*Warning: The post could be triggering for some women, especially those in their 40s who are trying to conceive*
A girl I know posted a rant on facebook yesterday and for the most part I agree with everything she said and others’ comments on her post. The rant was due to some unsolicited and entirely inappropriate advice from a female doctor. The girl, who is currently single, somewhat overweight (although she has lost a lot of weight and seems quite happy and active now), and pursuing her PhD, was told, “You should consider putting down the thesis and remembering your eggs are only good for another 5-6 years.” and she “should consider losing 5-7lbs in order to find love and have the babies, so that [she’ll] have someone to take care of [her] when [she’s] older.”
I find these statements appalling from a feminist perspective. As the girl in question so aptly put it, she does not need anyone to take care of her and being single does not mean that she does not experience love, caring, companionship, or happiness. She also reported that she does not need to sacrifice her family or career aspirations to achieve one or the other. I do agree with this last statement but I think there’s often give and take from each area in an attempt to have it all. In no way though do I think that you must entirely sacrifice one for the other. I went to grad school and am proud of my education and professional status, but I also really want a family that includes at least one child and to be a very nurturing, hands-on mom. It will be stressful and I won’t always be a superstar in both areas at the same time (or at all), but I will have my version of having it all.
The big thing that I took issue with was not the rant itself, but some of the people’s comments because I felt that they were misguided. I wasn’t about to say so though because I didn’t want to instill panic in anyone and it wasn’t the purpose of the rant. A few people made comments about being frustrated when people make it seem like there’s an age limit on starting a family and one person said she recently posted a link to an article about eggs dying at 32 being complete bullshit. First, I know 35 is a turning point in fertility (as a whole, not for everyone) so 32 seemed like a weird age to mention. Second, eggs start dying in utero and continue throughout our lives, yet the girl’s comment made it sound like there’s this “myth” that eggs suddenly start to die in early to mid 30s. These are nitpicky things. The thing that had me dying to drop some knowledge bombs on people was that age does actually matter. I feel this more so I think because I found out I have diminished ovarian reserve at 29. Of course, some people have way longer than others, but it’s not like age isn’t a factor at all. I was totally overanalyzing people’s posts, which is likely due to being hypersensitive about the subject, but I felt like people thought it would be effortless to conceive whenever they feel like it, regardless of age. Of course you can start families without conceiving and carrying a biological child and some of the commentators might never want to have children, but I just got this sense that people were oblivious to the effects of age, in denial, or relying on artificial reproductive technology (ART).
IVF and other ART are amazing medical advances, but they aren’t the easy guarantees that some people think they are. I have heard reference to people saying things like, “Oh, I’ll just do IVF.” These comments are clearly not made by people who are actually faced with the present reality of IVF because it’s not something you just do like booking a spa day. There is nothing easy about it, and I say this confidently without having had to follow through with our plans for IVF. Also, it’s not a guarantee. Because the number of eggs was a huge concern for me, I did some googling while we waited to start IVF. I found a great graph. For those under 35 (the category that most concerned me), there is a 65% chance of a live birth if the doctor can retrieve more than 10 eggs in an IVF cycle. Really great sounding odds, but as someone with DOR, I wasn’t banking on that kind of number. If 7-10 eggs could be retrieved, the odds are 56%. This is still great, and the number my doctor said he aimed for, but again, not a guarantee. My antral follicle count ranged from 5-7 and while some woman can produce more follicles and eggs during an IVF cycle, many seemed to report that they managed to get the equivalent of their AFC or less. So if the doctor retrieved 3-6 eggs, the chances of a live birth would be 38%. Not horrible, but the odds scared me. If less than 3 follicles were present my doctor said he would have strongly recommended switching to an IUI, which I agree with for a few reasons, one of them being that 1-2 eggs only gives 16% chance and the rates for IUI in that case would be higher. Now, for comparison’s sake, if I was 41-42, more than 10 eggs gives a 35% chance. So there is a difference.
Aside from IVF, there is a difference with natural fertility as well. The chances of a woman in her 20s getting pregnant any given month range from 20-25%, whereas a woman in her 40s has about a 5% chance each month of trying. After 45, it’s 1% per month. It’s not just the number of eggs that are left, but the percentage of remaining eggs that are considered normal. As my doctor told me, he would favor me with my 5-7 follicles over an older woman with the same number because the likelihood was that mine were higher quality. Small comfort when I was freaking out, but egg quality reportedly matters more than number.
Another thing that the rant and the above train of thought had me thinking about was the cost of IVF. We were given an estimate of 14-16K per cycle because I would need a very high dose of medication ($$) and ICSI was recommended. So while the 38% chance per cycle (in my case, this would be if I had 3-6 eggs retrieved) is higher than the natural cycle rate, keep in mind that it often doesn’t take just one cycle for natural or assisted conception. More than half (57%) of all people trying to conceive naturally will do so within 3 months of trying. I know it’s not equivalent, but translate that to IVF and that would equal 42-48K for us. Seventy-two percent conceive within 6 months of trying. Six cycles of IVF would cost us 84-96K. Within a year, 85% of couples conceive naturally. Our out of pocket expenses for 12 cycles of IVF would be 168-192K. We would never have been able to try 6 or 12 cycles of IVF. In fact, 3 was our predetermined limit. But doing the math and seeing the staggering costs really drives the point home that this is not an easy venture, especially considering that finances are just one component to the hardships couples face when pursuing IVF.