This is a three part story about my journey to freeze my eggs. In part 1 I discuss the science and process of egg freezing. In part 2 I discuss the motivation behind why I chose to freeze my eggs. In part 3 I discuss the detailed logistics of the procedure as they pertained to my particular case.
The Science
A variety of factors influence fertility. The mother’s age is just one, and research points to the age of the eggs themselves being the most important factor, barring other issues. Male infertility is a huge problem, and is also exacerbated by age. Some conditions one can test for years in advance, others only show themselves when the mother tries to get pregnant and has difficulties. Women who have children at an older age who run into issues, including those they would have run into when they were younger should they have tried to get pregnant then, have fewer or more difficult and costly options given their age. Moreover, they often have older partners themselves increasing the odds of issues occurring, and health issues, such as cancer, rise in prevalence with age, and treatments can cause infertility.
While egg freezing offers a promising line of assurance, it is by no means a guarantee of overcoming future fertility issues. One method of treating infertility is in vitro fertilization (also known as IVF). The egg freezing process is similar in the production of eggs, which are then extracted. But it differs in that instead of some of the eggs immediately being fertilized, grown into embryos and implanted for hopeful pregnancy, the eggs are instead frozen for potential future use. In recent years both development of a “flash freezing” technique and the discovery that an individual sperm may need help piercing the lining of the egg have advanced the technique to achieve success rates nearly on par with IVF.
Successfully freezing a number of eggs offers the following knowns:
- N, the number of eggs available to do IVF with. For some women, especially at an older age, obtaining eggs with which to do IVF is difficult/impossible. Moreover, the older the eggs the more that are needed for successful fertilization/implantation. Freezing eggs offers the knowledge that a certain number N are available. The ability to produce N eggs in a round of the procedure may drop with age, but N>0 is already a good indication that there aren’t certain fundamental issues.
- X, the age of the eggs at fertilization: this is simply the age of the mother at the time the eggs were frozen; the clock stops at the time of freezing. Roughly speaking the closer the age of the eggs are to women’s peak fertility window, the more likely the eggs are to be successfully fertilized, to implant, and the eggs are less likely to carry chromosomal abnormalities.
The larger the N and the smaller the X the better, as it equates to more options later on.
However nothing in certain. Firstly, one might just ignore the eggs in the bank and get pregnant naturally, in which case the previous exercise was academic. Given the desire to use the eggs, there are further unknowns lurking:
- T, the percentage of eggs which survive thawing. This is thought to be roughly 75%, but given the unpredictability of the process, the smaller the N the bigger the worry, and there’s no guarantee.
- F, the percentage of eggs which fertilize. This is influenced by the fertility of the father (the sperm get a helping hand, but still have to pull off their half of the bargain), but is also thought to be roughly 75%. Again the smaller the N the bigger the worry, and there’s no guarantee.
- I, the percentage of eggs which implant. This is partially influenced by the age of the mother, though it isn’t a primary factor. It is thought to be roughly 50%. Again the smaller the N the bigger the worry, and there’s no guarantee any eggs will implant.
- B, the number of babies. Here I’ll stop talking about percentages and start talking about emotions and humans. After an embryo implants the same worries apply to any pregnancy, including the possibility of miscarriage, health scares, problems for the proto-baby and mother, and delivery issues.
- E, the error bars on all the stats. The number of babies born from egg freezing is very low! Moreover there is some conflation within the statistics as women with fertility issues are more likely to opt for the procedures.
Even given these unknowns there are several advantages to undergoing the freezing process
- Without going through further costly and difficult hormonal treatment, eggs could be tested for fertility issues and chromosomal abnormalities in the event of small F or I.
- The number of babies can be more effectively controlled.
- A notable absence of M, the mother’s age at the time of implantation, from most of the equation!
The Process
There are risks of the procedure, everything from overgrown ovarian follicles, torsion of the ovaries, an inappropriate hormonal responses, to problems during the surgery to retrieve the eggs. Some of these complications (ovarian hyperstimulation disorder) are potentially deadly! None are to be taken lightly (ovarian torsion is extremely painful, and can result in the loss of an ovary)! It remains to be seen whether the hormone cocktail I had to put myself on to retrieve (and potentially to use the eggs) has adverse side effects down the line, research indicates “not really”, but the procedure is relatively new and there isn’t an abundance of data.
The basic idea behind the procedure is that a woman is born with all the eggs she’ll ever need. Each month about 20 eggs from the ovaries enter a race to maturity, and typically only the most viable egg is released into the fallopian tube while the rest are never to be heard from again. The goal of the hormone cocktail is to have all the eggs in the cycle be viable, to extract them via a minor surgical procedure, and to quickly freeze them for potential thawing, fertilization, and implantation at a later date. Ovaries have follicles, and each contains only one egg. The bigger the follicle, the more likely the egg is to be viable, but if the follicles get too big complications are more likely. It’s a balance.
Regular monitoring-at first every other day, and then every day-via vaginal ultrasound probes and blood work is required while taking the hormone cocktail to monitor follicle size and to identify the sweet spot at which the maximum number of mature eggs can be harvested without complications. After the follicles get large enough, the body wants to ovulate, so additional hormones are taken to prevent that from happening. Finally, a hormone is given to induce ovulation at a scheduled time to enable extraction on the chosen date.
The egg extraction surgery is done under anesthesia and involves, somewhat horrifyingly, the same vaginal ultrasound probe, this time with a needle attached. The stuff of nightmares. Luckily you are asleep for this portion. The needle pokes and extracts the fluid from each follicle which likely hosts a viable egg, and a technician then hunts through the fluid for the egg. Eggs which aren’t quite mature sometimes mature in the lab before they are frozen.
Finally, the hormone cocktail and surgery is over, and a course of antibiotics and pelvic rest (no sports, sex, hot tubs, or tampons) is prescribed until the ovaries have a chance to shrink down and the small punctures have a chance to heal without infection. For egg freezing patients who don’t go on to try to get pregnant immediately (as opposed to IVF patients who do) complications are less likely, due to both a slightly different hormonal procedure and the fact that the body has more time to recover without the stress of a pregnancy.
The Cycle: TL;DR
In part 3 of this blog series, I discuss the egg freezing cycle in a diary type format, including exact costs and a blow-by-blow account of my daily life, but here I’ll give a rough view of my personal egg freezing cycle:
Day 0: my period
Days 1–9 : two injections in the evening designed to grow my ovarian follicles, doctor’s visits every other day for a vaginal ultrasound and bloodwork.
Days 7–11: in addition, one shot in the morning designed to prevent ovulation
Day 9–11: now, doctor’s visits every day for a vaginal ultrasound and bloodwork.
Day 12: a shot at 2am and a shot at 2pm to trigger ovulation.
Day 13: surgery to retrieve the eggs
Days 14–28: recovery, IUD insertion, pelvic rest and follow-up consultation
Total cost out of pocket: ~$10,000
Eggs frozen: 17
Cost per egg: ~$588
Stay tuned for parts 2 and 3 of the series!