When Are You Going to Have Children?

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When are you going to have children?  How many of us have heard that dreaded question?  Often times, (hell, the majority of the time) that question feels like a condemning command, a judgmental inquiry, or just an outright rude and nosy ask.  But today, out of love and genuine concern, I am going to pose two questions to you.  Do you want to have children?  If so, when do you want to begin having those children? As women, these are two key questions we must take seriously and strategically plan out if we want to have biological children.  Our reproductive years are limited and successfully preserving our fertility requires many considerations.

It’s quite ironic that the ages when we are bodies are the healthiest to have children 16 to 24 are typically not the most ideal times to have children for the many women.   This is due to a number of factors whether it’s being emotionally unprepared, financially unstable, the challenges of finding an appropriate partner, or purely the simple fact of not being ready to take on the role of motherhood.  Additionally, the next period when women are the healthiest to have children (young adults between ages 25 and 35) is a critical time in a woman’s work career that influences her earning potential.  These years directly affect the financial trajectories of women in the workforce.  This is the irony of being a woman in the 21st Century. 

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Claire Cain Miller reveals in her April 9, 2018, New York Times article that there is a 10-year baby window that seems crucial when determining if a woman will be able to overcome a pay gap between her and her male counterpart (e.g., coworker or spouse).  The article is based on the Census Bureau’s working paper published in November 2017. The findings as reported by Cain show that “when women have their first child between age 25 and 35, their pay never recovers, relative to that of their husbands. Yet women who have their first baby either before 25 or after 35 — before their careers get started or once they’re established — eventually close the pay gap with their husbands.”  In honor of National Infertility Awareness Week, I want to share my journey of fertility awareness, and the considerations I pondered before deciding to freeze my eggs in the effort to hopefully preserve my fertility. 

 

I Can’t Have Babies

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I must have been 11 or 12 when a childhood friend told me her female cousin couldn’t have children.  I was shocked to hear it.  I’d always assumed that ALL women could have children.  I did not realize that many women can’t have children or often have difficulty conceiving.  Although I was shocked, I was too young to think about it longer than that day.  Fast forward about 15 years later, I’m now 27 years old at summer job.  My co-worker mentions that she’s been trying to have children with her husband, but informs me that they’ve been unsuccessful because her eggs are “bad.” I had no clue on what I was supposed to say, so I casually asked, “Did you just recently get married? She replied, “No, we have been married for ten years.” Her response forever changed my view on fertility.  Again, I was shocked, but this time my co-workers words shook my core. This woman was not much older than me-she was 33.

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“Bad eggs,” I didn’t know what that meant. I was thrown into an emotional state of code red, high alert. My mind was flooded with questions.  I thought to myself:

 

• How is that possible?

• How does she have “bad eggs?”  She is still young.

• When did her eggs go bad?

• Were her eggs good, but she waited too long?

• Did anyone tell her that her eggs were going bad?

• Do I have bad eggs?

• How do you find out if you have bad eggs?

 

Are My Eggs Bad?

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I was now concerned about my own fertility and needed answers.   I remember going to my primary care doctor and inquiring about my fertility.  I told her that I was almost 30, and I was concerned about my fertility.  My primary care doctor was a straight forward, unemotional eastern European woman. She looked directly at me and curtly said, “If you want to have a baby, start now.”  I was not prepared for her response.  I was angry at her for not showing compassion and I was angry with myself for being in my predicament: single, approaching 30 years old with no serious dating prospects.  In that moment, I started to hear the deafening tick-toc of my biological clock.  All of the background conversations and images of fertility from years past became front and center in my mind:

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The overheard conversations about an office manager who had suffered reoccurring miscarriages.

The older attorney that was pregnant again less than two years after having her first baby.

All of the teenage girls that seemed to nonchalantly get pregnant.

 

My mind was consumed with the fear of losing my fertility. In an act of desperation, I contacted my ex-boyfriend. We made a verbal agreement that if neither of us had “found” anyone else in the next 5 years we would marry each other: we are not married. As the years past I became increasing more aware and vigilant about my fertility.  I began researching and reading as many online articles and studies as I could find on fertility, egg health, IVF, age and fertility, healthy hormone levels. During my online journey I found a fertility post and was simultaneously introduced to the life changing word of YouTube’s trying to conceive (TTC) community.  I’ve been a proud unofficial member of YouTube’s TTC community since 2007. YouTube has been a wonderful source of support and knowledge for all things fertility related. 

 

Watching Your Fertility Window

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I’d begun monitoring my fertility intensely in 2007 by a fluke  I had begun using my company’s Flex Savings Account (FSA) benefits, and in 2007 I was in jeopardy of losing the remainder of the allotted healthcare funds in my account at year’s end (use it or lose it).  I proactively decided that I would use the remainder of the money in my account to do fertility testing and get as many baseline levels as I could.  I also become an established patient with a reputable reproductive endocrinologist (RE) and seriously started to monitor my fertility routinely- thank you FSA. 

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My RE first discussed egg freezing with me in October of 2010.  Egg freezing was classified as experimental but my fertility center had begun offering the service to its patients in the spring of 2010- the experimental label was removed in October 2012.  .  I was fearful of having to inject myself with needles, so I declined.  I had just turned 37 two weeks before that initial conversation.  The fear of needles created a mental block.  Fear delayed me from freezing my eggs a year earlier when that option was originally suggested to me by my RE.  However, after reflecting on the years of hormone testing and watching my fertility fluctuate but trend down year after year.  I realized I was watching myself lose my fertility before my eyes; it was a torturous feeling.  After each hormone test, I would wait anxiously for the results hoping they would reveal that my fertility was unchanged. Ironically, it was the fear of witnessing my fertility window close on me that finally moved me to action.

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Prepping for Egg Freeze

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I’d begun searching the internet reading as many articles as I could on egg freezing.  I came across articles and charts that suggested that it wasn’t wise to freeze eggs past age 38 because the chromosomal abnormalities of eggs were almost over 50% by age 38.  It was the last final push I needed.  In October of 2011 as my 38th birthday approached, I finally made the decision to freeze my eggs.  I contacted my RE and informed her that I wanted to do an egg freeze cycle at the beginning of the new year: 2012 in order to take advance of my FSA benefits at the start of the year.  Once my decision was made the preparation began.

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I searched the internet for articles on improving egg health.  I researched how many eggs I needed to freeze to secure a live birth.  I knew I would only have one change to have a successful egg freeze cycle; it needed to be a one and done cycle.  I would not have the resources to afford another cycle.  My initial goal was 22 mature eggs at retrieval.  I started a vision board with 22 in the center of the board and pictures of healthy happy babies surrounding the number.  I then came across an article declaring the magic number for a successful IVF cycle was 15 mature eggs at egg retrieval. According to the article, anything more than 15 put you in a precarious risk of becoming hospitalized because of with hyper stimulation (i.e., ovarian hyper stimulation syndrome (OHSS).

I began prepping for my January 2012 egg freeze cycle three months prior in September 2011.  I had a stack of supplements that would give any geriatric a run for her money.  Three months prior to my egg retrieval, I was incorporating over EIGHTEEN different supplements to improve my egg health. 

 

Taking supplements; egg freeze egg retrieval was 1/16/2012.  My goal was to get my AMH levels to my 35 year old age levels of 2.1.  Achieving 2.5 was based on 3-months of prior egg freeze prep work with various vitamins and herbal supplements .

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Funding My Egg Freeze Procedure

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Unfortunately, many health insurances do not cover infertility treatments.  Luckily for me, even though my insurance would not cover the cost of the procedure, it I discovered it did cover the costs of all the medications I would use, all of my labs and monitoring visits, and the cost of my anesthesia for egg retrieval (after co-pays).   I was able to pay the balance for the procedure with my FSA funds.  I’m so grateful that I acted when I did, for the FSA limits for 2013 were reduced to and my insurance cover change in March 2013 to a plan that did not cover fertility medications.  I literally almost missed my fertility window for egg freezing for I would not have been able to pay for the procedure post December 31, 2012.  Please review your insurance policies for fertility and infertility.

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What is Egg Freezing?

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So what exactly is egg freezing? Egg freezing is essentially the first half of an IVF cycle.  Your doctor is will stimulate your ovaries with fertility medications in an effort to get your body to produce as many healthy viable eggs as possible for a subsequent egg retrieval and freezing eggs (i.e., “banking of eggs”) for use later.  Egg freezing was still considered an experimental procedure when I had it done in January 2012. 

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My Protocol

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As in IVF cycles, there are different protocols for egg freezing.  It's prudent that you discuss with your doctor all of your concerns and options before your cycle, so the two of you can devise the protocol that is best. Discuss the medications you wish to take whether it’s matching you protocol to use the medications that are covered by your insurance plan or using medication that will reduced the amount of shots required for administering the medications.  As with many IVF cycles, my egg freeze cycle started with birth control pills (BCPs).  I started BCPs on December 24th of 2011, and began administrating my fertility medications on January 5, 2012.

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Say Hello to My Little Needle

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My protocol called for  300IUs of Gonal F to be taken every 12 hours for 4 days (7am and 7pm); I would then reduce Gonal F to 150IUs at 7am and add Menopur (75IU) and Ganirelix (75IU) at 7pm for days 5-9; my final shots would be Gonal F 150IUs at 7am and an Ovidrel (HCG trigger shot) at 10pm on day 10 .  It was the moment of truth 7am January 5, 2012; it was time for my first injection of Gonal F. The fear of that needle had caused me to delay the egg freezing process for a year.  I was now face- to- face with the needle. It didn’t seem that bad.  It was a small needle, but still I froze.  I looked at the syringe in my right hand and stared at the tiny needle jutting out from it that was this long “____.”   I then looked at my left hand that was strategically pinching an inch of belly fat above my right ovary. After 5 mins of stalling and deep breathing to calm my nerves, I pressed the fine needle into the inch of belly fat between my left thumb and index finger and further released the medicating into my skin.  I did it; I my AM injection was done. “That’s it?” I thought.  I’d let the fear of needles punk me out for nothing.

The injections really were not that bad.  I do recall that one of the meds (I believe it was Menopur) stung a little, but the sting can be reduced by numbing your injection area with ice prior to administering your shot. Even my trigger shot was manageable; all of my injections were to my stomach including my trigger shot.  My egg retrieval was January 16, 2012.  I’m happy to report that 18 eggs where retrieved (16 of the 18 were mature), and now sixteen eggs are on ice.  I’m grateful to all the brave women of YouTube that have shared their stories and have encouraged me to share mine.  My world has forever been changed.

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For more information on a free seminar discussing egg freezing and oocyte (egg) health please email Oocyte411@gmail.com  Below are articles and data referenced in this piece to help you learn more about your own fertility:

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New York Times: The 10 Year Baby Window

Census

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Advanced Fertility: Age Eggs Chromosomes

Fertility Plus (Hormone Levels)

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