Infertility is a problem many people struggle with, and although it is often considered only a woman’s condition, both men and women can contribute to it. While the topic has long been considered hush-hush, in recent years, conversations about fertility struggles are becoming more normalized, with even celebrities opening up about their difficulties. Typically, you’d expect that when a celebrity publicly discusses issues related to infertility, they would be met with an outpouring of support. Not so for Paris Hilton, whose recent comments about her decision to undergo IVF are causing outrage.
On a recent episode of a podcast called The Trend Reporter With Mara, Hilton opened up about her decision to start a family, remarking that she and her boyfriend Carter Reum had decided to try IVF. She explained that her friend Kim Kardashian was the one who recommended IVF in the first place, saying that before Kardashian’s recommendation, “I didn’t even know anything about it.”
The CDC reports that 1 to 2 percent of all U.S. births annually happen via IVF, and according to WebMD, only about 5% of couples with infertility seek out IVF, so Hilton’s decision to speak publicly about her decision to undergo the process is significant. Although infertility is a fairly common struggle that couples go through, with about 1 in 8 couples having trouble getting pregnant or sustaining a pregnancy, the stigma of it persists, and women may be on the receiving end of the worst of that stigma. According to a 2019 survey conducted by Modern Fertility, about 1 in 5 women reported that they experienced discrimination or prejudice because of their infertility, which led to them feeling guilt and shame. In addition, 59% of the women who participated in the survey felt that women who are infertile are unfairly treated.
So while Hilton being open about her decision to undergo IVF is commendable and can help lessen the stigma for other women and couples going through the same process, her reasons for going that route are coming under fire. Hilton explains on the podcast, “We wanna have twins first, and then I don’t know, like either 3 or 4 children.” When host Mara Schiavocampo asks if she’s considered surrogacy, because it’s kind of hard to plan twins, Hilton reveals, “we have been doing the IVF so I can pick twins if I like.” Later on, when Schiavocampo asks Hilton what made her decide to undergo IVF, Hilton explains, “I think it’s just something that most women should do just to have, and then you can pick if you want boys or girls … I want to have twins that are a boy and a girl, so the only way to 100% get that is by making it happen that way.”
Hilton’s comments quickly earned backlash and were called “insensitive”. First, there’s the casual remark that every woman should just undergo IVF just to be able to have the option of it, which completely leaves out the fact that for many people, IVF is prohibitively expensive. The average IVF cycle can cost anywhere from $12,000 to $17,000 before medication and not including genetic testing, and it may or may not be covered by insurance. Furthermore, it usually requires more than one round. Most people are not Paris Hilton with net worths of $300 million, and doing IVF is a huge financial undertaking.
And that’s saying nothing of the intense emotional and physical side-effects. Felice Gersh, M.D., an award-winning OB/GYN and founder/director of the Integrative Medical Group of Irvine, in Irvine, CA and the author of PCOS SOS Fertility Fast Track, tells Betches that with IVF, there is a risk of “tubal pregnancy and hyperstimulation of ovaries leading to very enlarged ovaries and illness from too much estrogen produced.” This is on top of “all the issues of any pregnancy”, plus the risks of any procedures, such as infections and bleeding. Most common? The “risk of failure and disappointment and emotional toll is great,” she says.
There’s also the fact that having twins, even through IVF, is risky for both the mother and babies. According to the Fertility Institute, IVF multiple birth risks include the babies being born preterm (almost 60% of twins and 90% of triplets are delivered preterm), which can in turn result in low birth weight and increased risk of long-term issues such as cerebral palsy, vision loss, and hearing loss. There are also serious risks to the mother; complications such as gestational diabetes and preeclampsia are more common in twin pregnancies. (Kim Kardashian suffered from preeclampsia during her pregnancies, which is why she ultimately decided to use a surrogate after the birth of her second child). Twin pregnancy is also associated with greater life-threatening maternal complications. Also, age is one of the most common risk factors for high-risk pregnancies, with women over 35 being at greater risk. Hilton is 39. The point is, having twins through IVF at any age should not be taken lightly. Dr. Gersh emphasizes that undergoing IVF with the express purpose of having twins “should never be the goal, as multiple gestational increase risks to the mom and babies.”
And while Dr. Gersh says that “male and female factors for infertility are the usual reasons” for choosing IVF, couples sometimes go this route “to choose gender due to sex linked disease.” Gender selection can happen during IVF if parents choose to have their embryos screened for genetic abnormalities. During that process, the doctors can also look at the sex of the embryo, at which point, parents can choose the embryo. Chrissy Teigen did this when she was pregnant with her daughter Luna. She subsequently was criticized for choosing her child’s sex, forcing her to explain that it was only one part of the process, writing on Twitter, “I think I made a mistake in thinking people understood the process better than they do.” Dr. Gersh says that choosing the sex “would be a personal decision between all concerned” and “is not an issue in the vast majority of cases.”
That said, there are couples who specifically undergo IVF so they can choose the sex of their baby, a practice which is controversial, and Hilton’s comments seem to imply that she may fall into the latter camp.
Shannon M. Clark, MD, MMS, FACOG and creator of the Instagram accounts @babiesafter35, responded to Hilton’s comments in a number of IGTV videos. She asserts, “The idea of being able to ‘pick twins if I like’ is not only incorrect, it’s dangerous and it’s irresponsible to put out there as a choice that anyone could have—because it’s not a choice that anyone could have.” She adds, “IVF is not available to everyone, and twins are a high-risk pregnancy.”
That said, we do not know precisely Hilton’s reasons for undergoing IVF, and given that she is 39 years old, she may very well have been struggling with infertility. Gender selection may have been a plus side of, but not the entire reason for, undergoing IVF. Still, the way she expressed it was flippant, and that could potentially have adverse consequences (though I kind of doubt anyone is seriously looking to Paris Hilton for family planning advice). We may never know exactly why Hilton is undergoing IVF unless she tells us, and the backlash to these comments might make her less inclined to open up any further. Her comments were out-of-touch and IVF is not feasible for everyone (for a multitude of reasons), and just because Hilton did not seem to experience serious side-effects does not mean it is an easy process. That said, there is a way to correct and provide context for her statements without coming for her personally, and unless we are told otherwise, we should give her the benefit of the doubt in assuming that she made the best decision for herself and her family under the guidance of medical professionals.
Images: Andrea Raffin / Shutterstock.com;
Amy Schumer recently posted about her experience with IVF and freezing her eggs. Spoilers: it f*cking blows. I did the same process in November when I froze my eggs—when you freeze your eggs, you’re undergoing the same hormone injection process as IVF—and it was one of the hardest things I’ve ever had to go through (and that’s coming from a stage IV cancer patient). And it was only two weeks! There is such a stigma around women and anything to do with children already. If you have trouble conceiving, there’s something wrong with you. If you don’t want kids, you suck. If you can’t breastfeed, the way you raise your child, etc, etc, etc. Women are constantly getting sh*t on in the fertility department for absolutely everything. Maybe it’s because of this that women, especially famous women, just don’t talk about IVF very often. In fact, a bunch of celebrities now hide their pregnancies and children just to get some privacy away from all of society’s opinions, and I don’t even blame them.
But look. IVF or egg freezing is really, really hard. And it’s hard when you’re a nobody and it’s hard when you’re Amy Schumer. Which is why I was honestly really glad when Amy posted this super real photo:
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I’m a week into IVF and feeling really run down and emotional. If anyone went through it and if you have any advice or wouldn’t mind sharing your experience with me please do. My number is in my bio. We are freezing my eggs and figuring out what to do to give Gene a sibling. ❤️
That bruising on either side of her stomach are from the daily injections to get your ovaries bigger than grapefruits (SERIOUSLY) to release a ton of eggs at once. Amy wrote that she’s “feeling really run down and emotional” and is only a week into her injections. Girl, been there.
For the record, the injections are insanely brutal. I ended up with three daily injections that I couldn’t do myself, so I went to the clinic every single day. At first, it’s like, “Yeah it sucks getting shots every day”, but then you go about your business and it’s NBD. But then things change—and quickly. By day three, you’re starting to bloat, you’re super emotional, and your sensitivity increases. And then it just landslides. What’s worse than getting three injections a day, you ask? Doing it when your skin feels raw and every needle feels like a white-hot electric nerve. You’re also getting an invasive ultrasound with what feels like a f*cking dildo and blood work almost every day. And even better? One of the injections burns like the fire of a thousand suns straight into your soul. F*CK Menopur, guys.
I looked four months pregnant, I was so sick I couldn’t get off the couch, I could barely eat, and everything in my whole body hurt. The hormones also make you feel insane. It feels like torture, and then you just go back every day for more. By Day 10, I was too fainty and lightheaded and sick to drive, so I had a friend take me every day. My veins receded from all the blood draws. On day 11, they did the ultrasound and barely touched my giant grapefruit ovary, and I still started sobbing hysterically because it hurt so bad (I was that sensitive). On day 12, I told the doctor that I was going to kill myself or her or both of us if she didn’t trigger me (an injection that releases your eggs so that they can harvest them) that day. Day 13, a celebrity I love (that I’m not going to out for being at the fertility office) saw me essentially throwing a tantrum like a toddler before my injections, but thank GOD that was my last day.
And the worst part? No one warns you about this part of it. Probably because they don’t want to scare you. It’s similar with my cancer treatment. The oncologist told me that the meds work and I won’t be that sick from chemo. Has she ever done it? No? Then you don’t get to say that. (And btw, I’m totally sick from chemo and they can’t give me any more meds, hi.)
Bottom line, it’s important that we talk about this and that women who go through this process understand that it sucks for all of us and you’re not alone. That’s why it’s really cool and important to see someone like Amy Schumer be so vulnerable and admit how hard it is. It really did break me, even though the process takes a relatively short amount of time. I also learned that it’s a really good thing I’m just a writer and not like, someone with government secrets, because I assure you, I would crack immediately at the slightest discomfort.
More celebrities being honest and upfront about the difficulties women go through when trying to conceive helps all of us feel less alone. Being a woman is really hard and can suck in a lot of ways, but it’s comforting in a weird way to know that even the rich and famous have these same issues.
Good luck with your egg harvest, Amy! And once again, F*CK Menopur.
Images: DFree / Shutterstock.com; amyschumer / Instagram
When we were in college (or high school, I don’t know your life), getting your period after a month of fooling around was the equivalent of Christmas morning. There was no better feeling than knowing you wouldn’t have to be a teen mom (without the reality show to boost you into Instagram stardom) and wouldn’t have to take care of a tiny creature that needs you all the time. Funny enough, now that some of us may be actually TRYING to get pregnant, it seems like the whole thing is, well, kind of not that easy. I wish we’d all known that back when we were ripping our hair out praying for our periods to come so that Frank the Tank from TKE wasn’t about to be the father of our unborn child.
Why is it that despite years of being careful with pills, Plan B, condoms, and the whole pharmacy aisle of family planning products for years, some people find themselves having a really tough time actually getting pregnant now that they WANT to have a kid? Here are some facts you might not know about getting pregnant.
1. It Can Take Up To A Year
Shockingly, a lot of couples trying to get pregnant won’t succeed on try number one. Although I myself am a freak of nature and this rule doesn’t apply to me (Betch Baby—out December 2019), according to WebMD and Dr. Robert Stillman, medical director of Shady Grove Fertility Centers in the Washington, D.C., area, about 85% of couples take one year to put a bun in the oven. “The average time it takes to conceive, for instance, is about six months, and women under 35 should wait until they’ve tried for a year before they consider calling their doctor or a fertility specialist with concerns.” So if you’re good with the idea of getting pregnant, don’t bank on getting it done in the first try. Give yourself six months to a year of tracking and trying before you start freaking out, k? There’s nothing wrong with you.
2. There Are No Tricks
Even though your mom may have sworn by being strapped upside down in moon boots (did we all throw up together), there are no “tricks” to getting pregnant. You know what will get you pregnant? Sperm fertilizing your egg. Boom. Magic. WebMD says, “There’s still only one way to get pregnant—by a sperm fertilizing the woman’s egg, which can happen for only about 12 to 24 hours after ovulation—approximately 14 days before the end of a woman’s monthly cycle. Ovulation sometimes can be harder to predict if a woman’s cycles are irregular. And for women who are getting older, monthly cycles first get shorter, then longer the closer they get to menopause.”
So, the big takeaway here is that even if your neighbor swore by mud masks and hypnosis, your bestie claims she was able to get pregnant because she only has sex in the morning on Wednesdays, and your mom tells you to invest in a water bed, the only thing that’ll get you pregnant is the right sperm at the right time.
3. Being Healthy Counts
Being overweight, underweight, or having little to no exercise routine (or healthy eating habits) can all affect how easy or hard it is for you to get pregnant. Today’s Parent says that being over or under weight (and anywhere above a 25% BMI) can greatly affect your chances of getting pregnant. For example, if you’re way under where you should be, weight-wise, your body may not be ovulating properly (which may explain why your periods are so irregular). On the flip side, if you’re overweight, that can affect your hormones balance, which can reduce fertility. And, while you may think that fertility treatments can help, they can actually be less effective for obese individuals. So, before you even jump into getting pregnant, make sure you’re healthy, kids.
4. We’re All Waiting Longer To Have Kids
…And that isn’t a bad thing! Having kids after age 30 means you’re out of your wild 20s stage and are (probably) somewhat more responsible. However, waiting longer means that you won’t have as easy of a time actually getting pregnant compared to your 19-year-old Mormon neighbor who seems to pop out a kid every other month.
According to The Bump, “a woman’s fertility starts to decline gradually at age 27 and then it drops dramatically after age 35. And while there are fertility treatments that can help couples conceive, they’re less likely to work if the patient is older.” So, yeah, you may see that a celebrity got pregnant at 48 or whatever, but don’t think that the rules didn’t apply to them or that they didn’t seek outside treatment or help in conceiving. We’re at our top fertility between 25-30, so once you pass that, your chances of getting pregnant start dropping each year. That isn’t to freak you out, it’s just to keep in mind if you’ve been dating the same guy for seven years and you’re about to hit 31 and he STILL won’t even talk about whether or not he wants kids.
5. Stress Is Sabotaging You
Not shockingly, the more you try and the more you don’t get pregnant, the more you’re likely to be stressed out and start feeling majorly negative vibes. You may ask yourself, “what’s wrong with me?” and feel like literally everyone around is getting pregnant in a snap while you’re a year in with no baby. A lot of fertility doctors are now recommending acupuncture, yoga, and meditation for women trying to get pregnant, since a crazy-high stress level is totally linked to an inability to conceive. “‘Some people truly have medical issues keeping them from getting pregnant,'” says Shahin Ghadir, MD, a reproductive endocrinologist and founding partner of Southern California Reproductive Center for The Bump. “‘But for others, when they relax and feel confident that they’re in good hands , things change. You can’t prove it, but I’ve seen miracles happen when people’s stress levels change.'” So do that meditation class. Go out for a walk. Book a 90-minute massage. Relaxing and trusting that you’re doing everything you need to do and taking care of yourself can work wonders.
6. Your Cycle Is Complicated
You may have thought you had a really good handle on how long your cycle is, when you ovulate, and what days you’re most fertile but, you could be wrong. Everyone seems to think that their specific cycle is 28 to 32 days long, right? Sorta. That can vary big time according to your personal genetic makeup. On top of that, most women think their ovulation date—the time they’re most fertile and likely to conceive—is exactly two weeks before the start of their period. Again, that can vary according to your cycle, which a new study helped shed some major light on.
According to Today’s Parent, the best way to tell when you’re ACTUALLY ovulating is to buy an ovulation monitoring device and check exactly when you’re at peak performance. On top of that, don’t freak out if you can’t or didn’t bone on your ovulation day. Sperm can live in your cervix for three days (I am SO DISGUSTED BY THIS), so even if you do the dirty on or around your ovulation day (especially before) you have a good chance of getting pregnant. Lastly, although your actual cycle can make you more lubed up down there or run dry depending on the month, try not to use lubricants. They can actually work against you and prevent you getting pregnant.
Images: Luma Pimentel, Unsplash; Giphy (6)
There I was, legs elevated in metal stirrups, counting backward from ten, losing consciousness by the second. Why? For $7K… duh.
There’s not much I won’t consider doing for money. As a kid, I worked a lemonade stand, sold snacks at yard sales, and scammed grown-ups with bets like $20 for throwing an inflated football through a tire. I’ve had an array of jobs since I was 16 and almost never just one at a time. I was even offered $200 in high school to take a guy’s virginity. I didn’t, but does that matter?
Donating your eggs is not easy money, but that is the illusion.
Just the lengthy application alone can weed out the weary. Then you have to get over the fear of stabbing yourself with needles, followed by the realization that you might release children into the world. It’s enough to make anyone think twice.
Obviously, money is a primary motivator when it comes to a procedure like this. A study published in the U.S. National Library of Medicine notes that 81% of egg donors “indicated that the offer of payment was significant to their decision.” Yet, I found that the end result was way more rewarding than the cash, and that’s why I donated my eggs not once, but twice. The money is long gone. After Uncle Sam reached between my legs for a quarter of it, I used the rest to leave a job I hated, pay off debt, and buy myself some boobs. But when I look back on my donation process, it’s not the money I remember.
First, it’s important to clear up a common misconception: Donating doesn’t affect your egg count. According to the Cleveland Clinic, women are born with approximately one million eggs. Even prior to puberty, these eggs die each month. So the eggs you donate would naturally die in your next menstrual cycle.
Thrust into living alone after my boyfriend broke up with me unexpectedly, my credit card became a crutch. I couldn’t get through the week without dipping into unpromised money. A friend of mine introduced me to Shady Grove Fertility, an organization dedicated to infertility treatments. She had considered donating her eggs but was daunted by the application process due to her family medical history. Less than 40% of applicants pass the initial screening, a statistic specific to SGF provided to me upon completion. I answered the preliminary application, which consisted of a few essential questions used to easily disqualify any red flags—one of which I held. I had traveled to the Caribbean with my ex (eye roll) just five months prior and ZIKA was a major concern. I was asked to apply again in another month, since six months was the threshold for exposure.
After re-applying, I was accepted and provided a link for the comprehensive application. Holy Moly. Now, I’m a writer and fully enjoy talking about myself, but this was on another level. I provided personal statements and short essays about everything down to my musical ability and every detail about my family including the color of my dead paternal grandfather’s eyes. The application actually serves as a profile for a donor when they are being selected by hopeful recipients. I uploaded pictures of myself as a child and an adult—the latter is not required but increases the probability and rate of being chosen.
I was then invited to begin the medical screening portion. Based on when I had started my most recent pack of birth control, an ultrasound and bloodwork appointment were scheduled. They also performed genetic screening which tested for 105 conditions. At this point, it had been about three months since I first reached out. I received $150 through an application promotion and $50 for approved lab work.
*calls produce manager of whole foods* hi yes i’m interested in donating my eggs
— you thoughtttttttttttttttttttttttt (@youonebigyike) September 1, 2019
I took a brief online course that provided an overview of the procedure and then was scheduled for “Donor Day,” which requires a day off from work when current donors meet at the office with a nurse for in-person training and screening. After screening, we took a 150 question multiple choice personality test, learned about the procedure, ate pizza, and practiced our first injection. We practiced mixing solution, dialing the pen to the correct dosage, and finally pinching some stomach fat and stabbing ourselves. I bled, which never happened again, but I had my first “what have I done?” moment. The day earned me $450.
Then, I signed consent forms and met with a social worker. Basically, it was a therapy session to ensure my sanity and comfort with the process, especially the fact that this would likely result in real live children running around with my DNA. I was and am completely comfortable with this fact. Once cleared, my profile went live for recipients to view. I was selected within a week. They switched my birth control in order to sync with my recipient’s and I received fertility medication to my home.
No more drinking, sex, drugs, tattoos, piercings, smoking, etc. Over the next two weeks, I injected hormones into my stomach at the same time each night and went into the office for bloodwork and an ultrasound about three times a week. The one shot, which I administered through an insulin pen, didn’t bother me. But the second shot, which required mixing a powder and liquid, burned as I pressed the plunger releasing the solution under my skin. You get used to it, but I always dreaded the second shot. The medication grows the egg follicles, and the ultrasound measures that growth process. With a lubed-up wand between my legs, I watched my uterus morph into a crop field on a blurry screen, and it was fascinating. My monitoring visits increased with my follicle size. Eventually, I added a third shot to my daily routine. The nurses followed my progress and emailed me with specific dosing instructions as they changed.
All of the coordinators, nurses, and doctors I worked with throughout the process were incredibly helpful. They answered my questions, wrote me a note to freeze my gym membership, and even worked around the travel required for my job, scheduling me at locations that were convenient to my home, office, and wherever I was traveling. And yes, I did this while working for an event production company (one of my bosses had actually used a donor herself). I brought my medication in a cooler and took strategic breaks so that I could shuttle to an offsite condo where I’d disappear into the bathroom with my needles.
I actually relished the time that preceded the retrieval procedure. My body felt productive, like a factory. I was preparing for this really important gift while still working full time and living my life. Around three days out, I could actually feel my ovaries sloshing beneath my pelvis. The hormones swell each ovary from the size of a ping-pong ball to that of an orange.
After about two weeks, monitoring took place every day and they watched my progress closely to determine the exact date and time of retrieval. My mom was on standby to come stay and drive me to and from surgery. Once a date was defined (about two days out) I was instructed to take my trigger shot at a very specific time two nights before retrieval. I also took an antibiotic the night before with no food or water following.
My mom and I woke at 4am and drove to the surgery center 45 minutes away. I started to cramp. The building was immaculate. I felt very safe and comfortable. The staff was warm and attentive and kept thanking me for my “gift”. They also handed me a check for $6,500.
I dressed in some fabulous surgery attire (booties, gown, hair net) and received an IV. The cramping started to increase minutes away from surgery. I received anesthesia through my IV. Aside from having my wisdom teeth extracted, this was my first surgery. I walked with my IV tree and a nurse to the procedure room. I laid on a table and lifted my legs into metal stirrups. For the first time, I suddenly felt incredibly exposed. The anesthesiologist placed a gas mask over my nose and mouth and before I knew it, I was asleep. While I was out, a long needle-like vacuum was inserted into my vagina and pierced the vaginal wall on each side to essentially suck out the eggs from each of my ovaries. They retrieved 13 mature eggs. The actual retrieval only took about 20 minutes.
The drive back to Baltimore was rough. I wanted to sleep, but the bumpy roads aggravated the cramping. Plus, my ovaries were still enlarged. I slept when I got home and watched Fixer Upper for the rest of the day. The doctor gave me a prescription for pain that I ended up not needing. By that night, I felt back to normal. I stayed home from work the next day because why not, ya know? I returned for a follow-up visit about a week later and I was on my way! I had sex the following weekend even though I shouldn’t have. But I missed alcohol and d*ck. TG for Plan B.
SGF reached out to me about three months later encouraging me to donate again. Although hesitant at first, I excitedly agreed. Since I was already vetted, the process proceeded much quicker—only about two months. They completed an initial screening before reactivating my donor profile. Unlike the first time, my profile was selected by three families instead of just one and my retrieval was split amongst them.
Things went even smoother the second time around. And not just because I knew the ropes, but because my body did too. I hardly experienced any cramping before and after surgery. They retrieved 22 mature eggs the second time and I received a total of $7,500.
I haven’t donated a third time (worth $8k) for a few reasons. Honestly, I’m nervous to jinx myself. The last thing I want is for something to hinder my ability to have my own children in the future. Another reason, which I only thought of more recently, is that I plan to stay in the Baltimore area as I have my own kids. This sounds like the plot to a titillating beach read, but my future kids could very well meet and date my donor children. One reason women aren’t allowed to donate more than six times with one organization is for this very reason.
Moral of the story: egg donation is incredibly involved, but it’s an extraordinary way to help a fellow human. If you made it to the end of this whirlwind article and are still interested in donating, do as much research as you can, especially as it pertains to the options in your area. Really consider the possibility of a child seeking you out in the future. Although the information is private, we all see the leaps and bounds DNA technology have already made. If you have more questions about my experience, feel free to DM me. Although I don’t plan to continue donating, I’d love to facilitate that opportunity for others.
Images: Kara Kinnamon (2); Nikola Radojcic / Unsplash; SGFertility, youonebigyike / Twitter
There are a few facts in this life that we can count on. Men lie. People who say “I’ll pay you back” will never pay you back. Your period will arrive like clockwork every 28 or so days. And before you come at me for that first assertion being untrue, I have enough text message receipts to fill the Old Testament to prove it. The bigger issue is that a new study led by UCL and Natural Cycles, a contraceptive app, found that a basic assumption we take for granted about menstrual cycles is not actually a given. And by that I mean, this “rule” that your period comes every 28 days? You know, the premise that a lot of hormonal birth control packs are based off of? Yeah, it doesn’t even apply to a vast majority of women. Cool cool cool cool cool. Good thing we don’t base a whole slew of other science on this premis—oh wait.
The study, published in Nature Digital Medicine earlier this week, examined over 600,000 menstrual cycles of 124,648 women who used the Natural Cycles app. These women were from the United States, Sweden, and the UK. Researchers set out to look at how menstrual cycles were influenced by factors like age, BMI, and body temperature, in order to try to understand when women are more or less likely to get pregnant. Now, to be clear, the sample size of this study is not a complete accurate representation of the general population. For one, the sample only consists of app users. For another, only 8% of the app users in the study are obese while 15% of women in the general population are obese. Finally, the study excluded those with a pre-existing condition that would impact fertility, like PCOS, hypothyroidism, or endometriosis, as well as women who were experiencing menopausal symptoms. This makes sense considering the study was specifically concerned with pregnancy, but it does mean its findings are not applicable to everyone.
i can always tell when i’m going to start my period by how close i get to cutting my own bangs at 3am
— gabbie hanna (@GabbieHanna) November 6, 2017
Now that we’ve gotten all the disclaimers out of the way (shouts-out to the AP Psych class I took senior year of high school), let’s get into what the study found, because it’s actually very interesting. Researchers collected data from women ages 18 to 45, with BMIs between 15 and 50, who were using Natural Cycles from September 2016 to February 19. The women had not been using hormonal birth control within 12 months from registering for the app. So, remember how I said that it’s basically taken as gospel that menstrual cycles last 28 days? Yeah. Guess how many of the cycles actually lasted that long.
Just 13%. Thirteen percent of women in the study had 28-day menstrual cycles, and yet that timeframe is the basis for a lot of birth control methods and, equally importantly, fertility windows. If you literally Google “when does ovulation occur”, the top answer will tell you that ovulation typically occurs about 14 days before your period starts, if your average menstrual cycle is 28 days. The problem with this model is that, according to this study, very few women do have a 28-day cycle, and in fact, researchers actually found the average cycle lasts 29.3 days. And, furthermore, 65% of women had cycles that lasted between 25-30 days—but that means 35% of people (or over a third) do not. That is a good chunk of people who do not even fall into this window that we take for granted as “standard”.
I love period dramas, I have one every month
— Karen Chee (@karencheee) August 11, 2019
So why does this matter? Researchers’ big takeaway was that this has significant implications for people trying to get pregnant. As Professor Joyce Harper, one of the researchers of the study, put it: “ovulation does not occur consistently on day 14 and therefore it is important that women who wish to plan a pregnancy are having intercourse on their fertile days.” More specifically, these results are important for people who are trying to conceive and are using apps or cycle dates to predict fertility days. “An individualized approach to identify the fertile window should be adopted,” said Dr. Simon Rowland, Head of Medical Affairs at Natural Cycles. “Apps giving predictions of fertile days based solely on cycle dates could completely miss the fertile window and it is therefore unsurprising that several studies have shown that calendar apps are not accurate in identifying the fertile window.” Harper added, “In order to identify the fertile period it is important to track other measures such as basal body temperature as cycle dates alone are not informative.”
On the surface, it’s not a particularly shocking conclusion that all reproductive systems are not identical, or that in general, biological functions and processes are complex and unique to the individual and cannot be generalized to a neat window or category that fits every single person. But then again, this is done all the time—whether we are talking about menstrual cycle lengths, body mass index, diets, or anything else. Am I surprised we are only now just being confronted with data that confronts the standard 28-day menstrual cycle, given that understanding of the female anatomy seems to be so low on the priority list that the clitoris was not even fully discovered until 1998? No, I am not surprised. But this study is giving me, and the researchers, hope that more studies will be done on the menstrual cycle, particularly, clinical trials done in controlled settings. “These initial results only scratch the surface of what can be achieved,” said Professor Harper. “We hope to stimulate greater interest in this field of research for the benefit of public health.” She added that with increased interest in and dedication to doing empirical studies, “there is enormous potential to uncover new scientific discoveries.”
Images: karencheee, GabbieHanna / Twitter
At 26, I’m the youngest of seven grandchildren on my dad’s side and the oldest of five on my mom’s. I’m also an only child. Besides a 22-year-old cousin, I am the only grandchild on either side to not be married or have kids. Even my cousin’s kid is engaged. Every trip home, my grandma asks when I’m going to bring home a nice man, when am I going to make my parents grandparents. And I finally have an answer.
I’ve decided that if I’m still single in roughly five years, I will proceed with steps to create a family on my own. I’ll be 31 and most likely on the cusp of decreased fertility. It’ll be like Jennifer Aniston in The Switch, minus all the theatrics. The concept of purposely having a child on my own is not a revolutionary one—according to Dr. David Harari, an OB-GYN and president and chief medical officer at the Reproductive Science Medical Center in California, parents on the Donor Sibling Registry are 50% single women—but it’s still one that catches raised eyebrows and dismissive comments. Or, I should say, cliches.
“Please, you’re so young.”
“You’ll meet someone when you least expect it.”
What if I don’t? Or, what if I don’t care to?
Ultimately, I’d rather have a child than a partner. The pros outweigh the cons.
If someone comes along, great! If not, it won’t deter me from having the life I want. I’ve created opportunity in every other area of my life, so why stop here? I can date until I die. But by design, having a child, especially without complications, comes with a time frame. Women are born with 1-2 million eggs, and by the time they hit 37, that number has plummeted to 25,000 eggs. That’s not to say it’s impossible, but it is way less opportunities to get pregnant. And, according to Dr. Harari, the loss of fecundity, or the ability to get pregnant, begins as early as 32 and decreases more quickly after age 37. When many guys, especially in big cities, don’t even think about becoming exclusive with one person until their mid-30s, that doesn’t leave me with a lot of time.
My mom: I want grandchildren
Me: well do you want to give me $20,000 to freeze my eggs?
My mom: well-
Me: and then would it be OK if I spent it on something other than egg freezing?
— Ginny Hogan (@ginnyhogan_) June 1, 2019
When my boyfriend of over six years ended our relationship out of nowhere, I woke up. I was 23. I had invested the majority of my energy into “us”, and in one night, all that vanished. I couldn’t help but think he had wasted my “best” years. Just that thought alone proves the pressure society places on young women. I realized that, if I waited until I found a husband or partner, my romantic life and the hopes of having a family would always be completely out of my control, dependent on someone else deciding I was worthy and not changing their mind.
And it’s not just me who feels that way. Dr. Harari remarks, “More women in their 30’s are recognizing that they want to control and drive their family creation goals proactively.” I wonder why.
Soon after my revelation, I told a pair of girlfriends over four-dollar sangria one night. Though my future is of course my prerogative, it was important to gauge their reaction. I was prepared for backlash or an eye roll, but they loved it. Ironically, my friend had a similar yet reverse dilemma. Should she break up with her boyfriend who she loved very much because he didn’t want kids? She’s 27. We ordered another round.
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A few years ago, I went through the process of donating my eggs (if only they let me freeze some while I was already under, but that’s another article). I was pressed for cash after my living situation suddenly changed because of my breakup, and I loved the idea of helping someone in such an intimate, personal way. The process was an education in fertility and family planning. I was exposed to the lengths people were going in order to become a parent or parents. And it brought my own fate even further into focus. I’m far from alone in this: In one study looking at Assessing Reproductive Choices of Women, the authors found that those women who knew optimal age for successful egg freezing was 20-29 were more likely to freeze their eggs.
At this point, I’m still a few years away from 30. This is a protection plan. A mindset, really. By establishing a timeline and telling friends, I am not only setting up expectations (and getting people off my back), but also affirming the plan to myself. An ironic Plan B. And the longer I sit with it, the more comfortable I am. Empowered. When the time comes, I can either freeze my eggs, or move forward with a sperm donor. And if unexpected difficulties arise, I’ll adopt. I don’t want to make this decision as the last beads of sand fall from the hourglass. For now, I can focus on my career and the present without frantically searching for a baby daddy. I don’t feel the pressure to date like it’s an Olympic sport. With this plan tucked in my purse, alongside my birth control, I’m one step closer to the future I want.
Images: ginnyhogan / Twitter; uuppod / Instagram
Let’s face it. Infertility is just one of those things in life that sneaks up on you, and you may not know until you’re trying to get pregnant. Once you realize you’re part of more than 6 million women whom it affects, it can feel completely overwhelming. The great thing is we live in an era of the best possible fertility treatments available. Family balancing, economic factors, and delay in childbearing have all lead to the increased demand in assisted reproductive technologies, but how much do you really know about them? For starters, more than 7 million women have utilized infertility services. Since information about fertility treatments isn’t typically discussed outside of the doctor’s office, let’s set the record straight on some common misconceptions about fertility.
1. You Don’t Need To Worry About Fertility Until You’re Ready To Get Pregnant
Just because your biological clock isn’t ticking yet doesn’t mean you shouldn’t consider where your fertility stands. Approximately 12% of women in the US have impaired fertility. After you turn 30 (!!!) your egg quality decreases, so it’s better to start fertility treatment with the best quality eggs—meaning when you still have a good selection available. If you’re thinking about becoming pregnant in the future, but your biological clock isn’t ticking quite loudly enough yet, freezing your eggs is a helpful option to “stop the clock,” so to speak.
This option isn’t just for those between the ages of 35 and 40. If you’re younger but focused on your career, traveling, or something other than starting a family, having the option to potentially conceive later can give you some peace of mind.
And when you are finally ready, be sure to visit a fertility doctor for an assessment. In addition to conducting an initial assessment of your ovarian reserve, they can teach you how to get your best chance of properly conceiving.
2. You’re Too Young (Or Old) To Consider Fertility Treatments
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Tired Hollywood movie plots tend to make it appear as though infertility will only hit once you turn 35, but that’s not the case. A woman is actually defined as facing infertility if she is not able to get pregnant after one year of well-timed intercourse (if you’re under 35) and 6 months of well-timed intercourse (if you’re over 35). If you’re under 35 and can get pregnant but have experienced multiple miscarriages, this is also considered to be a cause of infertility.
If you’re younger, your odds are higher that you’ll be successful with fertility treatments. If you’re over the age of 35, your chances of getting pregnant decreases, but a fertility doctor can work with you to see what your best options are for fertility treatments.
3. You’re Guaranteed To Conceive If You Use In Vitro Fertilization (IVF)
While using IVF doesn’t come with any guarantee you’ll become pregnant, it does increase your chances of conceiving, especially if you’ve been trying. Ultimately, your success rate is determined by your age.
If you’re 35 or younger, a single IVF treatment can increase your odds of conceiving to 50-60 percent. The use of next-generation sequencing in the screening of embryos for transfer has also led to shorter duration of time to successful pregnancies. For context, your chances of conceiving naturally during any cycle is less than 25 percent. And if you’re dealing with infertility, you may have less than a 5 percent chance of becoming pregnant. Generally speaking, about two-thirds of women treated for infertility end up having successful pregnancies.
4. You’ll Have Twins Or Triplets If You Use Fertility Treatments
No, you probably won’t end up as an Octomom. Though your chances of getting pregnant with more than one child increases with fertility treatments, not everyone experiences this. All in all, your risk of developing twins is less than 2 percent, and there are ways to control it—like choosing to have just one embryo transferred during IVF. Intrauterine insemination (IUI) can also inform how high your risk is of having multiples, since it allows your fertility doctor to predict the number of mature eggs that your body will ovulate.
5. IVF Is The Only Option
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IVF is actually not the first choice when it comes to fertility treatment. If you can conceive naturally, that’s your best bet, but if you’re facing fertility issues and you’re younger than 38, your fertility doctor will go the IUI route (usually a minimum of 3 cycles). You’ll have lower chances of conceiving with an IUI cycle compared to IVF, but it is less invasive and most young women who have fertility issues do end up becoming pregnant with this treatment. If you don’t conceive within three cycles, your fertility doctor will typically recommend trying IVF as the next option.
By no means is this list exhaustive of the questions you may have about infertility. Even if there’s a chance you may want children later in life, ask your fertility doctor so you can have all your information straight from the source. They can help you make a decision about whether it will be maybe-baby in the future and create an action plan to get there.
Dr. Ho is a board-certified OB/GYN and board-certified in Reproductive Endocrinology and Infertility. Dr. Ho has over 30 years of experience and is very proficient in treating patients of all backgrounds but specializes in treating patients of Asian descent. He has assisted elite clientele, including authoritative government officials and high-end celebrities in Vietnam.
Images: Dr. Ho; scary mommy (2) / Instagram