In the United States, some 10% of people who wish to have children struggle with infertility. It’s especially common in the African American community, and fertility preservation can be difficult for transgender individuals as well. But why is this? And what can be done about it? NOVA follows the journeys of people facing barriers to fertility, from the social to the biological, and navigating assisted reproductive technologies. Scientists and leaders in the African American community explore how racism contributes to infertility. Couples using IVF experience the challenges of low sperm count, egg freezing, and the ambiguity of “mosaic” embryos. And a transgender man explores fertility preservation, and his ability to give birth and create the family he hadn’t thought possible. The pain and joys of each story highlight the complexity of infertility in America, where both groundbreaking science and stark inequalities shape what it means to have a family.