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I like my eggs frozen.

July 26, 2018

After posting a photo on Instagram one day after my egg retrieval, I had many women inquire about the egg freezing process.  In efforts in be as informative as possible, this post is much longer than usual. Thank you!

 

 

 Last April (2017), I had an appointment for an egg freezing consultation with a doctor who was recommend to me. I was 33, single, and in no rush to settle down (very much a contrast to right before my 30th birthday when my biological clock hit hard and I felt the need to settle down right away! I even went on a dating spree-9 dates in two weeks was the most extreme-and then got over it very quickly when I didn't meet anyone I felt a special connection to).

 

My family was very supportive and encouraging of doing this, and they were also going to provide the financial backing.  The entire process is about $10,000, about $3,000 of that going to medication. (IMPORTANT SIDEBAR: Many insurances are starting to cover this, at least partially, so if you are considering I would contact your insurance company right away.)  

 

The day before my appointment, I ended up getting an audition that was the exact same time as my consultation.  I called to cancel, and said I would be in touch about re-scheduling...and then never did.  I didn't feel an urgency, and felt that if I was meant to have my own kids I would, and that I always also loved the idea of adopting.  My dear friend Alexis, who owns an egg donation company (GoldenEggDonation.com) which aids those who are having difficulty getting pregnant on their own, along with my parents, urged me to reconsider in one year.  Fertility rates drop after 35 years, so freezing the eggs before that would keep the eggs at the age they were frozen at (in my case, 34).

 

When that year mark came along, I still didn't feel the urge to freeze my eggs.  And then my dog passed away.  As I mentioned in my last post, this really helped me stay grounded in the moment without attachments to outcomes, because you never know what could happen.  Just under 2 weeks after her passing, on a Wednesday, I decided I wanted to freeze my eggs, and by Friday had an appointment with Dr. Kalan, who Alexis recommended.  I realized that while I can't know for sure the future, why not give myself as many options as possible.  Right now wanting children isn't in my periphery at all, but in 6-10 years (or sooner, who knows!) I may change my mind.  This is ultimately like insurance, I might not end up using them, but I have the option.  I could technically carry them myself until menopause, which in my family happens around 55, or get a surrogate.

 

 My parents and I went to meet Dr. Kalan at the Los Angeles Reproductive Center in Encino, CA on Friday, May 18, 2018. He was so kind, informative, and funny, and from the start I felt very comfortable with him.  He started giving a basic summary of the reproductive system:  Basically, women receive all their eggs while they're in their mother's womb! There are 1-2 million upon birth, and by the time they get their period there are a few hundred thousand remaining.  The eggs are stored in the two ovaries, and after every period the ovaries secrete the follicle stimulating hormone (FSH) and luteinizing hormone (LH), which cause 15-20 eggs to mature and grow in a small sac called a follicle. These hormones also cause estrogen levels to rise.  Around two weeks after the first day of the last period, the LH hormone triggers the most mature egg to drop from the follicle (ovulation) where it will continue along the fallopian tube to be fertilized by the sperm and then carried to the uterus for growth. The remaining follicles and eggs will then die out, and the follicle that contained the released egg will then release the progesterone hormone which helps the uterus prepare to carry the fetus. If fertilization doesn't occur, the woman will get her period about two weeks later.  At menopause, all remaining eggs will die out.  

 

Dr. Kalan said that women on average have about a 25% chance of getting pregnant naturally, 60% chance through IVF (where the egg is fertilized by the sperm outside the body, then that embryo is implanted into the uterus), and 50% through using frozen eggs which are fertilized at a later time (some don't survive the freezing and thawing process).  What I didn't know until further along in the process was that if I do use these eggs, I have to take progesterone shots in the butt 3 weeks prior to implanting a fertilized embryo to prepare the uterus for pregnancy (which would typically happen naturally after ovulation and conception), and then again until the fetus is 8 weeks old.  There is a suppository option, which isn't as effective, but more options are being worked on, thank goodness!!!

 

 

Anyway, by this point I was already 100 percent sure with my decision and wanted to start right away.  I was already on birth control and scheduled to get my period the following Wednesday, which meant I could start the process in exactly a week, the next Friday (May 25th).  Women not already on birth control will usually be prescribed one month of it before following through with the next steps.  That same day since I was ready, Dr Kalan and his wonderful nurse Amber did a vaginal ultra sound (to count the follicles) and blood work (to test hormone levels). Up until a few months prior, needles were one of my biggest fears, but I had recently gotten much braver after a routine check up the past September.  I realized the anxiety of the needle for me was much worse that the actual pain of the needle, which is good because I have small veins and it would take the nurses on average about two tries to take my blood each time during this entire process. The ultra sound doesn't hurt at all, at the most I would just feel a little pressure.  Much less than during a pap smear.  During the ultra sound, the doctor counted about 16 follicles (about 8 in each ovary), with the potential to be more but just hard to gauge from being on birth control.  He would ideally want to freeze 20, and on average women would have 8-15 that are mature enough to be frozen per round, and therefore would do multiple rounds.  My parents and I decided to just start with one.  There would be a discount if paying upfront for more, but Dr. Kalan seemed more confident that I would have at least 15 from that initial ultrasound (even though they may take out more, they test the eggs to ensure the most viable ones were frozen).

 

The process of egg freezing involves different hormone injections into the stomach area (pinch the skin/fat, do the injection), to produce more estrogen and encourage more eggs to mature, and then the procedure (the egg retrieval), where you are fully put to sleep under anesthesia. The doctor goes in with a vaginal ultrasound that has a tiny needle on the end, which goes into each ovary and drains each follicle to collect the egg.  Then they are sent to a laboratory to see which eggs are mature and healthy enough to be frozen.

 

On Friday, May 25th, I went back to the doctor's office to start the process.  Each check up would involve a vaginal ultrasound and blood work to see my hormone levels, the number of follicles, and the size of each one.  The doctor would measure them each time until he felt they were large enough to do the egg retrieval.  I was supposed to start on the hormone shots that night (two of them, Menopur, and Folistim), but for reasons I can't remember, was told to start them the next night (Saturday).  It was important to take the shots at night to be able to time the egg retrieval in the morning when ready.  For these two shots there was a window from 7-10pm where I could take them, so I decided to start at 8pm.  I am very lucky that I have had friends who had done IVF or egg freezing to guide me and share their experiences with me.  Though each person had different experiences, it gave me a lot of peace to have people to talk with about all of it.  I'm also very lucky that my dear friend Michelle, who has been a nurse for over 20 years, and my boyfriend, who is a biomedical engineer and has created injection devices, live near by and were able to give me my shots.  I had friends who were brave and gave them to themselves without a problem, and though I really wanted to be able to, I just couldn't.  Consistent advice that I got was to not put too much emphasis on the shots, and to continue to have a life.  Though the shots needed to be refrigerated, they would last outside the fridge for a some time, and one friend would even take them to dinners with her and just go to the restroom and prepare the shots then inject herself at the time needed.  

 

 

I definitely was anxious about starting since I didn't know how my body would react to all the medication, and how the injections would feel.  Oddly enough, my period and PMS symptoms that week prior of bloating and irritability were far worse than they usually, which I felt prepared me for what I was about to do. 

 

At that Friday doctors appointment, my nurse went through a demonstration of how to prepare and give the injections (The Menopur comes with one liquid vial and one powder vial which had to be mixed together prior to injection with a vial and syringe).  She also sent links to video's which gave demonstrations. The medications were to be picked up at a specialty fertility pharmacy, MDR, which was down the street from the doctor.  My friends who did it in different states had their medications shipped to them since there aren't many of these pharmacies.

 

I was allowed to have one drink a day during the process, so on Saturday when I was to start, I allowed myself a glass of wine at my friend's birthday happy hour.  My boyfriend and I left the party early and my friend Michelle met us at my place to give me my first round of shots.  I was warned the Menopur might burn for a couple seconds, and the needle for that one also seemed very large which had made me very anxious.  Fortunately, my friend was so good that I didn't even feel the Folistim injection, and the Menopur only hurt for a second! After giving the shots, we found smaller needles in the bag and I realized I forgot the nurse had mentioned that I could switch out the needle for the Menopur! This gave even more relief because the needle was so much smaller! The next night, Sunday, my boyfriend gave me the shots, and each barely even hurt for a second.  

 

 That Monday I went back to the doctor for another check up.  I was feeling great! I hadn't started bloating and my energy felt amazing.  The next day, Tuesday, I felt even better! It was so wonderful!!! Wednesday, when I went back to the doctor again, I asked if I was estrogen deficient and if I could always take these supplements to always feel so good.  He of course said no to both, and that everyone responds differently to medications, the same way some women feel amazing during pregnancy and others don't.  So far during the check ups my follicles were growing well and everything was looking good. I was told to add in a 3rd shot, Ganirelix, that night. This one had to be done at the same time every night. AMAZING TIP-my nurse said that the needle that came with this injection was more dull and had to be stabbed harder to penetrate the skin--however, the needles can be replaced to a smaller, sharper one and that you can get from the pharmacy! To my surprise, only one of the few techs at MDR knew about this!!  The smaller needles are free, and both sets of needles just screw on and off.  So don't forget to ask! When I was given the injection that night, even though it was now three in a row, it didn't hurt! 

 

 

Then Thursday, the Menopur really burned.  It was incredibly discouraging.  Friday my mood was very down.  My parents came with me to my check up that day, and my doctor said that my estrogen levels were incredibly high.  I forget the numbers now, but something like 40,000 instead of 16,000.  It put me at risk for a side effect called Ovarian Hyperstimulation Syndrome (OHSS).  I don't want to scare you though, this is SO RARE!!!! Maybe 2 out of 400 patients will have even a mild form of this, which is mostly heavy bloating after the retrieval.  The doctor only had to give warning because in extreme cases they might have to drain the excess fluids.  Anyway, two days before the egg retrieval you give yourself what is called a trigger shot (Lupron) which is to trigger ovulation by slowing down the production of estrogen.  This new Lupron brand started being used 2 years prior, and because of this new medication the doctor felt comfortable that my body's reaction to the egg retrieval wouldn't be too dangerous. In years prior, he would've cancelled the entire plan.  He also lowered my dosage of Folistin and extended how many days I would take all three shots.  I was originally supposed to take the shots for 10-11 days anyway, but I got excited thinking I could do less since my body was doing so well producing follicles that were growing well.  Needless to say I was so depressed that day.  I dragged myself around.  My parents were a bit worried too, and my dad especially was nervous and questioning if this was a good idea.  But I had already come half way, I wasn't going to stop.  That night I had a glass of wine to help take the edge off, and it really helped.  I felt much calmer and the depression went away.  I'm not advocating drinking to deal with depression, but one glass, again just one (binge drinking is not suggested and will likely make depression worse), calmed my nerves enough and the depression didn't come back.  Unfortunately though, the Menopur burned again that night, but I didn't get as discouraged as I previously had. 

 

 

The next night I was still a little anxious about the burning, and my boyfriend noticed that the last two times the medication pooled a little under the skin which caused my skin to bubble for a couple seconds.  He looked online and read that this can happen with Menopur and that turning the needle at a different angle, with the hole painting down, could help, and it did!! He noticed my skin didn't bubble this time. I was SO happy and relieved! Also, every night from this point on I started putting ice on my stomach for 10 minutes before, smelled lavender oil, and held a rose quartz crystal (good for calming) in my hand. Again, everyone is different, so it's best to try different techniques. Mine didn't work for my friend, who started this process a few days after I did.  Another friend was already very bloated by this time and her stomach was bruised and tender from the shots.  I still wasn't feeling more bloated than usual, and my skin wasn't tender.  There was some light bruising but hard to tell with my skin color.

 

That Monday, June 4th, I went back to the doctor and he was happy to see my levels were back to what he was wanting.  I also had so many follicles which were growing very steadily! He was so surprised that I wasn't feeling abnormally bloated or any discomfort as he said each ovary was the size of a grapefruit since I was producing so many eggs! This was all great news. He even told me that that night would be my last night of my three shots! I was so excited.  Weirdly enough, after I got the shots that night, I was a little sad since it had become part of my daily routine for the last 10 days.  I was told that the next night (Tuesday) I could take my Lupron trigger shot, then again Wednesday morning, 12 hours from the first dose.  That Tuesday night was when my stomach started looked extremely bloated, though I still didn't feel uncomfortable.

 

 Overall though these shots, I never felt too much except the awareness of what was going on inside my abdomen...as if I almost could feel the ovaries growing, but without pain or discomfort.   Wednesday morning I was stuck in traffic heading to my doctors office for another follow up where I was also going to have the nurse give me that last Lupron shot.  I called and was nervous I'd have to pull over on the freeway and give myself the shot, but they said a 15 minute window would be ok.  I would then have my procedure 23 hours later on Thursday morning!  

 

 

Wednesday night my parents came and spent the night with me so that they could take me early the next morning to the surgery center in Westwood, CA, which is only about 20 minutes away from me. The anesthesiologist also called to check in briefly and introduce himself.

 

The morning of, on June 7th,  I wasn't nervous at all! I was told that getting an IV wasn't much different than getting blood drawn, which was my only concern.  My parents had to stay in the waiting room, and I was taken back to prepare for the retrieval. I put on a medical gown and the anesthesiologist came to give me my IV.  I told him that they had trouble getting blood from my veins in my forearm, but he tried twice anyway.  He finally got a good line from the vein on my upper hand.  It was frustrating because he wasn't very gentle, and I got a huge bruise on my forearm from the attempts.  But overall it wasn't a terribly painful experience, just annoying. Soon after the IV started I was rolled into the operating room, where I quickly fell asleep. I was told the entire produce took only about 18 minutes, about 5 minutes longer than usual because I had so many eggs, and I was only away from my parents for about 45 minutes.  

 

Dr. Kalan removed FORTY SEVEN EGGS.  It was so rare! About 3 times more than average!  This was because my body responded so well to the estrogen (hence the earlier precaution), and I was already more fertile as is.  Since retrieving each egg requires a small prick per egg in the ovaries, Dr. Kalan prescribed Vicodin as opposed to the normal, over the counter Ibuprofen that is usually advised.  Most people have cramps that day and are fine the next, and I've know of people going back to work that same day! But with my high egg and estrogen count my recovery was much more intense.  The first couple Vicodins didn't help with the pain, but I felt some relief when I took two more a couple hours later.  It felt like I was stabbed a few times in the stomach. When I would have to go to the restroom, my bladder and intestines would push on my ovaries, which caused more pain a nausea.  I was prescribed Zofran to help with that.  I did throw up and have cold sweats about three times.  This lasted 3 and a half days, until Sunday, but fortunately I would have pockets of time where the pain was less.  I didn't need to take the Vicodin too consistently, but was glad I had it when needed.  Also, I had a liquid hot pack which provided a lot of relief.  I had never experienced such intense pain, but it also gave me some insight and empathy for people who have chronic pain with no end in sight. Again, this was from the OHSS and the number of pricks, so DO NO WORRY, this is very uncommon.  I'm just sharing my more extreme experience.  Dr. Kalan continued his support over the phone through the weekend, and I saw him again on Monday, June 11th, for our final check up which was to ensure levels were returning to normal.

 

 

I was told that about 80 percent of the eggs removed would be viable for freezing, from there about 80 percent would be viable for fertilizing-when I'm ready (with a partner, donor sperm, surrogate...so many options).  I don't remember exactly, but Dr. Kalan said about 80% from those fertilize, and another 80% of those embryo's are healthy for implanting for pregnancy.  Additional genetic testing can be done, which requires re-freezing and thawing the embryo's for shipping, which could cause some to be lost. Anyway, from my 47 retrieved, 41 were viable for freezing!! Dr. Kalan thinks this is a record for his office!! I was definitely in a lot of pain, but knowing I had so many eggs waiting for me helped. I got my period a week and a half later, Wednesday, June 13th.  I was told it would be heavier than normal, but it wasn't for me.  I didn't have cramps either.  It would take a few weeks for my bloating to go down though.  I was able to start birth control again that Sunday after.

 

Now that it has been 7 weeks since my procedure, the pain of it all is a distant memory.  I do still feel like I'm a little bloated, but that is possibly because I haven't gotten back on my balanced eating and workout routine (which I paid no attention to during the 2 week process).  I feel such a weight lifted in terms of now not feeling any pressure about having kids sooner than later because of my age.  I feel more timelessness overall, which is so freeing.  Knowing I have 41 eggs waiting for me in a freezer in Westwood has brought me so much peace of mind, and I feel more capable to fully focus on myself and my work without any rush.  

 

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