A Physician's Struggle With Infertility

As Editor of SheMD, I'm sharing my story of #PhysicianInfertility, because we have to start the conversation. We have to talk about the fact that we, female physicians, have INCREASED rates of infertility. Physician infertility isn't something we learn about in medical school. We learn about physician infertility when we become the patient, when it may be too late.

My fertility journey is not typical.  I have not spent years “trying”. In fact, I have spent years trying NOT to get pregnant!  

My husband has two daughters – AND a vasectomy.  So getting pregnant was a known challenge. Luckily, I like challenges.  We went to an infertility specialist, who told us that reversal was NOT an option for us, and that IVF was our ONLY option.   A bunch of testing later, they diagnosed me with diminished ovarian reserve and suspected endometriosis and recommended laparoscopic surgery. I had not even TRIED to get pregnant. I didn’t want surgery; I just wanted a baby.  The only problem I was aware of was getting my husband’s sperm. Or so I thought.

I have since learned that IVF is an emotional hurricane. They jack you up on hormones and then they give you bad news again, and again, and again.  Case in point. After multiple days of hormone injections, I went for my egg harvest (a procedure to retrieve my eggs for IVF). The downward spiral began as soon as I came out of my Propofol-haze to find out I had eight eggs.  Only eight. What if I do have a problem? What if I have diminished ovarian reserve or endometriosis? Should I have had the surgery? All of these questions started running through my head as I waited five long days for my transfer to occur.  The next day they called me to tell me only five of the embryos had fertilized. The questions resumed their onslaught.

On our transfer date, we were ecstatic.  It was October. We were “going to put a pumpkin in my belly”.  Our plan was to transfer two embryos, until we went in to the office and found out we in fact ONLY had two embryos.  Well there were two other ones that were in morula phase but needed to progress to blastocyst. We looked at each other, without much discussion and said, “Okay we have two.  We will have two more once they grow. Let’s put in these two.” And we did. I spent the day on the floor with my legs against the wall trying to encourage those two embryos to make a home in my uterus.  All the while I was wondering, “Was the doctor was right? Did I have my own reproductive problems? Had I managed to get to 31 years of age without a child because I am infertile?”

I hadn’t heard anything about my two other embryos, so I emailed my nurse to call me with the results.  She didn’t call. She sent me an email: No frozen embryos :( Sad face – like the one with the colon and the parentheses…yes that.  Breaking bad news is always a challenge. I break bad news almost every shift in the emergency department.    An email with a sad face to a woman jacked up hormones was not the best approach. I now had two embryos inside me that were my only chance of getting pregnant, and a 60% chance of success at that.

Ten days later, we did a home pregnancy test.  It was positive. We were overjoyed - for a short time.  The next day my blood test – a quantitative pregnancy test – came back.  49. My nurse called and calmly explained that it was lower than they would expect for a nine-day quant.  I agreed to a 48 hour repeat. The next day, I started bleeding on my overnight shift. I spent every free minute of that shift looking up infertility issues – endometriosis, surgical cure rate, diminished ovarian reserve, fresh vs frozen transfers.  I accepted that this pregnancy was not going to be viable, and I started equipping myself with the knowledge I needed to make the next step decisions. The next day my repeat quant was 98. EXACTLY doubled. I was still bleeding. My nurse called again – wanting to know if I want to keep repeating beta quants every two days or just wait for my 6 week US.  My immediate response was “No!” I did not want to be the patient I see in the ER getting repeat quants. I waited until my 6 week ultrasound.

On my ultrasound day, I had started to feel pregnant. I had started to believe I could be pregnant.    But as soon as the transvaginal probe went in, I could see the clear stripe of my uterus uninterrupted by any collections of fluid. It was utterly empty.  Immediately, the tears crept in the corners of my eyes. My doctor scanned out to the left, and there it was – a gestational sac, a yolk sac, no fetal pole, no heartbeat.  I had an ectopic pregnancy. That diagnosis I was always eager to make in others, I now made for myself. My doctor looked at me and said the most honest thing she could say, “I am so sorry.  You probably diagnose these way more than I do. It’s extremely rare with IVF, less than 1%.” Yes, I do diagnose them more than she does.

And yes, I am the 1%.

Ever wonder what happens when you get diagnosed with an ectopic?

Well that night, I had the residency over for a wellness Thanksgiving dinner.  I couldn’t cancel – I was hosting.  Then after dinner, I went in for my overnight shift. A colleague met me at the hospital and performed an ultrasound once more to confirm. The ectopic was still there. No heterotopic to be found. The next day, a friend administered my methotrexate injection- my husband, understandably, couldn’t bring himself to do it. And off I went to work another overnight shift.    I have never felt so ill on shift – EVER. I could barely get out of my chair. At one point, I told the chief resident working with me my blood type, just as a precaution. I survived the overnight shift, but by 5 am, I had to apologize to my residents – I could barely get out of my seat.

So that was it.  We had survived this struggle.  Or so I thought. A few days later I was at home, alone, when I had intense pain- truly 10 out of 10. I couldn’t move off the floor.  I couldn’t get to my phone. I panicked. The Emergency Medicine doc in me was no longer composed – my brain was racing with worst possible scenarios.  I was certain my ectopic ruptured. I was going to die on the floor of my bedroom in my underwear. It was certain. Eventually the pain subsided. I put on my scrubs (I was on the schedule… again) and drove myself to the Emergency Department (ED).  My friend did an ultrasound and we saw free fluid- a lot of it. I checked into the ED. MY ED. My husband left the fire station and rushed to the hospital to be with me. A colleague had to cover my shift. I put on a patient gown. I waited behind closed doors for my OBGYN consultant. I got wheeled through the hospital corridors to radiology, in a patient gown, past residents, past firefighters, past a lot of puzzled faces.  I waited in radiology for my formal ultrasound. I waited for someone to push me back downstairs to the safety and security of my ED. One of my own Emergency Medicine interns was on her ultrasound block, and she found me waiting in the hallway for transportation. She kindly wheeled me back downstairs to safety. I did not have a ruptured ectopic. I was just “lucky” enough to develop two very large cysts on my left ovary, in addition to my left-sided ectopic. When I got back to the safety of my hospital room, behind the closed door, I cried.  A lot.

For the first time, my personal life and my professional life had truly collided.  My work world was interrupted by this process of trying to make a baby. And finally, after being forced to take off my next shift, I was forced to take time to grieve.  

My story didn’t end at round 1.  A few months later (Februrary) I started injections for Round 2.  We retrieved 7 eggs. Three of those fertilized, and we ended up with one embryo.  My pregnancy test was negative. (I will tell you a secret. I took three home pregnancy tests, all in the middle of the night while my husband was at the fire station so I could wallow in private.  The test was still negative when he got home in the morning. And when we went for my blood test. I was decidedly NOT pregnant.)

Again, I had no embryos leftover.  

In May, I underwent the surgery they had suggested on my initial visit over a year prior.  As a physician, and more specifically as an Emergency Medicine physician, I didn’t want anyone mucking around in my abdomen.  The amount of desperation that I had to even consider this surgery was significant. So I had it, begrudgingly. The diagnosis was confirmed - Stage 2 endometriosis. It was all scraped out and I was good to go for my next round.

In August, we started injections for round 3.  At this point, I had been following a keto diet for almost 9 months, cheating only once.  I had been going to acupuncture for a similar amount of time. I had basically stopped all forms of working out, only letting my max heart rate get to 120.  I was meditating and practicing mindfulness for relaxation. I was doing EVERYTHING. I went in for my first ultrasound, and we found that my body was doing its own thing, not following the schedule for IVF.  We had to cancel my cycle. We rescheduled for September, but added in cetrotide to suppress my body from creating its own novel follicles. In September, at my first ultrasound, same thing. My body had been making follicles that were maturing at a rate much different than the ones induced by my injections.  I had to cancel AGAIN. At this point, my IVF Hurricane was category 5. I was tired of being the patient and more tired of being the patient in which NOTHING went right. The patient where the unexpected was expected. I was tired of being the 1%.

So why am I telling my story? Well the night I thought I was miscarrying at work and was searching through all the literature, I stumbled across an article on female physicians and infertility.  

For the general population, the infertility risk is approximately 12.1% according to CDC data. Women around the world with infertility state that they are the 1 in 8.  

As women in medicine, we have an INCREASED RISK of infertility.

I am NOT alone.  This study that I found looked at female physicians and found that our risk was 24.1% for infertility.  

For women in medicine, ONE IN FOUR of us will struggle with infertility.

Many will say it is because we attempt conception at an older age, and yes that is part of it.  But it is NOT the whole story. A study in Hungary looked at over 3000 female physicians and compared them to an age adjusted control group of professional women, other women who delayed child-birthing for their education and careers.  The study found that women in medicine STILL had a statistically significant increase in infertility rates.

So where do we go from here?

First, we have to start the conversation about physician infertility.  We have to start telling our stories and raise awareness about physician infertility.  As doctors, we can do so much to erase the stigma around infertility and to raise awareness in our own professional groups.  It is uncomfortable, but change can only start by working through discomfort.

Second, we need to counsel and protect the young women in medical school and early residency that will be joining our ranks.  We need to caution them in advance about their risk of physician infertility. I never thought 31 would be too old. We need to start the conversation so that the women coming behind us are better informed that I was; so that they know their risks - the risks I didn’t know - and can make decisions accordingly.

Finally, we NEED more data and better data about physician infertility.  Data will allow us to create policies and best practices to help protect women in medicine and keep them in the field. We need policies that not only ALLOW but that SUPPORT female students and residents that want to have a child during their training.  

In the meantime, as we wait for more data and better policies, as I wait for another round of IVF and the possibility of pregnancy, I will continue to tell my story to raise awareness about physician infertility.  I invite you to join me - #SayTheFWord and tell your story. Let’s show and share our struggle so others can learn from us.

This story was also published on my personal blog - www.melissaparsonsmd.com.

#PhysicianInfertility

#InfertilityAwareness

#SayTheFWord

#SheMD