Last June, I started an IVF Savings Account after the Year of the Pregnancy turned into a bunch of months spent getting over a relationship with someone who impregnated another woman instead.
My Baby Day savings account now has $538 in it. And my 35*th birthday is marching closer. I’m single. I’m proactively but not desperately looking for my guy (whose existence my friends are rapidly losing faith in) while schlepping myself out on Internet dates (I even seriously considered trying out a CrazyBlindDate) and wondering how difficult solo parenting would be.
Even if Mr Where-the-eff-have-you-been-all-my-life turned up today and was primed for fatherhood, I’m still making a bunch of assumptions about a key factor – my biological reproductive abilities. I have no specific reason to be concerned but I have had too many happy, healthy, loved-up friends go through IVF to take my fertility for granted.
Fertility is an elusive beast. Women don't really know what their reproductive capacity is until they start ‘trying’ for a baby. More and more the ‘trying’ starts later and later and becomes more and more trying.
What’s been happening in my ovaries for the last 20 years has been pretty clockwork. I have a textbook 28-day cycle, and am your average ‘carefree’ girl in all matters menstruation. I calculate since that Saturday morning in Year 7 when, getting ready to play a game of hockey, I first ‘danced in the red tent’ – I’ve had about 250 periods and 250 eggs have floated unfertilized out to sea.
Given most women are born with about a million oocytes (the fancy name for immature ‘eggs’), only a tiny fraction of eggs will have the opportunity to make a pilgrimage through the fallopian tubes to ovulation. Even fewer will be fertilised. The other 999 thousand or so will die of natural attrition, cell death known as apoptosis. As we inevitably age, apoptosis occurs at an increased speed (especially, it’s commonly accepted, after 35*) culminating in menopause. The trick it seemed was having a sense of not only how quickly the eggs were declining, but also how many are in storage.
Rather than ‘counting my chickens’ and merely assuming my egg stores and fertility were OK, I wanted to count my eggs. Literally. Enter the Egg Timer Test.
The Egg Timer Test is the colloquial name for a simple blood test that measures Anti-Mullerian Hormone (AMH). Produced only in ovary and granulosa cells (cells that are closely associated with oocytes), AMH is a considered a reliable marker of ovarian reserve. Think of it like a stocktake system.
When it first became available in Australia about 2 years ago, my GP was hesitant to give me a referral for the $75 test (which is not covered by Medicare). Simple curiosity about my internal workings were not enough for her to suggest I needed it. Nor was my willingness to contribute to science and the sample of over 800 women who had been used to develop norms for AMH levels. Wait a while, she suggested, until the science improved in providing more accurate information, by then I might already be pregnant, was her lovely encouragement!
‘Patience is a virtue’ I am told. ‘Information is power’ is my retort.
When I found myself back at my GP for a routine PAP test recently I brought up the Egg Timer Test again. As usual, my doctor was empathetic and thorough. What would I do if the results were not great and I had low egg stores? How would the information change my approach to having children? How much stress would a ‘bad’ result create for me?
This wasn't like being anemic and having low iron levels where you could simply take a tablet and get your ferritin stores back up. She reminded me that the test doesn't indicate anything about quality of the eggs. Nor at what rate the stores would decline, about 10% of women have accelerated egg loss that reaches critically low stores once they hit their mid-thirties. Good to know, but better to know where I stood in terms of the impact of delaying having kids.
Satisfied that knowing my position and being able to make decent choices had more pros than cons, off I trotted to have the blood test. I was in and out of the IVF clinic in 20 minutes. Sitting in the waiting room itself was a poignant experience, surrounded by a range of women and couples all embarking on their own journeys towards parenthood. Women carrying little cooler bags, couples clutching each other’s hands. It made perfect sense for me to get this information.
I leafed through some pamphlets on having eggs frozen, a process that, for the most part, is the same as IVF itself and the associated hormonal rollercoaster. The cost was a barrier and I’d read contradictory things about the efficacy of it, especially with regard to ‘defrosting’ eggs. Was a ‘fresh’ 38 or 40-year-old egg better than a 34-year-old frozen one? That thought was interrupted by a nurse calling my name.
Three days later my GP called me with the results. Turns out, my egg score-card was in the above average, but not too high range. Having high AMH levels (higher than the 75th percentile for your age range) is a reliable marker of PCOS (Polycystic Ovary Syndrome) - an endocrinal hormonal disorder with are variety of markers, and which many women are unaware they actually have.
Eggs counted, I can go back to enjoying uncomfortable dates and partying like it’s 2009. I might still have a bit of time on my side, but I’d be silly to put all my eggs in one basket.
Jocelyn is a psychologist and educator. She tweets at @JocelynBrewer
*bingo! An article about fertility that mentions the number 35.