“How do you envision your family looking?”

13 May 2018
By Arghavan Salles

My face crumpled up and tears erupted from my eyes as soon as the young doctor in front of me asked this question. I reflexively reached for a Kleenex to cover up my face and erase the signs of weakness. My cheeks turned bright red in embarrassment. But she took it in stride and gave me a moment to sob out, “I don’t know. I just want to be able to have a family someday.”

I was in a fertility clinic. From the second I walked in, I felt out of place. There were a few couples in the waiting room. I was the odd one out—a single woman in this stark place for couples struggling to have children. I wondered what they thought of me—what was this  single woman doing at a fertility clinic? Maybe they imagined a partner somewhere in my life who just wasn’t present today. Or more likely they didn’t imagine anything at all because they had their own problems to deal with.

Having “high standards” and being “accomplished” have apparently made it difficult for me to find a partner in life. As a surgeon I can’t honestly say I have spent a lot of time looking for one. I’ve been too busy spending my time with people—patients, colleagues, nurses, staff—in hospitals. That’s not the full explanation, though. I have prioritized my career over my personal life because I cannot tolerate the idea of being anything less than the best I can be at this job. People trust me, incredibly, to take a knife to their skin while they are completely unconscious. I owe it to them to be my very best.

Unfortunately that doesn’t leave a lot of time for finding love. Or friends. Or hobbies. There are people who do this better than me, for sure. There are people who draw boundaries and stick to them. But there are also many, many physicians and surgeons who are just like me. We are taught that the patient comes first. Tacitly we are taught to put ourselves last.

So after making a plan two years ago to see a fertility specialist and freeze my eggs, I finally made an appointment. For the past two years I have been dragging my feet, pretending I would maybe meet someone. (Where? On my couch?) Now that I am 37 it is time for me to admit failure in this one part of my life and seek help.

As I sat in the doctor’s office, I didn’t realize that help would sound so much like torture. The kind young doctor described to me how, depending on the protocol, I would have to give myself two to three shots a day. I would have to come in every four to five days for an ultrasound and lab draws. Whenever there were enough follicles, we would proceed with egg retrieval. As she was describing all this, I wondered how I would manage to take care of my patients. She said I needed to be available in the mornings to have tests done. And while she assured me that I could keep working throughout all this (while staying flexible and being available for tests throughout), she admitted that the day of the retrieval I would have to take the day off. Of course we cannot predict when that will be since it will depend on the lab tests and the ultrasounds. And by the way, there is a risk of injuring major blood vessels or intestines while performing the retrieval.

As she was talking, I was thinking about my work schedule—time in the operating room, time in the clinic, time in the endoscopy suite—and how I could possibly make this schedule work. I often don’t eat or drink anything all day as I am running around from one thing to another. How can I possibly fit in all this testing? And an unpredictable day off somewhere in there?

Finally we talked about the cost. Apparently the procedure itself costs about $10,000. The medications cost an additional $3000-4000. Yikes.

This is all for one round of treatments. She advised that at the end of all this, if we are able to retrieve six eggs we will have a 50% chance of ending up with a viable embryo down the line. There is, however, no way to predict how many eggs we will be able to retrieve.

That’s when I asked her how many times I would have to go through all this, and she responded with: “How do you envision your family looking?” How many children I want to have will dictate how many rounds we might need to do. When she asked that question, all I could think was that I had no idea what my family should look like. I haven’t even managed to find the partner with whom I would  have this mythical family. How can I possibly know how many children I would want? And why has it come to this? The majority of adults are able to find mates. Even though I went to great schools, have received amazing training, and am, by most accounts, a reasonably attractive and fun person, I have not been able to perform the most basic human function: reproduce.

After an uncomfortable pelvic ultrasound, the visit was over. I walked back to my office, just a couple of blocks away, and tried to focus on emails and academic work. If this visit rattled me this much, would I be able to do the injections and the whole protocol? Maybe I am just weaker than other women, but a little voice inside was screaming, “No! No! No! Are you crazy? Take two weeks off so you can languish on your couch.” Or maybe don’t do it at all.

For now all I need to do is get some labs drawn in a few days. That, at least, seems doable.

If you are interested in learning more about fertility treatments, here are some resources I have found useful:

Dr. Arghavan 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.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

One Reply to ““How do you envision your family looking?””

  1. Thank you for this honest and frank discussion of the realities you face as a woman, a surgeon, and a human being. Your willingness to share your vulnerability and struggle is a testament to your strength and will certainly be a source of strength to others. As long as we treat physicians as worker bees and automatons, physicians will never truly be able to be healers. Hopefully, one day, we will have a culture in medicine where physicians’ personal lives are respected and honored.

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