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January 16, 2019

'Take advantage of [your] fertility': One surgeon's advice to the next generation of female docs

Daily Briefing

    Like most surgeons, Arghavan Salles spent most of her 20s and early 30s in training. Now, at age 38, she's grappling with the reality that it may be too late to have a baby with her own DNA—and in a TIME article, she's offering young women in medicine a word of caution.   

    Starting a family took a back seat to building a career

    Salles, an assistant professor of surgery at Washington University, writes she spent her 20s and 30s "with people—patients, colleagues, nurses, staff—in hospitals." She explains, "I ... prioritized my career over my personal life, and when I was younger, th[is] tradeoff felt worth it."

    But now, Salles writes, "It feels time to consider my own life," and in particular the possibility of freezing her eggs so that she might preserve the opportunity to have children when she meets the right partner.

    The tough fertility odds

    To understand her options, Salles decided to visit a fertility clinic. Her doctor asked, "How do you envision your family looking?"

    "I reflexively reached for a tissue to cover my face and erase the signs of weakness," Salles writes. "'I don't know,' I said. 'I just want to be able to have a family.'"

    That's when the doctor told her that, while freezing her eggs for future in-vitro fertilization (IVF) was an option, her odds of success were relatively low. As a 38-year-old woman, she'd need to freeze at least 15 eggs to have a 50% chance that one egg, after later being fertilized and implanted, would produce a child. For a 75% chance, she'd need to freeze 30 eggs.

    As each cycle of egg retrieval would produce at most four or five eggs, Salles writes, "I quickly realized I would never get to 30 eggs, and maybe not even 15."

    And the effort would be expensive. The egg retrieval procedure itself would cost around $10,000, primarily out-of-pocket, while the self-administered injections taken during each cycle would cost $3,000 to $4,000. All of that was in addition to the ultrasounds, blood draws, and labs that Salles would need every few days to monitor her eggs to determine whether they were mature enough for retrieval.

    Despite those odds, Salles decided to begin the process.

    A devastating phone call

    Three weeks later, after many injections and six ultrasounds, she received a devastating phone call from her doctor.

    "She thought we should cancel the cycle," Salles writes. Salles' eggs had not matured as hoped.

    Even so, Salles wanted to try one more time. She writes, "Throughout this process I wondered, 'What is the point of my existence if I cannot perform this basic human function: reproduction?'"

    Her doctor agreed to conduct one more ultrasound, but to no avail. Salles' eggs still hadn't developed enough to be retrieved.

    "And that was it," Salles writes. "The daughter I had pictured growing up disappeared like the spots on an old black-and-white TV as it shuts off, leaving a dark screen."

    A word of advice

    "I know I'm not the only one grappling with these issues," Salles writes. "Far too many women in my generation are now facing the toll of having prioritized our careers during the most fertile parts of our lives."

    That's why Salles has decided to "raise awareness among younger women to take advantage of their fertility while they have it," which could mean either "getting pregnant sooner or freezing their eggs or embryos sooner."

    "For women studying to be doctors, there are very few convenient times to build a relationship, let alone have a child," Salles writes. But her hope is that, "armed with knowledge and data, younger women can make informed choices while they still have options."

    Salles has sought "several opinions" on her fertility, and each time, she writes, "[I] was told different versions of a similar message: I had waited too long, and my chances of one day having a child with my DNA were pretty low."

    But Salles notes she's not ready to give up on having a baby yet. While the first cycle of the egg retrieval process was "devastating," Salles writes, "I am going ahead with another cycle with a different medication protocol, crossing my fingers" (Salles, TIME, 1/3).

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