Maz Coote always knew she wanted a family. At 31 years old, she tested her AMH, which came back with a reassuring in-range result. This gave her peace of mind, and meant she didn’t consider her fertility again until years later. When Maz did retest her AMH, she discovered that her egg count had drastically declined. It was the last thing she was expecting.
After the initial shock of being told that it would now be challenging for her to start a family, Maz decided to educate herself about what this piece of information meant. She took matters into her own hands, studying research papers on AMH and persuading a receptionist for one of the top specialists in the country to book her in for an appointment. It was this appointment that changed everything. Maz learned that fertility is more than just your egg count and, if people were more informed about their own bodies when it came to fertility, they could make better decisions for themselves and their future. This is what ultimately led to the idea of WHEN Fertility.
Below, Maz shares her inspiring journey from believing she may never have a family to naturally conceiving her daughter.
When did you start thinking about your fertility?
“I was around 30. At this time, I was single, and a few years before that, I had started my own PR agency. I was very focused on my business, working long hours and most weekends. After a conversation with my Mum, who suggested I consider an egg count test, I started to think more about my fertility.
Medical note: Knowing your family health history is important so you can be proactive about your own health.
I took the test, and it came back in-range, but I didn’t realise that it was the lower end and that everybody’s egg count declines at different rates. When I repeated the test a couple of years later after meeting my then fiance, it had declined rapidly and came back low for my age.
That’s when my fertility conversation really started, in a meaningful way anyway. It’s so common in female health that the conversation starts when there is a problem. All the care comes when there is a problem.”
What were your expectations before beginning your fertility journey?
“What I didn’t expect was returning an in-range result at 31 and then a low result at 33. I was completely blindsided. I had put my in-range result in my pocket those years before and had not thought about it again.
I wish I had taken the time to educate myself about my fertility and my own body at 31, so I could have made better decisions to support my goals. I had treated my egg count as just a static number, not a dynamic number that could change quickly!
Having a family was important to me – if you had asked me at 28, 30, or 33, I would have told you that. I had family planning goals, and my mum knew enough to push me toward healthcare professionals who could help. If I could go back in time, I would tell the healthcare professionals I saw that having a family was important to me and ask them more questions. I needed stronger guidance.
I would have started the fertility conversation for myself sooner. I just wasn’t armed or educated to have those conversations.”
What did your fertility journey look like?
“At 31 years old, I had my first AMH test, with an in-range result of 7.8.
Medical Note: An in-range result for a 31 year old is 5.08 -54.2/pmol/L, Maz was towards the bottom of the in-range category.
Then, at 33 years old, I had a second AMH test with a low-range result of 3.6. My GP told me that because of this result, it was going to be very hard for me to have a family – which wasn’t actually correct. I spent the next couple of months diving into research papers about AMH and found one of the top specialists in the country (and our now Co-Chief Medical Advisor here at WHEN, Dr. Rachael Rodgers). I begged her receptionist for an appointment and ended up in her chair within the month. She told me that this result doesn’t mean I can’t have a family but that we need to talk about my family planning goals because my low AMH could indicate a shorter reproductive runway. We decided to preserve my fertility and freeze my eggs.
The next year, I had my first round of egg freezing in January, a second round in February and a third in March. At 34, I naturally conceived our daughter Charlotte, who was born the following year.”
Medical Note: AMH tells us about potential numbers you have left but not about the quality of those eggs. If you are ovulating regularly, you have the same chances of conceiving naturally as somebody with an 'in-range' or 'high' AMH level - all other factors the same.
Can you identify any moments during your journey that clashed with your expectations?
“The real moment of clarity in this was when I was sitting in Dr. Rachael Rodgers’s office. By this stage, my family GP had told me I would likely have a lot of trouble having a family and conceiving – and I had really gone to a place where, in the back of my mind, I now too believed this.
Dr. Rodgers sat across from me, looked me dead in the eye and said, “That isn’t what low AMH means”. All other things being equal, you have the same chance as someone with an in-range AMH to conceive if you were to try today.
Let that sink in for a moment. I had spent months thinking I couldn’t have a family, I had told my fiance that we might not be able to have a family (he was wonderful and said we would face it like any other challenge as a team). It was a shock, in a wonderful way, to have this new information and understanding about my low AMH, but there had been so much unnecessary pain.”
What was the most surprising thing that happened to you during this time?
“Once we had my low result and I had seen Dr. Rodgers, that is where the care part came in for me. The treatment path I chose was egg freezing, which was something I didn’t know much about.
I had read stories, though, and they weren’t encouraging. During my treatment, I did feel a little unbalanced from a mental perspective – but largely, the treatment was very manageable, which I like to share because I don’t want people to be scared of IVF treatments and be deterred from taking action that helps achieve their goals.
Where I did get caught off guard was that even though Dr. Rodgers had told me that my egg retrievals would produce fewer eggs than someone with an in-range AMH, on my first round, I really came to understand what this meant.
Medical Note: Higher AMH levels generally indicate the potential to collect a higher number of eggs during an egg retrieval.
Partway through my injections program (expertly administered by my husband every morning) for cycle one, Dr. Rodgers called and told me that there were three follicles on my internal ultrasound report from that morning and that, whilst each could be holding an egg so, there was the potential to retrieve three eggs, there was also a chance they wouldn’t be mature enough or viable when retrieved. It could be between three and none. For anyone who doesn’t know about the process, this was an only three follicles kind of moment. Dr. Rodgers said I could consider cancelling the round.
Medical Note: On ultrasound we can only see the fluid that the eggs sit within. It isn't until the fluid is drained and then looked at under the microscope that we know if there is an egg or not. It’s not uncommon for some follicles to not contain an egg at all.
Usually a fertility specialist will recommend cancelling an egg retrieval due to a low number of follicles. This would only be recommended if there was a possibility of a higher yield of eggs in a future cycle.
To put this into context, I just listened to a podcast that morning where the host recounted her egg-freezing experience and retried a wonderful twenty-eight eggs in one cycle. I felt so vulnerable.
I didn’t know people had to cancel cycles, or perhaps I hadn't properly absorbed the information in the written materials in the thick of it all.
Medical Note: Patients are given large amounts of information when they first undergo IVF treatment, it can be overwhelming and difficult to absorb all of the written and verbal information.
At that moment, on the other end of the phone, talking about my three fledgling follicles, I knew I was in for the long haul (we were aiming for 20 eggs). There was going to be a toll on my body – and let's not forget a financial toll.
I made the decision to continue with the retrieval, and I had to face reality. My egg count was low, and I wanted the eggs I did have on ice for my future even if I could retrieve only one egg.
I wished I had considered treatment options when my egg count had come back in the lower end of in-range. I also wish I had tested my AMH in annual intervals so I could have anticipated the drop. I had waited two years between testing and there was such a significant drop in my AMH. Unfortunately, I just didn’t understand what the information meant. Here I was a few years later, embarking on what would be multiple cycles and therefore taking what felt like extreme measures. It could have been avoided.
Now at 37, my AMH is 2.0 - it has continued to drop significantly through my 30’s. I am grateful I had the information to make the choice to preserve my fertility when I did, even if it was later than I would have liked."
Medical Note: In any single cycle of egg freezing or IVF, a person with a lower AMH level is likely to retrieve fewer eggs than what would be expected from someone in their age group. This means it could take more cycles to retrieve the target number of eggs.
What was the best or most rewarding thing that happened to you during this time?
“Many people don’t know this, but reproductive challenges can trigger a medicare contribution for fertility treatments. I was able to access this and large parts of my treatments, which totalled tens of thousands of dollars, were covered by Medicare.”
Medical Note: Medical egg freezing is when a person's fertility is affected, or will likely to be affected by conditions such as ovarian cancer, chemotherapy or radiotherapy and/or other medical indications like a low AMH and are entitled to a medicare rebate. Social egg freezing occurs when a person elects to freeze their eggs for personal reasons. This is not eligible for a Medicare rebate.
What do you feel is the biggest misconception surrounding fertility?
“That egg count can be used to predict if you will conceive. It doesn’t and this misconception is harmful – your egg count is just one piece of your fertility picture. It can help you understand what your reproductive journey could look like and ensure that you don’t have any options taken away, which can help you make better decisions to support your goals. That’s how, under the guidance of Dr. Rodgers, I used this information to examine my family planning goals.
We decided together that I would freeze my eggs as an insurance policy, given my egg count was already very low and would continue to drop, but that I was going to try and conceive naturally with my first baby – which I did just a couple of months later.
My frozen eggs were for the purpose that if I went into early menopause, I would still be able to try and have a baby using those frozen eggs if I wanted. They are still on ice, and I feel comfortable that I have done everything I could to give myself and my husband options and choices.”
Medical Note: Early menopause is when you go into menopause between the ages of 40 and 45.
What was the most helpful thing you did for yourself during this time?
“When I found out about my low egg count, I was in a deep zero self-care mode. It was all work, no play. I wasn’t looking after myself at all, particularly from a nutrition and sleep perspective. So, I wanted to change a few things going into treatment.
I cut out alcohol and didn’t have a drop during the three months of treatment. I put more of a focus on my diet and also started to try and better manage stress. One thing that I did very poorly is that I didn’t build a support network or give myself the space to move through the treatments with people to check on me or that understood what I was going through work-wise.
I told hardly anyone — not my friends, work colleagues, or clients. I just forged on like it was business as usual, and it was. I wouldn’t recommend that approach. I would pick up my medications and shuffle through the halls at work, hiding the branded esky bag (why are they branded, mind you?!).
I didn’t know anyone like me – I had never even heard of low AMH. I felt alone, and somewhere deep down, like I was failing. My mission is to change that for people and make sure we are sharing our stories so people don’t feel alone like I did”
Medical Note: It can be common for people to not share with their friends or loved ones that they are undergoing fertility treatment. The majority of fertility clinics offer in-house counselling for those who would like some extra support, these counsellors are highly specialised in all things fertility.
What advice would you give anyone who hasn’t yet gone down their fertility path?
“Information gives you a choice. Fertility is complex, and you don’t need to have family planning goals to start exploring that complexity. It is your body and your health, and the better you know yourself in that context, the better decisions you can make for yourself.
I would congratulate my 31-year-old self on taking that first step and having the test, but I would equip her with the right questions to ask so that the first AMH test, rather than being treated as a full stop, could have started a meaningful conversation that carved out a better path to achieving my goals.”
Disclaimer
This article is for general informational purposes only. It is not intended to be medical advice and is not a substitute for medical advice. You should speak with a medical professional if you wish to assess your fertility and before making any decisions about healthcare, including contraception.
