Everything Egg Freezing Part 3: Preparing Myself
Welcome back to my egg freezing journey! We last left off in Part 2 with my numbers having significantly decreased, cementing my decision to freeze my eggs sooner rather than later. As I mentioned, I waited until the late October- early November cycle because Aspen is so busy in the summer and early fall. Our office schedule is pretty full during that time of year, and I wanted to be away (working at most part-time) for a period of time that wouldn’t be massively inconvenient to my patients and coworkers. My primary employer was encouraging and supportive - I believe she would have even supported me taking time away during the busy season as well - and I’m so thankful for that. Knowing that I’d be choosing a cycle a few months from when I decided to proceed with the egg freezing process allowed me to dedicate those few months to my health and healing. I’ve tried to translate things into lay terms as much as possible, but please forgive the density of this post!
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.
**EXTRA DISCLAIMER FOR THIS POST** I am a highly trained medical doctor with extensive experience in integrative and functional medicine. Please consult someone like me if you are curious about testing and treating your hormone health and gut health. Do NOT use my personal journey as a template for your own treatment plan. It is highly individualized and tailored to my own results. Please visit my website to learn more if you’re interested in seeing me for a consultation, or find someone with similar training in your area that you can see.
The workup
I did a few functional medicine tests on myself this year to get a better idea of my hormonal health and gut health. One such test is called the DUTCH test, which uses dried urine assays to assess hormone metabolite levels. Results include sex hormone metabolites, multi-point cortisol and cortisone curves, morning melatonin levels, and more. The results of this test suggested that my DHEA (precursor hormone for testosterone) and testosterone levels were low for my age, and my cortisol and cortisone were high. My morning melatonin level was low. Confirmatory testosterone and DHEA-S serum (blood) testing supported these findings. I was surprised to see that my estrogen and progesterone metabolite levels looked pretty normal. It was really helpful to work with these results to target my treatment plan.
The DUTCH test can also give you an idea of how you process estrogen metabolites to eliminate them. Some estrogen breakdown products are safe and easy to eliminate through the gut. Others are easily converted back to estrogen and recirculated into the bloodstream, and some can increase your risk of a range of conditions like fibroids, heavy and painful periods, and even cancer. My results suggested that I am pretty good at metabolizing estrogen, but that my methylation system was lagging a little bit. Methylation is complicated to understand without a scientific/medical background, so I’ll just say that it plays critical roles in processing B vitamins, how enzymes in our body function, and how our genes are expressed. The many downstream consequences of poor methylation include mood changes, cognition issues, blood clotting, and even pregnancy loss when untreated. I did a serum test for mutations in the MTHFR gene which revealed that I was homozygous (mutations on both sets of genes) for one of the MTHFR mutations. Lucky me, my second genetic condition revealed over the course of this journey! I’m honestly not super surprised, and knowing this also gave me a target to treat and was extremely useful information.
Lastly, I was able to complete a comprehensive stool analysis earlier this year as part of a functional medicine educational experience. Gut health is implicated in many aspects of overall health, including the state of our hormones. I won’t go into great detail on these results, but I found among several interesting things that I have low levels of a cornerstone strain of bacteria called bifidobacterium and some chronic inflammation that I would target in the few months before my egg freezing process began.
The treatment
I went about treating my gut and hormones using an integrative and functional approach. This means that my treatment utilized appropriate dietary and lifestyle interventions, supplementation, and targeted pharmaceuticals when needed. For my low DHEA and testosterone, I started a DHEA liquid supplement at a low dose. Before I did this, I researched DHEA and fertility treatments, and I found that DHEA is actually used quite a bit for fertility support with well-researched and favorable outcomes. For a month or two, I also used maca and rhodiola tinctures to increase DHEA through less direct pathways. This is not something I would have taken unless I had my DUTCH results or serum testing that showed that DHEA was low, which is why it is so critical to partner with a trusted health professional if you want to investigate these levels for your own health optimization.
To target my elevated cortisol, I reduced my exercise frequency and intensity, specifically around weight lifting and high intensity exercise. Over the past couple of years, I had noticed that when I exercised more frequently in those ways, almost immediately my sleep quality was compromised in a way that could not otherwise be explained. This is something that is true for me/my hormone health and not necessarily the case for everyone. I continued hiking avidly through the summer and early fall, which did not have the same negative effect on my sleep, allowing me to stay very active without compromising my health and wellbeing. My melatonin was low-normal, so I gave myself permission to take a little bit more melatonin than the tiny dose that I had been taking, and immediately noticed improved sleep quality and duration. I took a magnesium supplement before bed that has seemed to help quite a bit as well.
I started a methylated B-complex vitamin and a supplement called trimethylglycine to treat the poor methylation from my MTHFR mutation. For my gut health, I got serious about taking my multi-strain probiotic regularly, increasing the diversity of plants in my diet, and adding a flavorless soluble fiber powder to my daily dandelion blend drink to feed and thus increase the abundance of healthy bacteria in my gut. I did not notice any specific sensitivity to food during my elimination diet in the spring, but I have noticed that excessive dairy and gluten seem to trigger inflammation in my body that I notice through puffiness, acne, and bloating. I tried to avoid large “doses” of either of those triggers while generally eating in a way that felt good in my body. I also added NAC and colostrum supplements for a few months to improve inflammation and support a healthy microbiome. I continued a vitamin D supplement for immune support, and would have taken a zinc supplement, but zinc does not agree with my system, which is very unusual.
This plan included me taking considerably more supplements than is typical for my day to day life. I embarked on my journey with the knowledge that this would be temporary, and that I would be repeating the tests after a few months of treatment and eliminating many supplements as I improved. I have also stopped almost all of them for my egg freezing cycle, keeping only the probiotic and methylated B vitamin complex once I started my medications. I am happy to report that with a couple of months of these changes, my energy improved, I was sleeping well consistently for the first time in over a year, my cycle length returned to normal, and most relevantly for this blog, my follicle count on my initial cycle visit for egg freezing was almost back to my initial number! I’m so happy with these changes, and it just reinforces to me that this area of medicine that I love to practice has such great potential for healing and low potential for harm.
I credit this success to these specialty tests and their results for giving me clear targets for treatment. Because the majority of functional medicine testing is not yet covered by insurance, it can be financially difficult to access specialty tests like these. Utilizing companies that offer wholesale prices to tests, as I do with my patients, allows me to cut costs whenever possible. Everyone, ideally, should be able to access this kind of testing, and I hope we see more insurance coverage in the future. I also started seeing an acupuncturist in my community regularly, and in the month before my cycle we really focused primarily on fertility-based treatments. I loved my experience with my acupuncturist. It was relaxing and a way to put some control of the upcoming journey in the hands of someone else who I trusted.
Up next in part 4 - The cycle begins!
Stephanie Karozos, MD
