See how Carrot can transform companies.

Podcast

2. Egg Freezing

Oocyte cryopreservation, or egg freezing, is a viable option for people with ovaries who want to extend their fertility or begin IVF. While it’s becoming more commonplace, the experience is not as simple as it’s sometimes made out to be: hormonal self-injections, frequent appointments, and going under anesthesia are all part of the process. So what’s really involved, and what can you do to make the procedure as smooth as possible? Sophie shares her tips on today’s episode.

Show notes

Sophie is a world traveler who went through oocyte cryopreservation to extend her fertility.  

This series of how-to videos makes egg freezing and IVF self-injections less intimidating. 



Transcript

Marie (00:04): A few months ago, my best friend and I were taking a walk around my neighborhood, the Mission District in San Francisco, and that night I remember a beautiful sunset was glowing behind Sutro tower. We passed people on the sidewalk who were walking home from work, or heading out to grab a burrito for dinner, or maybe not a burrito. I just assume that everyone, like me, is always thinking about getting a burrito.

Marie (00:32): But my best friend and I were catching up, and she told me, offhand, that she had heard on a recent podcast that women's fertility tends to drop off pretty sharply around age 35.

Marie (00:46): And let me tell you, I was shocked out of my blissful burrito daydream, and I started to do the math. If I want to have more than one kid, I should maybe start trying to do that in my early thirties, and that is creeping up pretty fast for me.

Marie (01:05): So I kind of panicked. But not for long, because I did some research. Turns out the fear of fertility falling off a cliff on your 35th birthday is overblown. Age does impact fertility, but it's not quite so dramatic. The slope is more gradual than I had imagined, and, of course, people do have children in their late thirties and beyond in many different ways.

Marie (01:36): And one of the reasons for that is improvements in medicine that are making it easier to extend fertility. More women and people with ovaries are taking advantage of opportunities to freeze their eggs. A process called oocyte cryopreservation. Ooh-site?

Translate App (01:53): Oocyte.

Marie (01:58): Oocyte.

Marie (02:01): Now, I may know how to pronounce oocyte cryopreservation thanks to Google, but I don't know a lot about what it's actually like to go through it. So I'm going to talk to someone who does.

Marie (02:18): This is Baby Steps, a podcast from Carrot Fertility about the many diverse paths that people take in the pursuit of Parenthood. I'm your host, Marie McCoy Thompson.

Marie (02:33): Sophie is an international jet setter. She's originally from Hawaii, and now lives in London. And when I talked to her, she had just gotten back from New Zealand. She's also sincere and thoughtful, and she's been through oocyte cryopreservation. So she's the perfect person to walk me through what's really involved, how it impacts your body, how much it costs, and why she decided to do it in the first place.

Marie (03:03): For Sophie, the start of her egg-freezing story is a love story. So how did you meet your husband?

Sophie (03:10): We met at a student organization back in university. We started out just hanging out at friends at first, and then we started getting to know each other. We initially started going to baseball games, and then before we knew it, we were starting going out on dates and whatnot.

Marie (03:26): That's so sweet. Did you two have conversations early on about wanting to have kids?

Sophie (03:31): I think so. I'm a few years older than my husband is, and so we had the conversation, if we want this to be a serious relationship, where do we see this going, and timing, and starting families and things like that. Obviously since then, our timing of a relationship, when to get married, when to start a family, has definitely changed throughout the years.

Marie (03:51): Totally. I mean it's one thing to plan your life in such an earnest way, and then things tend to happen that upend what you thought you might end up doing.

Sophie (04:02): Yeah, that's 100% true.

Marie (04:04): So then when did that evolve into having discussions about egg freezing? When did you start considering doing that?

Sophie (04:13): That wasn't until recently.

Sophie (04:17): I think at first, in my mind, I wanted to get married by 26, have my first kid by 28, the second one by 30, and if I wanted a third one by 32.

Marie (04:28): The reality of life isn't always so straight-forward. Even if it's not one major thing that throws off your course, sometimes it's just a series of choices that lead from one thing to another. And that perfect timeline seems to have taken a little longer than you thought.

Sophie (04:46): Fast forward to now, I am 32. We just got married last year. So I think from a female perspective, biologically speaking, there is a biological clock, I guess, ticking. The egg health does begin to diminish.

Sophie (04:59): And so, with all the traveling we've been doing for work and whatnot, we haven't actually settled anywhere yet. And so that's where the conversation started. Our company actually has this great benefit through Carrot, which kind of allows us to take advantage of like egg freezing. We didn't actually look into this benefit until it was offered by our company.

Marie (05:23): Where were you at that point in your life, when you were thinking, "Oh, I guess this is where I'm at." I mean, was it like, "Oh this is great, I'm taking charge?" Or was it sort of a mix of emotions and thinking about life plans versus reality?

Sophie (05:39): I think it's a little bit of everything. For me, I'm a type-A person, I like to plan everything out. And so while I was in Seattle, I had graduated from uni, and so I bought a condo. Started doing the boring things like grocery shopping, Costco runs, and things like that. So I was pretty settled in Seattle.

Sophie (05:57): And then when my husband actually got a job offer in California, that was the initial uproot. So we uprooted from Seattle to move to California, and then a year later we decided to move to Japan. And so basically I went from a mindset of, "Hey, I'm graduated from university, the next step is getting married, the next step is having kids, and," because that's what all my friends are doing back in Seattle.

Sophie (06:19): And so I went from that mindset to, "Okay, you know what? We're just going to do it. Whatever the world throws at us, we can manage it as we go along." And so the last few years I've kind of been like a whirlwind. We had the opportunity to go to London, so we did that. And I think in the last few years, I've just been in a state of mind where I'm not necessarily reactive per se, but I'm basically taking the curve balls as they come to me.

Marie (06:43): I think I understand a little bit. When I graduated college, I had an opportunity to move to Thailand for a year.

Sophie (06:52): Oh, wow.

Marie (06:52): And I was also someone who wanted to have a clear plan of where I was going, and I was feeling really lost. And then I had this opportunity, and it was sort of like, man, this is a once in a lifetime thing. I would be so ... I think I would regret it if I said no, and so I went. And it just totally changes the direction of your life, I think, taking on adventures like that.

Marie (07:14): And just, where life takes you can sometimes be so unexpected.

Sophie (07:20): Right. Having this kind of mindset shift of, just having everything planned out to, you know what? if an opportunity comes up, take advantage of it. Because never in my wildest dreams would I have imagined that I could live in Tokyo and London, basically one after another.

Marie (07:38): I think it's super brave to take leaps of faith like that. At the same time, time continues to march forward, and that does have an impact on fertility. And it wasn't like Sophie had completely forgotten that.

Sophie (07:52): I think it's always been in the back of my mind. Regarding fertility, it's not something that I had ever known about. That you go and get tested, basically you test your fertility. Because it's not something that's traditionally offered under regular insurance.

Sophie (08:07): Granted, I didn't look too much into it, but my understanding is that traditional insurances don't cover, even checkups. I may be wrong. Because we go, we see the dentist twice a year, we get our annual checkups, and all this preventative care.

Sophie (08:23): And then it's kind of funny to me how we do all these things to make sure that we're healthy, but it's not something that the insurance is covered. To even allow you to check, how's your fertility doing? Is there something you need to ... If you're having trouble, or if you know you're going to have trouble later on, what can you do now, earlier on, to kind of tackle it?

Sophie (08:43): Rather than try for an entire year with your partner, and then be able to go to the doctor to get tested, and then to qualify for IVF and things like that.

Marie (08:53): I hadn't heard that comparison to any other kind of checkup, and just going to the dentist. I think that's so true. And also reminds me that I need to make a dentist appointment. But yeah, no, I agree with you. I think that's a really good comparison.

Marie (09:10): Let's walk through this egg freezing process. So once you decided to freeze your eggs, what's the first thing you have to do?

Sophie (09:18): The first thing I had to do was pick a fertility clinic, and that was a little hard for me. I think because I'm so mobile right now, who knows where I'm going to want to have children. I'm currently in London, that's where I live. But realistically speaking, to me the US is still home.

Sophie (09:37): And so finding a place to have the procedure done was the biggest part. Different clinics do offer, you can basically transport your eggs internationally. So whether you decide to transport yourself to the eggs, or they can transport the eggs to you when you're ready to go ahead and fertilize them, and whatnot.

Marie (09:54): What kinds of other factors do you think is important to keep in mind when someone is looking at fertility clinics?

Sophie (10:00): You definitely want want to look for a fertility clinic that is very responsive, and has staff who are very empathetic to the process. Because it is very physically and emotionally tolling. And so you need someone to be there to answer your questions. And you're taking shots 24/7, and so you want to find a clinic who can respond to you 24/7. Do they have a nurse hotline? Are they available through email? Is there an online portal? So I think accessibility is a very important thing.

Marie (10:32): That's a really good tip and I think that's something that anyone can suss out. And you said that you're taking shots 24/7. What?

Sophie (10:43): Not literally 24/7, but the schedule is kind of crazy.

Marie (10:47): Yeah, I mean it's kind of 24 seven right?

Sophie (10:50): Yeah.

Marie (10:50): It is, it's a lot. So talk me through that. Now that you've found your clinic, then I'm assuming you make an appointment. Where do you go from there?

Sophie (11:01): Yeah, I made an initial appointment to kind of just do the health check and fertility check first, and just to do the consultation. We tested all the health of myself and my husband, and found out luckily we're both fine. And then from then on, you make an appointment to kind of have the procedure done. And so I flew in to Seattle to have the first consultation, and then kind of timed it for my next trip back to Seattle, to kind of do the procedure itself.

Marie (11:29): The procedure itself is somewhat involved. First, you have to give yourself injections to stimulate your ovaries. The hormones in the injections will trick your body into producing multiple eggs, rather than the one egg you'd normally produce in a given cycle.

Marie (11:47): That way, when it's time for the doctor to retrieve your eggs, they can take a bunch at once and you can more than one to freeze for your future. So you give yourself these shots at home over the course of two weeks, and during that period you're going into your clinic on a regular basis so they can adjust your dosage as needed.

Marie (12:08): And what are the shots that you are giving yourself?

Sophie (12:13): There's quite a few. I don't remember the names of all of them, because I did it earlier this year. But I do remember the most painful one is called Menopur.

Marie (12:23): It sounds painful. Just the name.

Sophie (12:26): Yeah, so the viscosity of that, what I just imagined is, when you go get a flu shot or a flu job, the nurse kind of wipes your skin down with alcohol, swab, jabs and just injects. It takes a second or two. But that's very different from what you're doing at home. What I didn't realize was that you had to kind of mix all of these formulas together.

Sophie (12:47): To make one injection, you have to pull out a certain volume from this vial, and then combine it with the dry and the liquid form and another vial, and then take another syringe to extract that, and then take that to inject it into your body.

Marie (13:03): They're asking you to just have a full on chemistry lab in your home, at all times.

Sophie (13:09): Yeah, essentially. So this is why it's so important to have nurses available to answer your questions when you have them.

Marie (13:17): Nurses and online resources. I will put a link in the show notes to a helpful video that demonstrates how to inject these hormones. As Sophie says, it's worth checking out a tutorial like that, since making mistakes can be costly.

Sophie (13:32): This isn't cheap. If you mess up a vial, that's not a small amount of money.

Marie (13:38): How much are we talking here, when you say a vial isn't cheap?

Sophie (13:42): I don't know how much per-vial it was, but I want to say the medication itself costs around three to $4,000. Basically, you have to pay out of pocket.

Marie (13:52): Oh my god, I thought you were about to say three to 400, and even with that I was going to be like, "Oh that is a lot." But then you said thousand, and that really is a lot.

Sophie (14:01): So it's kind of a high-stakes game here. So it was a lot of pressure. You want to make sure, if you're lucky enough to have someone to do this with, have someone there to double check your work. Because this is something where the nurses tell you, "Okay, based on your biology and whatnot, you have to take this many milligrams."

Sophie (14:17): And then you go in every few days and they do blood tests and everything like that. And then they kind of adjust the amount of medicine you need to take, or inject into yourself. And so it's not like you have to take X amount for X days, you kind of have to be fluid.

Sophie (14:32): And whatever the nurse adjust your schedule to, you need to be able to pull that right amount for the injections.

Marie (14:39): So this is a lot to sort of balance, and make sure that you're doing correctly. And I know I'm sitting here reacting like, "Oh my goodness, this is so much." But just to emphasize people this all the time, and you do have help as you go through it, even if it sounds intimidating.

Marie (14:56): And I'll ask you, I mean, was it something that you got used to? I mean, I'm hoping you kind of did, but I'd also understand if there's not really any getting used to stabbing yourself with a needle.

Sophie (15:09): Repetition definitely helps. Honestly, it hurts, I'm not going to lie. I'm not going to sugarcoat it. These injections hurt. And some of them, especially the Menopur, you stick the needle in, but it takes at least five to six seconds to get the entire, all the liquid out of the syringe. And so eventually, over the two week period, you do get used to the shots, but they're never easy.

Sophie (15:34): I think one thing to note, that I didn't realize, is that you could inject in several different places. And what I learned after my procedure was, you can do it in their stomach, in the back of your arm, your thigh, but you should definitely consult with the nurse. Because as I learned after my procedure, if you change where you do the injection, it actually changes the effectiveness of it.

Sophie (15:55): So I was fortunate enough where I changed it to the back of my arm from my torso. That definitely decreased the pain a little bit, and I was lucky enough to have that not impact my treatment. Because that could have changed how much of the hormones were absorbed, and things like that.

Marie (16:10): Yeah, that's really good to know. I think that's the type of thing that you're saying, when you have people who are helping you and good providers, that they can help answer all those types of questions.

Marie (16:20): Even with people helping out. It's up to the patient to maintain this regimen of self-injections, and it's not like you're giving yourself one shot every few days. The cadence is frequent.

Sophie (16:33): Yeah, it definitely depends on your schedule and what they have planned out for you. But first it starts off at one in the beginning of the day, and then they could change it to one than the beginning and one in the middle of the day, and one at the end of the day. But you're basically doing it multiple times a day. And you have to be, I think, within an hour, plus or minus, the exact time you did it from yesterday.

Marie (16:53): I just would like to offer my respects to you, and to anyone else who goes through this, even if it's not lasting for forever. Two weeks isn't nothing. And I think that's something that I wanted to learn more about. Because I think egg freezing is such an incredible option that more and more people have today, but at the same time, it's not quite as simple as I think it's often made out to be.

Marie (17:23): And so I think just having a full understanding of what you're signing up for when you are opting for that is pretty important.

Sophie (17:30): Yeah, it's definitely not a walk in the park. So if people ... I think when I looked online, there wasn't so much information about the details and whatnot. And so if you're able to talk to someone who's done it before you actually go through the procedure, it's much, it's much more helpful.

Marie (17:47): Or someone to listen to on a podcast.

Sophie (17:50): Exactly.

Marie (17:52): No, but I mean that's why I really appreciate you sharing this. Because like you said, I think there are a lot of details that aren't super widely available. And yeah, it's important to open up the conversation about what the reality is.

Marie (18:06): At the end of the two weeks of giving yourself shots, a doctor will determine if your eggs have achieved a mature enough size. And if so, you'll get something called a trigger shot. Which sounds kind of scary to be honest, but it's just another injection, and it will release a hormone to help the eggs mature and release them from the follicle.

Marie (18:28): The trigger shot is given 32 to 36 hours before the actual egg retrieval happens, and it marks the last of the hormone shots for this phase of oocyte preservation.

Marie (18:40): What about emotionally? I mean, we talked a lot about the physical aspect of this, and the technical and the chemical aspect of putting all of these injections in everyday. What is it doing to you emotionally?

Sophie (18:54): It's a lot to go through. Because this is, to be honest, I wasn't sure if I wanted to even come on this podcast and even share this. Because it blurs the line between professional and personal. Professionally, I still have to go to work, egg freezing is something I want to do, but it's not something I want my coworkers to know about, right.

Sophie (19:14): And so finding that balance of, who do I let know what's going on, and how much do I let them know? So that if my performance starts to slip, or I'm not as available over the next two weeks, what's going to happen? For me, when I got back to Seattle, my team was very understanding, and we have a flexible work schedule so I was able to go to the appointments in the morning. That was not a problem.

Sophie (19:36): But I think some people have different side-effects. For me, I just was fatigued and tired the entire two weeks. So I think emotionally and just mentally, that was difficult for me.

Marie (19:49): Yeah, absolutely. I mean I think that's completely valid, and you're trying to balance how to handle this in the workplace. And I mean, it sounds like a pretty exhausting time period. So once the two week period is over, then you go back to the doctor, and then what is that like? What's that final procedure?

Sophie (20:09): So they do the egg retrieval procedure in the morning. And so, when you go into the clinic in the morning, they basically prep you in the gown, and it's fairly quick. You go under anesthesia, and I think the procedure took about, want to say less than half an hour, 15 or 20 minutes. And the next thing you know, you're out.

Marie (20:31): While Sophie was under anesthesia, the doctor used an ultrasound-guided needle to retrieve eggs from the follicles in her ovaries.

Sophie (20:41): I remember going under, I counted backwards from 30 seconds or whatnot, and the next thing I knew, I woke up. And the doctor had come out and told me how many eggs they were able to retrieve, and it was a little higher number than average. And I think for me, that's when the weight was completely lifted off.

Sophie (21:02): Because over the two weeks, I was so busy to focus on, do it right, do it right, don't mess up. And when they told me they were able to retrieve and freeze X amount of number of eggs, I basically started crying. And it wasn't because I was sad. It was, I was so happy it was over. All the stress leading up to this, and it was over, and it was successful. So that was super emotional for me.

Marie (21:27): I mean, just everything that you did to get to that point, and then to have it go well, that's an incredible relief. I'm so happy that it went well for you.

Sophie (21:38): Thanks.

Marie (21:41): So now that you have those eggs frozen, they are waiting for you in Seattle. What are you feeling emotionally now, that all of that is over?

Sophie (21:52): I think it's still relief. As I said, it's like a backup plan. If I decide to start having kids soon, it's great. I may not ever need them. But if I don't start until later, or if something happens, I do have that as Plan B, if anything does go wrong.

Marie (22:10): What did you expect that egg freezing would be like from the outset? And how was the actual experience different from any of your expectations?

Sophie (22:21): To be honest, I didn't know what to expect going into it. Because there's just not a lot out there right now, there's not a lot of material that kind of talks about this topic, especially from the perspective of people not necessarily needing to freeze eggs.

Sophie (22:35): Because normally they taught, I looked online, and a lot of it's like, how to handle it emotionally and physically for people who have fertility issues. And so a lot of the material in that was based on, if you're having problems having children, and from that perspective. Which is a completely different perspective from where I'm coming from.

Marie (22:54): Yeah. I think that, from what I have seen, it's slightly newer to have people who are doing it in the way that you did without known fertility issues, but are doing it for a future family planning. And I think that we'll probably be seeing more of that, especially as the technology to do so improves, and more and more people are wanting to invest in their careers for longer, and wait a little bit longer for kids.

Marie (23:27): But yeah, I mean as it stands right now, like you said, there's not a lot out there. So what do you want to say to fill in those gaps?

Sophie (23:36): I would encourage people to talk about it more. It's something that's always been more taboo. And I'm not saying you have to talk about it with your coworkers at work, but like at least bring it up with your significant other, or your friend group. Because when I brought this up with my friends, I was just worried that, what their reactions would be. And they were all very supportive, and actually very curious to learn more about it. Because there's not much out there.

Sophie (24:02): So I think like the first step is just to talk about it, and then the second thing is really do your research, and definitely find a support system. Because wit's hard. It's a hard procedure. I'm not going to sugarcoat it, it's not easy, it's a lot to go through physically, a lot to go through emotionally. So I think the biggest thing is to know what you're getting yourself into before you actually go and do it.

Marie (24:26): And for you, doing your research involves understanding what the physical toll is, what the financial toll on might be. What other things do you think are important to research?

Sophie (24:38): Definitely the clinic itself. There's definitely lots of resources where they have reviews and things. I think it's important to, if you have a partner at that time, have the open conversation with them. It's one thing if you want to just freeze your eggs and you're single, but it's another thing if you want to freeze your eggs and have a partner. At least I found that, personally.

Sophie (25:00): So it's good to have open dialogue with them, and just understand, hey, this is why I'm doing it, this is my thought process. And so there's just, it clears up any misconceptions or miscommunications that could happen.

Marie (25:11): Can I ask, how did that conversation go with your partner?

Sophie (25:16): I think I went relatively well, because we both had access to that benefit. That was kind of the introduction. It's like, hey, this is available. And I think for us, because we're so mobile, and we have been in the last few years, we both do want to start a family.

Sophie (25:31): And I think for us, we're kind of on the same page, where if we can do something to help family plan now, let's at least look into it. We're not committing to anything. So he was very open to just having the consultation, and kind of talking through it.

Marie (25:48): It's really good to be on the same page, and I agree that talking through it really comprehensively is so important to do from the start, if there is anyone else in your life that should be involved in that conversation.

Marie (25:59): What's your view of pregnancy and parenthood now? Do you know what your plan is? Do you feel more liberated to have an extended timeline, so to speak?

Sophie (26:10): Yeah, I definitely feel more liberated. The extended timeline is nice. I do want to have kids. For me, just getting over the initial hump, I guess, it's so foreign to me. Because it's something you do, you just give up your body, basically. And not that having kids is the end of the world. Having kid is amazing. But it definitely changes your lifestyle and things like that.

Sophie (26:32): But I'm definitely open to having a family, and I think it's just going to happen. There's no like, "Hey, I'm going to start getting pregnant at X amount of time, and then I'll have my first kid by this month." I think it's just something like, when we traveled for work. When we find out, we'll find out. And we'll figure it out. We figured everything out so far, so we'll just work through this moving forward.

Marie (26:54): What do you think the Sophie of 10 years ago would say if she heard you saying like, "Oh, I don't know if it'll be in two years, or however many years, we'll roll with it."

Sophie (27:04): I don't think I would have believed it was me. Just because I would plan everything out all the time.

Marie (27:10): Isn't it great how we grow and evolve and learn?

Sophie (27:14): It is.

Marie (27:16): It is amazing how we evolve, and now Sophie has more flexibility in deciding how exactly she'll evolve. Her family.

Marie (27:34): Baby Steps is a podcast from Carrot, the leading global fertility benefits provider for employers. To demonstrate how Carrot helps its members, I'm here with Adam who is the head of Carrot's care navigation. Hi, Adam.

Adam (27:48): Hello.

Marie (27:49): I'm going to read a question to you that you've received from a Carrot member, and you are then going to walk through how you'd help that person. Sound good?

Adam (27:58): Sounds great.

Marie (27:58): So here is the question: "I'd like to find out more about egg freezing, what the cost would be, and if there are any restrictions to apply for reimbursement. Also, I'd like to know more about the possible duration of freezing the eggs, and when you'd be eligible to do this. My situation is that I don't have a partner and I'm 32 years old, wanting to have kids in the future. Last, I am Dutch, and live in Spain, and I'm curious how that would work if, possibly in the future, I would move back to the Netherlands."

Marie (28:28): So Adam, how would you tackle this on?

Adam (28:31): This one's pretty complicated, to be honest. Because it's taking place outside of the US. So we have to take into account various things as we're helping this member.

Adam (28:41): Internally, we have a global operations team that specializes in understanding different family forming paths outside of the US. So for this particular case, we would escalate it to them. And they would help us understand what nuances of care we can push forward with for this member, taking into account their citizenship, their location, their desired path of care, their desired location of care, and then any other kind of regulations or the like for that specific country.

Adam (29:12): For this case specifically, we help the member understand where there are legal restrictions for care, if there are implications of where they store their eggs, the expected cost of preserving their eggs, and then we provided options if they decided to transport their frozen eggs in the future down, the road.

Marie (29:28): Great example of how Carrot can handle a lot of moving parts, even if you think your situation is complicated. If you'd like to learn more, you can go to carrotfertility.com

Marie (29:48): Baby Steps is produced and edited by me, Maria McCoy Thompson, and also edited and mixed by the audio wizard himself, Jim Betsendorf, our original music is by Chili Quarter, whose name I will never tire of saying, and Chris Ploat, whose kindness is even sweeter than his music.

Marie (30:06): Our artwork is by Allie Packard, who sends the greatest encouraging gifs on Slack. This has been an All Turtles production, thanks for listening.