A fertility awareness educator’s take on egg freezing, PCOS and future fertility.
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Fertility fears, Florence Pugh and You
Florence Pugh has spoken publicly on the SHE MD podcast, about her PCOS diagnosis and why she chose to freeze her eggs aged 27, as a precaution for her future fertility. The impact of high profile women speaking about their health experiences is.. many things. The impact on an individual for instance, might be activating, connecting or enlightening. It might even be life-changing. But it can also have an anxiety inducing impact. Or it may be unintentionally misleading due to the lack of context and nuance applied to the reporting of said experience.
Coming from Pugh, a British movie star who manages to be at once highly aspirational and warmly relatable, this revelation has left young women with similar conditions concerned about whether or not they too should be considering egg freezing. Over the last month, 3 different women who have either PCOS symptoms or a full blown diagnosis, have asked me what I think about egg freezing.
Egg freezing isn’t for everyone
What strikes me with the Pugh conversation, is that it highlights one – highly medicalised – strategy which tends to overshadow any other approach. And it should come as no surprise, since highly medicalised allopathic approaches do typically take centre stage in mainstream conversations about what women and our health need, deserve and ought to fight for access to. But freezing your eggs is not the only way to preserve and optimise your chances of future pregnancy whilst dealing with PCOS, or endometriosis. In fact, it really is not for everyone for the following reasons and more:
1) It is a significant financial investment that you may not be in a position to make. Financial costs include injectable medicines to stimulate egg production, repeated blood tests and ultrasounds, the retrieval process (sometimes multiple rounds are needed to be successful), the cost of storing eggs each year, and finally the IVF process when you are ready to attempt pregnancy.
2) It is an invasive and intensive physical procedure which requires time, and consent. In other words, does your body say yes as well as your head?
3) It’s not a guarantee of future pregnancy, and you may feel that it provides a sense of false security. In the best of circumstances, IVF only works about 50 percent of the time.
Listen to your fears
So what then, is another option for someone who is, for instance.. In their 30s, who wants a family in the future, is unpartnered and has PCOS? If this sounds familiar, you’ll have plenty of anxiety inducing experience with the mainstream dialogue around infertility, health and aging. Know that PCOS is not an automatic death sentence to your fertility. Listen to your fears, however, as guidance. Notice if you are holding any beliefs around your ability to have a family in the future, and choose to engage with these concerns sooner, rather than later.
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PCOS and fertility
One way of honouring those desires, may be to understand why PCOS can get in the way of fertility. So let’s deal with that now.
PCOS is associated with difficulty conceiving and remains a leading cause of anovulatory infertility (infertility related to ovulatory dysfunction). Many women with PCOS do struggle to conceive due to the interaction of factors including hormonal imbalance, metabolic disturbances, and ovulatory dysfunction linked to PCOS. However, many women with PCOS do not have any problems at all! As Fiona McCulloch, N.D, author of 8 Steps To Reverse Your PCOS says; “ In almost all cases, women with PCOS can conceive. It simply takes the right treatment.”
There are three main reasons why PCOS can cause difficulties with fertility:
- Difficulty ovulating
- Hormonal imbalance
- Higher miscarriage risk
Tackling the difficulty in ovulating
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Without ovulation there is no conception! Duh! So it’s not difficult to see how delayed or infrequent ovulation makes it much harder to time sex for conception. In more severe cases, women may go months between ovulations, making it a world of waiting and confusion. The confusion is expanded by a lack of Fertility Awareness that can hugely increase your chances of conceiving. Using a Fertility Awareness Method (FAMs) allows even those with the most irregular and complex cycles to more closely identify the fertile phase of each and every cycle. Through becoming ‘aware’ of and tracking one to three ‘biomarkers’ or signs of fertility that all women’s bodies produce, an individual with PCOS can more accurately, and less stressfully, ‘try’ for a baby.
Allow me to drive this point home, by imagining going to your doctor after one year of unsuccessfully trying to conceive, and being labeled as infertile. What looks on paper to your doctor as a cut and dried case of infertility might, to a Fertility Awareness Educator, look very different. Because despite what felt like a year of the most sex, all the time, infrequent ovulation would deem that year as having only had less than a handful of “tries”. “Try” meaning: sex within your fertile phase. In fact, it is a theory of mine that the stats on labels of ‘infertile’ given by doctors, are wildly skewed by this lack of personal fertility awareness and correct sex timing.
Natural treatment for PCOS and future proofing
Ovulation, of course, is not the only factor needed for conception and pregnancy. Metabolic disturbance and hormonal imbalances such as estrogen ‘dominance’ which is associated with infrequent and delayed ovulation, and/or low progesterone may also lead to difficulty with conception. So although simply tracking your cycles may not be enough to improve and preserve your fertility and you might also wish to change your diet and lifestyle over time, identifying ovulation without devices or doctors appointments goes a long way in reassuring you of your future ability to conceive and guiding your choices around treatment, diet and lifestyle.
In conclusion
In conclusion, there is always much more to the conversation when it comes to individual choice, far more than a single article or podcast episode can get into. The best thing you can do is commit to knowing your own body well, as it is this which will guide you ultimately to making empowered decisions. Speak to me about learning Fertility Awareness or book a coaching call to talk through your personal fears and queries with a certified FAMM™ practitioner.
Egg freezing and PCOS References
McCulloch, F. (2016) 8 Steps to Reverse Your PCOS: Proven Strategies to Reclaim Your Health and Restore Your Fertility. California: Greenleaf Book Group Press.
Cunha, A., and A.M. Póvoa. “Infertility management in women with polycystic ovary syndrome: a review.” Porto Biomedical Journal 6(1) (2021); Lawrenz, B., et al. “Ovulation induction in anovulatory infertility is obsolete.” Reproductive BioMedicine Online (2022).
Hudecova, M., et al. “Long-term follow-up of patients with polycystic ovary syndrome: reproductive outcome and ovarian reserve.” Human Reproduction 24(5) (2009): 1176–1183.
Persson, S., et al. “Fecundity among women with polycystic ovary syndrome (PCOS)—a population-based study.” Human Reproduction 34(10) (2019): 2052–2060.
https://www.yalemedicine.org/news/egg-freezing-fertility