Investigating

Contemplating Egg Freezing 

I used to worry about the right age and stage of my career to have kids. Did I want to be a young mum and get kids out of the way before pushing for promotions or wait until my career was established? To be honest, it never really occurred to me that I would ultimately not need to grapple with those questions and that I would reach my mid-30s, with no partner or imminent prospect of one, and be looking at potentially missing my window to have kids. 

But, that is where I found myself earlier this year. 34 and single, having separated from my partner a year before. When we went our separate ways I did so knowing what it might mean for me. We had discussed having kids, it was just a question of timing. I thought I'd met my 'person'. But as it became obvious to me that the relationship needed to end I remember being acutely aware of my ovaries. I would never have stayed just to have kids, but I'm fairly sure this wasn’t a consideration of my partner (who already had 2 kids in any event) and wouldn’t be for most men in a similar position at a similar age. The reality is that men have more time. Conversely, women begin with a finite number of eggs and once we hit 30, our fertility starts to decline (around the time you can no longer bounce back from a hangover in 24 hours - your ovaries seem to shrivel at the same time as your liver). Age is the most important factor in predicting pregnancy potential in women. 

I had been considering getting my ovarian reserve tested once I hit 30 because my mum had had difficulty conceiving and I had some other issues in that area (PCOS and fallopian tube removal when I was 15), but once I got together with my ex at 31, I thought I was set. When I eventually picked myself up after the relationship ended, I started thinking again and when I turned 34, realised I was running out of time. People talk about 35 being the key age for fertility. But it's not like you wake up on your 35th birthday and your ovaries have emptied overnight. There is a steady decline from 30, which then turns into a cliff around 35. 

From: Fertility and Age (extendfertility.com)

Testing 

So, after my 34th birthday I arranged for blood tests to check my ovarian reserve. These tests provide an indirect estimate of a woman's remaining follicular pool (alas we do not yet have the technology to go in and count how many are left).

FSH (follicle stimulating hormone) is the hormone that is released from the brain to help ovarian follicles mature and release - the higher the FSH level the harder the body is having to work to make the ovaries do their thing so you want this number to be low . Normal levels are anything below 10mIU/ml.  FSH should be tested on day 3 of your cycle and increases with age. 

AMH (Anti-Mulleran hormone) is a protein produced by cells in follicles in the ovary so AMH levels strongly correlate with follicle numbers. AMH can be tested any day of the month and decreases with age. Levels of 0.5 to 1.26 ng/ml indicates perimenopausal transition within 3-5 years.

I didn’t realise until after I received the results that I was genuinely expecting the GP to say "you're good, you've got time" and I could forget about this issue for another year or two. One of the side effects of my PCOS was that I had rarely had periods and had lots of follicles on my ovaries. So surely all of my eggs must have still been tucked up in there, ready to go when I needed to call on them? It turns out they weren't. 

Results

My FSH was 12. Too high. My AMH was 0.7. Too low (see graph below). 

My fabulous (and always positive and compassionate) GP's optimistic view was "it's not hopeless" which was not really the threshold I was trying to get over. She referred me to a fertility specialist at the Cayman Fertility Clinic who confirmed with an internal ultrasound that I did indeed have Diminished Ovarian Reserve. This is "when a woman's ovaries lose their reproductive potential". It usually occurs in early 40s but lucky me - it hit at 34. I've always been ambitious but this was not a goal I wanted to reach early. 

Data from Facts & Figures | Fertility Statistics (extendfertility.com) 

While these results didn’t mean I would necessarily have trouble falling pregnant, they did mean that I was at the pointy end of the time within which I could reasonably freeze a good quantity of eggs. Importantly, they don’t indicate egg quality but it makes sense that the fewer eggs you have, the smaller the pool you have to draw healthy eggs from. 

Armed with this information I needed to decide what to do! [Spoiler alert - I froze my eggs...]