Once, Twice, Three Times an Egg Freezer
This is a rather colorful retelling of events from the past year. For a more factual version, see this post. Thanks for your interest, and ladies — whatever you do — learn about your options!
It’s 10 pm and my kitchen looks like a crack den. Syringes and antiseptic wipes are everywhere, with an array of suspicious-looking paraphernalia all over my butcher’s block table. My stomach is starting to show telltale markings from late night subcutaneous jabbings in the dark — when, hopped up on chardonnay, I’d inject myself and let the hormones do their magic, sans a dreamlike high.
Three drugs sit before me. There’s Menopur, two powders plus a sterile solution to carefully mix while trying not to create any air bubbles. There’s Omnitrope, the vial I mixed two days ago half full, with two more doses to go. There’s Gonal F, in its classy white pen — a fresh one ready for me to plunge half of its contents into my belly. I take a swig of cold La Crema with one hand while the other applies an ice pack in anticipation.
There’s a noise at the door, and suddenly my adorable boyfriend walks in with a lovely bouquet of ornamental kale flowers.
“I thought this kale looked cool but I don’t think we should eat it,” he says, then stops as he sees what I’m doing. I blush, sheepish.
“Ugh. I thought you were *off* that stuff.”
He rolls his eyes in disgust.
Moments later, we crack up and laugh off the awkwardness. We hug tightly while standing with our feet apart to leave space for my now tender tummy.
How did I get here again?
GNO Gets Real
Flash back to August of 2015, to dinner at a local ramen spot in the Mission, whiffs of heavenly tonkotsu broth in the air. It was Girls’ Night Out (“GNO”), which used to mean twerking late 90’s style aka doing the Running Man (the original that is; the ‘challenge’ version, whatever!), coast to coast, from Bob’s on the Lower East Side to the Pig & Whistle in LA to Sugar Lounge in Hayes. These get togethers (d)evolved into Urban Contemporary dance class at the ODC, where we’d emote for 90 minutes then complain about tight hips, stiff knees, and soreness the next day. Potluck bbq’s and arts and crafts nights followed before some of us scattered to the ‘burbs to have families and finally graduate into adulthood.
Now GNO meant ramen whenever we could. These were natural transitions in life, and we felt fine about them — our conversations now about career moves, home-buying, and IRAS instead of which foundation kept you matte at a Tribe concert or whether to swipe right. It was always so good to see these girls, who were the cool, older sisters I never had. So what if we couldn’t wear heels for more than 20 minutes anymore and were way less religious about our pedicures.
Our bowls of steaming hot soup had just arrived when one of them said,
“So, Tanya. You want to be a mom, right?”
I looked up, no longer mesmerized by my newly broken soft-cooked egg, its creamy center oozing in total #yolkporn.
“For sure. One day? When I meet the right guy, and you know — it, uh, feels right.” I stuffed my mouth with noodles that glistened with eggy goodness.
“Good,” the other said, with a tight smile. “Then it’s time we told you. This is going to feel like what do people call it?”
“The riot act,” said the other. I swallowed.
“Tanya, have you thought about freezing your eggs?”
“Yes, egg freezing. You should do it.” Vehement nodding ensued.
“Really?” Yet another talk about egg freezing. My midwife had suggested it a year ago, along with therapy in case I wasn’t sure how I felt about motherhood. Then a coworker froze hers, a couple months shy of her 40th birthday. She’d given me a similar talk to do the same but I thought, I’m younger. I have time. I was busy with our startup. Besides, my cousin got pregnant *just like that* at 40.
Another coworker, a mom of two, then said she had friends who froze their eggs to have more time between siblings. Add to that dozen friends from college and grad school who admitted to it in passing but didn’t really discuss it openly.
“I’ve sort’ve considered it,” I said. “Why do you say that?”
They shared their stories. One was so concerned about their ability to conceive that she and her husband “did it all backwards”: first came love, then the baby in the baby carriage, then came marriage, and now I’m pretty sure they spend time sitting in a tree, k-i-s-s-i-n-g outside their 4 bedroom craftsman in Alameda.
The other then told us about the painful struggle she and her husband had with conceiving. How after several years of dating, marriage, and seeing the world, they were having trouble with the most important bucket list item of all. They had a beautiful wedding, they had a lovely place together. They carefully decorated their nest, and now had difficulty populating it. Two miscarriages and an unsuccessful round of IVF later, there they were, burdened with great emotional, physical, and financial costs.
My heart hurt. The next day I booked a consult at the clinic closest to work, with the first available fertility specialist.
The First Consult
Three weeks later, I found myself at the waiting room inside UCSF’s Center for Reproductive Health in Mission Bay. I was warm from making the half mile walk from my office. I ignored the wilting orchids and roughed up People Magazines, while nervously fiddling with my phone and reviewing articles I had bookmarked.
Egg freezing, deemed no longer experimental in just 2012, sounded like a bizarre science experiment. High school health class had taught me my best reproductive years were in my twenties as if that was a bad thing (unexpected pregnancy, beware!). Who knew my late thirties would lead to this? Weeks of self-administering hormones — usually injectables, with real needles! — into your own body — yes your own body! — with your own two hands! — did I say needles??? — to stimulate your follicles to grow. An outcropping of teeny, tiny follicles each producing an egg, all at the same time, instead of the typical Darwinistic ovulation process during which the most dominant and strongest egg prevailed. A tiny, nanoscopic needle aspirating each egg, like a “powerful mini Dyson hose” one of my brothers would later joke. Eggs carefully vitrified and cryopreserved, suspended in time. (No, not like Han Solo. That was carbon-freezing). Then thawed and subjected to sperm overload at some point, when Mr. Right or Mr. Right Donor Profile emerged from the riffraff and let several million of his of man seed deluge my thousand dollar eggs.
“Tanya?” A nurse called out. It was on.
Moments later, I was in a doctor’s office, staring at uninspired stock art flowers at the wall. We had just concluded my first ultrasound. This was not your Grey’s Anatomy ultrasound, where a wee peanut of a thing peeped a heartbeat and brought tears of joy to everyone’s eyes, in awe at the miracle of life. Rather, it was an uneventful “hmm” and methodical counting of antral follicles by a soft spoken and serious Dr. Tran, who told me this ovarian survey of my “AFC” would shed light on my ability to reproduce.
A serious, thoughtful man with a serious smile, he shook my hand and gestured me to sit down. He moved quietly, efficiently, and with purpose, like a wiry and lean sensei. Little did I know, but I was in the presence of greatness: he was the sifu of fertility, in a white lab coat instead of a Kung fu uniform (also he is Vietnamese by birth, not Chinese so there’s that). Though we joke about it now*, I didn’t know he was first available because of a cancellation and that would be the first twist of fate that would forever change my future.
“Nice to meet you, Tanya. Before I begin, what do you know about egg freezing?”
I fumbled and tried to regurgitate what I could remember from the Internet. He nodded, and pulled out two sheets of blank paper.
“Women start life with about a million eggs,” he said, while drawing an angular, U-shaped chart, with the base of the ‘U’ in front of me. “Let’s say your age runs horizontal. This left axis is for your egg count. This right axis is for your egg quality.”
“The number and quality of eggs unfortunately declines with age,” he said, while drawing a steep L-shaped arc that fell sharply from left to right before petering out. “By puberty, say age 13, you have about 300,000 to 400,000 eggs. By age 25, you have about 100,000 eggs. By age 35, you have about 25,000 eggs. This is because every month, the female body ovulates and loses about 500–1000 eggs while only one makes it.”
“But, because egg quality also declines, not all the eggs that do come out will be good.” Alongside the right part of the angular ‘U’, he drew a series of hashmarks with percentages that decreased — 100%, 90%, 80%, 70%, 60%, 50% and on down.
“You’re here,” he continued, drawing a narrow box from the egg decline line down to where my age hit the horizontal line.
“Also, I reviewed your ultrasound and you should know that you have a low ovarian reserve,” he said, matter of factly. “It’s not dire, but it’s not the best.”
He paused to see how I was doing. I was dumbfounded. He continued sketching.
“Egg freezing is a process with several steps and not all eggs will make it all the way through. After the retrieval and freezing, about 80% thaw, 70% fertilize, and then how many we transfer and finally implant will depend on a number of factors — but I’d estimate that each of your fertilized embryos, will have about a 30% chance.”
My eyes were wide.
“But don’t worry. I’m confident we can get you enough eggs, and it is great you have made this decision to come in now. Many women wait too late and it’s a much harder process.”
I sighed in relief.
I looked at the tiny, diminishing triangle and 50% chance of having good eggs. I thought about starting with 7 eggs and did the mental math on my own probabilities. I took a deep breath and found my voice again.
“When can we start?”
Fast forward a year and I’ve struggled in writing this post. How much do I disclose? Do I put it all out there? Ultimately I’ve decided full disclosure is best — given the life turn this story has led to — but also in case anyone can benefit from what I went through. So here goes…
Cycle 1: Nervous Noob
I didn’t start this egg freezing process thinking I’d have to do it three times. I was too paranoid about all the details: the tests, the appointments, the orientations, the shots, and the impact, on my work, my finances, my body, my life. Let’s just get this done, I thought.
I began Cycle 1 in typical fashion when confronted with an unfamiliar situation: I became obsessed with the process. I made lists upon lists and a spreadsheet or six, along with uh, you know, a timing calculator that spit out expected trigger, retrieval, and recovery dates based on estimated start of stimulation. I made a binder for all the paperwork, forms, and receipts, using my P-Touch to label the tabs. The usual.
My Cycle 1 Treatment Tracker. Insane in the brain!
(See this post for a more factual summary of the process and results across the three cycles and how they compare.)
I documented away, also feeling strangely responsible for girlfriends who might also want to do this and to know the details. Cycle 1 was largely an orientation to how this all worked, and a trial on how my body would respond to stimulation.
I dutifully attended orientation and med teaching classes at UCSF. First, a mildly uncomfortable information session which combined an auditorium full of IVF and egg freezing patients with an intense sales pitch on their lab. Slide after slide made some of us progressively more confused, while the closing Q&A verged on traumatic. I remember one woman asking a string of questions involving the explicit details of her failed IVF experiences, the anxiety and pain palpable in her voice. Meanwhile, I sat in the back with the single ladies, all the single ladies, who didn’t yet have someone put a ring on it. And now we found ourselves awkwardly flipping through a thick spiral bound book of a handout, wondering which parts were relevant.
Then, a lengthy injection class where a very nice and well-meaning nurse tried her best to walk a bunch of busy, neurotic yuppies through an array of drugs and how to administer them. Everyone had different protocols, so she attempted to teach us about every drug that might possibly be prescribed, while we all stared at each other, fiddled with dummy needles, and took notes. I thought about those brave kids with juvenile diabetes who could show us a thing or two.
After that, I was ready to order medications. Boxes arrived via Fedex with drug upon drug, some on ice in insulated freezer bags. I stocked the other half of my fridge with wine and all my favorites, and steeled myself up for the experience.
A few ovulation tests later, and it was “time to prime”. Because of my low ovarian reserve as assessed with my antral follicle count, I began stimulation with what’s called “estrogen priming” which is typical in only about 20% of cases. For 12 nights, I injected — with needles! — shots of Lupron (Leuprolide) to regulate my hormones and ensure my follicles would grow at the same rate in concert, to maximize my yield of quality, mature eggs. With only one shot per night using a tiny insulin needle, it also felt like my “gateway” drug leading up to three meds per night in the next phase of stimulation to follow.
For 11 days, I was then on Omnitrope, Follistim, and Menopur, a nightly ritual of shots that had varying complexity in mixing and administering. Every night at 10 pm, I did the injections, alternating which side of my belly as instructed to make things easier. After a while, I felt like a pro and didn’t mind the solitude. I was my own Florence Nightingale. I spent those evenings throwing myself into work or domestic projects that sat on my to-do list for years. I reorganized my closets and cabinets, finally set up a new wi-fi router, and boxed up photos for scanning, while binge-watching Scandal and Suits on Hulu, guilt-free. I thought I’d be more affected by the hormones but all they did was make me tired and mildly emotional, like a prolonged bout of PMS had set in.
With about a week left to go before retrieval, monitoring appointments overtook my morning routine. I stopped by UCSF nearly every other morning before work, for an ultrasound to measure my follicle sizes and a blood draw to assess my AMH levels until Dr. Tran and the team thought I was ready. A trigger shot of HCG, human growth hormone, along with a final dose of Follistim made me feel like a bloated and moody gladiator ready for battle. 36 hours later, and it was time for the retrieval.
Retrieval day was thankfully uneventful. I showed up in sweats and thanked Dr. Tran for returning early from vacation to do my procedure. As I went under in the OR, I felt comforted by the friendly staff around me. I vaguely remember hearing some West Coast rap — and thinking, “Does Dr. Tran like Tupac?” — before deep sleep took over.
My retrieval was less than a three hour tour: an hour of prep, a 20 minute procedure under general anesthesia, an hour of recovery with what tasted like the most delicious cranberry juice and graham crackers, and I was done. Good friends took me home and let me nap the afternoon away. A neighbor dropped off home cooked food.
The next day I learned my results. Since it was my first cycle, I had a lot of expectations and yet didn’t know what to expect. With 6 mature eggs frozen from 11 retrieved (from 7 initial resting follicles), we nailed the number Dr. Tran had estimated as my result. We talked about next steps and agreed another cycle or two would be a good idea, especially if I hoped to have multiple rugrats using my own eggs and not a donor’s.
Overall, I was happy with my outcome. I was proud of going through the process, for doing this for my future family, and for finding courage in those odd late night moments when jabbing your stomach with a sharp object just felt extremely counter intuitive. I was glad I made it through.
How could I know the next round would be a disaster?
Cycle 2: A Bad Sequel
After round 1, I committed to my next cycle with UCSF and paid for it in advance. Due to a number of work-life-relationship reasons, I didn’t start until 7 months later.
By then, Dr. Tran had left UCSF to start Spring Fertility, a new fertility center in Lower Pac Heights. My case had been assigned to another physician but Dr. Tran left meticulous notes. Both assured me I was in good hands, and the protocol would be exactly the same with some minor adjustments on retrieval timing and specific lab techniques. I couldn’t be bothered with hassling UCSF to get my money back and since we were going with the same protocol, with the same nurse and clinic, I went for it. Should be same, same — right?
Nope. From the start, it was a very different experience. First of all, this time UCSF could not get it together. Twice I received automated voicemails telling me to come in, only to arrive and be told these were phone consults. Then I would have to wait for 20–30 minutes to meet with my doctor. Moreover, the actually scheduled consults were typically 20 minutes late, and several times I had to follow up with the front desk to ensure I would be seen. At one point, when a phlebotomist hollered into the waiting area full of patients, “Is anyone here for a blood draw?”, I felt like I was at the DMV.
The worst part was feeling disconnected from my physician, whom I will call Dr. X. Not gifted with the warmest bedside manner, he was nonetheless civil if robotic at our first appointment and complimented Dr. Tran’s abilities. “I trust his recommendations. We will follow them exactly,” he said.
Then he was out of touch. I barely communicated with him during the few weeks leading up to stimulation, only to meet again briefly at my baseline. After that, several different physicians handled my monitoring appointments as part of UCSF’s group practice model. I learned that my Cycle 1 was not the norm for patients at UCSF. Dr. Tran had a uniquely hands on approach with his cases. He was way more involved than others, insisted on seeing monitoring results immediately and doing the ultrasound measurements himself whenever possible.
For Cycle 2, aside from the initial and baseline appointments, I didn’t see Dr. X at all. Every time I went in, I felt like I saw a different physician, nurse practitioner, or medical fellow through the monitoring appointments. Each had their own way of measuring during the ultrasounds. The lack of consistency made me nervous — with some recording to the outer perimeter of each follicle and others the inner.
Why does that matter? Because monitoring involves frequent pelvic ultrasounds leading up to your retrieval, to measure the size of your follicles. Your specialists work to ensure a cohort of healthy, quality eggs all grow at the same time — like flowers blooming all at once instead of one at a time. On a stimulation chart, your follicles are mapped by size like a scatterplot, in one of the most personal data visualizations of all.
The retrieval itself was performed by another physician, whom I’ll call Dr. Y. I met him briefly at my last monitoring appointment when he came in to say hello but otherwise had no interaction.
In the end, my Cycle 2 results were dismal: two eggs preserved out of six retrieved. To have gone through 45 shots and four weeks of treatment, and spent thousands of dollars as well as the time and mental energy to only get two? I was devastated.
Cycle 3: Spring Time
After hearing about my results, Dr. Tran invited me to do a third cycle, this time at Spring Fertility. [Full disclosure: after my second cycle, I started consulting with the team on marketing and client experience. This was after helping out nights and weekends, first as an advisor from early construction days through launch. I now work there so I cannot help but be biased. It is what it is.]
He reviewed my two previous stim charts, and recommended a different, faster protocol. No priming, just Follistim and Menopur for six days, adding Ganirelix and continuing the three for four days until trigger. About 12 days of medications total before the retrieval. Helen, my nurse, and the team were incredibly supportive throughout. I saw first-hand how passionate and dedicated they are in delivering the best care and outcomes.
Cycle 3 was fast and uneventful, the retrieval complete just a month after round 2. The results: six out of nine mature! I was thrilled. I’m confident this is all due to the dedication and extraordinary ability of Dr. Tran, Dr. Klatsky and their world class team that does everything humanly possible to give patients the best care. I’ll never forget the smiles of Dr. Vaccari and Dr. Torcia, the husband and wife embryology team who first greeted me with such warmth before we began then such joy post retrieval. Dr. Torcia practically bounded up to me afterwards as I lay there chatting with the nurses, to get me to guess how many eggs were retrieved.
As I reflect on each cycle over the past year, can I say the whole experience was fun and easy? Not exactly. There were nights that were emotionally challenging, when Facebook “family” or “mommy” “tags” are the last thing you want to see, as happy as you may be about your friends’ beautiful families. The combination of hormones and reduced workouts (to avoid ovarian torsion) didn’t exactly make me feel like Beyonce, so going out was not really an option. Most of all, it was frustrating to learn that if I had only done this a few years earlier, I would have saved myself a lot of time, hassle, and cheddar. Three cycles is a lot!
But am I glad I did it? Without a doubt. I’m grateful for that fateful night over ramen, when GNO turned into a “motherhood preservation” intervention. I’m so thankful for the two girlfriends who called me out and literally sat me down to talk about it. They were my catalysts and it scares me that if they hadn’t, there’s a good chance that after years of trying to prevent pregnancy using birth control, I would have missed “my window.”
Nothing beats the peace of mind I have, now that I have put my eggs away for the future. I can look at my boyfriend and worry a little less about when we need to have “that talk” (seriously though, he has been amazingly supportive. I’m lucky!). I also enjoyed the copious amounts of “me time”, the periods of quiet and solitude where I could step back and reflect on what mattered most — and take care of me.
What was also an unexpected blessing is that over the course of my experience, I spoke with over two dozen people — friends, friends of friends, and total strangers — straight, lesbian, gay — who have shared their stories with me about egg freezing and IVF, and everything in between and beyond. Even now I feel a sense of community so strong and so deep about these difficult subjects and varying pathways to parenthood. As friends old and new, we’ve embraced each others’ choices and decisions, and have unique bonds that now connect us.
It has dawned on me that there is an unnecessary stigma about these topics, especially for single professional women who freeze their eggs. We who’ve pursued the career, grad school, startups, travel, and other life goals, or for whatever reason are a little later in the parenthood department, shouldn’t hide in shame or regret because we need a little science to help secure this important and empowering life choice.
Hence this post. In summary, I’m proud of and thankful for my three cycles, and happy to talk about the process and experience with anyone.
After Cycle 1, I became “that friend” who advocates egg freezing. I blasted people with passionate emails and shared my spreadsheet with whomever who would listen.
To my dear friends, sorry for nagging some of you worse than your mothers do. At least I’m not asking about the latest BF and whether he’s “the One”! Seriously, I just want to make sure you are planning for you and have considered this option if you think motherhood might be something you want to do.
And now, I feel extraordinarily lucky to be able to work in this field, with a very special team, and to support a mission so close to my heart.
Ladies: parenthood isn’t for everyone, but if you are even remotely thinking about it, then just know your AFC. Know your fertility potential. The biological clock is real.
*Full disclosure: as stated above, not was I proud to be a patient, but I was also honored to join the Spring Fertility team as their head of marketing and client experience through pre-launch and year 1. I am in awe of their ongoing commitment and dedication to empowering everyone and anyone of any race, origin, religion, identity, sexual preference or other, to own their reproductive choices and achieve parenthood if they want to, now or later.