My Story To Date: In May 2015, having just turned 40 with an AMH test result of 0.1 ng/mL (very low/undetectable), and once the initial panic and denial had passed, I knew I had to pull myself together and quickly. If I still had a chance I had to do something about it now and as they say ‘Knowledge is Power’ so I started to read and research online and in books.
I knew that if I was going to find a doctor who would even be willing to try and help me freeze my eggs with such a low AMH, that it wasn’t going to be a ‘one round’ process and so I was going to need a healthy steady income to fund it. So, quitting my job and moving back to the UK wasn’t an option at this time.
The First Hurdle: The first thing to do was to establish what is and isn’t accepted as a single female when it comes to Egg Freezing in the UAE. I found that even in asking this question I was judged so it was important I found someone who I could trust and speak openly and honestly with.
A week after my alarmingly low AMH test I approached an acquaintance who I regularly did yoga with. I knew she was a gynecologist in the UAE and thought maybe she could put me in contact with a doctor who could help me and who I could trust to be discrete (not knowing what was and wasn’t legal for a single female expat living in the UAE at this time).
The UAE Clinic: A few days later I had an appointment with (lets call him) Dr. Greg at a private medical facility in the UAE. This was a daunting experience, not because Dr. Greg wasn’t lovely, but because as I walked into this private healthcare facility as a single white western expat I quickly realized I was most definitely in the minority. As I approached the reception desk to confirm my arrival for my appointment I was asked for my medical insurance card and my marriage certificate.
I knew that being single my doctors visits were likely NOT going to be covered by my medical insurance, that I had accepted, but what I wasn’t prepared for was that it seemed that a ‘marriage certificate’ was a ‘must’ to even discuss ‘fertility’ with a doctor in this part of the world!
It turns out that a marriage certificate isn’t actually a requirement but I was made to feel like I was committing a crime even wanting to see a doctor to talk about my fertility without a husband. The looks and stares I got from both the waiting rooms filled with local patients and the reception staff was enough to make me want to burst into tears and run for the hills. I wasn’t sure if I could do this. Thankfully my dad always taught me that difficult situations should be viewed as ‘character building’ and this was definitely going to be one of those situations!
Meeting My Doctor: I was called to meet Dr. Greg, he was an arabic speaking western educated fertility specialist who recently moved to the UAE from the UK where he had been working for the past few years.
Dr. Greg was great. Open, honest and realistic, exactly what I needed at this point. If he hadn’t been, then I probably would have left that clinic, never gone back and maybe even never tried to start my egg freezing journey in the UAE.
I shared my AMH test results with Dr. Greg and as it happened I was on day 3 of my period, so he was able to immediately do an FSH test.
An FSH test is another test (apparently a slightly more accurate one than AMH) that measures a persons ovarian reserve. It is a blood test carried out on day 2 or 3 of your period to measure a hormone called Follicle Stimulating Hormone (FSH). FSH is made by a women’s pituitary gland at the base of the brain. Its purpose is to stimulate maturation of the egg containing follicles that remain in the ovaries. If the number of good quality follicles is swindling down, more and more FSH is needed to mature an egg that cycle. Your FSH level increases with age because as your fertility declines more of this hormone is produced in your body to help eggs become mature. Normal age specific parameters look like this:-
33 years or less = less than 7.0 mlU/mL
33-37 years = less than 7.9 mlU/mL
38-40 years = less than 8.4 mlU/mL
41 years = less than 8.5 mlU/mL
One thing to note is that FSH can vary a little month to month but you are only as good as your worst FSH, so if your FSH comes back high and then next month on day 2/3 of your period it comes back lower you should take the higher result as where you are in the process of diminishing ovarian reserve.
Another thing to be mindful of is that a lot of doctors or clinics won’t even agree to try egg freezing with a patient who has an FSH of 20 or higher as the chances of success are very slim AND a lot of clinics don’t want their egg freezing success rates to be impacted by many failed cycles, so they stay well clear of those people who have little to no hope.
Sadly some women can experience what is called Premature Ovarian Aging (POA). This is when FSH and AMH results indicate a low ovarian reserve relative to what is expected at their given age.
The Second Moment of Truth: My FSH test came back later that day. I had hoped, and secretly thought, that it was going to be ‘normal’ and not consistent with the alarmingly bad AMH test I had recently received. I was in great shape physically and generally very healthy, surely the AMH test was just an error….
That glimmer of hope quickly faded, my FSH was 22.38 mlU/mL. At first I had no idea what this meant but as I did more and more online research everything indicated this was bad, very bad. It is funny how our mind works when we don’t want to believe something, at one point I even thought I was reading the results using the wrong measure! As a 40 year old my ‘normal’ FSH should have been <8.4 mlU/mL. Again it took time for reality to set in, but it was real…… I was experiencing Premature Ovarian Aging (POA) and I was just one of the unlucky ones!
Complete Disbelief: To say I went into a tailspin would be an understatement. It sounds dramatic, but honestly, I felt like my life had come to an end. The one thing that had never crossed my mind was that in my life’s story I would have a biological child and become a mother this way one day. In hindsight, at my age this was a very naive thing to have thought, but honestly when you are told so often by friends and family ‘your time will come’ and ‘of course you will have your happily ever after, just be patient’ and when your ‘happily ever after’ (in your head) has always been having a biological child, if it is taken away from you over night, your world comes crumbling down and everything else in it seems insignificant.
What was my purpose for being here on this plant if not to reproduce. Isn’t that what women do? The rational part of me knows that this is NOT, in this day, the ONLY thing women do, but it is still an important role they play and one, which when taken away, as a women, made me feel very inadequate, ashamed and heartbroken. So yes, my world came crumbling down around me and I didn’t know what to do.
Sharing My Secret: There were four people I confided in, my mother, father, sister, and my best friend all who lived overseas. I didn’t want anyone else to know, I was embarrassed. I felt like a failure as a women. My head was plagued with thoughts like ‘who was going to want me as a partner now?’.
My four confidantes, like me, were initially all in denial and were frantically searching for a rationale as to why at age 40 it was ‘too late’ not just to freeze my eggs but to even have a child now! Maybe my results had got mixed up, maybe it was the birth control pill I had been on for 5 years, maybe it was even the UAE’s medical laboratories who had got it wrong. We were all clutching at straws to understand.
The more and more reading I did the more and more I realized that my case wasn’t unusual at all, in fact I wasn’t the ‘leper’ I had initially thought I was. I was just very naive and uneducated in the world of diminishing ovarian reserve.
What I Did Next: After pulling myself together and armed with my low AMH test results and my high FSH test results I went back to visit Dr. Greg. I ask Dr. Greg if he would take me as a patient and try and help freeze my eggs. There were still a lot of unanswered questions, I didn’t know if he would say yes , I didn’t know if it would work and I also still didn’t know what was ‘acceptable’ for a single expat women living in the UAE and what was not.
My second visit to the private healthcare clinic was just as daunting as my first, I was the only uncovered women in the clinic and I could feel all eyes on me as I waited to see the doctor.
Dr. Greg told me he would take my case. He managed my expectations by telling me that if I was in the UK they may well not take me because of my high FSH and that it may not work but that he was prepared to give it a go. This was the first bit of good news I had received since my AMH test results.
Dr Greg advised me that he could help with the stimulation part of the process which would be documented for clinic purposes as ‘Gonadotropins challenge test to assess reserve’. He informed me I would need to pay for the treatment because as a single female my health insurance wouldn’t cover seeing an IVF specialist doctor (which is what he was). He would prescribe me the injectable hormones and run regular blood tests and scans to check if the process was working but then I would need to get the egg collection done in the UK as collecting the eggs in the UK would provide me with a lot more flexibility in both length of storing them and in using them.
Dr. Greg was very laid back and told me I was free to use any doctor in the UK I felt comfortable with, it was totally my choice and he would work with whoever I decided to use. He did however mention that he had an old colleague who worked for a relatively new clinic in London and he would be happy to recommend me to him.
Picking a UK Clinic: I had already made initial contact with a couple of clinics in both the UK and in the USA at the very start of this process prior to getting an AMH test done. I wasn’t sure which country was more advanced when it came to egg freezing or what the first steps were, but all those I contacted told me I would need to get an AMH test and then I would need to have a consultation.
I was now at the stage that I had to make a decision as to which clinic I should use. I decided I wanted to go with one in the UK where my family were and there were quite a few to choose from. I didn’t know anyone else who had frozen their eggs, so a referral wasn’t going to be an option. My sister had a couple of friends who had both used The Lister Clinic in the UK which has an excellent reputation in both IVF and egg freezing. I contacted them but it was going to be over a month to get a phone consultation and despite their website saying they accepted ‘overseas’ patients, they seemed reluctant to work with my doctor in the UAE and just do the ‘collection’ part of the process. Something that 14 months later I found to be quite common amongst clinics.
I felt it was important that the doctor I would be seeing on a regular basis (Dr. Greg) felt comfortable with the clinic I chose in the UK. I had a phone consultation with the UK clinic Dr. Greg had recommended and it turned out that the doctor there had worked at The Lister Clinic prior to his current clinic. This filled me with confidence. I have called this doctor ‘Dr. Collection’.
Dr. Collection accepted to take my case and work with Dr. Greg in the UAE and the clinic seemed very open to working with me on cost for multiple cycles (which I knew at my age I would need) plus because I was having a lot of the initial scans and blood tests in the UAE and having to pay for them there they gave me an additional discount. All in all I felt very comfortable with my decision to go forward with them and knew it would be easier for Dr. Greg and thus me during the process. I had to complete an abundance of paper work and get various blood tests done and sent to the UK clinic. Test like HIV, Hepatitis B, Hepatitis C, Chlamydia, Rubella, Thyroid Function Test, Full Blood Count etc (all need to be less than three months old).
When I Would Start: It was agreed I would start the stimulation with Dr. Greg on day 2/3 of my next period and we would see how it was going sending the scans and bloods to Dr. Collection as and when I had them. Dr. Greg would recommend my treatment and then Dr. Collection would confirm he was comfortable with what he had recommended. After 5-7 days we would see if it was working and if so I would fly to the UK for egg collection.
Dr. Greg prescribed me with a DHEA supplement which he asked me to start taking immediately. 25mg three times a day. He told me to come back and see him again on day 2/3 of my next period to do a scan and then hopefully start my first round of stimulation.
DHEA (dehydroepiandrosterone) is a hormone that is naturally produced by the adrenal glands. As you age, levels of DHEA naturally drop. Many believe DHEA can help improve sex drive, build muscle, fight the effects of aging, and improve some health conditions including fertility.
This was it….. It was now June 2015 and my journey to try and freeze my eggs had officially begun. I would wait approximately 2-3 weeks for my next period and then it was back to visit Dr. Greg. I was scared but hopeful about the future.