By Maja Zecevic, PhD, MPH
Opionato's founder recounts her (in)fertility journey which culminated in the inspiration to create Opionato and help others better understand their fertility and act early on.
Fertility is not the opposite of infertility
“Infertility” is defined as the inability to become or stay pregnant. “Fertility”, thus, should be the ability to have a baby at any time. Sadly, this is false. The average woman is fertile in fact only a few days of each month and infertile the rest of the month. Therefore, for most woman fertility and infertility as two dynamic and evolving reproductive states over different and short periods of time. And, for 1 in 6 of us infertility occurs for a longer time period during our reproductive life (1).
We also operate under the mistaken assumption that we are fertile by default. Not surprisingly then is that 75% of us never discusses our fertility with our primary care physician or gynecologist (2). As we assume we are fertile, we entirely focus on preventing pregnancies by using contraceptives for many years even though we have never assessed or discussed our fertility with our doctor. Therefore — preventing infertility — isn’t something we think about at all. And this is so very wrong.
Perhaps another little known fact is that 60% of all the in vitro fertilization treatment cycles performed every year in the U.S. are done by women younger than 37 years of age (3). This tells that the inability to have a baby is not, as is often assumed, a lifestyle choice made by delaying to have a baby after age 40. Infertility is, in fact, a medical condition — underestimated and unappreciated. It does not then come as well as a suprise that mid-30s is the life period when most of us are diagnosed with the three conditions that are mostly linked to infertility: endometriosis, polycystic ovary syndrome, and pelvic inflammatory disease .
My own (in)fertility journey has been bumpy
My own fertility journey began when I was in my late 20s. I felt something was wrong when I started having mid-cycle bleeding and long, painful, and heavy menstrual periods. Given my age, my doctor recommended a “wait and see” approach. I thought, “I know my own body the best.” At my insistence, I had an ultrasound that revealed a uterine fibroid the size of an apple. Soon after, surgery removed the fibroid but my recovery was slow. Moreover, the surgery also revealed endometriosis on my ovary. My surgeon informed me then that any of my pregnancies would have to be delivered via C-section, owing to the possibility of uterine rupture should I attempt to have a vaginal delivery. He also advised me that I become pregnant as soon as possible.
Even though I was married at the time, becoming pregnant was easier said than done. While my career was starting to build momentum, my marriage was disintegrating, soon ending with a divorce. I had also just moved to New York City for a prestigious position as the sole North American Editor of The Lancet — one of the top medical journals in the world. This new role validated my previous 10 years of hard work that I devoted to cancer research. The new post gave me direct access to top experts and global leaders in biomedical research, medicine, public health, health policy, and health philanthropy.
Then, my life was soon to change for four different but related reasons. First, my father’s prostate cancer returned. I insisted he live with me in New York, which he did until he passed away. This was a very difficult time for me emotionally and physically. I realized then that having a family — the one I had not yet created — was what mattered the most to me. Second, at the same time, I discovered that I needed to have a second surgery to remove yet another uterine fibroid. Third, on top of that, I was diagnosed with autoimmune Hashimoto’s thyroiditis disease, of which infertility is a well-known outcome. Fourth is that I fell in love with a man who convinced me to follow him to San Francisco.
For the first time in my life, I finally had the right partner to have a family. But once in California, I quickly realized that at age 42, I was not young — reproductively speaking. Even though I thought I was medically literate, I was astonished to find out that assisted reproductive technology cannot entirely overcome age related reproductive decline. My reproductive endocrinologist, a leader in the field, informed me that due to my age only, my chance of having a baby was less than 5%. I then received another shocking news — if we are to pursue fertility treatment each cycle of in vitro fertilization (IVF) would cost roughly $15,000! Even with this astronomically high cost and 5% chance of success, I ended up enduring three insemination cycles and four in vitro fertilization cycles before giving up my hope of having a biological child.
It was a unique time in my life. I felt powerless, anxious, sad, uncertain, and hopeful — all at the same time. Even with the support of a loving partner and good medical care, I still felt I could and should be doing more to increase and optimize my chances of having a baby. I tried acupuncture, fertility massages, gluten-free diet, and over-the-counter antioxidants. I also tried to get a second opinion, wrongly assuming that it would be easy. I could not find a way to obtain an accessible, immediate, and affordable fertility second opinion. Therefore, I had to schedule another in-person appointment in one of the Bay Area based fertility clinics that would take months to materialize at the moment when urgency for me was everything. Then, I slowly came to suspect why my appointments kept getting further postponed and then canceled. My age and prior IVF failures meant I had a low chance of success. I would skew the clinic’s success rate statistics in the wrong direction. I was being denied medical care so the fertility clinics could keep their success rates in a more marketable range. This was unfair and unethical and it made me angry.
To make matters worse, around the same time, I made another distressing discovery about myself — that I am a pre-mutation genetic carrier for fragile X syndrome. Among other issues, this syndrome induces premature ovarian failure and lower egg count at earlier age, making me reproductively speaking much older than my actual biological age. Why, I wondered, was I just finding this out about myself at age 42 — something that I was born with and for which a simple and inexpensive blood test could have been done early on? Of course, had I known this genetic makeup about myself earlier in my life, I would have had the choice to act earlier when my chances of having a baby with natural conception and/or medical intervention were much higher.
I can’t turn back the clock but I can help others avoid these small but devastating oversights.
Understand your fertility and act early on
Most of us don’t realize how easy it is to assess, understand, and discuss our fertility. Instead of doing it proactively early on in our lives, we focus retroactively to repair it when the dialogue has already been shifted toward infertility talk as we start experiencing a fertility challenge — when often is too late to avoid a costly, invasive, and emotionally draining fertility intervention. If we know more about ourselves and our overall health and family health history early in life, many of us would be able to pursue motherhood on our own times and terms and when those interventions (if needed) would be performed earlier when the chance of their success is the highest.
Fertility physicians — reproductive endocrinologists — practice evidence-based medicine and are trained to help us ask, discuss, discover, manage, and/or treat fertility issues and infertility associated disorders. They are actually specialized OB&GYNS who go on to have three additional years of training in reproductive medicine.
Sadly, most of reproductive endocrinologists are unreachable to many women simply due to geography — almost one third of reproductive age women in the USA (a total of 25 million women!) do not live close to a fertility expert (4, 5). There are currently roughly 1,500 reproductive endocrinologists in the USA ( in a country of over 300 million people where 1 in 6 individuals need their help!). They need to be reachable to more women who want and need their help!
From pain and struggle, comes inspiration
I truly believe that with the right information about myself and my fertility at the right time from the right expert would have made the difference it my own fertility journey. That knowledge and empowerment about myself came too late for me. I want this not to happen to any women, men, and couple out there.
Thus, I have decided to use my personal fertility path experience, scientific background, and my extensive network of top medical specialists to help others bring a baby into their lives, when and how they want. My mission is to democratize fertility information and empowerment and to decentralize geographic location of fertility experts by making them accessible and affordable with no wait time to you 24/7 no matter where you live.
Opionato now offers you immediate, affordable, and uncomplicated go-to online fertility assessment, advice, and tools tailored to you independent of your pre-conception stage: future conception desire or current natural and/or fertility treatment conception attempt.
Opionato also provides you the following advantages:
Please act now
Find out now at this very precious moment as much as you can about yourself and your fertility — the time when you have the control and the power to take the right actions at the right time so your wishes come true when and how you want them. Opionato will be your calm and caring voice and that expedient fertility expert — that I wished I had but now you have.
The more we know about ourselves and each other, the more we help create the much needed infrastructure for sharing fertility information, knowledge, and empowerment, and in allowing a community of kindness and support. And more babies!
PS. Since this piece was written, I had my third fibroid surgery.
Opionato (www.opionato.com) is your trusted fertility navigator offering anytime from anywhere instant fertility assessment and fertility chat with the world's leading fertility experts. We empower you with knowledge about your fertility potential and fertility options so you can take informed fertility actions that make your path to pregnancy short, cost-effective, and stress-free.
Opionato started with one woman’s personal fertility experience and the vision to give others what she lacked. Read Maja’s story here: https://www.opionato.com/blog/what-i-wish-i-knew-my-fertility-journey.
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