Susan
As a woman in the midst of freezing her eggs, I can't help but look back to the choices I made that brought me here. My story is like a growing number of women in today's fast paced, modern society. I am a bright, successful and independent 35-year-old single woman with no children. Not being in a stable relationship means that there are no plans of marriage in my immediate future. This is not a situation I ever thought I would be in. Growing up and in my twenties, I just assumed that I would have found Mr. Right by now. I dreamed of having it all; kids, a husband, money and a successful and fulfilling career. It just didn't work out that way. As a Ph.D. student, I am still working on my career. Like many of us, I am far from reaching financial stability. The dream of settling down and starting a family has been deferred; much to the dismay of my parents. Like most parents and people from previous generations, this is not something they ever had to worry about. People often got married in their teens and early twenties so women did not have to deal with their so-called "biologic clock". Mostly men pursued a higher education and even if they spent their twenties and thirties moving up the corporate ladder to gain financial independence, most were still able to start a family whenever they wished. Now women have gained much more freedom and are allowed to pursue fulfillment outside the home. However, if they follow the male model of success and spend most of their fertile years pursuing success instead of starting a family, they risk infertility. This is a problem facing more and more women. In fact many of my friends my age are also unmarried with no children.
Soon after I turned 30, I started to notice various campaigns out there urging women to think about their biological clock. On average, fertility declines after 30 but drops significantly after 35 and the cold hard truth is that most women after the age of 40 cannot have children naturally. Even Oprah had couples and women coping with infertility on her show at some point. The experts on her show urged women to start a family before their eggs ran out. The problem was that this did nothing but raise my anxiety level. What if I don't find a good partner in time? I certainly wasn't willing to get married just because there is a chance I may become infertile in the near future. I was also definitely not interested in getting pregnant with donor sperm and raising a child as a single mom. At that time, egg freezing was still mostly unreliable. These experts also didn't give a clear way for me to figure out when I might actually run out of eggs. They had statistics for the population as a whole but they conceded that some women have healthy eggs at 40 yet some women actually run out of healthy eggs in their twenties! To make things even more complicated, the media and society in general sometimes advertise the idea that women can have it all, including a child at any age. The truth is that when one hears of a celebrity or any woman after the age of 45 having children, chances are that they did not use their own eggs. It often seems like the media is spreading misinformation but I understand why women who use donor eggs would want that kept private. They probably want to explain to their kids how they came to be when they are old enough to understand and not have them hear that they have another biologic mother from the media. I was consoled by the statistic that fertility in women usually does not begin to decline rapidly until after age 35 and since I was healthy with regular periods, I did not worry about it much then.
The years quickly passed and when I turned 34, I felt panic settle in and Googled for any information on age related infertility. Most of the information out there was for couples having IVF but I was really interested in figuring out how fertile I still was and if it was even possible to preserve my fertility. I then came across a great website by Dr. Silber called www.infertile.com. I found out about the antral follicle count test where a woman's ovaries are scanned using a sonogram for a cost of $350. Certain hormones measured from a blood test also help determine fertility. Immature follicles called antral follicles that are selected by the ovary to start developing are counted. Only one or two of these are eventually chosen to release a mature egg during ovulation. The number of antral follicles gives doctors an estimate to the total number of eggs left in the ovary and a rough idea of when the ovary might run out of eggs. According to a video about the test on the website, a woman ideally wants a total of 10 or more antral follicles. I called Dr. Silber's office to ask if there was anyone they knew that did this test in New York where I live and they referred me to Dr. Zhang's office. He is closely affiliated with Dr. Silber and his website has much of the same information as Dr. Silber's site. Great, I thought, finally a test out there that will let me know if I should start to worry or not. The test cannot determine the quality of eggs but the more eggs, the higher chance that at least one of them is still viable.
There was more to learn. According to these two websites, there are now ways of preserving fertility by successfully freezing eggs and even ovarian tissue. With ovarian tissue freezing, one ovary is frozen and could then be transplanted back into the body and the woman could then conceive naturally with this "younger" ovarian tissue. With egg freezing, up until then I have always heard that few eggs survived a freeze thaw cycle and that egg freezing was not recommended by many experts. This is unlike sperm and embryo freezing that has been done successfully for decades now. An egg cell is larger than a sperm cell or even the individual cells in an embryo and is thus filled with more water. In a more conventional freezing procedure, the egg is first dehydrated to remove some of its water and then "antifreeze" chemicals are used to protect it from forming crystals when frozen. However, using a conventional slow freezing technique may still result in the formation of ice crystals that will disrupt the delicate structures of the egg cell. A new freezing technique called vitrification does not require eggs to be dehydrated and a much lower concentration of "antifreeze" chemicals are needed. The eggs are flash frozen so quickly (dropped 23,000 degrees C per minute) that ice crystals don't have a chance to form. This allows eggs to now be safely frozen with a survivability of 95%. The live birth rate from eggs frozen using vitrification is around 30%, that same as with unfrozen eggs. In fact, I found out that Dr. Zhang's clinic was the first one in the east coast to use this freezing method. This was huge for me. It was nice to finally have options if I ever needed them.
I made an appointment for an antral follicle count with Dr. Zhang. Since I was then under 35 years old, we were both hopeful that my ovaries contained a large number of antral follicles and I would be able to use the snooze button on my biological clock. I was a little nervous before the test but hopeful as the doctor counted my antral follicles. I found out to my horror that I had a total of only six to seven follicles where an average woman my age might have more than double that figure. For some reason, I was probably born with fewer eggs than an average woman and I was actually starting to run out of eggs. It suddenly became clear that I would probably not be among the lucky few that could conceive naturally at 40. I may not even be able to conceive younger than that! I was suddenly confronted with my own biological clock in a very real and frightening way. This was particularly disturbing because thanks to Google, I found out that many regular fertility clinics and facilities that advertise egg freezing frequently reject women with low ovarian reserve. The doctor tried to comfort me and reminded me that we were still waiting for my blood results. Since I was still young, there was a good chance that the few eggs I was producing were still viable and could result in a baby. Dr. Zhang has a one good egg policy where as long as at least one good egg is produced, a woman will not be denied treatment. Thankfully my hormone levels looked good when my results came back. It meant that I would probably respond reasonably well to the IVF drugs if I were ever to take them. I was glad that I did the test when I did. It wasn?t too late but I had to do something soon. Since I wasn't ready to start a family at that point and didn't have a clue when I would be emotionally and financially ready, I decided to go ahead and preserve my fertility as best I could.
I found out that if I would opt to have my eggs frozen, I could have my eggs collected through the same process as a natural cycle IVF, regular IVF or a mini-IVF procedure except for the fact that the eggs would be frozen instead of fertilized and implanted. The cost of $8,500 for three cycles was the same regardless of the IVF treatment used. However, the drug costs of the mini-IVF and natural cycle IVF would be far lower ($400 at most) than regular IVF (as high as $5,000).
With a regular IVF procedure, the ovaries are first prepared with birth control pills that allow for more eggs to start growing at the same time. Then they are highly stimulated with drugs so they can produce as many eggs as possible, maybe up to 15 or more with young women. The eggs are then collected through IV sedation. In the end, only about 3-5 of those eggs will result in healthy embryos that are eventually implanted and result in healthy pregnancies. In addition, one must take 20-60 injections of drugs in a month that can cause many unpleasant side effects. There is also a recovery period between the cycles when the eggs are harvested.
With natural IVF, no follicle stimulating drugs are used at all and only the one or two eggs that your body would naturally mature would be collected with local anesthesia. This is the most natural approach since these are the same eggs that would have been fertilized in a natural pregnancy. The advantage is that these represent the best eggs your body produces. Since no drugs are used, there are virtually no side effects and no recovery period afterwards and no cycle need ever be skipped over. Some of the disadvantages are however, that since no drugs are used to control for and time the ovulation date, the cycles need to be carefully monitored. In addition, since usually only one follicle matures every cycle, there is always that small risk that no egg is produced from that follicle. However, more cycles can be used within the same period compared to conventional IVF. This procedure even boasts pregnancy rates as high as that of conventional IVF since only the "best" eggs your body produces are used.
A mini-IVF procedure may also include a preparatory period of birth control pills. Clomid, a safe and inexpensive drug used for many decades and only up to three hormone injections are taken before an average of 3-5 quality eggs are collected with local anesthesia. Mini-IVF produces more quality eggs than natural IVF has the advantage of timing ovulation to make retrieving a mature egg easier. Compared to regular IVF, there are very few drugs and injections. It is much easier on the body with fewer nasty side effects. This appealed to me very much since I found out that few of the many eggs collected through conventional IVF result in a successful pregnancy anyways. As with natural IVF, the idea with mini-IVF is that quality is more important than quantity and although fewer eggs are produced, they are far more likely to result in a pregnancy. According to Dr. Zhang's website, these gentler methods result in similar pregnancy rates with conventional IVF and even higher pregnancy rates among older women who may produce fewer quality eggs to begin with.
There are many advantages and disadvantages that each person needs to consider before deciding which fertility preservation treatment to pursue if any. Different treatments may be suited to different people. Ovarian tissues freezing is less expensive and one can possibly conceive naturally after the ovarian tissue is transplanted back but since my ovarian reserve was low, I didn't want to later try to get pregnant with only one ovary. Therefore, as soon as I was able to save the money I needed, I froze my eggs using the mini-IVF procedure. Dr. Zhang's focus on the quality of eggs collected rather than quantity and the fact that the vitrification method of freezing is used convinced me to go with the New Hope Fertility Center.
Due to my low ovarian reserve, only an average of 2-3 mature eggs were retrieved and frozen per cycle so I added a few more cycles than I originally planned in order to increase my chances of success. As expected, I had no side effects from the drugs I took. The egg retrieval process done under local anesthesia was a relatively painless procedure that took only 10 minutes or so and I was able to resume my normal activities right afterwards.
Throughout this process, I felt that I somehow dodged a bullet. Now that I am freezing my eggs and have some reassurance that they will survive the freezing process, I don't hear the ticking of my clock biological as I did. There are certainly no guarantees of getting pregnant using these frozen eggs in the future but I know that I did as much as I could to protect my fertility before it was too late. I don't plan on becoming a mother very late in life because of this. Ideally, I would like to have a child naturally but I know that if I cannot have a child when I am ready and need to opt for IVF anyway, I would have a better chance of success using my "younger" frozen eggs. The process of freezing keeps them from aging and they will be healthier and have less genetic abnormalities on average than those produced at a later age.
This is not something most women need to go through but it is reassuring that more options now exist to preserve a woman's fertility. It may save some women from the shock and trauma of infertility and from having to resort to using donor eggs to get pregnant. Egg freezing is a costly venture with no guarantees but I know that it was the right choice for me. My wish is that the antral follicle test will be given to women as part of a routine gynecological exam and such procedures as egg freezing will become more accepted in our society and are eventually covered by health insurance so more women may take advantage of these opportunities.