By Alyssa Brown
A few weeks ago, I apologized to my boyfriend for missing date night (again). I apologized that I feel like we are often just saying hi and bye and watching Bob’s Burgers in between. I apologized that even when I am physically present, I am not always emotionally present. I joked that I could add it to the list of things I can’t do right (things I can’t do right or don’t have the time and mental energy to do right). In truth, I barely feel like I can do anything right. As a PGY-2, often it feels like I am moving from crisis to crisis—like alarms in the SICU. Each small alarm or thing gets only a moment. Each upcoming deadline is finished just in time and often not the way I would like it exactly. It always feels more like a rough draft than a polished copy or effort. Residency often feels the same. I could always have prepared better, studied more, tied faster, stitched better, moved faster, or used my left hand more. I just add it to the list.
I have had a hard time figuring out how to write this piece, and honestly, the piece is not the one I planned to write. Last year, I volunteered to the committee that I would like to do a piece on egg freezing because I was planning on going through it in the fall. I planned to write a piece about how supportive my program was of the process, and how even as a PGY-2 surgical resident, I managed to squeeze it in. I managed to do my future self a favor.
I planned this well in advance. I started looking into it six months into my intern year. I had to have my Nexplanon removed and an IUD placed (because Nexplanon can suppress the egg-freezing cycle). This required extra visits, new doctors, and waiting 3 months for my IUD to regulate my cycle. I went to the appointments, took notes, and scheduled it. I put the payment for the freezing cycle on my credit card. I asked the chief residents ahead of time if it would be okay, and everyone was more than kind about saying okay. I traded call shifts to ensure my egg-freezing wouldn’t hit that day.
The medications were shipped to my apartment, which no one tells you takes up a whole shelf in the fridge. I planned it out. Each night, I would mix the two injections and give them to myself in the subcutaneous fat around my stomach. In the mornings, I would sneak off during rounds to go to my ultrasound and lab appointments done at 6:30 am, and I would be back by 7:15 to pre-op patients. I would hear from the clinic via message in the afternoon about what doses of medications to continue on. It felt like hoops to jump through. I hoped that if I did all the right steps I would get the result I wanted. I was aiming for 12 eggs. The other women in my program talked about how they had done it and gotten 28, 27, 20, and 18 eggs. Some talked about how they expected to get less, but it just worked out. By my third appointment, I started to worry. The ultrasound tech at the end of the first week mentioned that I didn’t have many eggs compared to other patients. I felt a pit in my stomach for the rest of the day. I emailed the reproductive endocrinologist and infertility (REI) doctor to ask if my levels were progressing normally. I sure didn’t learn what my estradiol levels and ovaries were supposed to look like during this process in medical school. I felt blind. I didn’t even know what normal levels or imaging were supposed to be. I tried not to stress. I kept doing my two shots at night and then progressed to two at night and one during the day. I kept my hope close.
At about 10 days, I got the call that it was my time to give the “trigger shot,” which matures the eggs. I took the call with the instructions standing in the hallway outside the ED before going to see a consult. I was supposed to give it at 11:30 pm. I had to set an alarm because 11:30 pm was well past my bedtime. I knew with the trigger that 36 hours later, I would have my retrieval, on a Saturday morning. Before the procedure, they told me to expect 12 eggs. I was a little surprised because I was hoping for more, but my co-resident reassured me that they told her 9 and she had 28. I kept my hope close that maybe I would get more than expected.
I’ve seen versed given hundreds of times, but it was so funny to actually have it. When I was in the procedure room, I looked at the anesthesiologist and asked, did you just push the versed, then fell asleep. When I woke up, I was back in my pre-op room. The nurse gave me some Lorna Doone cookies and a Diet Coke. I figured I would see the REI on the way out, but I didn’t. They give you the number of eggs retrieved post-procedure, and after 24 hours, they will tell you how many were mature. As I got ready to leave, I asked the nurse, how many were retrieved. She shuffled some papers and told me 6. It was all I could do not to break down there. I looked up the calculations. Six eggs gave me a 30% chance at one live birth. I was expecting 12, which would have given me a 60% chance of one live birth. I had been disappointed enough by the possibility of 12, but I was floored that six were retrieved. I went home, tucked myself in under the blankets, and cried for a long time. I went to our Holiday Party that night. I put on a happy face and went to spend time with my co-residents. I kept the hope alive that maybe all six were mature. Six wasn’t great, but hopefully, they were all mature. I tried to push away worse thoughts for the night.
I woke up to a notification from the REI office. I didn’t want to check, but I had to. 3 mature. 3 immature. 20%. I had a 20% chance of one live birth from these three eggs. Three eggs that would have to survive thawing, survive fertilization, implantation, and growth, not to mention hopefully having the correct number and arrangements of chromosomes. I was heartbroken again. It was a Sunday, so obviously, their office was closed andthe physicians were not available. I looked at the records and operative report. I tried to see what went wrong. Was I in the wrong position, maybe one of my ovaries was unreachable, maybe it was because I am obese, maybe there was an equipment malfunction. The operative report was bland, and it did not illuminate things further. The realization settled over me that after six months of planning, two weeks of shots, two weeks of appointments, and $4k debt accrued, I had failed. My body had failed me.
It was another thing on the list of things I can’t do well. I talked to the REI later, and she recommended we try again. We try again without an IUD. We change the medications slightly, and we try to adjust. I appreciated her optimism and willingness to change what we were doing, but I told her this was all I could afford. I could afford one more try. (by afford I mean put it on my credit card)
In a job that is often built on continually being hard on yourself and trying to improve each time, it is frustrating that my body and physiology failed me. It feels lonely when others in my program have had success. They have only had to do one cycle to reach their goal number of eggs. It feels unlucky and unfair, and it makes me ask why me? Don’t I already have enough on my plate? Why can’t something, anything go easily? The only reason I am doing it in the first place is that surgery residency isn’t the ideal time to have a child. I was being proactive in doing this, but now I feel like I could be too late. I jumped through the hoops, took notes, planned ahead, and wanted it to turn out okay. I want the chance to eventually be a parent. Data has shown egg-retrieval numbers and hormonal response are not indicative of overall fertility and chances of getting pregnant without the assistance of IVF, but it does still tickle at the back of my mind that maybe my body will fail me in that regard too. I wish I was writing this to say that it was a great experience, it was a hard two weeks, and I got all the eggs I need frozen away now. I was planning on writing that piece. It is hard to hold onto the hope that it will go better next time. It is hard to put belief there and still know it might break your heart. That’s the story of life and residency though, we keep putting one foot in front of the other, hoping that each day will be a little better. Maybe one day, my list of things I can’t do right will get shorter, but for now, the list will only continue to fill.
Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. She finished her third year of medical school in 2018 and wandered off the beaten path to get a Ph.D., before finishing her MD. In 2022, she graduated with an MD from the University of Louisville School of Medicine, and her Ph.D. in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is now a PGY-2 general surgery resident at Northwestern University in Chicago. She has been a part of the AWS Blog Subcommittee since 2018. You will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” embroidering, or off on a new adventure. You can find her on Instagram @Alyssa_b_futuremdphd and on Twitter @Alyssa_B_MDPhD.