"I've come across more and more people who've actually tried reading science fiction and can't make it make sense."
Most of the devices that work with human reproduction are either very simple devices that impose a barrier between the sperm and the egg (which require some element of foresight to use), or they manipulate hormones, which has a number of side-effects.
Stephenson proposes a very tiny machine that would live inside of a woman's fallopian tube and grab each egg that came along before it had the chance to encounter any sperm cells that might be passing by. Assuming that the nanomachine was well-trained, and didn't start attacking other cells that passed by, this could work.
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