THE MOTIVATION
My decision to start this journey was driven by few but very compelling factors, mostly because my firm provides fertility insurance, covering all related expenses. Paired with my flexible work hours, the consideration easily shifted from “why” to “why not”?. Now, I’m pretty fearful of needles and surgical procedures, but my cautious nature kicked in, and I began to see it as a sort of insurance policy, granting me the opportunity to delay motherhood until a later date. Egg freezing has often been compared to a safety net for women who aren’t quite ready for the mom life, a concept I wholeheartedly resonated with. However, I’m acutely aware of the privilege I enjoy in this position, especially after hearing from friends who cited financial hurdles as their primary deterrence. Furthermore, with many of us now navigating hybrid work setups, not everyone can easily juggle frequent doctor appointments or adhere to a strict injection schedule due to less flexible work arrangements. So, while I eagerly embraced this opportunity, I’m fully conscious that it’s not a path accessible to all.
For any one curious, you may read about my complete egg freezing journey here where I’ve shared the whole experience from start to finish in a step-by-step manner.
MY MISPLACED CONFIDENCE
I’ll confess, I embarked on this journey with a good dose of confidence. As a 32-year-old single woman who maintains a balanced diet, regular exercise, and nurtures my mental well-being, I initially thought this process would result in a generous egg collection count. Fueled by numerous personal stories I read online and experience from a similarly aged friend, I’d read about an “average” of 15 to 20 mature eggs collected per cycle for someone my age. So, for my first go-around, I had my sights set on around 15 eggs. However, my confidence couldn’t be more misplaced.
Fact #1 — Good ovarian reserve numbers (i.e. AMH levels) do not guarantee a high egg collection count
In my initial consultation, the doctor evaluated my suitability for the egg retrieval process, which included checking my Anti-Müllerian Hormone (AMH) levels. To my delight, my results fell within the “Good” range, a positive sign. This optimism was further fueled during the hormone injections when, despite using a lower-than-average dose, I had a strong response with more than 20 follicles developing. However, when it came to the actual retrieval, the final count was a bit of a shocker — only 13 viable eggs. It was then that I learned a valuable lesson: AMH levels aren’t an indicator of fertility but rather a snapshot of ovarian reserves, like a count of immature eggs, offering no insights into their quality.The doctor emphasized that even some women in their mid-40s with high AMH levels may struggle with infertility due to inadequate egg release caused by nutritional issues. In hindsight, I recalled the doctor diagnosing me with PCOS, a condition that hadn’t quite registered with me until after the procedure.
Fact #2 — What is Polycystic Ovary Syndrome (PCOS)? Should it matter if I am asymptomatic?
Let me break it down — Polycystic Ovary Syndrome (PCOS) is basically a hormonal hiccup that messes with how your ovaries do their job (I am still a bit fuzzy on the details). I must have read several searches on PCOS and experienced none of the symptoms listed. No irregular periods, no weight issues, no insulin resistance, and my ovaries looked pretty normal. But surprise, surprise, PCOS played a pivotal role in all of my doctor’s decisions.
Firstly, she placed me on the antagonistic route, utilizing Decapeptyl as opposed to hCG as the trigger hormone. Why? Well, Decapeptyl has a shorter half-life, which means less swelling in the ovarian department. Next, she was extremely cautious, monitoring me at every stage for any signs of Ovarian Hyperstimulation Syndrome (OHSS). Fortunately, I didn’t have any major side effects to report. OHSS symptoms are associated with fluid imbalances, leading to bloating, nausea, and, in extreme cases, fluids escaping into the empty spaces like the lungs, causing pneumonia. Seriously not fun.
In the end, the doctor simply stated that I probably had asymptomatic PCOS (“lien PCOS” was it?). Dissatisfied with the simple statement and unable to find more details for “lien PCOS”, I went off on my own with Google to self-diagnose myself with inflammatory PCOS, as most of the symptoms appeared to align with my personal experience.
Fact #3 — Anticipate unforeseen attrition throughout the entire egg retrieval process
As I’ve personally experienced, the egg retrieval process involves attrition at various stages. To illustrate with my own numbers, this attrition begins during the stimulation phase when multiple follicles are encouraged to develop, but not all of them will mature into high-quality eggs (from 21 follicles to 13 eggs collected). Following the egg retrieval, an Embryologist reviews the eggs to identify those mature enough for freezing, resulting in further attrition (from 13 collected eggs to 11 mature eggs).
In the future, not all frozen eggs will survive the thawing process, typically with a 90% survival rate. The attrition doesn’t stop there; it continues during the fertilization process, as not all fertilized eggs will develop into viable embryos. Even among these embryos, only a fraction may successfully implant in the womb, leading to yet more attrition.
Having a greater number of frozen eggs raises the likelihood of achieving a successful pregnancy. Considering my age and with 11 eggs in the bank, this translates to approximately a 60% chance of having one child (see chart below).
To illustrate the unpredictability of this journey, my doctor shared an anecdotal example of a woman with PCOS who had 40 follicles, yielding 20 mature eggs and eventually 12 embryos. I’ve also come across stories of individuals who began with 14 eggs collected but only 6 deemed mature enough for freezing. The outcomes are undeniably unique to each individual’s composition.
If I may attempt to summarize, this attrition highlights the intricate interplay of various factors in the first half of the path towards pregnancy through IVF, i.e. :
(i) Follicle count influenced by AMH levels, often referred to as ovarian reserve.
(ii) The quantity of eggs retrieved primarily hinges on egg quality, influenced by nutrient availability and overall health during the maturation cycle.
(iii) Successful fertilization depends on both egg and sperm quality.
(iv) The likelihood of successful implantation is contingent upon uterine health, including the absence of fibroids, polyps, or endometriosis, as well as hormonal equilibrium.
Just looking at these numbers makes it clear that the journey to pregnancy in later years can be challenging and emotionally draining. The combination of medical intricacies, the unpredictability of fertility, and the emotional toll of fertility treatments can really make you feel uncertain and anxious, whether you’re on this journey alone or as part of a couple.
Fact #4 — Even with healthy frozen eggs, achieving a successful pregnancy isn’t guaranteed
As highlighted earlier, I came to realize that egg freezing is just one piece of the intricate puzzle called pregnancy. You can think of the factor equation as pregnancy = egg + sperm + womb. Elective egg freezing, I learned, isn’t a guaranteed ticket to future motherhood. Instead, it’s simply a way for women to extend their fertility timeline, potentially increasing their chances of having a healthy child with fewer birth defects by using high-quality eggs. It suddenly became clear to me that a healthy uterus and a partner with good fertility health are key players in this equation. Thankfully, the doctor assured me that thanks to better nutrition and overall health, many women nowadays can become mothers in their 40s or even later with IVF.
It may seem like common sense now, but as a single woman on this journey, I didn’t immediately grasp that despite all my efforts to maintain my health, choosing a partner with questionable fertility health (especially habits like smoking, drinking, stress, and late nights) could potentially overshadow my endeavors. I remember asking the doctor a straightforward question: “IVF would be a last resort for pregnancy, right? I might not even use my eggs.” She responded with a polite yet very clear eye roll. “It takes both a sperm and an egg to create a pregnancy, I have patients with male fertility issues that can only get pregnant with IVF” she explained, sharing anecdotes of other couples she had seen. In fact, while waiting for my consultation one morning, the couple ahead of me discussed the husband needing to take supplements for six months before their IVF treatment. It was a poignant reminder that having a partner who maintains a healthy lifestyle doesn’t just affect your surface-level well-being; it deeply influences your journey toward building a family.
“By the way, Singapore doesn’t have any regulations requiring you to keep your eggs here. They previously considered limiting storage to three years onshore, but it’s an option to move your eggs overseas to places where it’s legal to use a sperm donor as a single woman.”
CLOSING THOUGHTS
Read about my complete egg freezing journey here where I’ve shared the whole experience from start to finish in a step-by-step manner.
Delaying motherhood through egg freezing offers significant benefits, but it also comes with several limitations, such as financial costs, your partner’s health, and your own ability to develop healthy eggs. Beyond the financial aspect, it’s crucial to acknowledge the non-monetary costs involved, including the time commitment and the discomfort of medical procedures. While the doctor assured me of no permanent harm, being someone averse to unnecessary medical procedures, I still shrug at the thought of going through general anesthesia and the courses of antibiotics. There were moments when I questioned my decision, wondering why I willingly subjected myself to the pain and time-consuming nature of this process. However, over time, I found solace in the invaluable peace of mind it provides.
While my aversion to needles and surgical procedures remains, this journey has left me profoundly grateful for the option to safeguard my fertility. It’s incredibly reassuring to realize that women can have healthy pregnancies well past the age of 35, using carefully preserved, high-quality eggs, and with good overall health, along with a healthy partner by their side.