First Egg Freezing Cycle: Consultation and Pre-Testing

As I have mentioned in previous posts, I have already been through a cycle of egg freezing. I started this blog is to share my experiences from the second cycle, I figure I may as well give an overview of the procedure while talking about my first cycle as well. I think of egg freezing as being divided into 5 main parts:

1. Consultation and pre-testing

2. Preparing for stimulation phase

3. Stimulation phase

4. Egg retrieval

5. Recovery

I’ll do a post on my experiences with each part.

Consultation and pre-testing

Prior to my first appointment, I stopped taking birth control pills for several weeks so that if hormone tests were necessary, they wouldn’t be distorted by the birth control pills. During my first appointment, Dr. Westphal went over my medical history, my reasons for wanting egg freezing, how the egg retrieval procedure works, the risks of the procedure, etc. She did a vaginal ultrasound to look at my ovaries, and said everything looked good with them. I was a bit nervous about the vaginal ultrasound, but for no reason--it didn’t hurt at all. Much more comfortable than a normal pelvic exam.

Dr. Westphal said it looked like I was a good candidate for egg freezing, but that we would need to get some lab tests done to be sure. Normally the tests for FSH and estradiol are done on the third day of your period. I was a little past that but she thought it was close enough that we could do the tests that day anyway, so she sent me down to the lab.

A few days later, a nurse called to let me know that my blood work was normal and that I was a candidate for egg freezing.

At that point, I delayed for over a year before actually proceeding with the egg freezing. I was moving to take a new job and thought I would do egg freezing in my new city, but I was so busy with the job that I didn’t get around to it until I moved back to the Bay Area more than a year later.

Will Egg Freezing Really Work?

I assume that, like me, most women who freeze their eggs hope they never have to use them. I certainly hope that I find a wonderful husband soon and that we will be able to conceive children naturally. But I also think there’s a very real possibility that I won’t find a husband soon enough and that I’ll have to use my frozen eggs. So I really hope this technology works!

There are no guarantees in egg freezing. Although the American Society of Reproductive Medicine (ASRM) removed the “experimental” label from egg freezing in 2012, it does not recommend egg freezing for elective purposes. Little is known about the success of egg freezing for elective purposes. It seems very promising, but there is a lack of both studies and anecdotal success stories. I have only run across four stories of women actually using their frozen eggs, and of those, only one was successful.

NYU has one one the most established egg freezing programs, but even there the success numbers don’t look that great. According to the “Oocyte Cryopreservation Program and Success Rates” portion of the NYU website:

• over 80 cycles have been performed where both freezing and thawing have been completed
• 26 women have delivered live babies
• there are 4 healthy ongoing pregnancies

That means that only 30 out of 80 cycles led to actual live babies, assuming the 4 healthy pregnancies continue successfully. About a 38% chance of success--and this is at a clinic that is particularly known for making babies out of frozen eggs!

On the other hand, my doctor at Stanford is pretty optimistic about my chances. She thinks that I could get 6 or 7 embryos out of the 11 eggs I already have frozen. That would be enough for at least 3 embryo transfers, since we would not be transferring more than 2 embryos on each try (no Octomom for me!)

Even though I know intellectually that there are no guarantees, I desperately want to believe that egg freezing will indeed work if only I can get enough eggs. In “Essential elements of informed consent for elective oocyte cryopreservation,” ASRM states that, “In the absence of clinic-specific outcome data, the following estimates based on published peer-reviewed medical literature should be used: a) An approximate overall 2% live-birth rate per oocyte thawed for cryopreservation using slow-freeze methods. b) An approximate overall 4% live-birth rate per oocyte thawed for cryopreservation using vitrification.”

That gives me hope that if I can get 25 eggs preserved through vitrification, that I would have a very high chance of having a live birth.

Closing In on a Clinic Choice

I feel like the choice of a clinic is being made for me, in that out of the four clinics I’m considering, only one can really accommodate my preferred timeline. It looks like I will be going with Stanford again for my next cycle. Here’s what happened with the other clinics:

• Nova IVF: as I mentioned in a previous post, they don’t have any appointments available for the rest of 2014. I went on a waiting list with them and sent in my registration materials. I emailed them some questions about the egg freezing program to try to figure out if it would be worth waiting, but have not received a response.
• FPNC (Fertility Physicians of Northern California): I have a consult set up for March. They have recently become part of the Palo Alto Medical Foundation (PAMF) and things seem to be changing a lot after the merger; the doctor I will be seeing in March is from PAMF and not from FPNC. I am a bit concerned about that because a big part of the reason I was interested in this clinic was their good SART statistics. I will now be seeing a doctor who didn’t contribute to those statistics, which I’m not so happy about.
• Zouves Fertility Center (ZFC): My consult was postponed AGAIN because my medical records STILL have not arrived from Stanford.

I have mixed feelings about going with Stanford again--it is easy, familiar, I like my doctor there, and I can start really soon. However Stanford’s success with regular IVF is well below the national average, and they don’t have much experience with turning frozen eggs into babies. I guess I am hoping that they will improve and gain experience with frozen eggs before I need to actually use the eggs! I can’t help but feel a little discouraged about it being so hard to complete research on all the clinics.

I am keeping my scheduled consults with other clinics because I may well do a third egg freezing cycle and so I will consider the other clinics for that future cycle.

SART Statistics and Egg Freezing

Every year, the CDC collects data from IVF clinics on the success rate of various ART (Assisted Reproductive Technology) procedures and reports that data on its website. The data is also reported on the SART (Society for Assisted Reproductive Technology) website in a format that may be easier to read. By comparing the reports for different clinics, you can see which have the highest success rates. SART warns that “Patient characteristics vary among programs; therefore, these data should not be used for comparing clinics,” but many people believe that in fact comparing success rates amongst clinics is a valid idea. You can also compare a clinic’s success rate against the national average to see if your clinic is above average or not. Carole Wegner points out in her “Finding a Good IVF Clinic” post, “I wouldn’t go to a worse than average clinic. Would you?”

The only problem for us egg freezers is that the CDC and SART don’t publish data on egg freezing. However we can still benefit from the reports. Common sense says that if you have a clinic that is great at other IVF procedures, they are more likely to be good at egg freezing than a clinic that is only mediocre at other IVF procedures.

In her “Finding a good egg freezing clinic” post, Wegner mentions finding a clinic that has a good success rate for regular IVF for the <35 age group. That would be “fresh embryos from non-donor oocytes” in SART language. But the reports also contain information on a couple of procedures that involve freezing and thawing: “thawed embryos from non-donor oocytes” and “thawed embryos from donor oocytes.” I wonder if looking at those numbers might be more meaningful for the case of egg freezing, because at least they have to do with freezing and thawing things--even if those things are embryos rather than eggs.

So here’s where things get confusing: of the four clinics I’m considering, the one that has the lowest success rate for transfers of fresh embryos has the highest success rate for transfers of frozen embryos. The one that has the second-highest success rate for transfers of fresh embryos has the lowest success rate for transfers of frozen embryos. How am I supposed to interpret this? If anyone has suggestions, please let me know in the comments!

Waiting for Clinics

Right now I am doing a lot of waiting for clinics. This is frustrating because I am in a hurry to get this egg freezing show on the road. Right now my job situation makes it pretty easy for me to take the time to freeze eggs, but that won’t necessarily be the case a few months down the road. So I want to get this done sooner rather than later.

• Nova IVF: They don’t have any appointments available for the next year (!). I went on the waiting list. So obviously Nova is not an option for anytime soon, but it could be attractive for another egg freezing cycle in the future because it is supposed to be a very good clinic. Nova has the highest rate of live births from regular IVF of the clinics I’m considering, which indicates that it is a good clinic in general, although I don’t yet know anything about their egg freezing statistics. (There are no nationally reported statistics on egg freezing but you can use the IVF statistics reported through SART to get an idea of if it is a good clinic overall. From Carole Wegner’s “Finding a good egg freezing clinic”: “Even though egg freezing is not tracked directly by the CDC, once you identify ART clinics that also provide egg freezing, you can check out their pregnancy and live birth rates using fresh eggs to get an idea about how good they are at routine IVF and by extension, suggest they might be good at egg freezing. Or put another way, having good IVF rates does not guarantee good egg freezing rates but being a below-average clinic for IVF does not lead one to expect exceptional egg freezing rates.”)
• Fertility Physicians of Northern California: I called to make an appointment but their new patient coordinator is out of the office, so I will have to wait until she returns to find out more information.
• Zouves Fertility Center: I was supposed to have the consultation today, but it has been postponed because my medical records from Stanford didn’t arrive in time.

So I am waiting for clinics. In the meantime, I am continuing with my supplement routine. I haven’t been as good about diet and exercise unfortunately.

I also just finished reading Sarah Elizabeth Richards’ Motherhood, Rescheduled: The New Frontier of Egg Freezing and the Women Who Tried It. It follows the stories of four women (including the author herself) who have frozen their eggs. It is a great read, I couldn’t put it down because I was so excited to see what would happen with each of the women in the end. I would definitely recommend this book if you are interested in egg freezing.

Choosing a Clinic

When I did my first egg freezing cycle, I did virtually no research before choosing a clinic. I went with the Stanford Fertility and Reproductive Medicine Center because it is close to where I live, and because it is affiliated with Stanford, I assumed it had to be excellent. I have no real complaints about the Stanford clinic, but I certainly didn’t do my due diligence when selecting it.

I recently found a great post on “Finding a good egg freezing clinic” on the Fertility Lab Insider blog and it contains a lot of good things to think about when selecting a clinic. I am currently in the process of deciding where to do my second egg freezing cycle, and that post is really helping me understand what kind of research I should be doing and how I can use SART statistics to inform my decision. It also has a great list of questions to ask the clinic.

I decided I should find out the answers to these questions for Stanford, even though I have already completed a cycle there. I contacted the clinic with the questions and received some answers in a voicemail (unfortunately I missed the call). Around 200 women have frozen their eggs at Stanford, but “very few” have come back to use the eggs. It was not clear in the message if any of those women who came back to use their eggs actually had babies. It sounds like there are no real clinic-specific statistics on the thaw survival rate, the fertilization rate, etc. The doctor said in the message that she “expects” the survival rate to be x, the fertilization rate to be y. But it sounded like she was quoting numbers from studies done elsewhere, not actual results from the Stanford clinic. This makes me a little nervous, because it sounds like Stanford doesn’t have much experience turning frozen eggs into actual babies.

However I did learn that Stanford now uses vitrification for freezing eggs. This was my #1 reason for not returning to Stanford for my second cycle; I had thought that Stanford used slow freezing. Now that I have learned that Stanford uses vitrification, I am considering returning there for my second cycle. The clinics I am considering:

• Fertility Physicians of Northern California
• Nova IVF
• Stanford Fertility and Reproductive Medicine Center
• Zouves Fertility Center

A More Encouraging Study

I found a study that was done on egg freezing in fertile women: Thomas J. Kim et al., “Vitrification of oocytes produces high pregnancy rates when carried out in fertile women” from Fertility and Sterility, January 2010.

I did not read the entire paper because only the abstract is free, and buying the full paper costs over $30. But I can see from the abstract that the live birth rate per vitrified and warmed egg was 5.1% in this study. That is actually pretty good in the egg freezing world. Let's say I get 12 eggs to freeze out of my next egg freezing cycle--if this study is right, that could mean an over 60% chance of having a live birth!

What is unique about this study is that it was done on fertile women who were using their own frozen eggs. Most egg freezing studies are either done on egg donors or on women who are already struggling with infertility. So, it is hard to know how applicable the results of most studies are to someone like me who is going through elective egg freezing:

• Studies done on egg donors: these women are probably more fertile than most women going through elective egg freezing, because they tend to be younger. Different egg donation programs have different age cutoffs--a quick internet search revealed cutoffs of 28, 29, 30, 32, 34, and 35 in various programs. But in any case most egg donors are on the young side and therefore success rates with frozen donor eggs might be higher than success rates for most women going through elective egg freezing.
• Studies done on women already struggling with infertility: these success rates may be lower than success rates for women going through elective egg freezing, because the women are already having trouble conceiving. That could mean that their egg quality or egg quantity is lower than for the average woman going through elective egg freezing.

In case you are wondering why women who are already going through infertility would be freezing their eggs--the most common reason is that they are going through normal IVF but that for legal or ethical reasons, they cannot or don’t want to make many embryos. For example, there was legislation in Italy that meant that only 3 embryos could be created. So in Italy, women would go through the egg retrieval, have the 3 embryos made, and have the rest of the eggs frozen. It is unfortunate that women/couples in Italy had to deal with this restrictive legislation, but we also learned a lot about egg freezing because of it--a lot of the studies on egg freezing come from Italy.

Incidentally there is an egg freezing calculator here:

http://i-fertility.net/index.php/probability-calc/item/94-egg-freezing-success-estimator-based-on-the-number-of-eggs-frozen-thawed

You type in how many frozen eggs you have, what age you were when they were frozen, and indicate if they were frozen using the slow freeze or vitrification method and it spits out the chance of having a live birth from those eggs. (Note: I find that the calculator is a little buggy and sometimes it doesn’t work.) As I mentioned in a previous post, I already have 11 frozen eggs that were frozen with the slow freezing method when I was 32. According to this calculator, that gives me only a 10.9% chance of having a live birth. Gulp! That’s not a very high chance! I’m glad that I’m moving forward with another cycle, with a clinic that uses vitrification, to increase my chances.

Consents and Exercise

Yesterday I sent off my preliminary consent to be treated to the doctor.

I am also working on getting into shape prior to the egg freezing. I am on week 2 of the RunDouble Couch to 5K program. I need to get my exercise in now because you cannot do most exercise for several weeks during the egg freezing process: you have to stop exercising (except for walking) after the first few days of hormone injections, and you have to stay off exercise for a while after the egg retrieval procedure--until your ovaries shrink back to their normal size. This is because while the ovaries are enlarged from the hormone injections, there is a risk of torsion--twisting of the ovary, which can lead to the blood supply being cut off and could even lead to you losing the ovary. To avoid this risk, the doctors advise you to avoid exercise. During my previous egg freezing cycle, I was told to stop exercise except for walking after the 4th day of hormone injections.

Preparing for Egg Freezing

There is a lot of information on the internet, much of it unsubstantiated, about how you can prepare for your IVF cycle. Special diets, Chinese herbs, yoga, acupuncture, supplements, and meditation are all part of the key to successful IVF according to some people--in particular women on IVF boards, but also in some cases the doctors.  Because  the stimulation phase and egg retrieval in egg freezing are  the same as the first part of an IVF cycle, it makes sense that some of these techniques might be helpful for egg freezing too. But which ones? There doesn’t seem to be much information  on which things would be helpful for retrieving eggs for freezing, versus for going through an entire IVF cycle that includes embryo transfer.

For example, my doctor sent me a packet of information on “maximizing IVF success” even though he knows I am doing egg freezing.  In this packet, it shows statistics about how the higher a woman’s BMI is, the lower the pregnancy rate is (up to a certain point--being underweight is also bad). Fine. But I am not trying to get pregnant right  now. I am just trying to retrieve a large number of high-quality eggs. Will lowering my BMI help improve the egg retrieval? Or  does it not matter for eggs, and only matter at the embryo transfer stage?

The information packet also says “...studies conducted in the Bay Area have shown that nutritional supplements such as antioxidants, multivitamins and amino acids can enhance both egg and sperm production leading to better fertility outcomes.” Enhancing egg production sounds good to me, so I have decided to do some supplements. I already have vitamin D and omega 3 supplements, though I haven’t been taking them, so I will start. I also ordered pre-natal vitamins and coenzyme Q10 and they arrived today. So I am starting my supplement routine! The other supplement recommended in the packet is wheatgrass/chlorophyll, apparently you can get liquid chlorophyll at Whole Foods and add it to lemon or lime juice and water. Maybe I will pick that up sometime this week.

If you  have information about which techniques may be helpful for improving egg freezing outcomes, please let me know in the comments!

Some Background

I have already been through one egg freeze cycle, and I am going to be doing another one. Why? As it turns out one egg freeze cycle may not get enough eggs to give a good chance of having a baby. There are a lot of things that have to go right for the baby to happen. I am not a medical professional so this is probably an overly simplistic explanation, but in general this is what needs to happen: The eggs need to survive the thawing process.Then the eggs have to be successfully fertilized. Then they have to grow into an embryo that can be transferred into your uterus. The embryo has to implant successfully and continue growing into a baby. There can’t be a miscarriage. At every step along the way, some of the eggs don’t make it to the next step. So you can end up not having enough eggs to result in a live baby. Of course even if you have tons and tons of eggs, there are no guarantees. But overall, your chances increase the more eggs you have frozen.

One of the factors that affects how many of your eggs make it through the whole process is the freezing method. There are two main freezing techniques, slow freezing and vitrification. Vitrification is a newer technique and it seems to be more successful. For example, consider the following data from Pelin et al., “Age-specific probability of live birth with oocyte cryopreservation: an individual patient data meta-analysis”:

	Slow Freezing	Vitrification
Eggs surviving thawing process	65%	85%
Eggs fertilized successfully (of those that survived the thawing process)	74%	79%
Implantation rate (of fertilized eggs that grew into embryos and were transferred into the uterus, how likely were they to implant)	>8.9% under age 30, 4.3% after age 40	13.2% for age 30, 8.6% for age 40
Miscarriage rate ages 30-40	36%-41%	19%-22%
Pregnancy rate per 6 eggs thawed in 32-year-old eggs	9.2%	21.6%

So as you can see, pretty much everything goes better with vitrification: more eggs move on to the next step at every stage. In my previous egg freezing cycle, I froze 11 eggs using a slow freezing method.  As you may have guessed, I didn’t do this research until AFTER that first egg freezing cycle, or I would have sought out a clinic that had vitrification in the first place!

Let’s run the numbers  on my 11  slow frozen eggs: Let’s assume that there is one cycle in which 6 eggs are thawed (with a 9.2% pregnancy rate) and another cycle in which the remaining 5 are thawed (maybe a bit under 9% pregnancy rate).That is just not a high enough chance for me--I want to be much more sure about my chances of getting pregnant, so I am setting out on another egg freezing journey, this time with a fertility center that uses vitrification.

Currently I have an appointment scheduled for a consultation with the new fertility center. I am excited to get going with the new egg freezing cycle, and I am even hoping that I will get more than 11 eggs this time. (The clinic where I did my first cycle seemed very worried about over-stimulating me, so I wonder if they somehow ended up under-stimulating me instead.)

I'm freezing my eggs

I am freezing my eggs. Why? I am 32 (coming up on 33), single, with no romantic prospects currently on the horizon and I am 100% certain that I want to have children. I never wanted to put off marriage and childbearing, I haven’t been postponing children for the sake of my career--it is simply a problem of not having found Mr. Right yet.  

In the best-case scenario, I meet my future husband tomorrow, we date for a year, get engaged, get married a few months later, and start trying for kids soon after that. That would bring me to about age 34. But I am not holding my breath for the best-case scenario to happen. As I mentioned above, I have not been trying to put off marriage--it just hasn’t happened yet. So what are the chances that I’ll meet Mr. Right almost immediately, just in time to have kids before my fertility takes a nosedive around age 35? I have to be realistic and realize that it may take longer to meet the right husband, and I could be well on my way to losing my fertility by the time it happens.

Thirty-two might sound young to be freezing eggs, but in fact it is probably a little later than ideal. A woman’s fertility starts to decline around age 27. The decline speeds up as time goes along, really speeding up around age 35 (see Dunson et al, “Changes with age in the level and duration of fertility in the menstrual cycle” and The American Society for Reproductive Medicine’s “Age-related fertility decline: a committee opinion”). So in fact the absolute best time to freeze eggs would probably be a bit earlier, more like the late 20s. Thirty-two is not bad, and many egg freezers are in their late 30s (see Aylin and Emre, “Current trends and progress in clinical applications of oocyte cryopreservation”). But the younger you are, the better the results are likely to be, so there is no point in me putting it off.

I’m writing this blog to document my egg freezing journey, so that other women who are considering egg freezing can learn more about what it’s like to go through the process.