Egg freezing + fertility options with Dr. Shieva Ghofrany
A Q&A about the choices women have when it comes to their reproductive future
Connect with Shieva: Website // Instagram // Tribe Called V
Dr Shieva Ghofrany strives to help people eliminate their fear by being “proactive not paranoid” about their health. An OBGYN since 1999 and co-creator of TRIBE CALLED V, her intention is to “increase our knowledge to decrease our anxiety”.
Having travailed 6 miscarriages, 3 births, endometriosis, weight loss surgery and ovarian cancer, she’s harnessed her personal experience coupled with her professional observations to genuinely help achieve a calmer perspective. She loves engaging with women on every level to guide them realistically in their quest for understanding of their bodies and minds.
What started as an endeavor to connect with other women on Instagram led to multiple consulting and speaking engagements live and virtually. As well she is frequently quoted in online publications such as Self, Huffington Post, and Parents where she discusses an array of women’s issues. Perhaps most prevalent is the request for her to address the mindset of fear surrounding health issues in general and cancer in particular, given her own experience with ovarian cancer and the surgeries and chemotherapy they required. She has been listed on Top Doctors with Castle Connolly for years and she has also been featured on Verywell.com, WebMD, and in the PBS series now on Netflix “HUMAN: the World Within” which have satisfied her long term pipe-dream of becoming a talk show host.
Through her work as a doctor in private practice as well as through her courses in integrative health—she’s used her education, clinical experience and personal journey to highlight the mindset she believes we all need to tackle our views of our bodies. She often notes how lucky she feels to have had hands-on experience with women of all backgrounds to inform her of the female condition.
Tell us about your experience becoming an OBGYN and working in women’s health.
My path to OBGYN is interesting in that I have a deep love for what I do not only from the medical perspective but from the social justice perspective with regard to honoring each individuals needs based on their specific social determinants of health. That said, while my patients and most who know me assume that I must have always wanted to dedicate my life to women’s health, medicine, and equity this would be romanticizing the truth! And I feel strongly that we never revise history, particularly in this regard as I believe that when young people consider their future careers, they often look to those who are already successful and assume that those individuals must always have been driven by certain passions.
It is with this sentiment that I feel that it is important to consistently highlight stories like mine. I was the second daughter born in 1970 to Iranian immigrant parents who were both physicians. Shaped by their culture and careers but also a deep sense of truth, they explicitly and intentionally encouraged my sister and I to value the importance of finding careers we loved that could also support us, and very much clarified that we should not become doctors unless we truly loved the field since they knew firsthand the immense amount of stress involved in the work.
As a student, I worked just hard enough to satisfy my parents which confirmed to me that a life as a doctor was probably far more challenging than I could handle–and this led me to major in liberal arts and languages and ultimately change majors four times through Georgetown University, ending with an American Government major. Because I had no singular “passion” (nor do I think many young people do!) I had moments of panic nearing my last semester and decided to enroll in a post-baccalaurete pre-med program at Columbia University. My thought process was that this was a path that at least I knew through my parents’ eyes.
After a rocky start with grueling basic science classes that attempt to weed out those “less hearty” I managed to struggle through– but/and the lessons learned were ones of perseverance and a newfound confidence in my abilities. This led to medical school being the first time in my [then 25 years of] life that I truly worked hard for my own sake and not to please others. And yet I still did not know exactly what path I wanted to take–I loved procedures and thus considered general surgery like my father. And I also felt the pressure of the notion that surgery is a hard field if you want to have a family that pervaded the 90’s and still does today. So I considered the more manageable field of pediatrics like my mom. At the time, the thought of gynecology was deeply distasteful to me, I did not particularly care if I experienced the arrival of human life nor did I feel a dedication to caring for women only–despite the fact that I was at my core a proud feminist within a family of like minded people.
But then it happened, my OBGYN rotation. Surgery, birth, and medicine– a beautiful marriage of getting to all at once do very serious medical care for people akin to that of general and cardiac surgeons while also getting to care for the patients throughout much of their life cycle and bond with them over time.
This sentiment has only grown over my last 25 years of being an OBGYN. I now see my role with great clarity as being able to help people heal from many of their OBGYN ailments, while also guiding them through the myriad “normal” phases of womanhood (puberty, pregnancy, perimenopause and beyond). And because I’ve learned that my superpower is not “being a doctor” and my passion is not “women’s health”-but rather my highest desire and achievement is to engage and be engaged and through that, I am able to guide, heal and collaborate with women and people who need it.
How has your experience as a "cancer thriver" informed the way you approach women's health?
I feel deeply lucky to have been born an optimist of sorts. This has served me well by helping me avoid feelings of fear with regard to life, career and health. And it has helped me not avoid the possibility of failure– I am willing to try to things without the angst that it may not work out. This trait has helped me most with regard to my health. I’ve often joked that I’ve had the “what’s what” of OBGYN issues: endometriosis, weight loss surgery, HPV, recurrent pregnancy loss, and ultimately ovarian cancer.
Each experience helped me further bond and empathize with my patients but certainly cancer the most as it gave me keen insight into many aspects of health and mindset. It helped me clarify my concrete messaging to my patients about their need for knowledge about screening tests, family history of cancer and symptoms all in the framework of knowing their anatomy and OBGYN health, but possibly more importantly helped me hone my message dissuading the pervasive sentiment of fear that we foment in this country with regard to cancer. The disproportionate amount of angst created by fears of abnormal pap smears, abnormal mammograms, abnormal colonoscopies or even the hint of malignancy is woefully misplaced but understandable. If we could instead shift focus from fear, which inevitably leads to avoidance, to a pragmatic view of an admittedly lousy entity that can often be found early and treated in the case of many cancers, we would improve the survival rates even more.
In addition, my history with endometriosis, weight and HPV alone highlight the common and pervasive themes of gaslighting, shaming and scaring women with regard to common health issues. Add to it pregnancy loss, birthing and lactation and again one can trace sordid history of the “what’s what” of women’s health via the lens of society’s hold over us and our mindset.
My experiences have deepened my resolve that women and people with vulvas deserve so much better–but we need true collaboration between the medical field and patients to be able to really understand why and where and how the system is failing us without the current culture of blame and disdain.
Tell us more about your virtual platform, Tribe Called V. What is the overall goal and mission?
TRIBE CALLED V is our online platform we are actively growing and scaling beyond it’s current offerings of a robust pregnancy class and a briefer but comprehensive perimenopause class. Our ultimate intention is to have short form video/audio and written content that can be easily digestible on all of the basic OBGYN health issues that no one ever has access to learning. We have reiterated that the great equalizer among women (though there is nothing “great” about it!) is lack of OBGYN knowledge through no fault of ones own.
Thus our overall goal at TRIBE CALLED V is to help people learn about their OBGYN health. While fields like neurology, orthopedics, and cardiology are all touched upon in our platform, we really want to be thorough and so we refer to our guidance as specifically OBGYN. This includes pregnancy and pre-pregnancy issues including trying to conceive, pregnancy loss as well as delivery and postpartum issues. And aspects relating to gynecology–breast issues and cancer, and anatomy and physiology of the gynecological organs (ie uterus, tubes, ovaries, vagina, and vulva). Our intention is to highlight what is normal and abnormal about all things OBGYN (periods, puberty, perimenopause, menopause, STI’s, endometriosis, PCOS, vaginal infections and beyond) in an effort to decrease the amount of anxiety associated with the unknown.
Our premise, clarified by my 25 years of caring for patients, is that the disproportionate amount of fear and anxiety surrounding our health could be greatly alleviated with explicit “preemptive” knowledge about these entities before one experiences them coupled with more intense reactive knowledge once an entity is diagnosed.
One of the topics women can explore with Tribe Called V is egg freezing, a topic that isn't often talked about. Can you explain more about egg freezing - why it's an important option, the process and what to expect, and how you help women through it?
Until the last 13-15 years, freezing one’s eggs was not an option. Assisted reproductive technology (ART) had been perfected to allow for aspiration of one’s eggs from the ovaries so as to combine them with sperm and create embryos that could be frozen and thawed to proceed to pregnancy, but eggs themselves struggled to survive the thawing process until recently.
The inception of TRIBE CALLED V actually was precipitated by my business partner, Jenny Hayes Edwards, approaching me as she was preparing to use her frozen embryos that she had from eggs she had frozen when she was 35 years old–she was one of the first women to use this technique at a prominent fertility center in Colorado–something she decided to do proactively in anticipation of wanting to preserve her possibilities given the fact that at that time she was not in a position to grow her family. She ultimately used her embryos and has a beautiful child from the process–all of which was documented for our TRIBE CALLED V pregnancy class!
As the technology continues to improve we will see costs come down and education and access go up so that more women and people with ovaries will have the ability to freeze their eggs to preserve the option of pregnancy. What’s very important to know is that egg freezing at this point should not be viewed as “an insurance policy” in that even with 15-20 frozen eggs, there is not a guarantee of a live born infant after the thawing process, the IVF process, and the embryo transfer process, but it certainly improves the odds and options. There is also a certain amount of discomfort as the hormones/medications used to stimulate the ovaries to release multiple mature eggs in one cycle can have physical and psychological effects. That said, the whole process can sometimes be completed from consultation through the entire stimulation, retrieval and freezing process within 6-10 weeks with the most intense portion often lasting 3-4 weeks.
I want people who are even considering the process to be evaluated by an REI (reproductive endocrinologist and infertility specialist) to hear more information and see if they are a candidate.
We are increasingly seeing companies cover egg freezing for their employees which is a step in a positive direction–especially at a time where ART in general are at risk due to the aggressive moves on the Republican legislators to limit access and increase regulation as they deem embryos to be “extrauterine children”. Scientists can easily delineate and demonstrate the falsehood in these claims, and that is by showing that [sadly] one may need many eggs or many embryos in order to have one infant.
We would strongly encourage all women regardless of their political affiliation to really look at the motives behind the GOP’s restrictions and recognize that protecting “life” cannot be their ultimate desire as delineated by their exposing women and pregnant people to varying levels of harm and danger.
Imagine a world where all people with ovaries had a discussion with their GYN in a very non-judgmental way about options to grow or limit a family now or in the future including egg freezing, embryo preservation, and permanent birth control to really know one’s option and have insurance cover these discussions and techniques. That would be in support of “life” for adults and their potential families!
If a woman isn't certain she wants to become a mother, what options does she have?
If a woman is 1000% sure she does not want to ever be pregnant then she has the option of permanent birth control in the form of removal of her tubes. This is a surgical procedure that has very small risks but needs to be discussed at length due to the fact that one is under general anesthesia and that the procedure is irreversible. If a woman is sure that she does not want any pregnancies in the future and she feels sure that she will stay in her current/monogamous relationship with a man then she also has the option of him having a vasectomy where the route for his sperm to come out is interrupted. This is often an office procedure with very little risk but is also permanent with limited options for irreversibility.
Sadly, due to the patriarchal nature of medicine, there is still a sense that young women don’t know that they don’t want children and so there are stories upon stories of people requesting permanent procedures who are declined because they are deemed “too young to make the decision”. Dr Franziska Haydanek, who is active on Instagram has compiled a list of doctors willing to perform “tubal sterilizations”.
On the other hand, some people may be very sure but not want a permanent option at this point and LARC’s (long acting reversible contraception) are a great choice (such as progesterone injection every 3 months, progesterone insert under the skin every 3 years or intrauterine devices).
What do you hope your legacy will be as it relates to your work as an OBGYN?
I would love to help export OBGYN health knowledge to the masses in an equitable way with the intention of “increasing knowledge to decrease anxiety” about our OBGYN health. I deeply believe we each spend disproportionate amounts of time with fear and anxiety over health concerns merely because of lack of basic knowledge and no amount of Dr. Google cures that. Currently the stark words written on a black and white screen without a metered voice explaining why most health entities will not lead to death are the only form of education as doctors have decreasing amounts of time to educate.
We are aiming to change that–let’s educate together!