PHILADELPHIA
THROUGH surgical masks, while retracting a portion of bowel, was not how I had envisioned having an intimate discussion about my fertility. Yet there I was, two years into medical school, in the middle of an open cholecystectomy, discussing with my attending surgeon my efforts to conceive. "So," she said, "a pregnant medical student. That's not the worst idea."
Soon after starting medical school, my periods had stopped. Further evaluation led to a diagnosis of hypothalamic amenorrhea, a form of infertility in which insufficient hormones for ovulation are produced. I had always thought of having children, but years down the road, in my 30s, with an established career. At that time I was 27, going to school more than 300 miles away from my husband. Starting a family was not at the top of my mind.
But our physicians told us that our best chance of conceiving was immediately, when my age was our greatest asset. So began our year of hormone injections, transvaginal ultrasounds and intrauterine insemination. After one of my professors, who quite accidentally became one of my reproductive endocrinologists, examined me in stirrups for the first time, I blushed before saying, "You must think I'm insane to be doing this now." His response surprised me: "No, actually, I think you're smart." But as I sprinted from the exam room to an 8 a.m. discussion on kidney disease, I couldn't help but think that I might be out of my mind.
Still, we were over-the-moon happy when we conceived without having to move forward with in vitro fertilization, a considerably more invasive and expensive procedure. And we continued to count our blessings when the pregnancy progressed normally.
I hadn't intended to disclose my pregnancy that day in surgery. But as I was scrubbing in, the nurse asked, "We're using fluoroscopy in this case, so there's no chance you're pregnant, right?" Fluoroscopy is an imaging technique that uses X-rays, and the radiation exposure is thought to be harmful to developing fetuses. Momentarily befuddled, I mumbled, "Uh, yeah..." It was clearly not the answer he'd anticipated. "Well, how pregnant are you?!" I told him 12 weeks.
Sanitation measures were ceased, and the scrub nurse proceeded to shuttle me between operating rooms, each time stating, "Anna, here, is with child. Are you using X-rays?" Finally we settled on the cholecystectomy — a gallbladder removal — which was deemed to be a procedure appropriate for my delicate condition.
I proceeded through as many of the core clerkships — internal medicine, family medicine, surgery, emergency, obstetrics, pediatrics, psychiatry, neurology — as I could before my due date. Each one confirmed my decision. When I arrived at morning rounds, hoping I didn't smell like my own vomit, I was thankful I wasn't the intern or resident, responsible for more than twice my number of patients. During pediatrics, while gaining some perspective on how much energy these adorable germ-bags consume, I considered that the sleep deprivation I experienced in med school had perhaps prepared me for something other than the sleep deprivation in residency. And during obstetrics, when the effects of age on fertility were drilled into us, I was relieved I wasn't putting off pregnancy until I had completed residency in my mid-to-late 30s.
EVERY woman is different, but we know that fecundability (the probability of achieving pregnancy in one menstrual cycle) usually declines in the mid-20s, drops more significantly in the early 30s and plummets a few years later, at about age 37. In the United States, around 6 percent of married women 44 and younger are infertile, and age is by far the most common underlying cause. That's a problem, considering that more than a third of college-educated women today have their first child at 30 or older.
Anna Jesus is a student at the Perelman School of Medicine at the University of Pennsylvania and author of the blog Anna in Med School.
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