fertility.” She started doing research and talking to her doctors. Her theory was that she was producing eggs and even getting pregnant but not getting good implantation.  

Amy says this probably happens to a lot of women, some of whom will stay pregnant long enough to pee on a stick and get their hopes up before miscarrying and others who will likely never know they were pregnant. She believes one of the main culprits in these miscarriages is progesterone, the hormone responsible for implantation and carrying a pregnancy.

“After ovulation, the body needs to make a lot of progesterone to sustain the pregnancy. There are some people who just don't make enough progesterone or whose progesterone drops too soon which can cause either infertility or miscarriage. As part of IVF, they put you on progesterone because they know that it helps you get and stay pregnant. So, when I wanted to get pregnant again, I told my doctor “Let’s skip the IVF part, but just do the progesterone part.” It worked, and I have a 9-year-old daughter.”

And this was her inspiration for Proov, which has taken off over the last couple of years.

“I realized if we could just develop a test that could help us understand if a person had enough progesterone after ovulation, we could help a lot of women get pregnant. I came up with the idea. I developed the test in my basement. A friend who was a fellow infertility warrior happened to also be a patent attorney; we patented the idea and started a crowdfunding campaign and confirmed that women really wanted this product.  

It's actually been crazy. We got our FDA clearance the day before the world shut down. We had no idea what was going to happen but then all the fertility clinics shut down and nobody could get access to care. They kept coming to us because they wanted that information, and the doctors came to us because they needed something to offer that was remote. And, so, we’ve expanded.”

To understand how the Proov test is different, we have to do a quick master class in ovulation. (Good thing I kept all of my notes from my Reproductive Biology class in grad school.) Those of us with ovaries have all of the eggs we’re ever going to have on day one, and they’re supposed to be released over time—one per menstrual cycle—from puberty to menopause. This is called ovulation and it’s controlled by a number of hormones. One of them, FSH (follicle stimulating hormone) gets things started by telling the ovary to ready an egg. When that egg is sufficiently matured, luteinizing hormone (LH) spikes as a signal to the ovary to release it. Then, the empty follicle on the ovary becomes a structure called the corpus luteum and begins to secrete progesterone, which helps with implantation.

Traditional ovulation tests are designed to spot this LH surge as a signal that you’re about to ovulate and that now is a great time to insert tab A into slot B if you want to get pregnant. As Amy explains, however, an LH surge is necessary but not sufficient to know that you’ve had a “pregnancy friendly ovulation.” This is the unique thing about Proov’s test.  

“We call our base kit Predict and Confirm. It looks for the LH surge to predict when you’re going to ovulate, and then we confirm it by testing for progesterone metabolite in urine. We track that over the four days after ovulation, which is considered the implantation window. We make sure that the progesterone level is high enough, long enough.

There are conditions that are very common in women—Polycystic Ovarian Syndrome (PCOS) is the one most people have heard of—that may mean you have an LH surge but you don’t actually ovulate. A traditional ovulation test would make you think you’d ovulated but that wouldn’t be accurate.”

Amy explained how Proov works.

“First, we have a companion app that helps you track your cycles and gives you suggestions about what days to start testing. On test days you collect first morning urine, dip a strip in it, wait 10 minutes, and then open up the app and the camera pops up. You take a picture of the test, and the app uses machine learning to match it to hormone values on the back end. Depending on the result, we’ll tell you, “Your test was negative, test again tomorrow” or “Hey, it was positive, this is the beginning of your most fertile days; come back in X number of days, and we'll confirm you actually ovulated.”

At the end of the cycle, users get an ovulation score that tells them how healthy their cycle was. If they don’t get a great score, we give them tips on how to raise it including diet and lifestyle changes that can support optimal hormone production.”

Because fertility takes two, Proov partners with a men’s health company called YO that offers at-home sperm testing. It also offers a connection to a telehealth provider if people want more help.

Proov also offers another test called FSH Reserve, which can help you know how many eggs you have left.

“FSH is usually high at the beginning of the cycle, and then goes down as your body selects a follicle to ovulate. When you have fewer eggs left, this hormone goes higher, because it's trying to stimulate ovaries, “Come on, man, we gotta go. We gotta go.” The higher this level is, the lower the number of eggs that you have.”

This test is important for a baseline of fertility, but it will also be part of the next set of tests Proov is developing. These tests are being designed for women who want to know if they’re heading toward—or maybe smack in the center of—menopause.    

I promised Amy she’d have a bestseller in that one, as this is a constant question among my peer set.

Period Language Survey Still Up

Just a reminder to take my period language survey is still up. So far, the results suggest I’m not alone in my hatred of the phrase “on my period,” and it’s the phrase you all hear the most often. In fact, three characters used it on the Very Special Post-Roe Episode of Grey’s Anatomy.