28 good eggs in the freezer

28 out of the 31 were good enough to freeze - mature, normal, and freezeable. This is a fantastic end result. I had to ask the nurse for verification - 28 were actually good? Not just mature, but also good as judged by the embryologist? I really would have been thrilled to hear that 20 made it to freeze because I figured many of those 31 would be immature or abnormal in some way.

When I started this process, I had been thinking I would certainly do 2 rounds of egg freezing just to be safe. Maybe a round now and another one in a year or two. But with 28 known good eggs, I don't think I need to. The average number of eggs retrieved for egg freezing by NYU (according to their site)is 14 - so 28 actually making it to the freezer is better than 2 average rounds.

Anyway, great results. This process was worth it for me (although I'll stamp that final approval once I get past the OHSS risk). Guys have it so lucky, 5 minutes and they've got 250 million sperm. For me, 28 eggs required a month of shots and side effects and health risks and anesthesia. But I'm not complaining!

For all the process, I think there's a really good shot there are some genetic halves of future babies on ice in a container at NYU with my name on it. Even if I don't end up using these eggs, I'm pretty sure I'll donate them to someone who needs them. At one point in my life I thought I could never be an egg donor because I wouldn't want to have biological children that I didn't know out there somewhere. But I don't feel that way anymore. For the effort I undertook in this process, and with all the blogs, forums, and such that I read about people struggling with infertility, I really hope these eggs make babies for someone if not for me.

Retrieval Recap

I showed up to the center at 10am (as requested) for my 11am retrieval. I filled out another form and had to change into two gowns (one tied in the front, one in the back), socks, and a surgery cap. I was weighed (up nearly 10 lbs since I started - normal, just bloating I hope) and interviewed about the last time I ate, medical history, etc. I had to sign things like "Yeah, I know people die from anesthesia" and was told that retrieval only actually took 10 minutes.

I sat in a chair waiting to be called into the surgery room, and watched other women in recovery. They seemed fine, relaxed, sleepy. That was good - I would be in their position in less than an hour.

When it was my turn I had to take one of the gowns off and got into the surgery bed. My IV was hooked up and then we all waited around for the doctor. I think they gave me a general sedetaive or something at that point (the anesthesiologist injected my IV and I asked if that was what was going to knock me out and she said it was just to relax me). Finally the doc came in and at that point they lifted my thighs into these big, ummm ... thigh holders?.... and that had me completely on show for the room of nurses and doctors - far worse than simple stirrups, which doesn't bother me. Ugh. At that point I was happy at the thought of getting knocked out and not at all worried (even though I had been worried about the anesthesia - I wasn't now). The anesthesiologist told me she was administering it, and I recall telling her "wow - I feel that kicking in." I felt drunk and I tried to see if I could control keeping myself awake (just as a science expirement) . That's the last thing I remember in the surgery room.

Next thing I know I'm awake in the recovery room, and there are sharp stabbing pains in my lower intestines. I didn't start screaming, but definitely let the nurses know I was in a lot of pain. The first one said "that's because you had a lot of eggs." My retrieval also took 20 minutes instead of the average 10 minutes. The pain would come in waves, but when I wave hit it was really bad. When I tried to sit up I almost fell over. They quickly brought a regular ultrasound over to see if I had internal bleeding, but it looked good. They said my bladder was very full (from the IV), and that, along with the sheer size/swelling of my ovaries post-surgery was pushing substantially on my lower intestines. Somewhere around now is when they told me the number 31, which was shocking since I thought I only had ~20 follicles. They gave me something for pain through my IV and also Tylenol by mouth.

While we waited until I was ok enough to get up, they gave me some juice and graham crackers (standard recovery fare).

I finally did get up and try to use the bathroom, hoping that would help things. I'll spare the details, but it took me multiple tries and a long time. With that and with the pain meds, I was in much better shape. They kept asking if I was light headed or anything, which I wasn't. So they were able to discharge me. It was about 1 pm - only 30 minutes later than my ETA discharge of 12:30. Instructions - no tampons, baths, sex, advil/aspirin, douche, saunas, etc for 2 full weeks. Call immediately if I get any symptoms listed [...]

My mom was in the waiting room waiting for me - they had to make sure that I had an adult driving me home - and we left.

It's now the next morning ... Things still hurt - hurts to sit, hurts to walk, but not as much. Now I'm just waiting for the call to find out how many eggs were good/mature/frozen.

I'm also reading up on OHSS (Ovarian Hyper Stimulation Syndrome - post egg retrieval, when there were lots of eggs, the ovaries can do things which essentially cause fluid to accumulate in the abdomen), which is a little scary. The fact that I'm under 35, have polycystic ovaries, and had 31 eggs puts me at a high risk (That's why ideal is 10-20 eggs. 31 is good for having gotten so many eggs, but it's not good for my health). Symptoms usually kick in 4-5 days post retrieval. From what I've read, it's sorta inevitable that I'll develop some level of OHSS and nothing I can do about it, I think the best I can hope for is that it's mild and doesn't interfere with life for the 1-2 weeks it sticks around.

31

retrieved 31 eggs. Whoah. I was in a lot of pain when I woke up and they had to give me extra pain meds - they said that's because I had so many eggs. I'm home now. More later.

Day Before Retrieval

Went in for bloodwork this morning.

My HCG is 157 - they want to see it over 50, so I definitely did the butt-shot correctly and absorbed it well.

E2 came back at 3568. That's a small jump from 3230 yesterday, but not the day-over-day jumps I was having prior. That's good, since I didn't take any stims yesterday, so it makes sense that it only rose a little. They want to see it either hold steady or rise slightly, but not drop. (A drop is bad - it suggests that eggs have started ovulating and once they ovulate, it's too late to go in and retrieve them. That's why timing is so critical). Remembering that each mature follicle registers about 150-200 of E2, and seeing as I have almost/about 20 follicles(?) this is a nice number. It would suggests that nearly all of them are mature.

Overall, the E2 number is really good. You want it to be high to show mature follicles, but levels over 4000 puts one at risk for Ovarian Hyper Stimulation Syndrome (OHSS) and causes doctors to cancel some cycles. So I think a mid 3000 level is good in this situation.

I check in for surgery tomorrow at 10am. Surgery is at 11am under Deep Sedation. I should be done with retrieval by 11:30 and recovered by 12:30. By the time I'm awake I should know how many they retrieved, and probably not too long after that they can tell me how many were good enough to freeze and what sort of quality they were.

Self Administered hCG Shot!

Iced for 5 minutes with frozen spinach :) and did the injection at 11:55 (my window was midnight with only a 5 minute allowance in either direction, so I started at 11:55 not sure if I could do it right away, but I did). It was so easy - I didn't feel a thing. It was easier than the little shots - I guess because I didn't ice before the little shots until the area was completely numb and I knew it was numb even before stabbing. I had to look down to believe I had all 1.5 inches of the needle in me. Pushed the plunger (that was met with some resistance) and withdrew. It bled a little for a few minutes. I definitely did not need to travel to the nurse - I'm so glad I'm not in a cab right now on my way home in this crappy weather. It probably would have hurt more (would she have let me sit around icing for 5 minutes?). I'm sure I did the shot right - there was no room to mess up - I mixed it right, stabbed where the nurse drew, and injected at the right time! 30 minutes later, I feel butt-muscle soreness, but it's mild. I go for a blood check in the morning (they can tell whether I did the HcG shot right) and for general E2 monitoring before surgery on Thursday at 11 (35 hours post HcG).

Triggering tonight

E2 was 3230 this morning. Definitely triggering tonight. Now I just have to figure out whether I'm going to try to give myself this very big shot on my own, or whether I'm going to get in a cab and take a 25 minute ride to a nurse at midnight to have her administer it.

Ouch

CD 12 / Day 10 of stims.

It definitely hurts to walk today. It hurt when I tried to lay on my side rather than my back last night to go to sleep, and it hurt when I woke up. Totally bearable, but quite noticeable. Had a scan this morning - still waiting on bloodwork, but it's pretty clear that I trigger tonight and have retrieval on Thursday morning.



The nurse assured me that I could give myself the intramuscular shot (this is a BIG needle and I goes in the waist/hip/butt area) and the only alternative I have is to take a 20 minute cab ride late tonight to go to her place and have her do it. I think I prefer giving myself the shot over having to take that trip. So we'll see.

CD 11 / Day 9 of Stims

CD 11 / Day 9 of Stims

Had a scan and bloodwork this morning.

Scan showed a few follicles in the 19 range - that's the target overall (trigger when the highest possible number of follicles are 19/20 - not bigger and not smaller, although anything 14 and up is potentially savable) and a bunch in the 15/16 range. Pretty likely I'll have to trigger tomorrow and be in surgery on Thursday. My E2 came back at 2019. That's a HUGE jump from the 527 it was 2 days ago and suggests a doubling every day. at that pace, I could easily be between 3000 and 4000 tomorrow. I know I have some geeks reading this - so if you, uh, wanted to track E2 growth by days, here's the breakdown:

-, - , -, 149, 257, -, 522, -, 2019

Anyway, so the target E2 is 150-200 for every mature follicle. I have about 19 or 20(?) follicles overall, I think. If they were all mature, my range would be 2850 - 4000. Most(?), but not all follicles will be mature by trigger - they grow at different paces (and they can mature some eggs in the lab before freezing if they're almost there).

As to how I feel - I can feel every bump or jolt in the cab - doesn't hurt (well, it does a little), but I'm aware of every shake. Wonder what it will feel like in about 60 hours from now when I'll probably be on my way to NYU for surgery ...

As an aside, the way these scans work is that different doctors are on shift. So today for the scan I had a doctor who must have read my chart quickly and not realized I wasn't a general IVF patient. He said "Your uterine lining looks great, perfect - it's about 13-14 and perfect" Doesn't matter this go around (it matters for implantation), but I guess that's good to know that I can make a good uterine lining ...

Needles

CD 10 / Day 8 of stims

So here's what I've learned in 22 days I've been giving myself shots (something like 33 actual injections so far).

1. The post-shot itchiness that happened on some shots is purely a function of whether I let the alcohol I just swabbed on myself fully dry before injecting myself. If the alcohol is at all wet, the injection site flares up.

2. The best way to not feel the shot is to go in at a 90 degree angle and very quickly. The fast you stab, the less you feel it.

3. Stay at the side of the abdomen - don't get anywhere close to the center - that hurts.

4. Sometimes the "don't stab myself" reflex kicks in. Incidentally, this developed the more I gave myself shots even though you'd think it would get easier - I guess each instance where it did hurt + Pavlovian stuff = gets harder to actually do it. And that works against the need to stab quickly. Although I'm not at all scared of needles, it helped to know I was numbing the skin. Flicking the skin using my index finger and thumb for a few seconds causes nerve overload and the skin goes numb. That has always worked and if I don't do anything else wrong (see 1-3 above) then I really don't feel the needle at all - so doing that first helps counter any hesitation.

-----------

Today I stopped at the drugstore and filled my other prescriptions, which I hadn't yet picked up (didn't want to get ahead of myself if I wasn't sure the cycle was going to work).

1. The HCG trigger shot - but when I got home, I saw that all I got was the meds (it's powder and water - needs to be mixed before injection), I need to go back and get the 1.5 inch needle!
2. The post-retrieval antibiotics

Ok - appointment tomorrow. I presume I won't get trigger instructions for tomorrow night, but it's possible.

Another day, another scan

CD9 / Stim Day 7

Had a scan this morning, things look good. Asked the doc if it was possible I'd get 20 eggs, and he said probably not 20, but that I'd get a lot. I asked what number I'd need to have a good insurance policy without doing another round, and he suggested that I probably had enough from this round, but that they'll know more post-retrieval, because they can actually grade/analyze the eggs on a pretty deep level (looking at how the spindle is aligned, or something like that). He said that post-retrieval they'll be able to tell me where I stand.

Also, during bloodwork I asked the nurses about arranging for someone else to give me the HCG shot. That's the big shot-in-the-butt that is given 35 hours before retrieval. There are a few nurses who live in Manhattan, and they think one can come here or I can go to their place. I'm not sure what standard protocol is, but I think $100 is around what I need to tip(?) - I don't know.

Anyway, so keeping with the protocol (300 / 5), next appt is Monday. My E2 is 522 today. During the scan, doc said we're looking at probably Weds or Thurs for retrieval. Based on the E2, I'd guess Thursday is more likely. The only way it would be Weds is if my level on Monday is so high that they say "trigger tonight" - and I doubt it can jump so fast.

Side effects - feels like puberty all over again. Nothing else to report!

CD7 - Day 5 of Stims - Second Stim Check (E2)

My E2 came back at 257! Nice jump from 149 yesterday. (Ending E2 is supposed to be about 200 for each mature follicle but it grows exponentially - look at 72% in just one day). That's a great increase, and probably why I actually feel pregnant right now. Well, not that I know what pregnant feels like, but I feel abdominal pressure.

Instructions are to take 5 units Lupron in the morning and 300 Gonal-F in the evening through Saturday. I go back for another blood test / scan on Saturday.

All in all, a day of good news and progress.

CD7 - Day 5 of Stims - Scan

Had a scan (it hurt this time!) this morning and it looks good - was able to see over a dozen follicles on the left, and about half a dozen on the right - and that number can still increase. There was a large-ish follicle on the right (no doubt the one that was there before they started me on stims)- about 15 mm while the rest were 10-11 mm (target: 19-20 mm). So that needs to be monitored a bit, and it's also, no doubt, the reason why my right ovary is an underperformer compared to the left.

Doc wasn't worried about the low E2 since he had me on suppression which does cause a slow start - what mattered most is the scan ("we want to see lots of littles") which was good. He says retrieval will be "at the earliest Tuesday, latest Friday." That window gets smaller the closer we get to it, naturally. Will find out this morning's bloodwork E2 levels and ongoing med instructions later today.

CD6 - day 4 of stims - First Stim Check

Bloodwork this morning - my E2 came back at 149. That is low-ish (I think), but I don't know if it's oversuppressed-bad-low or just-a-slow-start-low or up-the-meds-low. There's supposedly a lot of variation when it's this early in the stimulation/response phase. Nurse told me to take 300 gonal-f tonight (I was told to skip my 150 dose this morning before the morning's bloodwork). My next appointment was supposed to be in 2 days, but because of this result, I go back in tomorrow for more bloodwork and an ultrasound. Hopefully with a substantially risen E2 level.

CD5 / Day 3 of Stims

I don't have much to report today. Mostly, what's been on my mind is that this blog is very dull and factual, when, usually, if I want to, I can write with at least a little bit of entertainment value. Sorry 'bout that. I'm just trying to get a lot of info down as a record, and am not quite in a creative mood :)

So .... onto day 3
Side effects: Headaches, Exhaustion, hungry all the time!

Tomorrow I get my first post-stim blood test. This is significant. We want to see estrogen rise to show that I'm responding to the stimulation drugs, but not rise a crazy amount. This is really the first test to see if I'm a good responder to ovarian stimulation. So for example, if estrogen levels come back too low tomorrow, it would mean I was over suppressed or wasn't responding well for any number of reasons. Too high? (not exactly sure - maybe over stimulation). Not responding well could cause the cycle to be canceled. So tomorrow is another one of those checkpoints that I need to pass in order to get to actual egg retrieval this cycle.

This isn't such a terrible process physically, but what makes it a pain is all these little pass/fail tests.

CD4 / Day 2 of Stims

I learned some new terminology with all my googling around. instead of day 2, day 3, etc .... acronyms "CD4" = Cycle day 4.

So I took my Gonal-F last night and this morning - the Pen was pretty easy to use. It's a different kind of shot mechanism than the Lupron shot. This is not me (honest!), but this video on youtube shows exactly the system that I have.

this is a link to the youtube video on how the gonal-f Pen works

So day 2 on stims (stimulation drugs - FSH). I'm getting excited that I'm in the final stages. This could all be over in 10 days or so. Been thinking about it for at least 3 years, made a promise to myself back in May that I would definitely do it this year (On my 32nd birthday I made the committment that I'd freeze eggs before I turned 33), had my first real (A $600 not-covered-by-insurance real) appointment back on Aug 20 - exactly 2 months ago. I'm also likely about 2/3 of the way through the days where I have to give myself shots .... maybe 8 more days of shots and then retrieval two days later? (then I think a week or two of cramps, so maybe it's not ALL over in 10 days). But being on stims (finally) and knowing that actual egg retrieval is potentially so soon - it's exciting and novel again.

Day 3 - it's a go

I know I could combine these all into consolidated posts, but the goal here is mostly to document the process - and that includes the ups and downs.

So I got the call with instructions from the nurse.

Estrogen came back at 33
P4 was 0.6

And whatever that follicle was, the doctor says go ahead - so I'm going ahead. I'll be on 3 shots a day now.

Morning
Lupron 5 units (this is half the dose I was previously on)
Gonal F: 150 mg

Evening
Gonal F: 150 mg

Tonight I take 300 of Gonal F just to catch up.

Nurse says that on average, it's an average of 9-14 days of stims, so that means it's 11 - 16 days from now (including today as a day) until I actually am in surgery for egg retrieval. Since I'm starting stims today, surgery day is likely between Wed the 29th and Monday Nov 3.

Day 3

So I woke up way too early for a Sunday and went to NYU for my bloodwork and baseline ultrasound. The ultrasound wasn't so bad ... except the results have me a little worried.

So the point of this appointment was, now that I've been "suppressing" myself for 2 weeks, was to get the baseline - see what I look like suppressed, and then start pumping me up. My first injection of gonal-f is supposed to be tonight - and that's what makes all the follicles develop.

The ultrasound was supposed to show my ovaries completely at rest - nothing at all. But there was one little follicle .... that may mean something or not. Depends on how my bloodwork comes back - it has to show that I was in fact suppressed. Without hormones, why would my ovaries make a follicle? I'm playing a guessing-game here ... maybe it's just one left over from another cycle that hasn't disintegrated yet? I think that would be a good answer. I think a bad answer would be that it developed despite my taking suppression shots which would mean I wasn't suppressed enough. I don't know .... but I'm waiting for a call tonight to find out whether I have to cancel this cycle or whether we're still on.

Update: ok, a little searching around shows that this can happen, and the determining factor will be whether the follicle is currently active or inactive. If my estrogen comes back high, it will mean this is an active follicle and that's problematic because it will mess with the stimulation drugs I'm supposed to take. If estrogen comes back low, that will mean it's an inactive follicle and I can probably go ahead. At least that's what googling around tells me.

Day 2 - Ultrasound appointment tomorrow at 8 am.

This is a *different* kind of ultrasound .... Fun early Sunday morning ahead of me!

Day 1 / Recap / Looking forward

I am having an "Are you there God, It's me Margaret" moment. I've never been so glad to get my period.

They said it would take 8-12 days after starting Lupron. Well, today is 11 days since I started taking Lupron (Oct 6) or the 12th shot itself .... I'm not sure there's anything to be "relieved" about - but I'm glad. The more this goes according to schedule/expectations, the better.

So .... to recap.
- Oct 6 was 21 days since my prior period as started.
- They tested to see if I had ovulated, and I had. This was to ensure my ovaries were sorta done with their part for the month.
- I then started self-injected shots of Lupron -which shuts down my pituitary gland from making any hormones, essentially putting me into menopause.
- that's been going on for the last 11 days. I've discussed the various symptoms or lack thereof
- Now, 32 days since my last period, my new one has started. That didn't need any hormones to happen - I didn't start taking hormones until after ovulation, and in that time, my uterine wall had built up - so it had to shed eventually in the absence of a fertilized implantation.
- So, now on Day 1, I call NYU and let them know. I still take Lupron.
- On Day 3, I go in for bloodwork and an ultrasound (I need a whole post on the "ultrasound" - it's um .... and internal device
- If all is well, that day I start taking shots of gonal-f (there are other brands) to put my ovaries into overdrive, hopefully forcing lots of follicles to develop lots of eggs
- every other day or so I go in for more monitoring - they'll know how many follicles are developing - as will I. If too few or too many develop and they can't fix it with adjustments in hormones, they might cancel everything. (too many is dangerous, and too few makes the procedure not worth it given low survival rates of any one egg)
- after about 10 days of that, I take a big HCG shot which trigger ovulation
- 35 hours later I have surgery -light anesthesia - go home as soon as I can eat/pee/be picked up. By that time, they can tell me how many eggs they've gotten
- they freeze what they can and tell me what was good enough to freeze
- Years later, if I need them, I have to go through some more shots/prep and stuff, they thaw some of the eggs (not all will survive the thaw), fertilize them (not all will fertilize), watch them divide and grow for 3-5 days, and then implant the best 1 or 2, and then freeze any remaining embryos that are good enough to freeze.

So, schedule wise, we're taking Surgery Oct 31 / Nov 1 / Nov 2 - I think

Good retrievals get 15 eggs. I'm unrealistically hoping for 25.

Day 31

I am exhausted. Crashing at 8:30, though I had a full night's sleep.

Incidentally, I have had massive cravings (often indulged) for Spicy Indian Food over the past week. I have read that food cravings are often related to hormone imbalances. I'm certainly hormonally imbalanced a the moment. No idea what the connection to Indian food is - if any.

Anyway, exhausted - so so exhausted. Day 31. I'm really hoping to turn this around to day 1 soon! If nothing happens by Day 33, I have to call and go get a shot or something to force my period.

I look terrible

I can't put my finger on it. But as recently as 2 weeks ago, I felt like I was looking pretty good ... lost some weight recently, grew my hair longer .... I think I was looking better than I've looked in a few years.

But I can't put my finger on exactly what's going on - guess it's a combo of things - skin, bloating, hair, maybe the general lethargy .... whatever the shots I'm taking are doing, the net effect is that I look a lot worse in general ... and maybe some element of just feeling worse making me think I look worse. But add "looks kinda bleh" to my list of side effects.

Recap on side effects

Skin: Mild
Bloating: yes
Sore boobs: yes
lethargy: yes - much worse in the last 2-3 days
Hot flashes: I don't think so
Moodiness: Unsure ... I've had a grumpy day or two, but I'm not sure it's any worse than typical PMS or whether it's related to the economy, etc etc.

So far, side effects are still not bad enough that I'd hesitate to do a second round. I'd do this again in a second. But there are definitely side effects.

Day 30

Feeling ok. Talked to a relative who did IVF and she was on the same Lupron cycle that I'm on, but she was over suppressed and had terrible results when they tried to stimulate. On her second round she went with a different clinic and she went on the shorter cycle (the one stat starts on day 3 of her period, and is therefore about 10-14 days shorter overall as a process) and from this round - where she wasn't first suppressed - she had much better results and had a healthy baby.

Not that I think I should be on this Lupron cycle. It still is sort of my badge of honor here that they think I'm fertile enough that I can take it. (As a reminder - they think they get better quality results if they supress all hormones for a few weeks before they stimulate everything back up - but they will only go through this supression if they think you're a good enough candidate to get back up). Anyway, this just had me thinking, that although I've been giving myself shots now for 10 days, if I were on the short cycle, I wouldn't have even started yet.

Day 29 Cont

So I did eventually get up this morning and stab myself with a needle. I found that if I don't first pinch the skin, it's MUCH easier. I think that since this was part of the instructions (to pinch the inch) that as I noticed slight pain, I pinched more - and the more I pinched, the more I kinda felt it and the more it came close to bleeding. But this morning, I just felt so grumpy that I just stabbed straight in, and it was the easiest jab of all 9 injections so far. So that's what I'm going to do. On the downside, I pricked my finger with the needle int he disposal process. Thankfully I didn't have to be worried about pricking myself with some random needle. I knew where the needle had been, and had nothing to worry about.

Anyway, mood = grumpy-ish. Although my work isn't suffering for it. No one at work would think anything's up. Today's shot was easy. I want this thing to be over. I want to start stims. i want to go get an ultrasound. I want them to say "wow - you have 20 good looking follicles! awesome!" and then ultimately end up with 25-30 eggs, with 20-25 worthy of freezing. That's really my best-case scenario goal, but it's very very ambitious. The only reason I cut it off there is because in my training class I asked "how many follicles would be too much - would indicate overstimulation" and Jennifer said over 30 would be bad. So I want to just hit that. Realisitically, I'm still looking at 10-15 maybe on average. But ending up with 25 vs 12 is the difference between doing this whole thing twice or doing it once. or whatever.

Day 29

I'm tired. My complexion has seen better days. I'm a little sore.

My complex inborn instinct "don't jab yourself with needles even if it doesn't hurt" is first waking up, and it's pushing back and telling me that there are many many things I could be doing rather than stabbing myself. The needles and injections have definitely lost their novelty and coolness. Kind of like the first few times you ever filled your very first car with gas, it felt powerful to give the car what it needed to work. But then you get to the point where you're gambling on that 1/16 of a tank because you don't want to pull over and hassle.

But I've got like 2.5 weeks left of this. I can do it, no doubt, but it's less fun. Maybe when they start counting follicles and I get some real indication that this is going to work it will become more fun.

So I think if I make it to day 31/32 before switching over to day 1, egg retrieval has a good chance of being on a weekend day. Which would mean no missed work. That would be good.

FSH

Let's talk about FSH (Follicle Stimulating Hormone). FSH is one of the first things a doctor will test if you want to do IVF or egg freezing or are having any fertility issues.

- FSH is a hormone - it helps follicles develop eggs. It's a good thing.
- Ovaries that are older need more help - they need more FSH
- Your ovaries "know" how how many eggs they've got left (and how "old" they are), and ask the brain to tell the pituitary gland to make an amount of FSH roughly corresponding to how much they need to bring an egg to maturity.
- The older your ovaries are/fewer eggs they have/ the more help they need - the more FSH they ask for
- Ovaries only get older - never younger. No new eggs are created. You have all the eggs you'll ever have at birth.
- If you test the levels of FSH in the bloodstream, you can tell how much help the ovaries are asking for. This is the best indicator of their "age" - which doesn't exactly correspond to a woman's biological age (different women have different fertility - some hit menopause late, some early, etc). So this is why doctors treat FSH level as such an important thing - it gives insight into the age/quality of the ovaries and eggs.
- FSH might fluctuate slightly month to month, but that doesn't mean the ovaries are in better shape or that there are suddenly more eggs. Eggs are lost every month.
- In general, consensus is that levels less than 10 are considered ok, though lower is better. Lower FSH's correspond with better rates of IVF and egg production. Different fertility clinics set cutoffs at different levels. For example, if someone has an FSH of 20, she'll probably not find a clinic willing to treat her - it just means the ovaries are too old and won't make any eggs good enough to make a baby.
- If FSH was 13 one month and 12 the next month, it's not like the odds are any better. FSH is not itself the problem. The problem is that the ovaries ever asked for that much help.

In my training class (which was all egg freezers - though most were late 30's or early 40's) , this one woman was talking about how she wanted to do freezing a few months earlier, but had to postpone it. She now "realizes" in retrospect that this was good, because her FSH measured slightly lower when she just now had it retested. So in her belief, her odds were better now than they were a few months ago. But that's not true - she didn't suddenly have more eggs or younger ovaries ... and that's all that mattered. The hormone level just fluctuated for one reason or another.

Prognosis for egg retrieval is a function of the highest FSH you've ever had. Fluctuations down don't mean anything meaningful. Taking something to "lower" FSH wouldn't help. I've heard women ask if there were ways to lower FSH (doctors care so much about elevated levels, so lowering the level would be good, right?). But a lowered level doesn't create more young eggs. Preventing the needed/helpful hormone from being created doesn't make the eggs themselves any healthier or more viable. So, well ... that's that.

FSH is tested on day 3 of the menstrual cycle. This is the baseline day for testing hormones. Another thing they test is estrogen/estradiol, because estrogen can artificially lower FSH. So suppose FSH comes back at 7 - that's good - a great prognosis for IVF chances assuming the woman is also under 37 or 38. But if estrogen came back at 100, that would be bad - it would mean FSH might really be naturally higher than 7. Doctors will only trust the FSH number if the estradiol level comes back low enough to rule out that it's masking the true FSH level.

So what do doctors like to see?

FSH < 10
Estrogen < 50

Although there are still plenty of IVF babies born to women with values outside this range (though not too far off), those limits are the ones that have the best results.

Science lesson for the day!

Day 28

Nothing to report. Gave myself my shot, went to work. I've been taking hormones for a week now, and I really don't feel like my day-to-day has changed at all. I'm sure it will get worse once I switch to stims.

The Cable Guy

I had cable installed yesterday. The cable guy saw the needles and sharps container on a shelf and asked "Are you diabetic?" I said I wasn't. He said "It' ok ... my mom's diabetic - she's got all that stuff too." Oh boy ... I definitely wan't going to try to explain this one.

Day 27

Good Morning. I don't feel like getting up and going ALL the way to the refrigerator to get the vial of meds and then walking all the way to where I keep the needles so that I can give myself the shot around 9 am. Well it's not that bad, but I'd rather be sleeping. Whininess as a side effect? I dunno. As to other side effects .... "Breast Tenderness" yes very much. But it's also day 27, and that's just a standard PMS symptom. Worse than normal? Probably. Tolerable? Totally.

Overall, the side effects, if they really are side effects, are only questionably slightly worse than typical physical PMS stuff. On the flip side, with typical PMS, I can find myself wanting to cry at anything involving puppies or kittens or people finding their car keys when they had though they were lost. I have none of that going on - just the physical stuff. In my training class for this whole process, they said that that emotional PMS stuff comes from the relative drop in progesterone after it surges. So since I'm not going through a relative drop (same shot every day- and it's Lupron, which is maybe I think kind of like Progesterone) it makes total sense that my "emotional" symptoms are actually an improvement over typical PMS symptoms because there's no sudden drop.

Ok, time to do my 7th shot. Ouch, that one kinda pinched ... and bled a bit for the first time.

Day 26

So the shots I'm taking right now effectively put me into menopause - they shut down my pituitary gland and prevent the production of the various female hormones. So throughout this process, I keep my pituitary gland shut off, and any hormones that the docs actually want me to have are ones I get through injections. This gives them control over everything going on in my system.

So I dunno about side effects, but I do know that today I had an uncontrollable urge to pull out my tool set and take apart my broken dishwasher to see what was up with it. So I did that. Supression of female hormones .... taking apart household appliances .... I report, you decide.

Day 25

5 shots in, still no measurable/noticeable side effects. No mood swings or headaches or hot flashes or anything - I thought I was a little sweaty the other day, but it actually was just warm in my apartment. The shots take less than a minute of my time each morning, and I have no other indicator throughout the day that I'm even doing this.

Ultimately, when I think about how many days it actually takes to get through this, I think I should only count the days where life is at least somewhat burdened for being in the process. Right now, it's life as usual. These days shouldn't even count.

Day 24 - and waxing philosophic on uncertainties

- Today the market went into freefall, falling 7%, with no end in sight. "The Crash of 2008" if only there was a belief it won't happen again and again. I have watched my own retirement and savings shrink over the last day, week, month, year .... Thankfully, though I've lost a lot of money, I am not at risk at being unable to afford this $12,000 procedure (or a second round if this round doesn't result in enough eggs for me to feel sufficiently insured ... which it probably won't. Based on stats, I think I'll want 25 in the bank before I stop).

- Today was the Jewish day of Atonement - Yom Kippur - The day when, traditionally, the fate of each individual for the next year is said to be sealed. "How many will pass from the earth and how many will be created; who will live and who will die ... Who will rest and who will wander, who will live in harmony and who will be harried, who will enjoy tranquillity and who will suffer, who will be impoverished and who will be enriched ..." I don't actually believe any of this, but, whatever, with effort I could find some way to make this relevant here - to include it in my blog about trying to control my own fate - the creation of life and tranquility and so forth ....

-Today my brother, my mother's youngest child, turned 30.

- Today I gave myself my fourth injection in my 3-4 week process of attempting to extend my fertile years beyond what nature would otherwise allow me ... to build a little fertility insurance for myself.

Who knows what the future holds, but today I hit day 4 of injections (though really, I started this process months ago - with appointments and blood tests) in my attempt to build a little insurance for something I want. The markets may have screwed me and the world in ways that defy anyone's ability to predict anything. The god of my ancestors may have set my destiny, my mother had her 30 year anniversary of her last proof of her own fertility, but, well, today, day 4 of shots for me in my attempt to try control things for myself. Though I don't for a second think that any of this is really a sure thing.

Still no side effects. The above philosophical nonsense is just me being me :) I will try to keep this blog more informative and less blah blah-ing. Maybe.

Day 23 - still no side effects

Took my 3rd shot this morning. The novelty of it has mostly worn off, so it was more routine this morning than exciting. The injection site was a little itchy and a little red again for a minute, but the shot itself didn't hurt at all - I guess that's the theme. Still no noticeable side effects. I just realized that egg retrieval if all goes well might fall out right around Halloween so I might miss out on that partying. Oh well. Anyway, happy be be doing this!

My thoughts on Extend Fertility

Some people might come across this blog in their own considerations about egg freezing (that's really mostly why I'm blogging this anyway). If you're one of those people, you've almost certainly heard of Extend Fertility - the mostly-marketing firm that brought egg freezing to the masses (and by masses, I mean the tiny fraction of women who can afford to do this and the perhaps few thousand woman worldwide who have actually gone through with it). Extend holds seminars-slash-parties, partners with various medical clinics, and is largely a lead generator for these clinics (Extend takes a cut). I went to one of these seminar/classes. On the Upper East Side, it was quite literally a party (titled "Take Control of Your Dating Life" - I didn't go because I wanted to learn how to do that, but because this is what all the Extend informational sessions are called) with wine and cheese and fruit and a panel including a doctor, a new-age-y therapist and a relationship expert. An astrologer would have easily fit into the vibe. Late 30's and early 40's type-A women - mostly attractive and well dressed in power suits - eating their fruit and cheese and sipping their sauvignon blanc, learned a little about empowerment and how to go on a first date without seeming baby desperate. There was a little bit of biology tossed in there. There were conversations about the merits of sex on the first date. There were also raffles, little blue robin egg shaped chocolates, and robin egg shaped soap gift bags. Awww .... egg soap for egg freezing!

For all the partying though, here's how I sum up the message I heard at the seminar. "You are single because you are baby desperate and men can tell. And who knows, gosh darn it, if this experimental egg freezing thing will make you a baby someday - no guarantees. But doing this will make you less desperate - freezing your eggs is how you take control. And then you will finally be lovable. If you don't want to die alone, freeze your eggs." Quite a marketing play, don't you think?

Bless Extend for bringing more awareness of egg freezing to more people. It's important to at least counter all the misperceptions that are created when 45 year old celebs have babies (and that's always with donor eggs - it's just not common knowledge, and this makes women thing that babymaking in their 40's is normal). But when I did my own follow up research, I decided I really didn't want to go with the clinic that Extend partnered with in NYC. I found that NYU had a much better program, higher success rates, more real factual information even if there was a little less wine, no gift bags, and a little less pandering.

So again, bless Extend for marketing egg freezing to the masses of women who have no idea about their own biological clocks and would otherwise think that personal trainers and healthy eating and celebrity anecdotes will keep them fertile into their early 40's. And bless Extend for getting covered in all the magazines that these women read. I may very well be going through this process only because of the awareness Extend brought to me - strike that, I'm pretty sure that without Extend, I wouldn't have started down the path of getting as informed about egg freezing as an option as I am.

All that said, I'm glad to be going through NYU (who doesn't partner with Extend) .... although I still do have the blue soap that I got from the Extend seminar. I guess some of my guests have used it.

This is all just my opinion, and I encourage you to go to an Extend seminar yourself. Go. It's free, it's a party, and maybe I'm totally wrong about it being mostly a marketing lead-generation thing. And I might be wrong about the clinic in NYC that Extend partners with, and perhaps you'll be looking at a different Extend-partnered clinic altogether. It might feel right to you and you will certainly be no worse off for going and giving Extend a shot. At least you'll get some soap.

Day 22

So even though my first shot was last night, they told me that I could take today's shot in the morning if I preferred morning shots instead of evening. Since mornings are a little more predictable for me, that's what I chose to do.

I gave myself the second shot this morning and like the first shot, it didn't hurt or sting at all and I couldn't even feel the jab. Although this time I noticed a slight itchiness in the area right after the shot. The itch was gone within a minute. But that was different compared to last night when I felt absolutely nothing. I don't know if this has anything to do with the fact that I had to refrigerate the bottle of liquid hormone after opening, so this morning I was injecting cold liquid whereas last night it was room temperature. Regardless, it was easy and painless both times.

So far, I feel no noticeable impact from the hormones. Not like I suddenly got grouchy or anything. In fact, my mood is great, and I'm excited to be doing this!

Day 21 - PICTURES of the first shot!

So let's get this out of the way. This is the tiny little needle we're talking about. It's even tinier in person. It's smaller than the little pins that grandmas kept in pin cushions. It's tiny. (I took this pic after using this needle - wouldn't contaminate it like that)

The Sharps Box (It's illegal, like, $10,000 fine to dispose of needles any other way!) and the lupron kit





The Sharps Container - needles go in here, and then I give the whole thing to a hospital or the fertility place, or something.




Outside of the Lupron Kit


Lupron Kit Contents. A bottle of the liquid med. 14 needs, and some alcohol swabs.


Filling the needle for my first shot - 10 units. I feel so medical! And I don't have to worry about air bubbles (it's a myth that that can kill you - you'd have to be purposely trying to inject a big air bubble directly into a major vein)



I wiped my skin with alcohol first, like a good patient following instructions. And pinched as told. You can pinch an inch on me. Thankfully I guess.

Didn't feel it go in, don't feel it even as it's in. Really! Plunged right after I took this pic, and then withdrew the needle. No blood - just a tiny pink dot.



Responsible Disposal!

Day 21 - Progesterone 6.3

Ok, so jumping straight in on a little biology. Egg freezing is essentially like IVF - a bunch of weeks of hormones and then egg extraction. Except in IVF the eggs get fertilized and put back in, but in egg freezing, the eggs are frozen for later use.

1. Depending on your age/fertility level, you take shots of a gonadotropin-releasing hormone ( GnRH) agonist to shut down your reproductive system for a bit (if you're a little older, you might skip this part)
2. Some days or weeks later, you take shots of a different hormone stimulate the hell out of the ovaries to make tons of eggs. Actually these eggs are already there, but usually, in a given month, your body produces only enough hormone to "ripen" one - and the rest just dissolve. By taking added hormone, you get as many as possible to ripen. (it's not like you're pulling forward or borrowing future eggs - you're just giving all the eggs already tossed out for that month the hormone they need to get to mature stage. Those eggs, whether you took shots or not, would never be available in the future).
3. Once all the follicles are large/ripe enouogh, you get one big shot to cause ovulation. This is the only real scary-ish shot. It goes in the butt (the fertility clinic can draw a circle on your butt to show you where to do it) and it's a biggish needle because it has to reach muscle
4. Right before ovulation would have occurred (36 hours after that big shot), they put you under light anesthesia (you don't need intubation - but you're out of it) and empty each follicle to get the eggs. Decent egg retrievals should get between 10 and 30 eggs. Average is probably 10-15. Lower than 10 is considered pretty low, and near or over 30 means you were hyperstimulated and are probably in a little bit of medical messiness. For what it's worth, if you end up with fewer than 15 worth freezing, they will probably recommend another cycle. 15 or above is considered stellar so long as you haven't overstimulated. If I end up with 18 or more, I'll be ecstatic.

There are two basic protocols for the egg retrieval procedure. There's the short (most common) protocol, and the long day 21 protocol. I'm on the day 21 protocol, which means I start the program on day 21 of my cycle before the cycle where eggs are retrieved. For people on the shorter protocol, they don't do anything until day 2 or 3 of the same cycle when the eggs are retrieved. I could say a bunch about my understanding of who gets put on the long vs. short, but basically, if you're a "good" (i.e. young) candidate, they may choose to put you on the long protocol because it produces higher quality eggs and because younger candidates are at higher risk of responding too well to stimulation, which can be a problem. The longer protocol just involves a longer period of time when they shut down your system before stimulating it. If you're more borderline, they don't want to shut you down for too long, for fear that there will be problems waking everything up

These are some of my stats that make me a good candidate for the long cycle

Age: 32
Day 3 hormone tests:
FSH: 6.1
Estrogen: 24

Ovarian Ultrasound: Many Follicles. Like up to 30% of women, I have a very very high number of ovarian follicles. This can be bad, as it's the biggest sign of PCOS (polycystic ovarian syndrome) which is a major cause of infertility (most women with PCOS don't ovulate) and other problems, like excess hairiness and acne. However, I probaby do not have PCOS since I definitely still ovulate and don't have those other symptoms (i.e. not hair and not prone to acne). Only about 1/3 of women with high follicle counts on their ovaries actually have PCOS. But the high follicle count means I *should* make lots of eggs with very little help needed. So it's actually a plus here.

Ok, that was more background than I intended. Anyway, so although this is day 1 of my "treatment" I could also call today "day 21" for me - because I started my last period 21 days ago and in fertility stuff, they often reference the day by where yo are in your cycle. So I'm going to go from 21, 22, 23 ..... back to day 1, day 2, day 3 etc and will probably have a retrieval in the early teens of my next cycle. Anyway, so today being day 21, and my being on the day 21 cycle, I went to the fertility center this morning to get a blood test to make sure I've already ovulated this month - my progesterone came back at 6.3 which means I ovulated a few days ago. So we're good to go. That means my first shot is tonight.

I'll be on lupron (the antagonist - there's another brand called "antagon" and the choice of which you're on might just vary with what your insurance covers) until I start my next period (expected 8-12 days from now) and then 2-3 more days. Then I'll go back for bloodwork and an ultrasound. And then suddenly I'll start calling myself on day 2 or day 3 as if that makes sense to come after already being on day 21, day 22, etc. It makes sense. You're smart - You get it. Right?

Short Intro

There's probably a really long and really boring story as to how I got to where I am, but I'll leave that for artistic flashbacks as I proceed through the next few weeks.

In short, I am 32 years old and have decided to freeze my eggs. I am doing it "electively." That is, there's no medical reason I need to (for example, upcoming radiation that might render me infertile) and I am only doing it for deferred fertility or some language around that. Basically, so that I can beat my biological clock, have kids even when my reproductive system would have it some other way. In an attempt to squash a bunch of information in here, I'll note that the FDA considers elective egg freezing to be experimental, giving women false sense of security, etc and so forth. On the flip side, in the last 2 years, there has been a surge in success rates, with NYU showing a greater than 50% live birth rate for frozen egg cycles done by women under age 38.

People might think 32 is young to be freezing my eggs. Why not wait until my late 30's? I have plenty of time. Well, the point is, to qualify as an egg donor for someone else - say, for an infertile couple, the cutoff is usually around 30 or 32. And that's because egg quality starts to decline around 28, starts a deeper decline at around 32, and a really cruel decline at around 37 or 38. So if my eggs are just about at the cutoff for qualifying in quality to donate to someone else, it would make sense that if I am the intended recipient of these eggs, I'd want at least the same quality of donor that the medical community expects for donors who are strangers to the recipient. And once I freeze my eggs, they stay 32 forever. If I use them when I'm 40, the quality/risks will be the same as if I were having a baby at 32. As to whether I'll need these eggs? Maybe I won't. This is insurance for me. Hopefully I won't (and if I don't, I'll donate them to an infertile couple). But as a professional single 32 year old female living in Manhattan, the chances that I'll need them are much higher than are the chances I'll need my disability insurance (based on my "well duh" instinct about probabilities here) --- and I figure I'll keep that around too.