How Ob/Gyn Residency Faked Me Out About my Own Stupid Ovaries
I always considered myself lucky among the infertile. Lucky that I myself am a gynecologist; lucky that my residency program covered IVF; lucky that I had an extra frozen embryo after my twins so that I could have a third baby. My kids are the light of my life, and I’ve always felt grateful that I got to have three of them after being diagnosed with premature ovarian failure in my early 30s… but looking back, was all this infertility business just a red herring?
Back in 2012, I was a lonely junior Ob/Gyn resident at the University of Iowa at the age of 33. Like many single women, I started to hear my biological clock ticking. I really wanted to be a mom someday, so I opened up to one of my Ob/Gyn faculty members that I was worried I would never have kids if I didn’t meet someone soon. I said I was thinking about trying to transfer to a different program in a bigger city in the hopes of meeting someone. At that time, egg freezing technology was an option, but the success rates were pretty low, as I knew all too well.
My professor surprised me with an idea – what about freezing embryos?! I was only interested in women and was not planning on meeting a guy to procreate with; I was planning on using a sperm donor someday anyway. And frozen embryos, unlike frozen eggs, had a great success rate of turning into babies someday.
I did it. My residency program was supportive of me. I actually met the woman I would end up marrying and spending my life with around the same time, so we somewhat awkwardly looked at potential sperm donors together. The only snag was that when my anti-mullerian hormone (AMH) was tested to assess my ovarian reserve, it was unusually low for a now 34-year-old.
By the time I got around to actually undergoing the IVF cycle, my future wife and I were engaged, so we decided to go ahead and transfer an embryo in an effort to become pregnant. Unfortunately, they only got enough good eggs from that cycle to get one surviving embryo, and when the embryo was transferred, it did not implant to become a pregnancy. I got the call from the lab that my hCG level was negative at work. I cried a few tears and went back to rounding on post-op patients.
Then we sat down to figure out our next step. I remember my infertility doctor (and faculty) looking at my low AMH and poor response to ovarian stimulation, e.g., not very many eggs. He was concerned that I had premature ovarian failure. “Are you still getting regular monthly periods?” he asked. “Yes!” I replied, indignantly, knowing that my indignation was ridiculous. I wasn’t menopausal, for God’s sake! I had just gotten married!
We decided to do a few rounds of simple insemination instead of going right back to IVF. Three rounds without ovarian stimulation didn’t result in pregnancy. Three rounds with oral medication for ovarian stimulation resulted in one brief biochemical pregnancy (a very early miscarriage).
It was clear that the best next step was to return to IVF. This time, based on my low AMH and poor response to that first cycle, they gave me the absolute maximum dose of injectable hormones for ovarian stimulation. “Blow them up like balloons,” I said. (“You’re not really at risk for hyperstimulation,” they said, which was a reference to my poor ovarian reserve and kind of a sick gynecology burn when you think about it.)
It worked! I made some good little embryos! Based on my poor track record, they transferred two, since that was the most likely way to achieve a singleton pregnancy. But against all odds… both those little embryos turned into babies, and they are now in third grade, learning fractions.
In fact, I even had one little embryo survive to be frozen. That embryo was transferred, and it also turned into a baby. I was so happy and felt so lucky. My midwife friend suggested that I try for a vaginal birth after C-section (VBAC), since I had been delivered surgically for malpresentation with the twins. “No way,” I said. “If my uterus ruptures, and something happens to this baby, there’s no way I’ll be able to try again with my crappy ovaries.”
So I had my last baby.
Then I waited to go into menopause, which I assumed I would do at any moment.
But I didn’t. Not a hot flush. Not a night sweat. Seven years went by, and my babies turned into big kids. Meanwhile, due to the OB/Gyn shortage in Iowa, my job became untenably stressful, and I semi- retired to a lovely part-time OB hospitalist job.
Then a funny thing happened.
I finally had time to start taking care of my own health. I decided to start preventative tamoxifen due to my family history of breast cancer. When my oncologist checked some baseline labs… my FSH was 9.9! I was not in perimenopause at all! My mind was blown. How could this be possible, when I had premature ovarian insufficiency more than a decade ago?
I could have had another.
And our family is perfect the way it is – I don’t wish we would have had another.
But I had been working on false information.
My ovaries were fine. The stress of Ob/Gyn residency had just shut down my body. The sleeplessness, the endless days, the constant terror of being inadequate, the panic that I would get kicked out, or make a mistake and end my career before it started, with all my med school debt, and no way to support the twins I was gestating… it was hell to go through. We come out on the other end as surgeons, perfectionists, nonchalantly saving the lives of the patients nobody else wants to touch because they are terrified of pregnant women. If the nurses call me with the worst-of-the-worst OB emergencies at 3 AM, I can roll out of bed, put my shoes on, rub the sleep out of my eyes, and by the time I am down the stairs into the OR, I’m ready to scrub in to a stat C-section and get that baby out within 60 seconds of the anesthesiologist putting the patient to sleep.
As Ob/Gyns, we are here to take care of women. It is a privilege, and we do it because we truly find meaning in it. But the job and the training it takes to do it are intense, and the wear on our bodies, not to mention our souls, is often underestimated.