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“Trauma will age you more than time ever could.”
I recently came across this quote, which couldn’t more accurately describe the emotions behind an unexpected Diminished Ovarian Reserve (DOR) diagnosis and subsequent three failed in vitro fertilization (IVF) cycles.
The irony of it is that I have spent much of my adult life training to become a trauma surgeon, someone who combats trauma on a daily basis. In these traumatic situations, patients not only have life-threatening injuries, but also intense emotional distress in the aftermath of these world-shattering events. After these experiences, I’ve heard many patients say “I feel as if I aged overnight.” Though I could empathize with this emotion I never truly understood the depth of this statement until recently.
Over the course of the last fifteen years, there was always a goal, a destination. First complete college, then go to medical school, match into a surgical residency, and then into a trauma/critical care fellowship. Then finally there would be a light at the end of a very long tunnel. When I ultimately reached my goal and looked back, I had two thoughts. The first that those had quite easily been the toughest years of my life, but I had survived. The second, though it had been fifteen years, I didn’t feel much older than when I had started the journey. Little did I know that in a matter of months, both those statements would be rendered false.
I was diagnosed with DOR after my husband and I had been attempting to conceive for six months. Similar to most women, I initially made the appointment never imagining that something was wrong, but the ultrasound showed an antral follicle count (AFC) that was much lower than expected for my age. They drew my blood work, and then the first of many waiting periods began. A week later, it was official, my AMH was dismally low, my egg reserve sparse, a natural conception unlikely, and our entire world turned upside down. At that moment, I felt as if I had aged overnight.
When we experience traumatic events whether it be physical or emotional our bodies undergo a protective physiologic and psychological response. The fight or flight phenomenon dates back to ancient times when people had to defend themselves when faced with danger in their environment. We feel our heart rate quickening, our breathing becoming more rapid, our blood pressure rising, and our skin flushing. It’s a biological survival mechanism where our bodies are preparing to either fight or flee from a situation. As most couples do in this situation, we chose to fight.
We started our preparation for IVF cycle one, fully knowing it would not be our last. Despite my diagnosis, we were hopeful that these hormones were our ticket to starting a family. I took the shots religiously, was never late to an appointment, continued to work, and take twenty-four calls, all while keeping our diagnosis a secret from everyone, except those closest to us. Before each ultrasound, I would feel my heart rate increase, my palms becoming sweaty, my head pounding—this emotional rollercoaster was all too real.
As this was happening in the middle of a pandemic, my husband could not come to my ultrasound appointments. I distinctly remember walking back alone, wondering how this could be happening to us, on the verge of a panic attack, scrambling to call my husband. It got so bad that he would drive thirty minutes, just to sit outside the clinic to walk with me back to my office. Even with the hormones, my body was not responding. We retrieved one egg from our first cycle. I remember fighting back tears when the embryologist told me; I knew this was going to be a game of odds.
The next morning, we received the news that our one egg had fertilized, and we could temporarily breathe again. Maybe, just maybe this would be our golden egg turned embryo. I was sitting in my office at work when I received the call from my doctor five days later. Our embryo’s growth had arrested. It didn’t get easier after this. In fact, the uphill climb was even more painfully evident. We knew to keep our expectations low as we continued forward, but the flashbacks from the failed first cycle, the anxiety of waiting for the phone call to find out whether our egg had fertilized, and the sleep deprivation from the stress were almost unbearable.
Unfortunately, our next two cycles ended similarly to the first, one egg apiece, but this time neither fertilized. I felt as if the culmination of those three cycles shattered me, and what I already knew started to become clearer. IVF was in no way a guarantee, it was merely a CHANCE at having a child. I began to reflect on how the patients I treat every day must feel after their trauma. Though this was a different type of suffering, the slew of emotions in the aftermath was similar.
I felt ashamed, ashamed that the body I had taken care of for thirty-three years was failing me. I was furious that no one had ever told me that one in four female physicians carries an infertility diagnosis. If only I had known during residency, I would have frozen my eggs. I was in disbelief that focusing on my career in my twenties could have potentially cost me biological children. I felt an immense amount of guilt because I have an incredible husband to whom this was happening as well. I felt defeated, knowing that after three cycles and tens of thousands of dollars, we had nothing to show for it. I felt traumatized and broken, crying every day to and from work. These emotions were something I had to feel and cope with, and through this, I realized that sometimes, without reason life will be unfair.
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There is no magic answer as to why things like this happen, all we can do is keep moving forward. What we didn’t learn about this process until we were in the thick of it was how little control we had. I have zero control over what my ultrasounds are going to show, or how many eggs I will retrieve, how many embryos we will produce, or what the outcome will be. I have no control over people asking me when I am going to have children, or why I am not pregnant yet, or if we are having fertility problems. The only control we have is choosing where on my abdomen to inject the hormones, and even that is limited.
This is a very difficult realization for someone who is a Type A control freak. However, as with everything on this journey, we have had to learn to adapt to every roadblock and hurdle in our way, and this is no different. I have gone back to the basics, to the place where I am the most comfortable, the trauma bay. When a patient rolls in, the first three things we do are assess their ABCs, their airway, breathing, and circulation. We ask our patients to speak so we know that their voice and airway are patent, we listen to their breath sounds to ensure they are moving air through their body, and we feel for their pulses to make sure their blood is circulating.
In the moments where I feel myself spiraling, I revert to the hallmarks of my training. I use my voice to calm myself down and to ask the questions that need to be asked. I make sure that I am not holding my breath, taking a moment to breathe deeply. Finally, I take my own pulse so that when it is racing I can try to calm myself down.
“Even now as broken as you may feel, you are still strong. There’s something to be said for how you hold yourself together and keep moving, even though you feel like shattering. Don’t stop. This is your healing. It doesn’t have to be pretty or graceful. You just have to keep going.” – Maxwell Dawuch
So where do we go from here? Well first, I put my pineapple scrub cap on, and then we continue down the path of resilience. We keep moving forward, we fight, we hope, we pray, and most importantly, we do not give up. This road is not easy, it is unfair, it can be cruel and lonely. However, it has taught us that we can do hard things, we can climb this mountain, we do have the strength to overcome this, and though we have experienced failure we have also found the courage to continue. As we move forward with our IVF cycles, we are fully aware that we are sitting on a rollercoaster that will be full of hills, twists, and turns. All I can control are those three letters that will continue to keep me grounded. ABC, go…
Rathna Shenoy Moretti is a Trauma/Critical Care/Acute Care Surgeon who lives in Ohio with her husband Chris and their two dogs. She was diagnosed with Diminished Ovarian Reserve last year and has been undergoing fertility treatments. She loves spending time with her husband and pups, riding her Peloton, and watching re-runs of the Office. You can follow her Instagram @rathnamoretti.