Everything Egg Freezing Part 2: Initial Workup, Egg Retrieval 101, Health Updates
Part 2 of this multi-part blog will be about the initial fertility workup, egg retrieval basics, and some health and logistical hurdles I faced early on.
Please come along with me on this egg freezing journey! We will cover lots of things that have come up for me, from fun things like how to make a smoothie with 50g of protein, to tricky things like how to inject medications to minimize pain and (eek) bruising, to heavier things like coping when you get less than fantastic fertility news. I am generally an open book, and I’m here to share my experience to hopefully make someone else’s experience easier.
Disclaimer: I am always attempting to be as gender neutral as possible when writing and talking about parenthood! Also, I will try to put up a content warning whenever fertility-related things are getting heavier in my posts so that you can skip along if you are not feeling like that kind of content would be good for you to read right now.
Initial workup
I decided to start looking into egg freezing last year after I turned 33 for all of the reasons I go through in detail in Part 1 of this blog series. There are many great options for fertility clinics in the Denver area, and I’d encourage you to explore them all before making a decision if you’re looking into this process if you’re local. I had a lovely friend Dr. Arlene Go who is finishing her REI (fertility specialty) fellowship and was happy to speak with me about the options. Thank you, Dr. Go! Folks in major cities likely will have more than one option, and you can have initial consultations with multiple clinics before committing, if you want.
The initial workup at my first visit involved a blood panel and an ultrasound to assess how many follicles were present in each ovary (this is called an antral follicle count or AFC). The two metrics that the fertility center uses are the AFC and a hormone level called anti-mullerian hormone or AMH. Using those, they can predict a rough range of how many eggs to expect from a cycle. My initial numbers were in the normal range but not super high. To be honest, this step alone was extremely helpful. It was great to know my numbers to be able to make a more informed decision. If my numbers were low, it would have been useful as well, as I would have felt a pull to freeze my eggs more expeditiously. I completed that workup and some additional blood testing that included a blood count, STI screening, and genetic carrier testing. The vast majority of the initial workup, with the exception of the genetic carrier testing, was covered by my insurance, so I only paid the copays for the visits. I’d strongly encourage anyone to at least complete this step if you’re thinking about egg freezing, so that you can make a more informed decision!
Something unique that came up in my workup was the results of my 23 & Me testing that I had done the year before. That test results indicated that I had two separate gene mutations that were suggestive of a combined hereditary thrombophilia, meaning that I have a genetic condition where my blood would be far more likely to clot if I’m exposed to extra estrogen, among other possible triggers. The fertility doctor asked me to consult with a hematologist about these results, who suggested some confirmatory testing. Unexpectedly, my confirmatory testing showed that I actually had two of the same gene mutations (homozygous) for a condition called Factor V Leiden and did not have the other mutation that 23 & Me picked up. Because of this, I am significantly more likely to have a blood clot with the egg freezing process and with pregnancy in general. This means that I have to inject an extra medication called lovenox to prevent my blood from clotting while I’m taking the medications for the egg retrieval. I was shocked at these results. I was on a birth control pill that contained estrogen for 10 years from age 16 to 26 without any issue, which is very fortunate. It truly does reinforce the importance of a healthy lifestyle - I have always exercised fairly regularly, eaten lots of fruits and veggies, and avoided smoking, all of which reduce your likelihood to have a blood clot. I really do credit these lifestyle choices at least in part in helping me to avoid a blood clot so far in life! This is a PSA from your friendly family/integrative doctor 🙂
Logistical hurdles & egg retrieval basics
Here’s a little summary of the egg retrieval process that I’ve tried to make as simple as possible. In ordinary ovulation, one of the several follicles in either ovary would mature and produce an egg, which is released during ovulation. The egg retrieval process involves taking medications to stimulate all of the follicles in your ovaries to grow and mature at the same time while delaying ovulation until the time is right, so that many eggs are produced instead of just one. This requires quite a bit of oversight. You have to be close to your clinic in order to get ultrasounds and lab draws frequently - approximately every other day. Then, once as many follicles as possible are the right size and maturity, you take an injection to trigger ovulation and the retrieval happens about a day or so later in the office with some anesthesia and sedation. After my initial assessment in the summer of 2022, I moved to the Aspen area from Denver. Because I moved three hours from my clinic, I would have to spend 2-3 weeks away from work in Denver to go through the egg retrieval cycle. This added a significant logistical hurdle that I had not really considered before moving. Folks who live in or near major cities will generally not have this issue. Because of this and with the knowledge that my numbers were pretty reassuring, I decided to pause the process and revisit it in the spring of 2023.
Personal journey
*CW: less than ideal fertility news & coping*
In the spring of this year, I turned 34. I contemplated freezing my eggs at that point, but I was still recovering from the stress of the previous year from moving to a new town and changing jobs to grieving the loss of a loved one, and physically I did not feel great. While things were certainly improving, I was still not sleeping well some of the time, and I felt that something was off with my hormones because of all of the stress I had experienced during the previous year. By summer, I was pretty curious about the state of my ovaries. My cycle length had shortened a bit, I was having some pretty intense hot flashes at night, and I had noticed some physical changes in my body that suggested that my hormone health maybe wasn’t optimal. I sent a message to the general OBGYN at my fertility clinic, who was wonderful and took my concerns very seriously. She repeated the ultrasound and did some more hormone testing. Unfortunately, my follicle count had decreased significantly. I won’t log my exact numbers here to avoid unnecessary comparison and stress for anyone else going through this (from personal experience with hearing someone else’s numbers). My AFC was still not technically “low” but was certainly on the low end of normal. My AMH had also decreased a little bit, but my other hormone levels looked okay. While these results were really reassuring that my thyroid health was normal and I was not going into premature menopause or something more serious, things weren’t looking fabulous for egg freezing.
I was deeply affected by this news. To be honest and vulnerable, it was an extremely difficult day. While I realize that I am so fortunate to have numbers that were technically still normal, to have them decrease so significantly in a year was really jarring and concerning. It is really hard to predict how information like this is going to hit, so it was nice to be able to go back to one of my close friend’s apartments after the visit to decompress rather than make the drive back to the Aspen area right away. I would really encourage anyone doing any kind of fertility testing to plan to have some time and a safe space to retreat to afterwards to be able to ground and begin to process all of the emotions that may come up. I let out some tears on my own, then on the phone with my mom and boyfriend, who both were very sweet and supportive. I think it really reinforced how badly I want to have a baby someday, which was actually really helpful, and it did add some urgency to my egg freezing decision. After this visit, I decided to go through with it, but I’d wait until the “shoulder season” which is a time between leaf peeping season and ski season where Aspen is a little sleepier to take some time off of work and proceed with the egg freezing.
I was provided with quite a range of dates by the company, which batches their cycles so that everyone is starting and finishing around the same time. The cycle that ultimately worked best for my schedule was late October through mid-November. It was really empowering to finalize the dates and start planning. After deciding this in late June, I resolved to dedicate the next few months to recovering my physical, emotional and mental health and taking true care of myself. I utilized some expanded panel testing and treated myself with functional medicine. This was wildly successful, and I can’t wait to tell you all about it! More on that in the next post, which will cover the few months leading up to this process!
As always, if you have any questions or want specific aspects of this process addressed, please DM me on instagram @stephkaroz or leave a comment below!
Stephanie Karozos, MD
