owning your fertility by Krystal Bick September 15, 2019 Fertility. It’s a topic that’s been popping up amongst my friend circle more and more lately. Usually at dinner, over drinks, starting off in hushed “shall we go there?” voices at first, until it becomes a lively round table discussion — raised eyebrows and curious, excited questions all around. And considering my friend group is comprised of all well-educated and self-aware women, I have to admit, it’s fascinating (as well as disheartening) to me how little we all actually know about our individual fertility health, yours truly included. For some context and also a disclaimer here, this post isn’t announcing my foray into starting a family of my own. If I’m being completely honest, that possibility isn’t on the immediate horizon for me. In fact, if I’m being even more honest, I’ve never been 100% sure if having children was right for me — a decision that would largely depend on how both my partner and I feel about taking on the parent role down the road. I’ve always felt at peace with either scenario coming to pass — with children of my own and/or adopted or without — and it took a good amount of self-reflection and soul searching to reach that place. Admittedly, what I haven’t spent a great deal of time considering were the actual logistics of my situation, if I were to in fact to choose the family path in this board game of Life, which is where today’s post comes in. Perhaps unsurprisingly, a lot of you are in a similar boat. When I mentioned this post topic last week, I was blown away by how many of you responded with a resounding, “Bring it on!” usually followed with, “I wish someone had talked to me about this when I was younger.” That last sentiment is largely how I’ve been feeling lately, too — especially considering I used to work at a company whose insurance policy covered egg freezing in full, a rarity in today’s insurance climate. I know, damn. It should be noted though: None of what follows is meant to make anyone feel like they have to freeze their own eggs or even feel pressured to start a family of their own if it’s not what they 100% want — but what I hope it does is underscore how much power there is in knowing all available options to you as a woman, and yes, as a possible future mother if you choose that path, so you can make the best decisions for yourself now and down the line, even if that means you don’t take any action on those options. Moreover, I hope it means we can start to shed the stigma of talking about our fertility with each other. So let’s dive in. Personally, I suppose I started thinking about my own fertility at my annual pap smear appointment earlier this year. With my feet still in the cold metal stirrups, my gynecologist (who I adore by the way) caught me off guard, asking the hot topic question for 30-something women — “So have we been thinking about babies?” Her chirpiness, while well-intentioned, threw me for a loop. I gave her the sheepish shrug, universal for “Yeah, maybe. Perhaps. Eventually. Or not.” and threw on my jeans. Fast forward to later in the year when my good friend, Kelly Augustine, partnered with Trellis — a new fertility studio here in the city, dedicated to helping women “own their fertility” — and my shrug turned into a definite lean in, because I realized I wanted to learn more. Way more than what I currently knew. Fast forward even more to today, where I’m now teaming up with Trellis myself, to dig into my 33-year old fertility status. Here’s what I’ve learned so far… What is Trellis? First things first, what is Trellis? As I mentioned above, Trellis is a new concept in the fertility health space — a dedicated studio to all things fertility-related, founded by a group of women who all have gone through their own unique fertility journeys. They offer a wide array of services, ranging from fertility tests, fertility coaching and wellness, and yes, egg freezing. Understandably, when you hear the phrase “Fertility Studio”, it’s easy to assume it’s meant only for those who are looking to start families of their own, but that’s what I love the most about Trellis’ ethos — they truly want to educate all women about their current fertility health status, whether or not they are actively looking to start a family. Why focus on fertility? This is where I’ll throw some numbers at you. Ready? As women age, the quantity and quality of their eggs decline, usually starting at age 32, and accelerating through their mid-30s. By the age of 44, it’s considerably difficult to conceive, even with IVF. Diet and lifestyle impact ovarian reserve (the ability of the ovary to produce egg cells capable of fertilization). Speaking of ovarian reserve, every woman is born with all the eggs they’ll carry in a lifetime (crazy thought, huh?!), and this number decreases as she ages. During peak productive years (18-26), 20%-40% of her reserve remains. By the age of 30, 10% remains. By the age of 40, 3% remains. I want to caveat all the above statistics with this: every woman’s body is vastly different, which is why a fertility assessment is truly eye opening. What services did I receive at my visit? For my recent visit, they ran a few blood work tests, an ovarian ultrasound (SO COOL!), an informational consultation with Dr. Sergio Oehninger, a reproductive endocrinologist, and a consultation with Haritha Reddy, one of their fertility coaches. Here’s the breakdown of the tests: The blood work tests for: Follicle Stimulating Hormone, which will help determine whether or not your ovarian reserve is in decline. Anit-Mullerian Hormone, the most accurate indicator of your current egg supply. Estradiol, a hormone that signifies follicle growth and is essential in reading the FSH. Blood work takes about 1-2 weeks to process, so I don’t have my results back yet. The ovarian ultrasound tests for: Resting Antral Follicle Count, where the doctor can actually count the number of resting/unstimulated ovarian follicles. What’s an ovarian follicle, you ask? It’s a fluid-filled sac that contains an immature egg. During ovulation, a mature egg will be released from typically just one follicle. Ideally, there are 12-18 follicles total between the two ovaries, but they’ve had good egg freezing success with numbers higher and lower than this range. I personally thought this portion was SO fascinating as they actually show you your ovaries on a large screen during the procedure and count the follicles with you. My count came out to 20 for each ovary, 40 total, to which Dr. Oehinger commented, “You’re very fertile.” Wow, now that’s a sentence I never expected to write in a blog post. From there, I sat down with both Dr. Oehinger and Haritha Reddy to discuss how the process works, how an egg freezing procedure is done, from start to finish and their thoughts in general for my outlook as a potential egg freezing candidate. I felt completely at ease during this process — no question was considered stupid in their eyes — so if you’re heading in yourself, don’t hold back! A friendly disclaimer: it’s a fun refresher on high school biology so if you’re like me and geek out over that kind of stuff, you’ll love it. I’ll go into some of their responses for the questions I had during my visit with them, a lot of which were among your top questions from Insta Stories. What exactly IS egg freezing? Egg freezing is the process of extracting, freezing and storing a woman’s eggs (oocytes). They are UNfertilized. What are some of the reasons you might consider freezing your eggs? There’s a million unique reasons why a woman might decide to do this, but these are the most commonly cited reasons: You’re not quite ready to get pregnant, but you want to increase the likelihood of a biological child down the road. You’re not entirely sure you want a child at all, but you want to keep that door open just in case you change your mind later. Certain medical treatments — like chemotherapy — might interfere greatly with your fertility — so egg freezing is considered a great backup plan. What’s the best age for egg freezing? Maximum age? This will be a fuzzy answer, as technically, younger eggs are better eggs. But, of course, when I was 25, working at Google — a company who would cover the cost of egg freezing — no one ever really talked to me about this procedure not to mention the idea of family planning in this way seemed so foreign to me anyway. The Trellis clinic sees women as young as 23 and 24 coming in to freeze their eggs. Women in their mid to late 30s might require multiple cycles to ensure a fruitful egg yield. The maximum age largely depends on the individual woman’s health and hormone levels, but the doctors at Trellis recommend 43 as the upper limit. How many eggs do I need? Their team recommends retrieving at least 15-20 eggs for women to have a strong chance at pregnancy. Who’s a good candidate for egg freezing? Statistically speaking, women in their 2os and mid 30s, as the age of the egg, generally speaking, directly correlates with the health of the baby. Women looking to delay pregnancy for a few years, for a variety of reasons including: career, waiting to secure a stable long-term relationship or prolonging until they’re ready to become single mothers themselves. Women willing and able to make the time and money investment. It’s not a cheap procedure — and it’s only partially covered by about 10% of major insurance carriers — making it largely unaccessible to those not in certain socio-economic groups. We could go into the politics of this and why I feel strongly it should be covered for all women, regardless of their income bracket, but we’ll save that discussion for another day. What are the success rates? The jury is still out on this one. While more than 20,000 American women have had their eggs frozen, about 85% have not had their eggs thawed. We’re truly in a stage of — only time will tell. It should be noted, vast improvements have been made to the freezing and thawing process, meaning you’ll have around a 90% egg survival rate once they’re thawed out. Is egg freezing safe? In general, yes. But, as with any medical procedure, it’s highly dependent on the individual. Potential risks include: Ovarian hyperstimulation syndrome can occur due to the medicine given to stimulate the ovaries and egg production. Symptoms can include bloating, dehydration and potentially life-threatening blood clots. As I mentioned above, my follicle count is 40, meaning I would potentially be at risk for overstimulation during an egg stimulation process. What I found comforting is that Trellis automatically schedules mandatory follow up appointments during the medicine administering phase to ensure everything is looking normal before egg retrieval. Bleeding can occur where the needle is inserted into the ovary. There could be complications with the anesthesia. All other potential individual risks would be discussed in full with a doctor before starting the process, with the necessary check in appointments laid out. So what’s the process like, step by step? OK, let’s say you’re ready to take the plunge and freeze those eggs of yours. From start to finish, it’s roughly a 2 week process. You’ve had your fertility consultation and assessment, complete with blood work, ultra sound and reviewing of family history with doctors. You’re ready to start the process for your next cycle. Medication would be ordered and in-office tutorial would be given. Partners/friends/relatives are encouraged to come along to also learn how to administer the shots, in case you need help along the way. Come in for a baseline blood test and ultra sound on Day 2 of your cycle Begin nightly injections (usually 3 once a day, some of them might be twice a day, depending on your situation) for the next 8-11 days. During this time frame, you’ll have reoccurring studio visits to check in with the doctors. The final medication is given 36 hours prior to the retrieval procedure to essentially trigger the release of the eggs at the right time. In-office egg retrieval procedure. From start to finish, this takes 15 minutes and you’ll be administered anesthesia. This process is essentially a small needle that gets inserted into the ovary to extract the eggs. You’ll receive a preliminary egg count at the end of your procedure. It’s advised you take it easy immediately after the procedure but most women are able to go back to work the following day. Once the eggs have been evaluated, you’ll receive your final count and from there, they’ll be transferred to SIRM-NY Fertility Institute where they’ll remain frozen until you’re ready to do something with them. Or not. Up to you! What was my recommended time frame? When I sat and chatted with Dr. Oehinger, he was simply going off my family history and ultrasound results (blood work is still pending). His initial thoughts were that I’m an excellent candidate for egg freezing as he’d likely be able to get a good egg count yield from me at 33. As far as utilizing those frozen eggs if natural pregnancy doesn’t occur down the line, he recommended I do so before the age of 40. Just food for thought. Does this process hurt? You won’t feel anything during the egg retrieval procedure itself as you’ll be under sedation. While administering the medication, some women experience PMS-like symptoms (bloating, cramping etc.) and these may continue after the retrieval itself, along with some vaginal discomfort. What happens after egg freezing? Well, the beauty of it this is you don’t need to do anything with those eggs if you don’t want to. Most can be successfully frozen for up to 7 years (and potentially longer) so if you do decide down the track you’d like to thaw them out, you’d have to start an IVF conversation with your doctor. Trellis doesn’t handle IVF but they can refer you to a network of doctors who do. OK, but what does this all cost? Ah, the million dollar question. Pun intended. I won’t sugarcoat this for you. Egg freezing, no matter what clinic or facility you go to, is expensive. My personal quote (the low end, mind you) came out to $11,000, but it can greatly increase from there, depending on if you need to do multiple retrieval cycles to hit a recommended egg count or other complications that could arise. On top of that, egg storage is around $50-$80 a month. Of course, IFV should you choose it down the road, is a separate procedure and thereby, a separate cost. I was relieved to see the payment plans Trellis offers to help offset these costs though and their staff is always happy to chat through options with you. As I mentioned above, this is a procedure that is largely NOT covered by most major health insurance carriers so unless you have an amazing employer who will happily cover it (ahem, Google, Facebook, most tech companies), than it’s a huge financial investment. The silver lining here? Costs have slowly started to trickle down across the board — typical for procedures once they become more and more routine and offered at more studios. Got more questions? Feel free to send them my way or you can check out their FAQ page here. Wrapping up Wow — if you’re still reading, almost 2,600 words later, than consider me impressed! Hopefully this was somewhat insightful for any of you potentially considering egg freezing for yourself or perhaps you’re just curious to know more about your overall fertility health. Either way, I truly believe knowledge is power, especially in situations like this and I hope to delve more into topics like this moving forward — because we really need to normalize these types of conversations. If you want to learn more about Trellis, I know their team would love to hear from you! You can reach them at info @ trellishealth .com and please tell them Krystal sent you! Main image by Allie Provost Please note, while I am working with Trellis on a series of sponsored Instagram Stories, they did not sponsor this blog post. My in-office visit for blood work and the ultrasound was comped, but as always, all opinions expressed above here are my own.