Editor’s Note: For more on the challenges as well as strategies to address physician infertility, please read this Academic Medicine Invited Commentary, cowritten by the author of this blog post.
Most of us in medicine pride ourselves on being organized, detail-oriented, conscientious and able to achieve excellent results with enough hard work—and are not used to failure and loss of control. My experience with infertility has been the first time that I truly experienced failure and complete loss of control, realizing that fertility is not a merit-based system. No matter how hard I try, how many doctors I consult with, and how many pills, injections, and other treatments I take, there is absolutely no guarantee of a positive outcome. Giving up all control of my body and emotional stability is extremely challenging and, at times, heartbreaking.
I waited to try to have children until I was finished with medical training, and my husband and I were academically and financially “stable.” After a year of trying naturally, we underwent a comprehensive workup, which led to my dual diagnoses of hypothalamic amenorrhea and polycystic ovarian syndrome. I started metformin and attempted fertility medications (letrozole), but no luck— so we decided to take the plunge into in vitro fertilization (IVF). I had the chance to talk to two colleagues who had done the same, and even though they emphasized the complete lack of control and devastation that IVF can bring, telling me that the process is “not for the faint of heart,” I had no idea of the journey I was about to embark upon.
We started the process of ovarian stimulation/egg retrieval in December 2018. Our first “cycle”—three types of subcutaneous injections, daily estrogen levels to titrate medication dosing, and almost-daily ultrasounds—was initially challenging because of the time constraints (fitting in labwork and ultrasounds around inpatient service, knowing I would miss a day of work for the egg retrieval procedure, but not knowing when until the ultrasounds/estrogen level indicated I was “ready”). Yet the real heartbreak came after the retrieval. Although we got 15 mature eggs, only one made it all the way from fertilization to the 5-day embryo stage where it could safely be frozen. The only explanation per the medical team was that my eggs looked “degenerate” under the microscope, and our one blastocyst was low-quality and unlikely to lead to a successful pregnancy.
In the literature, the emotional stress of infertility has been compared to that of cancer. Though I am not personally familiar with the latter (aside from patients I have cared for), the news we had only one (poor-quality) embryo was heartbreaking. I spent the better part of the next month walking around in a daze. I had always thought that having children was a choice, but now I felt as if this choice may be taken away from me. I began to hate myself for what I perceived as my own failure, because I felt my body had failed me; my own “degenerate” eggs had taken away the chance for my husband and myself to have a family together. I felt broken, deficient, and less than a woman.
In the infertility journey, we can only pick ourselves up and try again. I ultimately went through three more stimulation cycles. The final cycle led to successful retrieval of eggs, and we finally got a good number of embryos with the potential to become healthy babies. This was the “high” of the journey, the time we felt that things were finally going the right way.
Then we tried to transfer an embryo. The transfer went smoothly, and although I knew statistically that not all transfers, or even the majority, are successful, I still hoped that it would be. Nine days later, I took a blood pregnancy test—it was negative. The transfer had failed. Although I had done everything “right,” and the embryos were genetically normal and the uterine lining was the right thickness, it still failed. Once again, I felt like a complete failure, but without any explanation for why this time. I sat in my office sobbing, trying to get myself together in the 15 minutes I had before leading inpatient rounds. Then, of course, came the calls and texts from all the people who had been hoping and praying for us to have success. They had to be informed that unfortunately we had failed.
This is the journey of infertility. Huge highs and heart-wrenching lows, all accompanied by alternating hope and hopelessness. Once again, our only option is to pick ourselves up and try again. While the journey is heartbreaking, I do now have the self-awareness to realize that no matter the outcome, my infertility is separate from my value as a woman and a human being. I will not sugar coat the fact that my “failure” as a potential mother has taken and continues to take a huge physical and emotional toll on myself and as well as my incredibly supportive husband. However, I have at least realized that I have worth as a human being no matter what my eggs do or do not create in the future. Dealing with failure gives us the tools to acknowledge our own self-worth.
By: Ariela L. Marshall, MD
A.L. Marshall is a hematologist at Mayo Clinic in Rochester, Minnesota. She is passionate about mentorship, career development, women’s health, and women’s rights and is an advocate for gender equity and reproductive rights for all women.
Marshall AL, Arora VM, Salles A. Physician fertility: A call to action [published online ahead of print November 12, 2019]. Acad Med. doi:10.1097/ACM.0000000000003079