When I was 23 years old, I was diagnosed with breast cancer. Little did I know just how straightforward cancer treatment would be relative to the unknowns I’ve struggled to wrap my head around in the eight years since—namely, my fertility.
Since finishing treatment (a relatively standard protocol of a double mastectomy followed by three months of chemotherapy and one month of radiation), perhaps unsurprisingly, I’ve become unequivocally obsessed with my health. When you realize just how fragile something is, coupled with a type A personality, you want to do everything in your power to be proactive and get ahead of it. Sadly, this is where the healthcare system, designed to be reactionary, fails us. None of my doctors cared to engage in a conversation about my reproductive future. It was up to me to figure out how to optimize, execute, and in some instances, totally recalibrate.
And that’s where things can get dangerous. As a motivated patient dedicated to minimizing my risk of cancer recurrence, I resorted to the internet and the wellness industry writ large to supplement what I wished my doctors would tell me. I wound up self-experimenting according to what I heard has worked for others (intermittent fasting, keto, IV therapy, HRT...the list goes on), who don’t necessarily share the same medical history, risks, or even goals. And then I held my breath, waiting for my desired outcome, hoping I didn’t cause any harm to myself or my body in the process.
I followed the guidance I received through podcasts, blogs, and Dr. Google. I became so restrictive about what I should and couldn’t eat, and when I should eat, that I pushed myself into a chronic state of stress. In other words, my body shut down.
Given how far along we are in the wellness boom, and how prevalent women are as consumers of wellness services, it’s surprising just how little many of us know about our own bodies. With the conversation now trending towards maximizing longevity and slowing down the aging process, it’s no surprise women are constantly trimming fat, restricting calories, doing HIIT workouts, etc. Unbeknownst to me, the research around these modalities has primarily been done on men, and their constitution and their hormones are jarringly different from mine. According to a 2010 study from the National Institute of Health, “Underrepresentation of females in animal models of disease is commonplace, and our understanding of female biology is compromised by these deficiencies.” In fact, it’s mostly the opposite advice anyone trying to get pregnant should follow. “Wellness” is not created equal, nor is it one “time” fits all.
Ultimately, that’s where I went wrong. I tried to optimize without any guidance, and ended up hurting myself—and my fertility—along the way. Eight years into remission, and my pregnancy journey ended up being way more complex than my cancer journey. I struggled to figure out why I was no longer ovulating or producing a period. I went through several rounds of IVF and IUI, but ignored the big elephant in the room: my weight. I was too skinny (my BMI was hovering around 16.4) and stressed, and each step in the process somehow made it worse. After several failed IVF attempts, I pursued surrogacy. I feel extremely fortunate to have been able to choose that path, but if I could do it all over, I would tell myself to just gain five to 10 pounds and try my best to relax.
The fact of the matter is, I should have received a more comprehensive approach to my fertility. I went to the best reproductive endocrinologist in New York City. He looked at my hormone levels and was confident my deficiencies would be resolved through IVF alone. As long as I took the required medications, he said, I should have no problem getting pregnant. Two miscarriages later, I realized it was time to get a second opinion.
What I later learned was, yes, I could get pregnant, but I couldn’t carry a healthy pregnancy until I reversed the damage I had done to my thyroid and hormone health. To this day, it’s hard to say why my doctor felt the way he did. But what I do now understand is that intermittent fasting coupled with an overly restrictive diet, overwork, and overexercise is not the way to support fertility—at all. According to a 2022 study using data from the National Health and Nutrition Examination Survey, “There [is] a non-linear relationship between BMI and infertility, with each unit increase in BMI reducing the risk of infertility by 33 percent when BMI was < 19.5 kg/m2.” I had been so focused on optimizing my health for cancer prevention, that I had lost sight of how my obsession with my health and wellness was actually hurting, not helping.
I can’t say I look back on my cancer or infertility experience fondly, but I am grateful for the insights I gathered, because it led me to build The Lanby, a healthcare members club. Wellness, just like medicine, needs to be personalized. Healthcare requires an integrative approach, and we can’t rely exclusively on physicians to carry that burden. I wish I had been able to collaborate with a registered dietician (or in our case, a designated wellness advisor), who could’ve guided me to a healthier lifestyle around my needs and goals at the time. Equally importantly, wellness modalities should be monitored and tracked by a medical professional to ensure patients are optimizing safely and effectively.
As a “professional” patient, it’s easy to see just what needs to be done to bypass the archaic, incomplete, factory-like experience of traditional primary care, in favor of a healthcare system that considers our future as well as whatever is ailing us in the present.
Chloe Harrouche is the co-founder of The Lanby, a primary care members club based in New York City that prioritizes a patient’s needs from all perspectives of healthcare.
