Perimenopause Symptoms You Might Not Realize You’re Experiencing
One of the most confounding aspects of engaging with assisted reproductive technology is that there is no clear, defined path to build a family. It’s a white space, with thousands of nodes uncoverable through evaluations by reproductive endocrinologists (RE), diagnostics, procedures, and luck. When my husband and I started trying to build a family, we knew I had low levels of Anti-Mullerian Hormone (AMH), a hormone that can act as a proxy for the number of eggs a woman has remaining in her ovaries, her ovarian reserve. We quickly found ourselves in an RE’s office and decided to pursue in vitro fertilization (IVF) to have kids.
IVF is a step-by-step process. At each stage medical professionals guide you carefully, but there is no roadmap, because each step determines the upcoming path. My experience of IVF was like a constantly twisting, unknown forest. I worked at a biopharmaceutical company and still found myself drifting uncertainly through that forest. After a setback like a poor egg retrieval count or a failed implantation, the emotional impact was significant. I was terrified by the possibility that I might not get pregnant, and being a data-driven person, the lack of evidence or assurance that I could – that I would – one day get pregnant, made the experience all the harder. I didn’t know at the time where to find a community of other women who were going through the same thing and could relate to my wild emotions.
Several years after walking into that first RE’s office, I had my first son. Today I have two boys and am now pregnant with our third baby. To create our family, I have done five egg retrievals and seven implantations. I am incredibly lucky. IVF was successful for me, and I know this is not the case for everyone.
One major surprise I had was the minimal insurance coverage I received for IVF treatments, and how quickly that insurance coverage ends, often with the first egg retrieval – prior even to trying to implant an embryo. I was grateful to work at a company that provided me with commercial healthcare coverage options, as many women who need IVF to plan and build their families do not have commercial insurance options. Ultimately, my husband and I used our savings for these treatments, an option we were thankful to have.
As we were trying for a third child, I met Daisy Robinton, co-founder and CEO of Oviva Therapeutics. Oviva is a category-defining biotechnology company that develops therapeutics to improve ovarian function and extend female healthspan. Oviva’s lead drug is an engineered form of the hormone AMH, currently being developed for increasing egg count in IVF. Later, it has the potential to be used for delaying the onset of menopause, and holding off on depleting the egg supply. The treatment is currently in preclinical research, and Oviva expects to apply for FDA approval to run clinical trials in humans.
I was amazed by the drug’s potential. Should this drug be successful in clinical trials for IVF, and receive FDA approval for use, it has the ability to increase the number of eggs a woman gets in an egg retrieval process. That in turn has the potential for reducing the total number of cycles a woman like me, with low AMH, and others might need to go through to get enough eggs to move forward with a reasonable chance of success in IVF. Not to mention that each cycle costs thousands of dollars, and this could cut back on the amount of cycles needed and the total investment of IVF. That also has value when it comes to time: It translates into years more time with that future family.
I built my career in investment management and on the business side of drug development organizations. I joined Oviva as COO, giving me the opportunity to work on a product that could positively impact women who are also facing the same challenges I had in building a family, or those planning for the future.
Find community. Earlier in my infertility journey I wish I had a community of women undergoing similar fertility challenges. There is an organization called Conceive that is focused on changing fertility outcomes and connects women with fertility education, a fertility nurse and coach, and a tight-knit community of women who are on similar fertility paths. I needed something like this to feel understood by women who have the same fears, procedures, ups and downs as me (disclosure: I am an investor now in Conceive, having seen the incredible impact it has).
Get a second opinion. You’re not married to the first reproductive endocrinologist you meet; I saw one RE for over a year and didn’t feel comfortable with the path forward she suggested. I changed to another RE and have been working with him ever since. There are of course some logistical challenges to switching providers, like the time it takes to find and meet with a new RE, and the paperwork, but it’s absolutely worth considering to ensure that you feel comfortable with the specialist guiding your treatment.
Understand the out-of-pocket costs, as much as you can, upfront. Only a handful of states mandate any form of commercial insurance coverage for reproductive treatments, and many women do not have commercial healthcare insurance. To the extent you can, get a sense of the cost of each step in your process that you will need to pay for. I naively didn’t know how to ask the right questions about my own healthcare coverage and felt shocked by the flood of bills I received throughout my IVF process. It’s worth meeting with a counselor or other professional who is well-versed in these costs and what they may look like for you over time so that you can plan accordingly and make the best choices for your own situation as early as possible.
Take a break when you need it. This can be a long, surprising, and grueling journey. Stepping back and going away for a few days or stopping procedures for a few weeks was something I needed emotionally and physically. I fought negative thoughts in my head that I was being wasteful with my time by taking a few weeks off, but I really needed it. Preserving your mental, emotional, and physical health is essential, and often taking a little break is the best way to support that.
Spend time with a therapist. If you have the resources, meeting with a therapist is helpful to is helpful to manage the wild emotions you might experience. It gives you space to open up about things that you might feel weird or embarrassed saying to your partner, your parents, or friends. With a therapist you can unleash all of your feelings unabashedly, and you don’t risk taking out your frustrations on your loved ones. Here, I learned from my mistakes.