Which Comes First: Family or Career?

What if I say you don’t have to choose? If you have a family and a career, you know there is no “first”. Both are important and both will race for attention, often with one winning out one minute, the next winning out the following minute.

I’m a mom and a reproductive endocrinology and infertility specialist so I can tell you, balancing family and career will be what you decide works for you and your family. (Note that I didn’t say easy.) Getting to this family is the point of this particular article. For many female physicians, there are common questions of when, how, and with whom as it relates to their family building plans. I see many patients who feel the impact of a natural fertility decline that comes with age. The ticking “biological clock” may start to sound louder and louder around age 30 – 35 – which just also happens to be when female physicians hit a career stride.

Women in the US, and on a global level, are waiting longer to become first-time mothers. In 2018, the average age to have a baby in the US was 26.9 years, according to data from the National Institute for Health Statistics compared to an average age of 22.7 for a first baby in 1980.

The average age to have a baby varies on a number of factors such as marital status, education, and place of residence. Statistics show that the higher the education level, the later in life a woman will become a first-time mother. And, the most common reason for women to delay child bearing is not having an ideal partner. Also, when you look at the incidence of infertility, it is almost double in post-graduate students – likely due to age-related conditions.

Fertility preservation is one way to address the question of family or career first by offering an option that allows for one to be literally “frozen in place.” Before 2012, egg freezing was considered experimental because the technology was suboptimal. In 2012 a process known as vitrification (flash freezing) was improved drastically and the egg thaw survival rate increased to about 80%. Since then, the number of egg freezing procedures has gone up. In 2009, 475 women froze their eggs according to the Society for Assisted Reproductive Technology (SART). By 2016, that number was 7,276.

I’m often asked about when is the best time to freeze eggs. The answer is always “now”! The younger the woman, the better. Studies tend to find that pregnancy rates for women who freeze their eggs after age 38 are significantly lower than for those who freeze their eggs at younger ages. Another study found that women who froze their eggs at age 37 and above were most likely to use them and grateful they went through with egg freezing! Nothing, however, is a guarantee.

I encourage women to think of egg freezing as an insurance policy. There is never a guarantee of a live birth. The more eggs you have frozen, though, the better your chances for success.

A typical egg thaw rate is about 80%. However, we don’t know the developmental potential of these eggs. On average, of those that thaw correctly, about 60-70% will fertilize and of those, about 40-50% will go on to develop to the blastocyst stage. How many eggs you may want to preserve depends on your personal health and family building plans.

The process of freezing your eggs is similar to your own body’s cycle. The difference between your normal cycle and an egg freezing cycle is the stimulated growth of your eggs and, of course, the procedure to capture the eggs before they are naturally discarded in your menstrual cycle.

Every month, your body recruits 90-100 eggs naturally. Out of that, 6 – 12 are “fed” with follicular stimulating hormone (FSH) and rise to the surface. This “biological clock” is time and age dependent, not hormonal.

One of the newest ways we can assess fertility is by measuring AMH – antimullerian hormone – in order to assess ovarian reserve or egg count. As a fertility doctor, this number gives me an idea of how many eggs I can expect to retrieve from a patient in any one cycle. In an egg preservation treatment plan, your fertility physician will prescribe medicine that stimulates many of the eggs you would naturally produce that month to grow to maturity rather than just the one that your body typically does in a natural cycle. After stimulation, the egg retrieval procedure is performed under twilight anesthesia and the follicles are aspirated using an ultrasound to obtain the eggs. At this point, the eggs are frozen and then preserved until the woman is ready to use them in an attempt at pregnancy.

Some women consider multiple rounds of egg retrieval in order to retrieve the number of eggs they feel give them the best chance of the future family they’ve envisioned. It is suggested to have 8 – 15 eggs frozen for every one live birth you would ultimately like to have using your preserved eggs. Each retrieval cycle is reflective of our natural cycle, meaning some months produce more and better quality eggs than others. (This is why we don’t get pregnant every single month we have unprotected sex.)

As a first step, I always recommend women have their fertility potential tested. This typically occurs on day 1 – 3 of your menstrual cycle and consists of a blood test to assess AMH and FSH as well as an ultrasound to assess antral follicle count – the number of “resting” eggs your body is ready to recruit for your next cycle. From there, you will have a better understanding of your reproductive health and can, with your doctor, make informed choices about what’s best for you and your future family. Ultimately, I believe that women can have it all – though it rarely looks as composed as that sounds. If you haven’t found the right partner or it isn’t the right time for you to start or expand your family, preserving your fertility may be a great option.

Roohi Jeelani, MD, FACOG is a Reproductive Endocrinologist & Infertility Specialist with Vios Fertility Institute in Chicago where she also serves as the Director of Research and Education and Co-Director of the Fertility Preservation and Ovarian Aging Center of Excellence. She loves connecting and sharing with colleagues on Instagram; follow her @RoohiJeelaniMD.