“Peri-Menopause”

By Arghavan Salles

        In January of this year, I started investigating the process for egg freezing. Having spoken with three more reproductive specialists after my original consultation, I have been told three versions of a similar message: I have waited too long, and my chances of having a child that carries my DNA are pretty low.

        After my initial visit, I obtained the obligatory testing (FSH, estradiol, AMH levels) which indicated that I might not have success with stimulation (for a nice summary of what tests you can expect see here). I had been on oral contraceptives for 18 years due to a diagnosis of ovarian cysts, so we decided to stop the pills and repeat levels after I had a few “normal” periods. Having been on the pill for so long, I had no idea what my “natural” cycle would be like. There was a significant delay (three months) before I had a period. Then another three months passed before I had a second period. My repeated labs after that were maybe slightly better than they had been the first time.

        In the meantime, I met with a friend, a physician, who had gone through several cycles of IVF. She had all sorts of recommendations, ranging from easy to not-so-easy to do. I should note she also has a PhD and is a scientist.

• Wear socks at night (why not?)
• Download a fertility app and use the guided meditations (they’re somewhat soothing and involve imagining going to an island in the middle of a serene lake. There are worse things to try)
• Take coenzyme q10 (not just any version, but a specific one which costs $100 per bottle; take 2-3 times a day—why not?)
• Take ground flaxseed (admittedly have not picked up any so haven’t done this)
• Avoid saturated fat (sure)
• Go gluten free (I protested this one—doesn’t that seem like too much to ask?)
• Minimize stress (Sure. Would love to)
• Sleep well (See above)

        She also emphasized the importance of the lab where one does the retrieval. The success rate of egg freezing is so low (about 6%) that having a lab that has the best protocols for freezing and thawing is essential. She suggested Shady Grove in the Washington, D.C. area. Of the three centers she had tried, this was the one where she ultimately had success.

        This private practice clinic is apparently the highest volume center in the US for these types of procedures. Their recent paper was cited to me by two of the three specialists I spoke to. Examining all their data, they have generated graphs that patients can use to determine how many eggs they might need to achieve their family planning goals.

        I spoke with three more specialists, one at my local center and one on each coast. Their interpretations of my situation were subtly different and ranged from predicting I might not be able to generate any mature oocytes to thinking I might be able to get one or two to thinking I might be able to get up to five or six. In the last consultation I had, the specialist was so concerned that she said I was “essentially in peri-menopause.” No, I don’t really know what that means but it doesn’t sound good.

        I have no more insight now into what I want my family to look like than I did at my initial visit, but that may be a moot point. According to the Shady Grove paper, to have a 50% chance of having one child, a woman my age needs to freeze at least 15 eggs. My last consultation was with one of the physicians at Shady Grove, and she said she usually recommends women my age freeze 30 eggs to have a 75% chance of having one child. Given what we seem to “know” about my ovaries 30 eggs does not seem a realistic goal. Fifteen might be doable, depending on how things go.

        I have been lucky to have other women in similar positions to commiserate with. One of my colleagues was told she has premature ovarian failure and can’t try stimulation. Another colleague froze a number of eggs but then was unsuccessful when they tried to fertilize them. Another colleague just went through her first cycle and was able to freeze seven oocytes. Experiences like ours are not uncommon. A recent study of surgeons from multiple specialties found that 32% of women surgeons had difficulty with fertility. In comparison, only 11% of women in the US report infertility. Thirteen percent of babies born to women surgeons were conceived using assisted reproductive technologies.

        I’m going ahead with my first cycle to see what happens. But I’m also making it my mission to raise awareness among younger women, particularly those in long surgical training, to take advantage of fertility when they have it. Far too many of the women in my generation are now facing the toll of having prioritized our career during the most fertile part of our lives. Hopefully armed with knowledge and data, younger women can make informed choices while they still have options.

 

Dr. Salles completed medical school, residency, and her PhD at Stanford University. She finished her formal training with a fellowship in Minimally Invasive Surgery where she has stayed on as faculty. Her dissertation research focused on negative stereotypes about women in surgery and how those affect women training to become surgeons. Her current research focuses on diversity in medicine as well as physician wellness. She invites you to follow her on Twitter @arghavan_salles.

 

 

 

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