Thursday, May 2, 2013

Got Questions on Egg Freezing ? CNN has Answers

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Brought to you by Sam K. of Egg Freezing 101    

5 questions on egg freezing

By Dr. Jeffrey Steinberg, Special to CNN
updated 8:08 AM EDT, Fri April 26, 2013

Technological advances including egg freezing are allowing women to have babies later in life.
Technological advances including egg freezing are allowing women to have babies later in life.

  • Women's eggs begin aging even before birth
  • The best time to think about freezing eggs is in your 20s and 30s
  • Healthy babies have been born from eggs frozen from five to nine years

Editor's note: Dr. Jeffrey Steinberg is a board-certified reproductive endocrinologist based in Los Angeles, New York and Guadalajara, Mexico. He is the director and founder of The Fertility Institutes.
(CNN) -- We all know about the importance of contraception in preventing unwanted pregnancy -- in 2013 more women are aware of their reproductive options than ever before.
While there have been great strides to make birth control and contraception common knowledge, women's options in terms of fertility are often not widely known. During National Infertility Awareness week, we have the unique opportunity to discuss reproductive aging, a topic that affects all women yet is rarely addressed.
As a woman, you are born with every single egg you will ever have for the rest of your life -- a fact most women should know and many find shocking. Unlike men, who are constantly able to produce new, viable sperm throughout their life, a woman's eggs begin to age even before birth and continue to do so until their final depletion at menopause.
This may seem like a terrifying concept for most women who plan on having children later, but it doesn't have to be. With egg freezing and the many new related technological advances in the field of reproductive medicine, women are now able to have children later in life. The key is not only knowing your options, but knowing them before it's too late.
Dr. Jeffrey Steinberg
Dr. Jeffrey Steinberg
Egg freezing is one of the easiest ways a women can radically slow down her biological clock, and it's something I recommend to all women concerned with their fertility. Here are some of the most common questions I am asked regarding egg freezing.
Q: How old should I be when I start thinking of freezing my eggs?

IVF to help 'balance' families?

Freezing reproductive potential in time
A: The best time to freeze your eggs is in your 20s and 30s. Younger eggs freeze better and have a better a chance of withstanding the freezing process -- ultimately providing you a greater chance of creating a baby.
The egg-freezing process is much simpler than many might think. Once the patient has been qualified as a candidate, we plan a cycle around her menstrual period. Soon after a menstrual period begins, we start administering fertility hormones. Patients take the fertility hormones in daily injections for up to two weeks. At the end of the two-week period, we extract the eggs, which is done with light sedation while the patient is asleep. The process is completed in 30 minutes or less. It is painless and quick -- and just like that, you've got yourself a great insurance policy against future infertility.
Q: Will I run out of eggs earlier if I freeze my eggs now?
A: This is a common misconception that could not be further from the truth. We're using eggs that you would have otherwise lost.
As human beings, we are designed to reproduce -- this is what nature wants us to do. So to make sure this happens, instead of choosing one egg per month to be "the" egg, nature chooses between 10 and 20 eggs. But, a woman is only able to produce enough fertility hormones to ovulate one of these eggs. So the others that weren't able to get that fertility hormone and make it to the "finish" line in time just die.
What we're doing is stepping into the equation and offering more fertility hormone to take advantage of those eggs that would have otherwise died off. So in actuality, we are saving your eggs.
Q: Does insurance pay for this?
A: In almost all instances, insurance does not yet cover egg freezing. Fertility preservation is seen as an elective procedure, much like plastic surgery or anti-aging medical procedures. However, if a woman is diagnosed with cancer or has to undergo surgery, radiation, chemotherapy or some sort of medical procedure that will render her infertile, we can usually get the insurance company to cover the process.
Q: How long are frozen eggs good for?
A: That's a question we don't really have an answer for simply because it is such a new science -- we haven't been freezing for all that long.
In the beginning, the odds were not very good at all, but the technology has been around for more than 10 years now and it has definitely enhanced. We now flash-freeze instead of slowly freezing eggs, which has improved the success rate tremendously. We have healthy babies from eggs frozen five to nine years, and babies from sperm that has been frozen for over 30 years. There is no reason to think that eggs would react any differently to the freezing process than sperm.
Q: Are babies created via in vitro fertilization (using frozen eggs) just as healthy as other babies?
A: Babies created via IVF, whether by frozen or fresh eggs, are just as healthy as babies born the old-fashioned way.
Occasional studies examining the very fine health details of IVF babies versus their non-IVF counterparts have shown that there may be a very slight increase in birth defects or subsequent health problems in IVF babies. When studying all problems, babies in the general population show a 6.6% risk of having a minor or major birth defect, versus 9% of the IVF babies.
What should also be taken into consideration is that many of these studies did not account for the fact that many couples undergoing IVF for infertility have other medical problems that may increase the chance for a problem in their resulting baby, or may be of advanced reproductive age and using older, more mature eggs.



    Friday, April 5, 2013

    Ovarian Hyperstimulation Syndrome ... It Happens!

    Abdominal Cramps, OHSS

    I apologize for the delay on this post. It has now been a few weeks since my post egg retrieval procedure and I can safely say that I am 100% back to normal with my hormones and body. The bloating has now subsided and I only have my laziness to blame for my muffin top and lack of six pack abs. I do want to address a serious topic that is rarely talked about at the doctor's office when considering the egg freezing process: Ovarian Hyperstimulation Syndrome. There are different levels of it, and it happens more often than some doctors surmise. I have heard that OHSS impacts at a mild / moderate level about 15 - 25% of all egg retrieval patients. I was in that % that got it and for a period of 24 hours I thought I might die and was immobile. I could only go back and forth to the bathroom and was in extreme abdominal pain and looked about three months pregnant. I went from being constipated to having the runs. Gatorade and Immodium were my saviors.

    The symptoms and formal definition of OHSS is described below.  Click here to read more.

    Monday, March 25, 2013

    Egg Retrieval Day ... Success and Alcohol

    By: Sam K.        

    The Egg Retrieval Day ... I woke up excited and hopeful about my future family. Granted there are no guarantees, but I was predicting about 11-13 mature eggs and I had it ingrained in my mind that I only needed approximately 10 of those to make a baby. Therefore, I felt the odds were in my favor. 

    I got to the office waiting room on time only to wait an additional 45 minutes to be taken back to get prepped for surgery. I was getting nervous, because from the trigger shot of HCG to the release of the eggs is 36 hours and we did not have a lot of wiggle room. The eggs won't wait on traffic. They release on their own time frame. I remember briefly talking to the anesthesiologist about when I could get alcohol in my system again. No, I am not an alcoholic, nor do I drink everyday. However, these past two plus weeks have been the longest time I have abstained from alcohol since before college. It was a master cleanse of some kind for me. No alcohol, caffeine, sexual activity, or rigorous exercise for 16 days. If I could pinpoint what was the most difficult for me to give up, I would have to say the intense working out. I love to eat and the way I keep my somewhat girlish figure is by burning calories from running, cross fit, and biking. It was a bit of a letdown that I found out that I would need to wait an additional 10 days post surgery before I could start running again. If you work out too early, you run the risk of ovarian torsion, and could have to amputate your ovary if it gets severely damaged. Surgery can repair the damage though for most people. The reasoning is that your ovaries are majorly enlarged after the stimulation drugs and once the eggs are removed, the ovaries are a little slower to respond*. Patients with ovarian torsion often present with sudden onset of sharp and usually unilateral lower abdominal pain, in 70% of cases accompanied by nausea and vomiting.

    Monday, March 18, 2013

    The Ovidrel Shot .. Yuck! (Make Me Ovulate)

    Written by: Sam K.     E-mail: 

    It should actually be given in your
    stomach area or upper thigh!

    My RE doctor decided to stimulate me for one more day and had me trigger on day 14. My estrogen must have been at least 4500 by the trigger shot time. I was prescribed one pre-filled dosage of Ovidrel to take at exactly 35 hours and 30 minutes before my egg retrieval time. On day 13 of stimulations, the bloodwork showed my estrogen was 3955. I had to trust my doctors that they knew what was best for me and one more day of injections would not make too many of my eggs over mature  My goal was to get enough good quality eggs in the bank for a future baby down the line, not to implant an embryo a few days after the egg retrieval. Therefore, I was predicted to not be at major risk of major OHSS (Ovarian Hyperstimulation Syndrome).

    An aside on weight gain during the egg freezing process ... everyone responds differently. However, there is a general consensus that you will temporarily gain about 5 pounds throughout the two plus weeks of shots and egg retrieval time. I gained only two pounds on the scale during the injections. I will update on the entire weight gain later.

    I planned my Sunday evening around the shot. I went to a documentary movie that got out at exactly 9:30. I wanted to be home in time for my prep work for the shot and for any unexpected surprises. I kept the Ovidrel in the refrigerator the entire two weeks. I took it out 15 minutes prior to the shot. No mixing anymore. Yeah! The HCG injection was easy. The aftermath was not. About an hour and a 1/2 later, my stomach started feeling queasy and I had to run to the bathroom. Initially I thought it would go away. No, I spent 1/2 the night up with diarrhea and abdominal cramps. I hate to be so graphic, but I promised full disclosure of my experience and I am not leaving anything out. I finally took Immodium and within 20 minutes, the symptoms subsided and I felt better.  I woke up feeling sluggish and a little forgetful. My doctor assured me that everything was normal and the back end release was one on the side effects. I could not have been more excited / nervous for egg retrieval day.

    I slept really well the night before.  Finally, egg retrieval scheduled at 10:15 AM for the next morning. I am ready. My lower area did feel heavy, but I did not feel incredibly bloated yet.

    Here is a video on how to inject the Ovidrel shot for Newbies. Good luck!

    Written by: Sam K. 

    Saturday, March 16, 2013

    Follicle Counts, Hormone Levels, and Jennifer Love Hewitt

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    Well, I promised full disclosure of my egg freezing cycle and I am keeping my word. I am slightly bloated and craving a work out, but overall I am really functioning at a high level right now.

    Here is a chart of my progress throughout my egg freezing cycle. Througout the process, I had my doubts that my little follicles would mature fast enough. Some of it is just anxiety and some of it is real fear based on what I have heard and read about other people's IVF cycles. When estrogen reaches above 4000, the doctors want to trigger ovulation for fear of ovarian hyperstimulation and loss of egg quality. Right now I am on Day 13 waiting for the Go sign to trigger or take one more day of meds. I actually needed to order an extra day of medications just in case I need to stimulate for Day 13. My medications have cost $4800.00 in total for the 13 days. This is with the Heart discount for Menopur and the Go Savings for the Cetrotide and Gonal F. I ordered from Freedom Fertility Pharmacy and I would highly endorse ordering from them. They check the prescriptions, give you free syringes and needles, and deliver exactly when they say they will.   Continue on by clicking read more.

    Friday, March 15, 2013

    Fertility Stimulation Gonal F and Menopur (What a Combo) and Side Effects

    Written by: Sam K.                 For questions or comments, please contact me.

    Statistics: Age - Turning 37 Baseline Stats: AMH - Between .7 - .9 FSH  6.7 LH 3.4 E2 15.4  

    No DH to speak of yet. DH in the fertility world stands for Dear Husband. Not giving up hope yet. 

    Fertility by the Numbers

    Before I took the plunge to sign on the dotted line for the egg freezing process, I did some research on the internet on the success of embryo freezing vs. egg freezing. It gave me conflicting answers. Some sites said that egg freezing was nearly as effective in producing a baby than embryo freezing, while others said entirely the opposite. What I gathered over my three months of research is that embryos are hardier than eggs and that there is a risk on losing more eggs than embryos from dethawing. However, as technology is improving so is our ability to freeze and unfreeze both without fear of killing the cells. I honestly was not ready to give up on my dream to have the father of my unborn, not yet created baby, be a known entity to my child. I still wanted it all. I checked YES to start the process and bought the $4500.00 of drugs I was prescribed.
    Prior to my egg retrieval cycle, I was put on Desigin BC pills for 21 days was off them for 3 days prior to starting fertility stimulation injections. I started them on day 2 of my period. I had cramps medium to severe from period, but not the drugs. I had a lot of trepidation about the fertility drug injections. I was not scared of putting a needle in my body, it was the mixing of the drugs and dosage amounts that petrified me. It really was not that bad at all. I watched the video by a professional nurse coordinator from NYU and felt confident that I was ready to mix my dosages of Gonal-F (225 iu) and Menopur (150 iu) on my own. I had a q-cup and used the 27 1/2 gauge needle to assist me in the process. Do not use the 22 ones. I flicked out the bubbles with ease and even remembered to not shake the containers when mixing. I merely rotated them around. All in all, it was a successful 1st day with my egg freezing process. I had no immediate side effects that night. 

    Cetrotide on lt; Syringe in middle with Menopur and
    sodium  chloride; Gonal F Pen on rt.

    The next day I immediately developed a dull headache that lingered the whole day. I felt really confident when I did my shots on night two. No major hiccups to note. During the first week of stimulation injections, I had a hard time going to sleep, but I did not feel overly emotional or any pain from the drugs. I think I have a higher tolerance of pain than most. By the 7th day, I started to develop   a little bruising from the drugs. I am sure that if I went to the beach, people would think I was doing heroine subcutaneously from my abdomen area. It was not a pretty look. Luckily, I was not dating anyone serious at the time. I did go on some dates which I will blog about that separately.

    Cetrotide is a drug that prevents the LH surge from happening. This is necessary to prevent ovulation from coming too pre-maturely. Everything has to be timed perfectly to make the magic happen.

    So, the Cetrotide stings slightly directly after the injection and for me, created a red circle around the injected area. I used small ice packs to soothe the pain and minimize the itchiness and redness. I am hoping that my body will get used to the shots and that I will no longer get the red areas every time.

    Stay tuned for more on  Egg Freezing  .... True Confessions if you have any questions or comments. 

    Monday, March 11, 2013

    Single and Over 35 ... Clock is ticking!

    Written By: Sam K.                     Contact me at for Q's or Comments
    I vividly remember the first time someone introduced the subject of egg freezing to me. I was 34 and my OB / GYN glanced at my chart and then me, and asked, "So, have you ever contemplated freezing your eggs or creating an embryo?" To be perfectly honest, I was in shock and a little bit offended. I guess the single, unmarried box, next to my birthdate was her trigger to broach the topic. I was fit, dating someone new, and about to be 35. Why would I need to worry about my biological clock, right?

    I mean, everyday I was reading in US Weekly about a different celebrity that gave birth to another child over 40. Couldn't I wait too? What I did not know then was that most of these women were using either egg donors to get pregnant or were doing rounds of IVF (hormone injections and then an embryo transfer) to achieve the same result. I was so naive. The first thing I did on my journey to decide if freezing my eggs was the right thing for me was to educate myself on the process, the potential costs, and to find out what my chances were to have a baby one day with these eggs. I am going to give you my own personal take on the process and the pros and cons to Egg Freezing. egg freezing Egg Freezing

    Here is a little Egg Freezing 101 and Infertility vocabulary:
    • AMH: Anti-Mullerian Hormone, also referred to as MIS (Mullerian Inhibiting Substance), is produced by the ovarian follicles. AMH levels correlate with the number of antral follicles in the ovaries and gives an estimate of remaining egg supply. Women with lower AMH have lower antral follicular counts and produce a lower number of eggs compared with women with higher levels. AMH is only one factor that comprises a women's ovarian reserves prognosis. (Women with very low AMH <.2 and > 10 FSH are not good candidates for the egg freezing process.)

    • Antral follicle count (AFC):The number of follicles detected by the ultrasound at the beginning of the menstrual cycle, which indicates the size of your ovarian reserve.
    • ART: Assisted Reproductive Technologies (i.e.: IVF, egg freezing, egg donation, etc)
    • Chromosomal abnormalities: An atypical number of chromosomes. When numerical abnormalities occur in germ cells (i.e. sperm and egg cells) or during the very early stages of fetal development they may result in a miscarriage or in a developmental abnormality such as Down’s syndrome.
    • Egg donation: The process by which a woman donates several (usually 10-15) eggs for purposes of ART.
    • Egg freezing: also called human oocyte cryopreservation, is a rapidly advancing technology of extracting, freezing and storing a woman’s eggs (oocytes). The eggs can later be thawed, fertilized, and transferred to the uterus as embryos months or years later.Reproductive cryopreservation is not new. Medical clinics have been freezing sperm since the 1950s and embryos since the 1980s. Doctors in Australia reported the world’s first pregnancy using frozen oocytes in 1984.
    • Egg vitrification: Instead of slowly being cooled, eggs are quickly vitrified by replacing their water content with a cryoprotectant solution. When ready to be used, vitrified eggs are thawed instead of warmed resulting in decreased rates of ice crystal development that often occurs in the slow cooling method.
    • Embryo: A fertilized egg that has begun cell division.
    • Estradiol: The primary female sex hormone. It is formed from developing ovarian follicles and is responsible for female characteristics and sexual functioning. Estradiol levels are also measured in the FSH Day 3 blood exam to check ovarian reserves. For each mature egg, your Estradiol goes up another 200 pg. By your egg retrieval day, you could be over 5000 pg. For more information on estradiol, click here.
    • Fallopian tubes: Two tubes that transport the egg from the ovary to the uterus (womb).
    • “Fast” egg freezing: Preferred method for preserving eggs for storage. see egg vitrification
    • Fertilization: The union of mature male and female gametes (reproductive cells) to form a zygote (or fertilized egg).
    • FSH: Follicle stimulating hormone; causes follicles to grow
    • FSH Day 3 Test: Follicle stimulating hormone test is a routine blood test administered on Day 3 of menstruation to measure ovarian reserves. High levels of FSH may indicate poor ovarian reserves while low levels of FSH indicate strong ovarian reserves.
    • LH: Luteinizing hormone; causes eggs to mature. In the egg freezing process, you want to make sure you control the surge. Drugs like cetrotide and ganelrix delay or suppress the LH surge to give more eggs time to mature before ovulation.
    • ICSI: Intracytoplasmic sperm injection is used to fertilize frozen eggs. The technique involves directly injecting a single sperm into a single egg with a needle instead of allowing sperm to penetrate the egg naturally in a Petri dish.
    • In Vitro Fertilization (IVF): The process of fertilization by manually combining an egg and sperm in a laboratory dish. If successful, the fertilized egg or embryo will be transferred to the uterus. For more information, click here.
    • Mature Egg: An egg housed in a follicle that is between 18mm - 22mm in size. Only mature eggs can be fertilized with sperm to create a healthy embryo.
    • Menopause: The cessation of ovulation and menstrual cycles.
    • Oocyte: An immature, or unfertilized, female egg cell.
    • Oocyte cryopreservation: Commonly referred to as egg freezing, oocyte cryopreservation is a procedure that extracts, freezes and stores unfertilized eggs for future use.
    • Ovarian Follicles: A cellular structure found in the ovary where immature eggs mature, leading to ovulation and either pregnancy or menstruation.
    • Ovarian hyperstimulation: The use of fertility drugs to stimulate the ovaries to develop follicles. Not to be confused with OHSS
    • Ovarian reserves: Indicates a woman’s fertility potential and is commonly used as a barometer for the likelihood of fertility success. Measurements such as FSH, AMH, other hormones, and the renting antral follicle count are used to determine the prognosis of one's OR.
    • Ovary: One of a pair of reproductive glands located on each side of the uterus. The ovaries produce eggs and female hormones. During a healthy menstrual cycle, one egg is released from one ovary.
    • Ovulation: Time at which a mature egg is released from the ovary, passed through the fallopian tube and ready for fertilization. It occurs post the LH surge.
    • Ovum: see oocyte
    • SART: Society for Reproductive Technology
    • “Slow” egg freezing: Process by which female eggs are slowly dehydrated by replacing their water content with small amounts of cryoprotectant, or freezing agent. When the eggs reach minus 32 Celsius they are placed in liquid nitrogen and transformed into a solid.
    • Ultrasound: A medical imaging technique that uses high frequency sound waves. Ultrasounds are used in egg freezing for visualizing the follicles in the ovaries.
    • Vitrify: To change or make into glass or a glassy substance.
    • Vitrification: Instead of slowly being cooled, eggs are quickly vitrified by replacing their water content with a cryoprotectant solution. When ready to be used, vitrified eggs are thawed instead of warmed resulting in decreased rates of ice crystal
    Stay tuned for my next blog on how I made the final decision to invest in freezing my own eggs to preserve my fertility for the future.

    True Confessions ... Egg Freezing 
    Contact Me with any questions or comments at:

    True Confessions ... Egg Freezing