Primary Ovarian Insufficiency

“When I first experienced difficulty achieving pregnancy I assumed it must be stress related to my grueling work hours of residency. After all, I had no trouble getting pregnant with my first child. Why would I have trouble with my second? I was young (26), thin, healthy. I had no risk factors for infertility. My husband was similarly young, thin and healthy. The word infertility- the diagnosis infertility- was not within the bubble of my ideal reality at the time.

Going through the motions, I felt numb. I went for the tests. I kept my identity as an OBGYN resident a secret. When the REI physician came in to perform my hysterosalpingogram (HSG), he gave me a puzzled look. I knew he was searching his mind for that connection. I had introduced myself to him just a few weeks prior. I was the OBGYN resident who assisted in the delivery of his granddaughter. I had wished him a warm congratulations. I would be the resident who would join him side by side on the reproductive endocrinology rotation in just a few months time. But I kept that a secret. I remained just 'another patient.'

I want to scream: I suffer from premature ovarian insufficiency! I need to attempt IVF to have another child and there is no guarantee. My first cycle was NOT a success. I underwent a second, I got pregnant, I miscarried it at 9 weeks in my office- all while caring for my pregnant patients!

I feel I have entered a "club of sorts." A silent community of women who have endured IVF or or terrible losses in the process of creating a family. The women who put on a fake smile or who laugh in agreement when a conversation about family planning comes up. The women who when asked, "So when is the next one coming?" and pretend like life is just "too busy" to have another one right now. The women who state that the large gap between their children "was absolutely intentional," when secretly, all they want is two children close in age so they could be best friends.

I am that woman. I am part of that secret club. The one whose members harbor deep scars that no one knows or sees.

I initially entered that club as an outside observer. A physician who was keeper of those deep secrets. 3 years ago I entered as an anonymous subscriber. This dual role - someone who knows many of the member's secrets, vulnerabilities and pains - and yet is a member with all those same fears and insecurities, all that makes my character quite a unique and tormented one.

Now once again I need to start over in hopes that my failing ovary will produce yet just one more healthy egg to fertilize. It's scary. It's very emotionally draining. It's so expensive I am afraid I can't afford it! The shots can be painful. The instructions confusing. I often cry. I often question whether I want to continue. I have trouble sharing my thoughts and emotions with my husband, family, friends. I feel hopeless and hopeful at the same time. I don't know if I will ever have another child. I don't know if I will ever have the family I want. I will likely never have a child naturally again (and that scares me most of all!). I want to bury myself in work but yet my work brings me even more pain and confusion. I am not strong enough for this!

I try to reflect on the experience. As an OBGYN, I treat women during the most pinnacle moments of their lives- the birth of their child- every single day. It is routine for me, but do I take a moment to remember what this is for THEM? Do I focus on each person individually? Is this the lesson I am supposed to learn from this? Is there even a lesson I am supposed to learn from this?

I rely on the minimal support I can garner from the few OBGYN colleagues I am willing to share my story with. My colleagues appreciate what building a family means to me. But to many of them the 2 children, I have is their ideal family. They can't understand the innate feeling of loss - the hole I feel burning inside for more.

I can NOT turn to my non physician friends due to my fear of crumbling the "role" I play for them. I am their friend, "the OBGYN." The one they feel privileged that they can call about any obstetric and gynecologic question, big or small. The one they can share the first urine pregnancy dip stick result with because it's still within their accepted realm of "not yet telling anyone." The one with whom they can share the taboo of "I got pregnant the first time I tried!!"

But then again I stopped myself - How could I join a support group? The people in the groups would be MY patients. They would the ones who came to MY office and looked for MY support through this process. How could I reveal that I too needed my hand held? I too was scared. I too wanted to cry. How could I showcase such vulnerabilities to the people who looked at me to protect them from the same vulnerable moments?

What if they knew that despite this being the job I do every minute of every day, there is a bucket that my job is slowly filling. That every obstetrical question I answer leaves another tiny drip in the bucket. Every comment I endure about the ease of getting pregnant leaves a drip in the bucket. Every baby I deliver with my enthusiastic and charismatic smile and

congratulations is a drip in the bucket. Every patient I see in the office, every heart beat I elicit with the doppler, every ultrasound I perform, is a small drip in the bucket.

And I am unsure how big this bucket is, but one day it will most definitely completely tip over.

There are moments, points in time, when a leak in the bucket occurs. Times when something just makes the tears start and I can't stop them from coming. It comes along with the inevitable all body shaking, that catharsis. Those times feel like just a small leak, but it makes room, and enables the bucket to continue to fill each day just a little bit higher than the last. It makes the bucket remain light enough that I can carry it, but still sufficiently heavy that I feel its weight on my shoulders constantly.

But ultimately, here I am. I am standing.

I am living.

I am still an OBGYN physician and I am still a mother.

I am someone's sister.

I am someone's daughter. I am someone's wife.

I am many peoples' doctor.

But besides for the few identifiable features in my essay above, I am anonymous. And for the sake of my own defense mechanism of denial, the sake of my ability to survive this, for now my identity will stay that way.

I just hope that my bucket is deep enough and my shoulders wide enough, that for now it doesn't need a second person to prevent it from tipping.”