Guest Writer: Susan, a Letter to Her Doctor

Dear Dr. S:

I’m writing to thank you for your help, guidance and wisdom while I was trying to conceive. You may not recall, but my visits to your office are as clear to me as your scribbled notes are illegible.

My husband and I first met with you in the fall of 2010. I was 40, well into the “advanced maternal age” territory. But despite this, you encouraged us to try on our own. We did, and in fact got pregnant naturally in December 2010: 6 months after we had started to try.

While I miscarried at 6 weeks, everyone (including you) told me getting pregnant was a great sign. Of course, you also told me that I had to get serious about getting pregnant. Wasn’t getting pregnant – even briefly – a strong indicator that I was serious?

Unfortunately, I was distracted. When we started trying to conceive, my dad was diagnosed with cancer. By April 2011, his health had spiraled downward. I was too drained to create a life while watching his slip away. He succumbed to the disease on June 30, 2011. Even as we kept trying for a baby, my heart wasn’t in it.

I finally returned to your office in September 2011. You lectured me for waiting and reminded me of the diminishing returns on my ovaries. You pushed me to get more aggressive. I tentatively stepped into the world of ART – Assisted Reproductive Technology. We had success on my very first clomid-medicated IUI (intrauterine insemination) cycle, but after a promising 6-week ultrasound, I began to bleed and felt a familiar, unfortunate ache. This started on Saturday night and by Monday morning you confirmed what I knew: another miscarriage. My husband was shocked. I stared at the ultrasound image, a sad, small clump of cells that refused to grow.

After that nightmare was over, you suggested we try IVF with testing of embryos before implementation. But I wasn’t ready to take the leap to IVF. I’d been pregnant twice in 9 months. While I worried about recurrent miscarriage, I didn’t think that getting pregnant was the problem. You agreed, but didn’t stress how much of a problem staying pregnant could be. It wasn’t until a couple more failed IUI cycles that you dropped the bomb, just shy of my 42nd birthday.

You said my AMH (anti-mullerian hormone) numbers were now undetectable. I had the ovaries of a woman over 45 and even IVF with testing wouldn’t help. In your opinion, donor egg was my only option. The odds of success with my own eggs were less than 3 percent. Without a donor, you could no longer help. You wished me luck on my way out the door.

I was at a critical moment in my pursuit of parentage. I was ready to give up, but my husband and friends encouraged me to get a second opinion. One friend recommended the clinic she’d used to get pregnant, specializing in “last resort” patients. Under their guidance, I started taking a DHEA supplement -- linked to improved egg quality and outcomes -- and my AMH numbers were suddenly measurable again. My husband and I also began to explore adoption.

Before I could dive in, or begin an ART cycle with the new clinic, I got pregnant again. The third time had to be the charm, right? I followed a daily ritual of medications that included bruise-inducing shots in my belly and steroids. I used music to calm my nerves and said a constant mantra of “stay, be healthy, grow.” It failed to change the outcome: not viable.

Your words rang in my head.

Our doctors at the new clinic remained hopeful, but didn’t push IUI or IVF. They told us to keep trying on our own (taking the DHEA and getting my AMH levels monitored). This was July 2012 and we decided to wait until the end of the year to try ART again. Circumstances beyond our control, including a bad taxi accident on New Year’s, contrived to push our next (and possibly last) assisted attempt to mid-February 2013.

I tested positive on March 11, 2013. Despite the bold “PREGNANT” on the store bought test, I wasn’t optimistic. I was batting 0-3. Your words haunted me, especially during those first weeks. Through my early ultrasounds, where I could see that clump of cells getting bigger, tentatively taking form. Through that first glimmer of the heartbeat and its rhythmic sounds. Each milestone gave way to the long wait for the next one. Sure, we had a heartbeat, but what if the genetic screening indicated serious chromosomal issues? What about the 20-week ultrasound? I was never fully secure that my journey would end with a baby in my arms. Even as my due date neared, I would still qualify any mention of a future child with “hopefully.” But unlike when I sat in your office in March 2012, hope had crept in, taking the form of the little being growing in me. He defied my age, my eggs, the crazy odds and your words and was born on November 7, 2013.

I considered sending you a birth announcement, but was never sure what I would say. Gloat that you were wrong? That never felt right to me, because I know that despite the birth of my son, you weren’t wrong – I was incredibly lucky. You didn’t want to give me false hope and offered a perfectly valid and beautiful option in donor egg. You had the power to change my life, to turn me off one road and onto another. But ultimately, you couldn’t decide what was right for me and my family.

My hope is that the next time a 40 plus woman with “poor egg quality” is in your office, you are willing to see past the statistics, to view her as a person versus an age, a hormone level or both. She may end up surprising you.