Eggcellent Insurance?
It is no secret that there have not been many men in my life - especially not any that seemed like the right person to procreate with. I bought a Chevy Tahoe when I was 23 and was certain I would have kids in it before I was done driving it. I drove that car seven years and the next SUV for four...then moved to Finland...and still no kids. Perhaps I should have purchased the two-door sports car at some point if I wanted this to go a different way. Anyway, that is all to say life certainly has not taken me where I expected it to at this point - turning 36 in less than two weeks. For the most part, I am okay with that. I have had a pretty awesome life and have gone on some pretty amazing adventures. I live a life I am proud of and one that I am happy with. My family is amazing, work is not too bad, and as of recently, I am a homeowner. Living the American dream, right? Mostly. I do not spend much time focusing on what I do not have because what I do have is pretty darn fulfilling. Alternatively though, I fear I have become REALLY good at being single and am pretty much just a flaming bachelor now (but wait, do bachelors go out all the time? If so, I fail).
I wish I could remember when, but one day when we were eating at Matt's El Rancho with good friends of my sister and her husband (who have also become good friends of mine), Vickie spoke up and said "I'm only asking this because I've had two margaritas - but would you ever freeze your eggs?" At that time, my answer was a very confident "no." I assume I was around 31 or 32. The wheels turned a tiny bit after that but I was still squarely in the "no" camp. I had decided that if I got to the age where my eggs were too old that I would probably feel too old to have a kid anyway. Not that that was what I wanted, but for whatever reason, I just did not think I would want to be 42 using my 32 yr old eggs to have a kid.
Minds Change
Fast forward a few years to the Fall of 2014 and my mind began to change. I had a brief (as in less than a few hours) scare upon receiving results to some blood work that made me think perhaps I would not be able to have children as easily as I would like, or perhaps not at all. I do not think I would call that a turning point but it was the first time I was faced with the thought of infertility and it did not sit well. By early 2015, my mind had definitely begun to change and I was getting my head around the idea of doing it. The fact that I had been on all of three dates in the five years since moving to Austin may have pushed me towards a change of heart as well. Then, of course, my boss asked me to move to Finland and in some ways part of my life was put on hold for a good two years. By early Spring I decided I definitely wanted to freeze my eggs but did not have enough time before moving abroad. I think that one of the biggest lessons I learned about myself through the process is that my mind can change, and that it is okay if it does. But also that I do not need to assume that just because I feel a certain way today I will always feel that way.
The Before
Once my move-home date from Finland was settled, freezing my eggs was at the top of my list of priorities for things to do when I made it back. I started to do my research over last summer and asked around my group of Austin friends for doctor recommendations. I ended up having a consultation with Dr. Vaughn at Texas Fertility on a trip home in August. A friend was currently seeing him for IVF and the whole practice was widely recommended. After my consultation with him, I did not think I needed a second opinion. TFC's pricing was actually on the lower end of what I was thinking this may cost and I liked Dr. Vaughn. I had an AMH blood test while in town and they let me know the results of that looked promising for egg freezing. I was to get back in touch when I was home for good.
The During
I arrived home from Finland on December 1 and was supposed to call the office on day 1 of my next cycle. They had to do a bit of calculating to make sure the timing of my egg cycle would steer clear of the lab closure for the holidays. They decided I'd start taking birth control on December 11 and take it for 3 weeks. On December 27, I went in for a baseline sonogram and started my first injections. That drug was Lupron. I started at a dose of 10 units to be injected within the same 30 minute window every morning. Lupron basically shuts down your hormones and is used to prevent ovulation. I moved down to 5 units daily starting on January 6. Lupron was surprisingly covered by my insurance. Otherwise it would have been a little over $500 for the entire course.
I went back on January 5 for another ultrasound and to get dosage instructions for the next drug - Gonal-F. Gonal-F is the important one - the one that makes the eggs. Generally, you release one egg month. The goal here is to get as many growing and released as possible. No one will really tell you what a "good" number is as there are so many factors that go into it, however I had 15-20 set in my head. I did not want to do another cycle as a second cycle would likely be more expensive than the first due to needing more drugs (assuming cycle 1 did not go well). Gonal-F is pretty much liquid gold. I spent roughly $2500 on that drug alone. I started Gonal-F at night on Jan 6. Fortunately neither of these two injectable drugs hurt very much. I'd given myself allergy shots before and was not too worried about this. You inject in your stomach. This was the first time I've ever been thankful for my gosh-awful stomach roll(s). At times I felt like I was running out of fat and I have no idea what those darn skinny girls do! One evening I had to give myself two shots of Gonal-F and for whatever reason, that one bruised really bad. I'm very thankful none of the others bruised or I would have really run out of space.
January 9 was my first estrogen blood check and sonogram "on stims." Each "check in" consists of blood work (estrogen) before 8am and then a sonogram at some point during the day - just based on normal appointment availability. They then use the estrogen levels and the measured size of your follicles from the sonogram to decide what level of Gonal-F you will take over the next days before your next check in. At that first appointment, they measured 7 follicles. I wasn't thrilled with that number but did not have much to really go on. Dr. Vaughn didn't seem worried. Note normal levels of estrogen are below 100 (depending on where you are in your cycle) and mine would climb to over 4900 before this was over.
I went back the next Thursday (Jan 12), Saturday, Monday, Wednesday, and Thursday. At the Jan 12 appointment, it was decided my follicles were a little lazy and/or slow growing. The number of follicles had gone up to 17 which was great, but the size was still a bit small. They upped my Gonal-F and we re-checked on Saturday. By then there were 18 but still a bit small. Over the next week some grew well and others lagged a bit. It becomes quite a balancing act to get the smaller ones to grow without over stimulating. Ovarian hyperstimulation syndrome (OHSS) is a potential side effect that the Dr works to avoid at all costs, while still pushing the number and size of follicles to their max. That Wednesday, Dr. Vaughn decided to stim one more day while also putting me on a drug called Dostinex that can help prevent OHSS.
I "stimmed" (took stimulation drugs) for 13 days. Originally my nurse said she thought I'd be in the 8-10 day camp so the last few days begun to drag on a bit. But I wanted the best possible outcome so I just went with the flow. By the Monday, Jan 16 appointment, Dr. Vaughn said we were probably looking at a weekend retrieval. I was quite bummed as I'd been so looking forward to a sick day. Who wants a sick day on a weekend? Again...needing my follicles to grow as much as possible, I just had to go along with it. I had my last appointment Thursday and was then called and given a time to take my HCG "trigger shot" Thursday evening. The HCG shot is a huge dose of pregnancy hormones that causes the ovaries to release their eggs approximately 36 hours after injection. Surgery was then scheduled for Saturday morning, 36 hours after the trigger shot.
I had had relatively few issues or side effects thus far in the process. The Lupron gave me a headache after a while, but it went away when the dose was lowered and the Gonal-F began. The second week I was a bit bloated here and there but still nothing debilitating. I had friends say they felt like they could not really move the last few days and I was able to work out up until the day before my surgery. I was told to avoid repetitive bending at the waist and any twisting. My ovaries were growing to an abnormally large size and would be at greater risk for ovarian torsion. So I was a little cautious during the second week of working out, but wouldn't say I slowed down much. I was also pleased that the hormones did not seem to affect me, especially after one friend said she cried almost nonstop and another said she was verifiably bat shit crazy. All my good fortune was coming to an end though. I woke up in the middle of the night Thursday after the trigger shot and threw up. I felt okay again Friday but was uneasy again by the evening. I took some Zofran and was okay though.
Retrieval
My surgery was 8:30 Saturday morning. The Austin Fertility Surgery Center is just two buildings over from the Texas Fertility office which was convenient. Ovation Fertility is also located in the surgery center building...makes sense as this way they are not carting your eggs/embryos all over the place. Vickie had volunteered to take me to the surgery back in August when I let her know I was finally doing it. Everyone that morning was very nice and the process was easy. I asked about getting sick from the HCG shot and the nurse said "yeah....you are probably going to have pretty bad morning sickness when you have kids." Whohoo! We arrived an hour early to do paperwork and get all set and I walked into the OR right at 8:30. They did not tell me they had hooked up the good stuff and all of a sudden my eyes started doing crazy things. I asked if they had started the drugs and they said they had...I do not think I got three words out in response.
I was back in recovery and waking up just after 9 so it is a really quick procedure. I was in a good bit of pain when I got back so they gave me two rounds of dilaudid through my IV and then I took a percocet at some point after that. I had said ahead of time I was already a bit nauseous from the HCG and that pain medicine makes me very sick too. They said they had pumped a lot of anti-nausea meds into my IV and that I should be good. Well, I was good for a bit and then I was not. I got sick and then felt better for about 20 minutes. They brought me a Zofran and as soon as I put it under my tongue, I puked again. We made a run for it after that thinking I might have another ~20 minute window before I got sick again. Critical mistake. I made good use of the fancy new puke bags they gave us in Vickie's car on the way home. Conveniently enough, traffic was horrible on Mopac because it was the women's march day. I felt terrible that I was puking in Vickie's car but kept telling myself "she has kids...she's dealt with this before." I got sick one more time as soon as I got home and then planted myself on the couch and did not move for several hours. I was in and out of it but afraid to move. My niece Molly was in and out through the day and helped me out. My friend Bonnie came by in the afternoon as well, after going on a city-wide search for good Jell-O and Chewy Lemonheads and Friends (not just any Lemonheads would do). By the evening I finally braved some pain medicine (Tylenol with codeine). It did not make a noticeable difference in my pain, but fortunately, my pain was not really bad at all by then - just a little crampy. The other good news is that I did not puke from the medicine...in fact, I ordered Mr Gatti's. Watch out. That ended up being the only pain pill I took. I took regular Tylenol a few times after that, but mostly for headaches. I was to avoid NSAIDS at first to prevent bleeding and then started on baby aspirin starting two days after to prevent blood clotting.
Recovery
I slept fine Saturday night and woke up Sunday ready to move on with life. I had expected to spend most of surgery day on the couch and then to be pretty much normal the next day. I knew I would be bloated and possibly uncomfortable, but was not expecting anything more than that (based on all but one of my friends' experiences - and even she was okay until later in the week after). I went to church and was moving a bit slow and awkward but nothing terrible. Molly came over after church and we watched Netflix on the couch all afternoon. I'm not sure at what point it was, but I realized I just didn't feel great. I had weird pain/pressure between my belly button and diaphragm. It made me a bit queasy. I was told to monitor my weight daily and if it went up more than 4-5 lbs in a day for two or more days, I needed to call the dr. I had forgotten to weigh myself the morning of the surgery, but on Sunday morning I was ~5 lbs heavier than I had been the Tuesday before. That was definitely all fluid in my stomach. Monday morning I was the same but by Monday afternoon it had started to go down. The problem was when I woke up Monday and had originally planned to really be back at life (ie work), I realized the only place I was going was my couch. I spent the day there fairly nauseous and uncomfortable. By then food was sounding pretty terrible and I was sick of Gatorade. I called the Dr office and they said it was normal as long as my weight was not going crazy and my urine output remained normal. They also said symptoms usually peak days five through seven. What?? I was not expecting that and on day 2/3 did not think that was going to be me. I was not having any of it.
Tuesday morning I went in to the office for about three hours and felt okay. I planned to take the afternoon easy and possibly head to San Antonio that night to surprise my niece for her 10th birthday the next morning. I made dinner for a Sunday School friend who had just had her 3rd baby and while dropping it off she told me all three of hers were "Dr. Vaughn babies." I had no idea! The number of families in my Sunday School class alone who have gone to Texas Fertility is staggering. I think it is wonderful such help is out there, but also a bit sad at times too that infertility still is not talked about very openly.
Speaking of open, a fair number of people were aware I was going through this. I never intended to overshare, but did not necessarily feel the need to hide it either. Turns out the same week I had my retrieval, I had one friend going through IUI with Dr. Vaughn and another having a hysterectomy after having twins from Texas Fertility. Being able to talk openly with these girls was great. I was also open about it at Sunday School the day after my procedure - someone asked why I was sick or something and I figured it was easiest to just flat out say what I had had done the day before instead of talking about some vague topic. One of the guys in my class paid me a compliment after that saying "way to put that out there." His first baby was a Texas Fertility Center IVF baby as well.
Some of the conversations about freezing my eggs were a bit more awkward than others...I am sure I made more than one person uncomfortable along the way and feel bad for doing that (namely those with a y chromosome). There just was not really a better way to say why I might be out of the gym for a while, or why I was at home sick for a while, or why I cannot bend at the waist or twist but can do everything else just fine. For the most part, the reception is very positive - ranging from purely inquisitive about how the process works to "should I be doing this?" To that I tell people to talk to their obgyn and have their blood levels tested and to just take the conversation from there.
Back to Tuesday evening. By the time I left my friend's house, I was feeling pretty lousy and did not think driving to San Antonio was a good idea. I was fairly sad but felt too bad to try to go. I ended up puking again around 9:30 and then woke up in the middle of the night dry heaving. I had not had any true pain until then - at that point I was worried my huge ovaries were going to explode. Thankfully I was not sick again but I am not sure I slept the rest of the night. I was in a good bit of pain and just had to lie very still. Wednesday morning I knew there was no chance of going to work. I did have an acupuncture appointment scheduled for noon for my hamstring and was on the fence about that. I did not want to cancel but did not want to puke my brains out on the table either. I ended up making it there and the hamstring took a backseat to trying to fix my nausea. I felt amazing for the 30 minutes or so I was lying there and would have been thrilled if I could have just spent the rest of the afternoon there. Sadly that was not an option. By the time I got to my car I already felt like poo again. I think the hormonal shit storm that was in my stomach was too much for those little acupuncture needles. I left there and went to pick up a prescription for phenergan Dr. Vaughn had called in for me after my beloved Zofran was not putting a dent in my issues. Back to bed with the phenergan, wondering if day seven was, in fact, going to be the worst as the nurse said it could be. The problem with that plan is one of my dearest friends was getting married in Houston on Friday, day seven.
Thursday was more of the same - nauseous and zero energy. It was also closing in on the longest amount of sick time I have ever taken from work. No big deal - it was only year-end (we file our 10k on Feb 1), and January month-end. I tried to drink more on Thursday and realized I was just not right because I normally love water and had trouble even getting that down. By this point I decided my body was so confused I was not sure if it would ever get sorted out. I think my electrolytes were off from the beginning after I puked so much Saturday morning, and then again throughout the week. I had been off and on four drugs that all had constipation as a side effect...fun. I had been told to stay on top of that and probably went way too far on that early in the week and then was behind the tide again later in the week. And on top of that, my stomach was full of huge ovaries pressing on things and putting things in weird places, and I had huge amounts of estrogen just floating around in my stomach (when they remove the eggs, fluid fills in the follicles where the eggs once were, and it is that fluid that can cause all sorts of issues). I was told to eat high fiber and high salt - neither was the least bit appetizing. By Thursday night, I assumed I was not going to make it to Houston the next day. I was also left solidly wondering where in the world a baby goes in a women's body when she is pregnant. My ovaries were the size of softballs perhaps and that was enough to wreak total havoc...what about a 7 lb child? I just don't get it!
Friday morning I woke up and before I even moved, I thought things seemed noticeably better. I had an Airrosti appointment at 9 that morning and that was going to be my first test. The doctor commented on my "high spirits" in extreme sarcasm, but I was at least there. I took a short nap after the appointment and did not feel like death after. That was all I needed to get in the car and head to Houston. Halfway through the trip I would have described my condition as a functional hangover - ie feel pretty bad but able to go about my business. By the time I got to Houston I was feeling that much better. At the ceremony I noticed I had not stopped eating after about an hour and that is when I declared myself miraculously healed. I had not thought I would make it to dinner originally, but I did and I think I ate everything in sight. I could not believe how much better I felt by Friday night, even compared to Friday morning.
By Saturday I was pretty much back to normal - weak and tired, but certainly back to the land of the living. I started working out again on Monday. I took it pretty easy and could still feel a bit of weirdness in my stomach - it was hard to distinguish though what I was feeling...ovaries, stomach muscles, intestines, or what. I still avoided twisting and bending for a few more days but by Thursday I am feeling pretty much back to normal. I was told it would take one to two weeks for my ovaries to get back down to a normal size and I think I'm close to there.
My Little Frozen Eggs...and What's Next?
Before I left the surgery center Saturday morning, the embryologist came in and let me know they retrieved 18 eggs. I was probably the most nervous I had been about the whole thing for the three seconds between her walking in and her telling me the number retrieved. Eighteen is a great number and was really the most I could have expected based on my sonograms. Eighteen was the highest number of follicles they ever saw at one time. The next step was for them to see how many were freezable - they said I'd hear from them by the next day at the latest on that. I was happy with 18 but was hoping the number did not drop off much.
I had said going into this that I was only financially and emotionally equipped to do this one time. I was not prepared to face the possibility of only getting a few eggs and needing to go through it again. As soon as they told me I got 18 eggs though, the possibility of round two was in my head. The embryologist said I probably had a pretty safe number for one kid but that if I wanted "like three," that I should probably do another round. I do not have to have three but I want more than one. The thought had not entirely occurred to me that I could have what is considered a very successful outcome with round one and still consider a round two.
A few hours after I got home, they called and let me know they were able to freeze 15 mature and 1 questionable egg. That is still very good - and a low drop off rate. Thoughts of round two became greater and greater. I had pretty much decided that I did not want money to be the reason I did not do it. At that time (Saturday), money would have really been the only thing stopping me at the same time. I really have no business shelling out another $9000 any time soon on anything that does not involve a home loan, but I do not want to be 40 looking back thinking "wow...had I just spent the money then..." Adoption or multiple rounds of IVF or who knows what else I could be looking at down the road would all certainly cost much more than $9000.
After spending the better part of six days knocked out on my couch though, the decision for round two is much less clear. I'm not sure if anything could be done differently next time to not be out so long after. The before was really not a big deal for me. Yes I had to be in Austin and available for many early morning blood draws and mid-afternoon sonograms, but I'm fortunately enough to have the flexibility in my job for that to be okay. And somehow the traffic gods were in my favor through the whole process until surgery day! I have to think about missing work and unfortunately cannot really plan around low times because this is all based on my body's timing...nothing else really. I can have control obviously on what month I do it, but not much else.
I held my chin high through this whole process and was not really down about the fact that my life had led me here and did not do much feeling sorry for myself. I am relieved about that. But it is funny that now I am struggling a bit with it all - whether or not to do it again. I do not have to make a decision any time soon and will definitely continue to pray about it. I feel fairly confident I will come up with a decision I am at peace with before too long, but I do not do undecided well :-) Only now am I starting to feel a bit of the cruelty of the situation...if I want to call it that. But the flip side is I have 15/16 eggs hanging out there waiting for me that could one day make me a mother - and some people in my position will never be able to even say that.
So I have an insurance plan of sorts in place now. The difference between IVF and egg freezing is egg freezing ends with a big question mark. I will not know the quality of my eggs until they are fertilized and God only knows when that will be. It could turn out that I have amazing eggs and they meet some amazing sperm some day and provide all the kids I could ever want. Or it could be that those eggs do not even produce one viable embryo. Only time will tell there. I still have zero regrets about it and have at least made that question mark much smaller than it would have been without this eggcellent insurance plan. And if I can help even one person navigate this process then I'll be even happier about going through it and being open about it. I am eternally grateful to my friends who were there for me as I went through.
A few have asked if I plan to use a sperm donor either now or down the line. My nieces begged me to have a kid now - convinced it would be the cutest. While I was flattered they think I would make cute offspring, I told them there was currently no trust fund in place to take care of said cute kid, unless they wanted to take care of it. Currently, I have zero plans to ever enter parenthood alone. I cannot imagine doing so. I know many end up single parents and are rocking life at doing it, but few ever plan to be single parents from the beginning. However, as I said above, I reserve the right to change my mind at some point. I really hope that is not what God's plan is for me, but we will just have to wait and see.
Edited to Add:
Wow - in the three hours since I've posted this the response I've received has been amazing. More and more thoughts keep popping in my head and I want to get them out there. Forgive me if they are all over the place but here we go.
- Timing. Some people were shocked I did this as quickly as I did after coming home. Some, especially, because it was during year-end at work. I have a few reasons for the rush:
- I had been waiting for over two years to do this - I had put work over everything else for a very long time. It was time to put me first for a bit. Fortunately I have a female boss and she was very supportive in December when I told her the timing. Her only response was "okay, well, if you are crying, please don't come into work. Just email me "HOH" as in "high on hormones" and I'll know what is going on." That was pretty funny.
- I was pretty set on having 35 yr old eggs vs 36 yr old eggs. Yes we are talking about the difference of a few weeks, but it mattered to me.
- My employer offers a wonderful infertility benefit. However, you have to be deemed infertile to use it. The definition of infertile is trying unsuccessfully to have a child for 12 months under 35 and for 6 months over 35. I asked if exclusively swiping left on Tinder counts as trying but apparently it does not. In some ways it stinks I cannot use the benefit, but on the plus side if I'm still there when it is time to use my eggs and I have tried unsuccessfully for six months (for real) to get pregnant, the fertilization and transfer of the embryos should be paid for. Granted that is the cheaper "half" of the process, but oh well. I will be glad to have whatever help I can get.
- One more work point/story. One of my Norwegian co-workers walked into a conversation that I gave him the opportunity to get out of but he did not flinch. I ended up telling him what I was doing and he continued to not flinch. Then I remembered our Nordic counterparts do not freak out at things like Americans do. He said it best - "we're not freaked out by bodies or anything like that, but we are really freaked out by guns." It was pretty funny. His closing comment on the ordeal was that he was going to call me a hen because I was laying my eggs. I couldn't help but laugh at that one.
- At some point pretty early on in the stimming process, Dr. Vaughn told me "now, you CANNOT have sex right now. That would be a very bad thing." As in I could have turned into Octomom. My response: "No sex? That is why we are here." He did not laugh and said "I'm trying to scare you." I appreciate he thought there was even a chance. I told him I'd put it in sky writing if I go on a date so he can be warned.
- When I was at Airrosti at some point getting my hamstring worked on, the Dr said "okay, flip over and let's work on your psoas (hip flexor)." He put his hands on my hip bone and was about to go to town and I said "ummm....I have to tell you something." Which began another of the fun conversations, but this one not nearly as awkward as it could have been. Turns out he and his wife used Dr. Vaughn too!
- I did not make too many lifestyle changes during the process but did make a few. I had my last alcohol on Christmas Day. Not drinking isn't really the end of the world for me so this was not a big sacrifice. Also I did not have any big social events going on during the time so did not ever end up in a situation where I felt like I was really missing out. I also began taking the following in August and took them through retrieval: women's multi vitamin (prenatals did not work for me - the iron made me nauseous), Folic Acid, Co-enzyme Q10, Vitamin C, Vitamin D, and the other stuff I take regularly (Zyrtec, Flonase, DHEA, melatonin - all were okay for me to continue taking). I'd like to say I ate better during the stimulation process but it certainly wasn't perfect, but probably close to as good as it gets for me. Everything you read about IVF says to avoid stress at all costs. There isn't much to read out there about egg retrieval alone. I think some of the IVF part is related to the subsequent embryo transfer, but I may not be entirely right there. Anyway, I did not avoid all stress for sure, but did manage to keep a pretty even head about life in general during that time. I made sure I got good sleep and did not go crazy working out. My bum hamstring conveniently helped keep that in check.
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