Starting a Family: It’s Still a Possibility (Part 1)

Most women who learn they’re prematurely menopausal, whether naturally or through surgery, find the loss of fertility one of the toughest things to handle about their condition. Even those women who already have children find this very difficult to deal with.

The idea that you are infertile is a very painful concept to digest when you are in your twenties or thirties. Your peers are talking about having children. Friends and family may be pregnant or happily anticipating a time when they will be.

Joyous couple hold and kiss infantAds on television show glowing women excitedly checking at-home pregnancy tests. Magazine articles about women’s health assume that you are in your childbearing years and focus on this aspect of your health. In the back of your mind is a terrible fact: you are unable to have children.

But if you want to, you can. Having a child isn’t an impossibility.

No, it’s not as simple as you may have wished. When you are prematurely menopausal, you can’t just bank on regular biology as your friends can.

Researching Your Options

Some women with premature menopause do become pregnant the old-fashioned way. Some studies show that about 8% of women with premature ovarian failure (POF) spontaneously ovulate and get pregnant (1).

Of course, you can’t predict with much accuracy if you will be one of those fortunate women. And if you are in surgical premature menopause and have no ovaries, this can’t happen to you. But there are options open to you that will enable you to become a mother.

Your Experiences

One of the most difficult aspects of learning I was in premature menopause was being told I couldn’t have a child — at least not my own biological child from one of my own eggs. I first thought that there had to be some mistake, that there was some way around it, taking fertility drugs to force ovulation, or harvesting whatever eggs I might have.

But a reproductive endocrinologist at a fertility center gave me the facts as honestly and compassionately as she could: with premature menopause, the chances of getting pregnant were slim. It could happen, she said, but it would be somewhat of a miracle.

My best chances of having a child were either opting for a donor egg or adoption. And if I wanted to go the donor egg route, I could start immediately. I was already so confused, trying to grapple with my diagnosis and come to grips with the huge change that was being wrought in my life, that I decided to wait, think, and research all of the options open to me.

— Anonymous

This helpsheet explores these different options. It covers the most popular form of assisted reproductive technology for women in premature menopause, egg donation, which allows you to be pregnant, carry, and deliver a baby that can have a genetic link to your husband.

This article will also examine the science behind more experimental ways of getting pregnant with your own eggs. We’ll look at what each method of having a child entails, what you can expect, what you should know to help you begin making a decision, and specific sources to help you learn more.

More than anything, however, this helpsheet is designed to let you know that premature menopause doesn’t mean you have to give up your dreams of having a child. It may have changed how you go about having your child, but motherhood is still an attainable goal for most.

You may have to readjust your expectations and seriously think about the many issues that arise from not being able to have children naturally. You may need time to mourn the fact that you won’t be able to have a family as simply and naturally as you had expected. But if you choose to pursue the different paths open to you, remember that motherhood is within your reach.

Spontaneous Ovulation and Pregnancy

It is rare, but it does happen: women who have been diagnosed with premature menopause — those who still have ovaries — suddenly begin ovulating again and get pregnant naturally.

Doctors are not sure why this happens in some cases, or indeed how they can predict the likelihood of it occurring for any particular woman. Here are the facts:

  • Research has shown that as many as 50% of women with premature ovarian failure (POF) have what appear to be ovarian follicles when their ovaries are examined by ultrasound (1).
  • Studies have suggested (depending on the source) that either fewer than 5% or up to 8% of women diagnosed with premature ovarian failure suddenly revert to “normal” for no apparent reason. Their follicle stimulating hormone (FSH) levels drop to premenopausal levels, and they begin ovulating again. These women may find it possible to conceive spontaneously (1).

Pregnant mother cradles her bump

Could you be one of those lucky women? There is little way of telling. Isolated reports suggest that this spontaneous reversal of premature menopause may be more likely when a woman is on estrogen (2). Some doctors hypothesize that this may occur because the estrogen makes the FSH receptors on the follicles more responsive to the FSH your body is circulating. More studies are needed, however, to investigate this occurrence.

Also, because pregnancies after premature menopause haven’t been closely studied, it is unclear whether being on estrogen helps cause a remission of premature menopause, or if it’s just that the women who report this reversal are ones that have been tracked because they are on hormone replacement therapy (HRT).

All in all, it’s impossible to be sure at this stage. Other women have reported great success with herbs that have estrogenic properties. Still, others say that they’ve done nothing, but suddenly they began getting their period again and continued as if nothing had ever happened in the interim.

The problem is that no one is sure why and how this happens. A number of factors may be involved: some researchers theorize that traumatic stress — anything from the death of a spouse or parent to an accident to low-grade constant stress from a job or bad relationship — may cause temporary menopause, and that, after a while, when the body is relaxed again, it returns to its normal menstrual cycle.

Another possibility is that when you are in the beginning stages of premature menopause, your body periodically reverts to normal hormone levels. So you may ovulate on and off when you are first in premature menopause even if your FSH tested at a high level, because in certain months your FSH may have slid back down to “normal” levels. In rare cases, ovulation may occur again if the ovarian failure was caused by an autoimmune disease, and the autoimmune disease goes into remission.

One thing, though — and on this one, I speak from experience — having a period again, even from an extended amount of time, doesn’t necessarily mean that you’ll be able to get pregnant. In my case, I started having my period again for over six months and assumed that everything was completely normal again.

However, during that time, I also had my FSH levels retested and discovered that, although I was getting my period, I didn’t seem to be ovulating, since my FSH levels were still well over 100. And I didn’t get pregnant.

But for all the negative stories, there are positive ones as well. I know of one woman who got pregnant after several years of premature menopause (she was on estrogen and used some herbal supplements) and another who got pregnant after having done nothing for her premature menopause at all.

The general rule of thumb: pregnancy may happen to you if you’ve still got your ovaries and follicles. The odds aren’t with you, but sometimes miracles do happen — and one could possibly happen to you!

Donor Eggs (Oocyte Donation)

When I went to a reproductive endocrinologist (RE) for a second opinion about my premature ovarian failure diagnosis, the first thing she told me was, yes, I was definitely menopausal. The second thing she told me was that if I wanted to have a child, I should consider donor eggs. Given my health and my age, the odds were excellent that I would be able to bear at least one child, possibly more — “an instant family!” as the RE enthusiastically put it.

More often than not, if you’re prematurely menopausal, still have a uterus, and want to have a child, you will hear the same thing. Your doctor will tell you to think about going through in vitro fertilization with a donor egg.

Your Experiences

Having a child — carrying the child for nine months and being able to bond with it — really matters to me. So my husband and I have finally decided that egg donation is the right choice for us. I’m very excited about the prospects. I know that this way I have a real chance of being the mother I have always wanted to be.

— Sarah, age 28

This is a tried-and-true way for a woman who doesn’t have working ovaries or viable eggs to be able to carry and bear a child — often a child who has a genetic link with her partner, since his sperm can be used.

Egg donation was initially available only to women with premature ovarian failure. Now it’s also offered to a wide range of infertile women, including those who have failed other attempts at assisted reproductive techniques, older postmenopausal women, and women with genetic diseases.

For many women in premature menopause, this is the best answer to their infertility for a number of reasons:

While there is no guarantee, you do have a very good chance of getting pregnant and delivering a baby through donor eggs

This method has one of the highest success rates of all assisted reproductive procedures, about 50%, which means that half of all donor cycles attempted are successful — that is, they result in the birth of a baby.

When you get a fresh egg transfer (as opposed to having a frozen embryo implanted), the success rate should be the same as you would have had if using your own eggs. One key point, however, you should be aware of is that different clinics have different success rates, so if you decide to follow this procedure, be sure to find out the success rate for the particular clinics you are considering. The top practitioners can achieve a success rate upwards of 75%.

You have the opportunity to carry a baby

You can be the baby’s “gestational” mother, as it’s scientifically called. This allows you to bond with the child throughout your pregnancy, to experience the birth of your child, and to breastfeed if you choose.

Because you are carrying the child, you have control over prenatal care

You can be sure to do all the right things: follow the best possible diet, not smoke or drink, everything and anything you think would be best for your baby.

The child can have a genetic link to your husband

This is often a great comfort to both father and mother since their child can share a biological bond with at least one of them.

Although the child will have no genetic link to you, he or she may resemble you

Some women opt to seek donor eggs from a family member. In this case, your child will have genes from your family “gene pool.” And in most cases, if you are using an anonymous donor, efforts are made to find a donor who “matches” you physically. In other words, if you’re short, brunette, and olive-skinned, the fertility clinic will match you with a donor who is also short, brunette and olive-skinned.

This is one of those factors that may not matter to some women, but does make a difference to others, especially those who feel that it’s easier for the child if he or she physically “fits” into the family, and those who would prefer not to tell people that they had their child through egg donation.

How It Works

Visual of in vitro fertilizationEgg donation is a relatively straightforward procedure. To boil it down to its most basic, a donor, a woman usually no older than 34 or 35, donates eggs to be used by a donor recipient, a woman who can’t produce her healthy eggs.

These eggs are fertilized in vitro and the embryos implanted into the recipient’s uterus. The recipient’s partner’s sperm is usually used for fertilization, but it can also be done with donated sperm.

More specifically, a known donor (usually a close relative, such as a sister or first cousin) or an anonymous donor screened by the fertility clinic is given hormones to ovulate and produce a number of mature eggs. In the meantime, the recipient takes hormones to synchronize her menstrual cycle with the donor’s cycle and to prepare her uterine lining for the egg.

When the donor’s eggs are mature, they are harvested, usually by a method called “aspiration,” in which a long needle withdraws the eggs from the donor’s ovaries. The eggs are then fertilized in a laboratory and finally implanted into the recipient’s uterus.

For the first three months of pregnancy, the recipient continues taking progesterone and estrogen. After the first trimester, though, the placenta takes over, and the pregnancy proceeds like a normal one.

Continue Reading…

Because this helpsheet is intended to be highly in-depth, we split it into two parts to make it more manageable. In Part Two, we’ll look more closely at the steps involved in egg donation. We’ll also explore surrogacy and experimental methods of giving birth, such as ovarian tissue transplant.

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