Egg Freezing: An Update

N.B. – This post is ongoing. Parts I-II are finished, parts III & IV are not.

I. Injecting

I was both on edge and unprepared on my first night of injections. I didn’t bother watching  injection preparation videos, figuring that it couldn’t be any more complicated than high school chemistry class. My boyfriend and I had plans to see hipster fantasy wrestling at 8 PM, so I decided to take my first shot after work at 7 PM. To prepare the shot, I had to mix 1cc of saline solution with four vials of powder (Follistim and Menopur). Carefully, I drew up the solution with my big mixing needle and injected it into a vial of Follistim. Somehow I managed to jab the vial in two locations. When I inverted the vial to draw out the liquid, some Follistim dripped out of my first needleprick and spoiled my dose.

Chest tightening with shame, I tossed everything out and started over, only to spill the Follistim again. Nostalgic memories of being a straight-A chemistry student gave way to reality: I was an incompetent mixer of preposterously expensive fertility drugs. Worse, it was after working hours, a time when I felt depleted and unable to think straight.

I ended up wasting four bottles of Follistim that first night and never made it to the fantasy wrestling. Over time, I got more efficient at preparing my injections, but it always required an unusual level of concentration. On day 6, I repeated my folly with Ganirelix — a drug that’s dispensed with an annoyingly dull needle. I tried to decant the Ganirelix into a thinner needle, without success, and lost three doses (worth hundreds of dollars).

By contrast, injecting myself was easy. For each injection, I made sure that the medication formed a small bead at the very tip of the needle. Then, while standing upright, I pinched a generous roll of fat around my belly button and inserted the needle into it at a 90 degree angle. After withdrawing the needle, I lay down to make sure my body absorbed every last drop of the drug.

I took care to vary the injection sites. In the beginning there was only one injection, so I switched from my left to my right side every night. Because the needle was sharp and I was injecting into fat rather than muscle, I could hardly feel it. The real bugbear was Ganirelix, a second injection that I started on the sixth day. Ganirelix came in a needle so dull I had to push it in with extra force, a needle clearly not designed with the comfort of patients in mind.

II. Farming My Body

Before the injections began, I had gone in for a baseline ultrasound. The doctor inserted a probe inside my vagina and pressed it up against each ovary. On a wide-screen monitor, I saw the ovary: a sac containing smaller, fluid-filled sacs. The smaller sacs were my follicles, membranes containing unripe eggs. I had an antral follicle count of 24, which was above average for a woman in her 30s.”You might not feel young,” my doctor said cheerfully,”but you are.” Assuming my follicles ripened at the same rate, I expected I’d be able to harvest and freeze around 20 eggs.

After starting injections, I went to UCSF for ultrasounds and blood draws every 2-3 days. The doctor measured the diameter of each follicle to see how it was maturing. He also measured the thickness of my uterine lining (which wasn’t immediately relevant, since I didn’t plan to get pregnant right away). As time progressed, my follicles got bigger and new follicles developed in response to the hormones. On the third day, I had 24 follicles, all less than 10mm in diameter. On the ninth day, two days before harvest, I had 29 follicles ranging from 7mm to 20mm, with the majority above 13mm.

After my daily ultrasound, a nurse drew my blood to check my estradiol levels. As follicles mature, they produce increasing amounts of estradiol, a form of estrogen. A low and unchanged estradiol level would mean I was a “poor responder” to the fertility medications. Fortunately, my estradiol level steadily increased, going from 148 on the third day to 3,291 on the ninth day.

It was satisfying to watch the follicles get bigger. My ovaries, normally olive-sized, got as big as oranges. Coming to work after the ultrasounds, I felt a manic happiness: for the first time in my life, I was growing something inside my own body! “MY BODY IS A FARM,” I texted ecstatically.

On the ninth day, the doctor took my measurements and decided to schedule egg retrieval two days later. A mature follicle is typically 15mm+ in diameter. On that day, 18 of my 29 follicles were 13mm+ in diameter (and expected to grow at least 2mm more before retrieval). That night, I gave myself the final shot of human chorionic gonadotropin, the “trigger shot”. HCG helps eggs mature and detach from the follicles in preparation for retrieval.

On the eleventh day, I came to UCSF for egg retrieval. I put on a sterile outfit and waited with my mother in a small, clean room with a view of the ocean. A nurse inserted an IV and started a saline drip. An anesthesiologist appeared and told me that I would be deeply sedated with propofol & fentanyl. At the appointed hour, I walked to the operating room with my IV. I lay on a table, feet in stirrups, surrounded by machines and monitors. The anesthesiologist asked me if I was getting sleepy.

Thirty minutes later, I woke up on a gurney. The nurse escorted me back to the waiting room and offered me graham crackers and apple juice. My mother and I walked down to the lobby and called a Lyft to take us home to Oakland. I was told the doctor had retrieved 23 eggs (out of 29 follicles total).

Two days after retrieval, UCSF called to say that 18 eggs were mature enough to freeze. My doctor smilingly told me that I had enough eggs to make a baby. He didn’t think another round of freezing was necessary.

III. Side Effects

IV. Conclusion

[TODO!]

Three days after my first injection, I switched to stretchy pants. I spent the month of August either in Spandex or loose-fitting tunics and leggings.

• so many women in that room
• blood pressure
• side effects, ovarian torsion
• recovery
• emotions
• I cried a lot during the egg freezing, but not for the reasons I thought I would.
• moment where I had to decide what to do with unused eggs
• As planned, in the month of August I froze 18 eggs. The process itself took 11 days, from the first night of injections to the egg retrieval surgery. As I expected, I gained weight, suffered from anxiety, and occasionally wept.