“How do you envision your family looking?”
My face crumpled and tears fell from my eyes as soon as the young doctor asked me this question. I reflexively reached for a tissue to cover my face and erase the signs of weakness. “I don’t know,” I said. “I just want to be able to have a family someday.”
I was in a fertility clinic for an initial consultation about egg freezing. Of the people in the waiting room, I was the odd one out: a single woman among couples struggling to have children.
As a surgeon, I can’t honestly say I have spent a lot of time looking for a partner. I’ve been too busy spending my time with people—patients, colleagues, nurses, staff—in hospitals. I have prioritized my career over my personal life, and when I was younger, this tradeoff felt worth it. But now that I’m 38, it feels time to consider my own life.
For women studying to be doctors, there are very few convenient times to build a relationship, let alone have a child. Once I got my first real job as a surgeon, after spending my 20s and early 30s in training, I sought several opinions and was told different versions of a similar message: I had waited too long, and my chances of one day having a child with my DNA were pretty low.
At first, this came as a shock. Later, though, I felt certain that too much time had passed and I had subjected my body to too many nights on call, irregular exercise habits and too much stress. As I pushed myself to write one more paper, do one more study, say yes to one more project or responsibility, I never considered the impact on my body.
The doctor described all the steps in the egg-freezing process. I would have to inject four shots a day into my abdomen and get ultrasounds, blood draws and labs every few days until my eggs were mature enough for retrieval. There would also be a risk of injuring major blood vessels or intestines while performing the retrieval. To add to my anxiety, the procedure would cost about $10,000, most of which wouldn’t be covered by insurance. The medications cost an additional $3,000 to $4,000—for one round—and I was told to expect four or five eggs, at best, from one cycle.
The overall success rate for IVF is low. In a 2016 paper, researchers at Shady Grove, a Washington, D.C.-area fertility clinic, found that at their clinic, only about 7% of retrieved eggs went on to produce a live birth. The study found that to have a 50% chance of having one child, a woman my age needs to freeze at least 15 eggs. To have a 75% chance, I would need to freeze 30 eggs. I quickly realized I would never get to 30 eggs, and maybe not even 15.
I proceeded with a cycle of egg freezing anyway, including the monitoring labs and ultrasounds that came with it. Each time I got an ultrasound, I would watch the large-screen TV onto which my insides were projected. The technician would search for and measure follicles, first on the right, then on the left.
“That could be the one!” I found myself thinking during an early ultrasound. “Maybe that egg, that one right there, is the one that will develop into my daughter (or son?).” It didn’t take much to start envisioning the little one’s birth (it’ll be messy—they all are), childhood (she’ll be super cute, just like I was) and adolescence (a little awkward, and she’ll probably be too serious to be “cool”). It was a little like watching the movie Boyhood in fast-forward.
I repeated this ritual of ultrasounds and labs six times over the three weeks of injections. It was hard to tell whether there was any progress. At the end of each visit, all I was told was when my next appointment should be.
After my sixth ultrasound, my doctor called and, unexpectedly, said she thought we should cancel the cycle. But I had just that morning looked at that egg, envisioned the future of that child. Cancel the cycle? I had endured endless shots, severe headaches, bloating and cramping. I hadn’t been allowed to exercise. I had spent thousands of dollars on medications. But none of that had made the eggs mature enough to be worth going through with retrieval.
I had to make a decision: go ahead with an expensive procedure that would be low yield, or cut my losses and maybe try again. The latter may have been the rational choice, but it felt like failure—perhaps the most consequential failure of my life. Throughout this process I wondered, “What is the point of my existence if I cannot perform this basic human function: reproduction?”
So we settled on one more ultrasound. If the smaller follicles had developed, we could go forward with retrieval. If not, we would stop there. I went through the same, familiar routine, but this time, there was no monitor for me to watch. I heard the clicks on the ultrasound machine and felt the discomfort of the probe as the technician searched and measured. Based on the measurements she gave me at the end, it seemed to me like maybe two of the follicles were growing. I was hopeful.
But the doctor called that afternoon and said they hadn’t really grown. Maybe a little bit, but not much. And that was it. The daughter I had pictured growing up disappeared like the spots on an old black-and-white TV as it shuts off, leaving a dark screen.
There still are many options and paths toward having a family. When I’m ready to get pregnant, I can try IVF either with my own eggs or with donor eggs. There is always adoption as well.
For now, all I really want is to preserve the possibility of having a child if I ever find a partner I care enough about to create a life with. Although the first cycle was devastating, I am going ahead with another cycle with a different medication protocol, crossing my fingers.
I know I’m not the only one grappling with these issues. Far too many women in my generation are now facing the toll of having prioritized our careers during the most fertile part of our lives. It is now my mission to raise awareness among younger women to take advantage of their fertility when they have it—which might mean getting pregnant sooner or freezing eggs or embryos earlier in life. I am writing about my experience and opening up to my younger colleagues, encouraging them to make a plan for their family, and embarking on research to understand the burden of infertility on female physicians.
Even those of us who love to control everything in our lives must surrender to the reality that we cannot control fertility. Hopefully, armed with knowledge and data, younger women can make informed choices while they still have options.
Dr. Arghavan Salles is assistant professor of surgery at Washington University in St. Louis.
