As an OB-GYN, this is what I wish I had known before freezing my eggs

The idea of freezing my eggs or embryos did not cross my mind until my early 30s. As an OB-GYN, I was constantly advising my patients on the topic and discussing the pros and cons of the process with them; however, it never occurred to me that I would be in their position myself. Helping my friends and family navigate their struggles with infertility, recurrent pregnancy loss and complications in pregnancy also influenced my decision to pursue this process. Statistically speaking, physicians as a group experience a higher rate of infertility, miscarriage and pregnancy complications than the rest of the general population.

My decision to start the egg freezing process was rooted in my desire to have a family eventually—however, I was not married at that time and had not been with my then-partner for very long. In the conversations that ensued with my partner, his family history was particularly relevant as the factor of male infertility played a predominant role in our decision-making process.

There was an underlying sense of uncertainty and fear as my situation was atypical; I was planning on undergoing a procedure that would create a permanence between myself and another person who I was not committed to on paper. We needed to have deep and revealing conversations about our future and goals before arriving at our decision. I questioned whether I should freeze only my eggs or pursue embryos using his sperm. Embryos tend to survive the freezing and thawing process better than eggs, although the live birth rate for both options is fairly similar. This was relevant for us at the time, as we also considered the financial aspect of the process; we wanted the best possible outcome to try and avoid the potential of needing several rounds of egg retrievals or in vitro fertilization (IVF).

Saving stress around fertility in the long-run

During the initial medical evaluation, we discovered that both he and I had medical conditions that could contribute to struggles with fertility.

One of the biggest struggles that I often see with infertility patients is the stress caused by their race against time. They spend six months to a year trying to conceive, only to be unsuccessful and told they are infertile. Then, the process of egg retrieval and IVF begins if they are lucky enough to have the financial security to afford these expensive procedures. As each month passes, their chances of pregnancy incrementally decrease.

This causes an undue amount of stress and pressure on these couples. While both of our medical conditions could have proven obstacles to our fertility goals, being able to go through my procedure without the added stress of the ticking clock was a blessing.

Beginning the process of embryo freezing

As we started the roughly two-week process of injections, blood work and ultrasound monitoring for the egg retrieval process, what surprised me the most was the amount of time and work that this process required. I struggled to balance a busy schedule filled with clinical work, surgery and delivering babies while finding the time for endless blood draws and ultrasounds. On top of all that, I had to estimate the time frame in which the retrieval would take place so that I would not have to miss extra work. Luckily, my IVF clinic was located in the same hospital where I worked, which saved me from having to commute for all these appointments.

On top of those scheduling restrictions, my partner needed to be present at the time of the retrieval, but traveled extensively for work. Having to align our work schedules for an estimated retrieval window presented its own challenges. (The egg retrieval is not a procedure that is scheduled beforehand. Unlike other surgeries where your medical provider can, for the most part, give you a time and date, egg retrieval is largely dependent on how well your ovaries respond to the medications you are given.) After having that experience, I now counsel my patients to consider their proximity to their IVF clinic to avoid extra stress during the process.

Finding your support network is crucial

Throughout this process, I relied heavily on my friends who had previously gone through this procedure. We often compared side effects or reactions to medications and talked about symptoms and sensations during the injections as well as after the retrieval. Unlike my friends, I suffered from more physical complications, whereas emotionally, I did not feel as drained or affected by the excessive hormones. But I did develop an allergy to one of my medications, and every injection resulted in a painful welt at the injection site. Toward the end of my stimulation period, I was quite bloated, as my ovaries had become enlarged due to my PCOS.

At my last ultrasound, I asked the ultrasound technician to measure them; they were each approximately the size of a small grapefruit. I could no longer sit up comfortably in a chair—I could only lean back to accommodate my enlarged ovaries.

When I finally underwent my retrieval, I felt a tremendous sense of relief from the bloating and discomfort. At this point, I thought I was in the homestretch. We were lucky and ended up with a substantial amount of eggs. Having them removed provided that initial relief from the bloating , but little did I know that it would soon return with a vengeance.

While my friends were able to resume their normal activities one or two days after their retrievals, my recovery was more complicated. I developed a rare condition called ovarian hyperstimulation syndrome after my procedure. I became extremely bloated and experienced severe abdominal pain. At one point, I was only able to lie flat on my back as that was the only position that the severe bloating would allow. I had to take a few extra days off of work as my recovery took almost an

entire week. Luckily, I did not have the severe form of the disease, which requires hospitalization.

My pain and discomfort were not routine or typical of most people who undergo IVF. Everyone going through this process should realize that it is generally well tolerated and safe; however, your body is put through a lot of stress. It is a medical procedure, and you must consider all the associated risks and potential complications so that you can make an informed decision for yourself and your family planning goals.

There was a long waiting period of two to three weeks in which we found out how many eggs made it to the embryo stage and also tested genetically normal. The attrition rate was shocking. Only 25% of the eggs we initially retrieved went through the final freezing process. It’s good to recognize that not all of your eggs will successfully fertilize. Of those that do, less than 50% make it to day five or the blastocyst stage, and of those that do make it that far, only about 50% of those embryos will be genetically normal.

4 tips from an OB-GYN to keep in mind if you are considering fertility treatments

1. Prepare financially

Fertility treatments and egg freezing can be expensive. Whether you are bearing the brunt of the costs yourself or sharing that cost with a partner, think about your financial situation and whether you can afford the cost of the procedure or whether you will need to save over a period of months to years. If you consider your options early and budget accordingly, you will be prepared financially by the time you are ready to go through with the procedure. You do not want to be in the position where you need fertility treatments only to be unable to afford them.

One way to assess whether you need to plan financially for this procedure in the future is to speak to your medical provider. Your medical provider can assess your ovarian reserve or egg count to help you determine if you need more immediate plans for family planning or if your egg count is relatively normal for your age.

Additionally, if you have medical conditions that can predispose you to infertility or may increase your risk for this condition, be proactive and talk to your medical provider or a fertility physician sooner rather than later. These medical conditions may include PCOS, endometriosis, uterine fibroids, a history of pelvic infections or STIs, cancer treatment, or premature ovarian insufficiency.

This will allow you to incorporate the projected expenses into your financial planning goals over a period of months to years if need be. Even with fertility insurance coverage, there may be unexpected out-of-pocket costs that you may not be financially prepared for.

2. Plan for your family goals regardless of your relationship status

You can consider egg freezing regardless of whether you currently have a partner or not, and you can freeze embryos with someone whether you are married or not. Marriage should not be a barrier to having this discussion with your partner. I often advise my patients that even if they have an inkling of a desire to have a family in the future, this topic should be discussed with a medical provider so you can assess your options. Don’t let your relationship status delay you from having a conversation with your medical provider if you’re keen to plan!

3. Find and ready your support group

Find a support group, whether it be friends who have gone through the process, your partner, family members or through social media. The infertility journey can be isolating.

As we give voice to these struggles, we normalize this process, allowing for open, honest conversations about the topic. The combination of hormones and relentless poking and prodding of injections, blood draws and ultrasound exams can make you feel like an emotionally drained human pin cushion by the end of the process. Having your support group can help to alleviate some of the inevitable stress that comes with this journey.

4. Be proactive and use available at-home tools

You don’t know until you know. Make an appointment with a provider to discuss your fertility goals and how to achieve them. The accessibility of home tests to assess your ovarian reserve allows you to determine if there may be an issue that needs to be discussed with your medical provider when it comes to your fertility options. These tests typically involve checking the anti-mullerian hormone level (AMH).

While these home tests should not be considered diagnostic, they can often give us a window into your future potential for fertility or lack of it. If you have medical conditions that can predispose you to fertility issues, be proactive and discuss your options with your medical provider. You may benefit from an early fertility evaluation to determine if your medical conditions will be obstacles in your fertility journey. Using apps like Flo to track your cycle can help you determine if there are irregularities that warrant a conversation with your medical provider, as abnormalities with your cycle can affect your ability to get pregnant.

The age-old adage of “knowledge is power” does not ring more true than when it comes to fertility planning. Having access to information allows you to make informed decisions about your future. It gives you choice and agency, which can be so empowering as you embark on this journey.