When I first met Deborah Anderson, she was nursing her 3-week-old daughter, Yara. At 33, Deborah has a personality similar to mine. She’s bubbly and excited about life, a fast talker who rarely takes breaths between sentences. Like me, she also wears flannel shirts and high-tops to work.
Deborah and I have other things in common, too. She was among hundreds of readers who reached out to me after watching the first three episodes of my documentary “Should I freeze my eggs?” chronicling my personal journey into understanding the reproductive tools available to me as a young, single millennial who would like a family someday. As people like Deborah have shared their own stories with me, I have come to feel less isolated and bewildered along the way. Searching for answers has suddenly become a team effort.
Just as I did, Deborah found out that she has low ovarian reserve — or fewer eggs available for fertilization than is typical for someone her age. In the early stages of their marriage, she and her husband, Jake, checked out egg freezing so they could delay having children for another 10 years or so. When Deborah found out her reserves were low as part of testing for egg freezing three years ago, her doctors urged them to act quickly. So Deborah and Jake endured three expensive failed hormone stimulations and egg retrievals, anxious speculation about early-onset menopause, and two miscarriages.
Along the way, they took the reins themselves, just as I am trying to do. They questioned their doctors, sought knowledge on their own and ultimately discovered that doctors aren’t always capable of determining who can have a baby and who can’t. There’s a lot that can’t be fully planned or explained. As it turned out, despite all of the dire, stressful warnings, Deborah and Jake were able to conceive naturally.
During our interview I watched Jake patiently listen to Deb as she spoke. In joint interviews, the person who isn’t speaking often struggles to find a place to focus their eyes and attention. Jake’s focus is clear. It’s Deborah. He hangs on her every word, taking his time to process her perspective before sharing his own. Deborah responds similarly, carefully assessing when Jake has finished his thought before jumping in to add her own. I could see that their bond had clearly been strengthened by their ordeal.
Deborah recounted her experience with the fluidity and confidence of an expert. She knows what she is talking about and no longer relies on doctors to tell her how her body works. She and Jake had moved beyond fear, replaced ignorance with knowledge and have used their research to create a company in San Francisco to help others make informed fertility decisions.
Listening to Deborah and Jake talk about their purposeful journey to parenthood was inspiring for me.
Since I received the jolting news about my own low ovarian reserve a couple of months ago, my emotions have settled, and a healthy journalistic skepticism had reemerged. My fertility doctor’s assertion that egg freezing was the best solution for me as a 29-year-old felt premature. Having children one day is important to me right now, but spending $20,000 based on one doctor’s opinion doesn’t seem wise. So I decided to reach out to Clarisa Gracia to get a second opinion.
Gracia is an obstetrics and gynecology professor and director of the Fertility Preservation Program at the Hospital of the University of Pennsylvania. As a physician, she focuses her practice on oncological fertility and reproductive aging. She sees cancer patients, both newly diagnosed and longtime survivors, and counsels them on fertility preservation. Her perspective is informed by dealing with a population forced to make hard emotional choices quickly, and it is reflected in the way she communicates. Her disposition is authoritative, yet calm and inviting. Her office feels like a living room with a blue accent wall, colorful art and a placard that says, “Put your big girl panties on and get over it!” on the windowsill.
She explained my results holistically within the context of fertility, rather than limiting the scope of our conversation to egg freezing. Presented with the exact same test results, Gracia and my previous doctor drew very different conclusions.
The follicle stimulating hormone test (FSH) and the antimullerian hormone (AMH) blood tests gives me a sense of my ovarian reserve.
Follicle stimulating hormone is produced by the brain’s pituitary gland. It uses your bloodstream as a loudspeaker to tell your ovaries to grow follicles. The pituitary gland sizes up your ovaries and decides how much FSH to release, based on the number of follicles you have overall. As your ovarian reserve diminishes, your brain hikes up the amount of FSH it releases to keep your body churning out eggs every month until you run out. The amount of FSH in your bloodstream provides a general idea of how plentiful your ovarian reserve is.
The antimullerian hormone blood test is regarded as the most accurate of the three tests. AMH is produced by follicles, and the amount of it in your bloodstream is directly proportional to the number of eggs you have.
But my ovarian reserve is not an indicator of natural fertility, Gracia told me. A recent study found that, among women ages 30 to 44, there is no statistical difference in the ability to conceive naturally between those with normal hormone levels and those whose levels indicate diminished ovarian reserve.
However, these blood tests can be an exploitable gap in logic for doctors whose patients are unfamiliar with the data informing their results, encouraging women to make a reactive decision informed by fear, rather than facts. Deborah and Jake Anderson are examples of that.
The only way to know if you can get pregnant, Gracia points out, is to try to conceive. Unlike Deborah, I haven’t found the life partner I want to do that with yet. But her words were a refreshing affirmation that my results are not the end-all.
It will likely become more difficult and expensive to harvest my eggs as my numbers continue to decline with age. But I can also change my plans for timing, method or even when it comes to having children at all, based on new information. My journey isn’t just about egg-freezing; it’s about gaining a more informed perspective on family planning that will allow me — and all of us — to be more intentional about our decision-making, wherever it may lead.
While you’re watching her personal journey, Nicole would love to hear from you. Join her Facebook group for the series.