When the doctor becomes the patient: Why I chose embryo freezing
I thought I wanted to have kids, but I wasn’t sure when. I spent the better part of my 20s either in a library studying or in a hospital working.
I knew I wanted to get through my medical training before having kids and I knew I wanted to travel.
But, I also knew that each year I put off having kids my fertility was slightly declining. Sure, in my 20s and early 30s it didn’t matter as much, but what if I didn’t want kids until my late 30s or 40s? We know that a woman’s fertility starts to decline in her mid-30s, slowly at first, and then more rapidly in her late 30s/early 40s. So the longer I decided to wait to have kids, the harder it could potentially be.
Why I chose fertility preservation
I chose to go through this process for a couple of reasons. First, as I mentioned, my husband and I didn’t know when we wanted kids. But, we knew we wanted options for the future. We had both just been through four years of college, four years of medical school, four years of residency and I was doing an additional three years of fellowship training in reproductive endocrinology and infertility. Put simply, we just weren’t ready. We wanted to enjoy each other’s company outside of the intense medical training we had both just been through.
Additionally, what propelled me to act now instead of later was my experience with patients. I have seen, firsthand, women who come in at 41 and want to freeze their eggs, except now they have diminished ovarian reserve. Or the couple who struggled to conceive a second child after having no issues trying for the first. My patients’ experiences definitely had an impact on me.
I believe that women shouldn’t have to choose between a career or kids. With modern technology, we have the option to take action now for our future later. My hope is to empower women to learn about their fertility so they have the knowledge and information to make the most informed decision about their health. I don’t want to convince every woman to freeze her eggs—it’s a personal decision based on a woman’s own lifestyle, goals, and desires. But I also think it’s important to acknowledge that as women, we do not have an indefinite amount of time to have kids, and if we are going to choose to postpone having kids, we should at least know our options. We should at least have the choice to be proactive about preserving our fertility.
Why I froze embryos and not my eggs
The decision to freeze embryos and not my eggs came down to where I was in life. I had a partner I knew I wanted to have children with, so we chose to freeze embryos. The benefit of embryo freezing is that you may have a better idea of what you are working with on the front end. With embryos, you know how many eggs it took to be retrieved and fertilized and allowed to develop to get to day 5 or day 6 embryos that can be transferred at a later date.
On the other hand, the best thing about egg freezing is that women have the option to preserve their fertility immediately, for when they are ready to have kids in the future. You also do not need to be in a relationship to freeze your eggs. By freezing eggs, you allow yourself the flexibility to find the right partner and, if needed, can fertilize them at a later time. Egg freezing has undergone significant scientific improvement over the past 7-8 years and, as a whole, our field has a pretty good understanding of how to freeze and thaw eggs to maximize a woman’s chance of a live birth from those eggs.
How many eggs do you need to freeze?
This is one of the most common questions we get from patients. The number of eggs you need to freeze is highly dependent on the age you are when you decide to move forward with egg freezing. We know that a woman’s fertility declines as she ages, so older women typically have fewer eggs than a younger woman at any given point in time. Additionally, we know that the quality of the remaining eggs starts to declines as we get older. So, the number of eggs you need for a chance at a live birth in the future is highly dependent on the number and quality of eggs retrieved. A prediction model that I often show my patients demonstrates that for a 30-year-old to have an 80% chance of a live birth, she would need approximately 12 eggs retrieved. A woman who is 40 would need 50 eggs retrieved to have that same chance of a live birth. As you can see, success rates are highly dependent on age.
How much time does it take?
In regards to time, the whole process, starting from day one of injections to retrieval day takes about 10-15 days, so two weeks of your life will be devoted to this process. During that time, you usually need to come into the office every 2-3 days for ultrasounds and blood work. The good news is, most clinics have early morning appointment times so you can get in and out quickly and still get to work on time.
Wait, I have to give myself injections?
Yes! But I promise, having done it myself, you can do it! Usually, you will have to give yourself 2-3 injections each evening for about 2 weeks. The needles are very small and you are injecting the medication into the fat tissue of your stomach (think 2 fingers to the side and below your belly button). I won’t lie, I did make my husband give himself an injection first with saline, he did fine, so I figured I could too! It’s definitely a mind game getting used to sticking yourself with a needle, but after 1-2 days you will get the hang of it and it will be second nature.
How will you feel?
This varies among women. I usually tell patients they may feel bloated, tired, happy, or moody. Some women feel great and some women have more of these symptoms than others. Usually, these symptoms resolve after you get your period, about 10-14 days from the retrieval. For me, I experienced some bloating and a little constipation but otherwise felt fine. During stimulation, you may be told to avoid smoking and alcohol by your physician, as well as to limit exercise to prevent the ovaries from twisting on their blood supply.
What does egg freezing cost?
Cost may be one of the biggest factors prohibiting women from freezing their eggs. As a fertility doctor, we get this. Trust me, as a community, we are constantly trying to figure out how we can improve access to care and insurance benefits for women to have these procedures covered.
The cost for egg freezing starts at around $6,000 and this usually does not include the cost of medication, which may add an additional $2,000-5,000—the more medications you need, the more it costs. Typically, the more eggs you have the fewer medications you need and we know that female age is the biggest impact on the numbers of eggs expected. This is yet one more reason, if possible, to consider the procedure in your early to mid-30s instead of in your 40s. Because I was able to do egg freezing through my workplace, I had significant discounts on the medications, the ultrasound, labs, and the procedure itself.
Will my insurance cover it?
This will vary significantly based on the type of insurance you have. There are some companies, such as tech companies, the movie industry, and some major banks and fashion employers, who cover the costs of egg freezing. They may even cover medication costs. Again, our ultimate hope is that all employers eventually offer this procedure to women who are choosing to postpone having a family in order to advance their education or career or to meet the right partner.
What happens once the process is over?
All the mature eggs will get frozen. Eggs can be frozen for an indefinite amount of time. And when you are ready to use your eggs, they can be thawed and fertilized with either your partner’s sperm or donor sperm, depending on your life circumstances.
It’s important to remember that egg freezing does not guarantee you a future live birth. Yes, it definitely increases your chances of being able to have kids in the future but no doctor or clinic can guarantee you that this process will work. As physicians, we owe it to you to tell you the whole story so that you have realistic expectations moving forward.
In the end, I am so happy I decided to be proactive regarding my fertility. You can never predict the future and there is no guarantee that we will ever need these embryos or that I will even become pregnant if I do use them. But, I like having the option.
As a fertility doctor, my hope is to spread awareness to women about their reproductive health options. When women are armed with knowledge about their health, it gives them the power to take action. Even a woman wondering about fertility who is armed with knowledge but who chooses not to freeze her eggs is still making a powerful choice for herself. One of the most heart-breaking comments a patient with infertility can tell me is, “I wish I would have known this sooner and then I could have done something about it.” Well, the time is now for women to know and understand their health.
Your body. Your knowledge. Your power.
Author Bio Dr. Temeka Zore is a reproductive endocrinologist and infertility specialist and board-certified OB/GYN. Dr. Zore works at Reproductive Medicine Associates of Southern California in Los Angeles. She completed her residency in Obstetrics and Gynecology at St. Vincent Hospital in Indianapolis, and went on to graduate from the Reproductive Endocrinology and Infertility (REI) fellowship program at University of California, Los Angeles (UCLA). She received her medical degree from Indiana University School of Medicine, having been awarded a full merit scholarship. Before attending medical school, she graduated with honors from University of Texas at Austin, where she majored in biology. During college, Dr. Zore received high honors for her academic excellence as well as her athletic achievements in Track and Field, including the Arthur Ashe, Jr. Sports Scholar Award, the Pacific Coast Reproductive Society In-Training Scholarship, the Cross-Country Coaches Association Division I All-Academic Honors, and the V.F. “Doc” Neuhaus Award. She was also named ESPN the Magazine Academic All-America, second team and Academic MVP for the University of Texas Women’s Track & Field team. Dr. Zore has contributed to several peer-reviewed articles related to topics including PCOS and pre-implantation genetic testing of embryos. She is passionate about educating women about their reproductive health and fertility preservation.