Dr Divpreet Sacha

I am Punjabi. My mother is a pharmacist. I trained as a doctor. I say that not as credentials but as context, because it matters that despite all of this, the conditions shaping my reproductive health went unnamed in our family for most of my life. The facial hair and the heavy periods every three weeks were just what the women in our family had. That was what my mum had. That was “normal”.

I had been on the contraceptive pill since I was fourteen. Not for contraception, for the pain and the heavy periods that no one had a name for yet. The pill worked, so we didn't look any deeper. I stayed on it happily until I was ready for a family.

When I tried to conceive, my periods became irregular after a few months. I'm a doctor, so I could get the tests done quickly. PMOS (formerly PCOS) was confirmed on ultrasound. They thought I had a bicornuate uterus. It turned out to be stage 3 silent endometriosis, with polyps and scar tissue on my uterus. My BMI was 22.5. “Normal” on any chart, Western or South Asian. And yet I had the full metabolic picture. Because BMI alone misses what our bodies carry. South Asians hold visceral and ectopic fat at lower BMIs than other populations. “Normal weight” doesn't mean metabolically healthy. Not for us.

I had one NHS IVF cycle. I overstimulated, which gave us six embryos: one transferred, five frozen. The negative pregnancy test came on my twenty-ninth birthday.

Between the NHS cycle and the private one, I read everything I could. Ethnicity-specific BMI thresholds. Vitamin D reading “normal” on paper but still insufficient for fertility. The research on South Asian bodies is thin, and what exists rarely reaches the clinic or gets tailored for us. The private frozen cycle worked. Six months after my first child, I conceived my second naturally.

Afterwards I spoke to my mum. As we went through her own history, it became clear she had probably had PMOS (formerly PCOS) her whole adult life. She was only diagnosed at 70, because she believed PMOS (formerly PCOS) meant visible cysts on an ultrasound. The clinical symptoms were there the whole time. Missed for a generation.