Everything we hoped for
All the things we wanted
Everything that was sure
Now there is a scar where the old men used to be."
--Dave Matthews Band, "Alligator Pie."
In August of 2001, I walked out of a courtroom, turned to my attorney, and joked that the title of my memoir would be “Divorced by 25 (and all the other things I never meant to accomplish).”
At the time I would hardly know how perfect that title would truly be for my life.
Plans, shmans. Thinking we know where life is going to take us is life’s funniest joke on us. The most amazing, most refining experiences of my life have been the many things I never thought I’d do. Such as:
- Divorced (again!) at age 32
- Becoming an athlete and finishing two full Ironman races
- Moving around the country, from Utah to DC, Michigan, Texas, DC, Wisconsin, DC, California (AND!! More to come!)
- Finishing a second master's degree at 38
- Preserving my fertility through two rounds of egg freezing, including 26 days of self-administered hormone injections and trigger shots in the (rear) by my loving boyfriend.
There is some information “out there,” but not a lot. Not really, about the process. I’ve shared this with a lot of people already, and every time I speak to a friend or colleague who meets the description above, the conversation starts with “Hey, I just wanted you to know what was going on with me” and ends with me sharing every detail... because the person across the table or desk wants to know everything, because they know someone or ARE someone who might want to know all about it.
Getting to the place where I could make this decision took a while. The first time someone mentioned “egg freezing” and “maybe you should think about it” I was 35 and recently out of a relationship. I was fairly significantly bruised by that break up, and I was not emotionally in the right place to seriously consider fertility preservation as a POSITIVE option for my future. I was offended, actually, that someone would think that I wouldn’t find a partner “in time” to start a family.
But, the best part about that particular break up was that I realized I wasn’t really getting the love I deserved. Not from him or the 3 men before him who said they loved me. I finally decided that I was absolutely not going to waste another second in a relationship where I was not loved for who I am or treated the way I should be. And the resulting 3.5 year period of being **really** **super** **single** in my late 30s wasn’t exactly what I had planned in life.
But, I finally fixed “my picker.” I stopped wasting time with men who weren’t good enough for me. I had all the freedom in the world to do whatever (or whomever) I wanted, and I didn’t really date anyone for more than a few weeks. Because that’s all it took for me to realize “this guy ain’t it.” A married friend from high school didn’t understand why I wasn’t bringing randoms home with me every night (since I could). That was exactly the OPPOSITE of what I knew would make my heart happy. I decided that I really HONESTLY would rather go to sleep alone than wake up next to the wrong man. So I slept alone.
And then I was 38 going on 39, and I had to get real with myself. In my heart of hearts, I have known for many years that I am called to be a mother. I’m independent and capable, and I don’t necessarily think that motherhood is defined by “baby in belly,” but it is something I always imagined I’d do. So I started looking into my options.
Aaaaaaaaand I was also training for Ironman Maryland.
Aaaaaaaaand simultaneously I (re)met the love of my life.
So, fast forward to about 6 weeks before Ironman Maryland, about 4 ½ months into our relationship, when I say to boyfriend, “So, I’m planning to freeze my eggs as soon as I finish Ironman.” Boyfriend wouldn’t still be boyfriend if there was anything less than support. And the support was enthusiastic and loving and rock-like during the swings that the hormones brought on. I’m grateful for boyfriend’s prior training as an EMT, as well, for the administration of the two injections I just couldn’t do myself… the intramuscular trigger shot(s).
And with that, let’s get into the science. (And PS I literally started the Tuesday after Ironman.)
Egg freezing (oocyte cryopreservation, fertility preservation) is pretty hardcore. Maybe there are people out there who would rather go into these things blindly, but I wish I had a little more detail when I embarked on it. The clinic I chose was amazing, and the nurses and my doctor were kind and friendly and incredibly supportive, but none of them have actually personally been through fertility treatments, and they didn’t really have the language to describe what I would experience.
After some baseline blood tests and a baseline ultrasound, I was determined to be a “good candidate” for the process. Not everyone my age is. Let’s face it: I’m old as far as fertility goes. As I write this, I’m less than a month from turning 40, and 39-year-old eggs are not as viable as 19-year-old eggs. My age is the reason I did two cycles.
See, the math ain’t good. I should say, “I’m too good at math to know that the statistics aren’t in my favor.” It’s estimated that only 80% of my frozen eggs will eventually fertilize, and less than half of those will be chromosomally normal. Future efforts will consist of taking 12 eggs out of cryopreservation, attempting to fertilize them (yes, with boy juice), and implantation. The numbers suggest that only about 9-ish of those will become embryos, and then 4-ish might be free from genetic abnormalities. And then implantation has a success rate of less than 50%.
So I knew I needed some quantity. With two successful rounds, I now have 37 little oocytes in the freezer—enough for 3 attempts like I described above.
Okay now, here’s how it works.
Each month/cycle, (normal) ovaries offer up several follicles for stimulation by brain hormones. Eventually, one will start to grow bigger than the others, and the egg inside that follicle ends up hoarding all the brain chemicals to grow and mature. This is the egg that would eventually get ovulated during that cycle, and the other follicles die off. A 19-year-old might have 40 follicles volunteer during a given cycle, and a 39-year-old is lucky with 15-20.
In an egg retrieval cycle, the doctor will monitor the follicle growth. The process begins when most of the follicles and eggs volunteering for that cycle are roughly the same small size—before any of them start growing bigger than the others. This is usually regulated with birth control pills for timing. Then you flood the body with enough hormones to grow ALL of the volunteers (or as many as you can). About halfway into the process you add an additional medication to prevent ovulation, and then when “enough” of the eggs are large/mature enough, you administer a trigger dose of hormones to prep them all for retrieval. And then you have a procedure where the doc takes them out. If you're going straight into IVF, your eggs are mixed with boy juice and immediately fertilized. In my case, the eggs went straight on ice.
Sounds… fairly straightforward and scientific.
It kind of is. Except that it’s not.
First of all, we are talking about an organic process (one that has to be monitored with transvaginal ultrasounds every 2 to 3 days, in fact). Women will respond to the stimulation medications differently. My normal hormone levels are quite low—perhaps because of the athleticism—so my body was slower to respond. This means that it took longer for my follicles to grow to the appropriate size… which means higher and more doses of the medications… which directly translates into: more days injecting myself + higher doses of medications = more expensive + more….everything.
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| Cheer signs on my bathroom mirror |
More needles. More bloating. More weight gain. More tears. More nightmares. More physical discomfort. Just more.
It takes an iron woman to do this. Because you have to want to. I hear that Google and Facebook (and recently: the military) are offering to pay for the procedure for female employees. That’s great and awesome and progressive. But this is not something I recommend doing “because everyone is doing it” or “because it was free.” Just like Ironman or getting a PhD, you have to WANT it to give what it takes. It’s HARD. CORE.
And it turns out, I do. It’s expensive, too, so unless Facebook is paying for it (which they didn’t for me), you have to hand over some cash.
So let’s discuss that for a second. I have been brutally honest so far (and way more to come), so let’s just go there.
It cost $21,000 for the two cycles. The doctor’s fees and a year of storage cost $12,000, and then you pay separately for the meds (for me, about $9000 for two rounds--and I shopped around to different fertility pharmacies to get the best prices). All 100% OUT OF POCKET. Yes, these are qualified tax-deductible expenses once you get past the threshold of 10% AGI, which I will. My clinic offered a fairly sizable discount if I paid up front for 2 cycles, and considering the statistics and the number of eggs I wanted to have “in the bank” to feel like I had a “reasonable chance” of carrying a child someday, I figured I would need to do this twice. It’s probably a good thing I paid in advance… Not that I would have backed out on the second cycle, but I had really good results from my first cycle, and committing to this process means:
- No swimming or running for 3 weeks (no twisting or flipping activity at all, and the running would hurt too much)*
- Self-administering hormone injections for 10-13 days (13 if you’re like me)
- Gaining weight (15 pounds for me)
- Potential ovarian hyperstimulation syndrome (which I got the first time)
- Mental and emotional swings
- A pretty yucky recovery, with very painful and uncomfortable bloating for a day or two after the procedure, and then slowly diminishing discomfort and getting back to my normal self.
I was 100% willing to do this and take on the difficulties that came with it. Sure: women get pregnant in their early 40s all the time, but it turns out (due to hypothalamic amenorrhea--another story) I was going to have to do IVF anyway. So why not do the first half while I’m still in my 30s? When the eggies are aging every single day, and the chance of genetic abnormality increases every single day, and “the oven” will be good for another 6-8 years, why not stop the clock on the eggs, now?
Right now?
I am lucky (OH SO LUCKY) to live in a time when this science exists.
I am lucky (OH SO LUCKY) to have the means to exercise this option.
I am lucky (OH SO LUCKY) to have the strength and determination to take on this challenge… and the love and support of my amazing boyfriend, good friends, supportive co-workers, and some family to get me through.
I am OH SO LUCKY to have 37 (!!!!) eggs in the freezer so that someday, I can give the “baby in belly” thing a shot.
Of course, it might not work. I know that. In spite of the money, the time, the discomfort, the weight gain, the fantastic doctors, the determination. It might not. But given my options at this point in my life, this is the decision I’m making, to buy a small insurance policy and a little extra time to give it a shot.
SO REALLY, YOU HAD TO INJECT YOURSELF WITH HORMONES?
Yep. Thirteen days in a row each cycle. Days 1-6: Mix 300 iu Gonal-F into 75 iu Menopur, dilute with .5 mL sodium chloride, draw into syringe, inject subcutaneously. Days 7-13: Mix 300 iu Gonal-F into 75 iu Menopur. Reconstitute 25 iu Cetrotide with 1 mL sterile water. Mix all medications together, draw into syringe, inject subcutaneously.
WHAT DOES THAT MEAN, “INJECT SUBCUTANEOUSLY???”
It means into belly fat. For me, I have less fat on my belly than I do on my back above my hips (“the love handle” or “top of muffin”), so after bruising myself several times during the first round, I did all of my injections the second round into my low back. Per instruction, I alternated right and left sides for a total of 7 in the right side and 6 in the left. No bruises the second round.
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| Clockwise from top left: Cetrotide 25 iu kit; Menopur 75 iu powder and Sodium Chloride for dilution; the needle that is used for injection; a Q Cap for mixing vials; an injection tip for the Gonal-F pen; a Gonal-F pen; and a syringe for mixing and drawing medications. You DO NOT use that huge needle for the injections, thank goodness. |
DID IT HURT?
Meh. I’m an Ironman. What is pain?
NO BUT REALLY.
Ok, the poke hurts a little, and the Cetrotide stings. There’s nothing gained from pushing the medicine in slowly, so just get it done. I would get a little light headed and braindead for about an hour after the injections. Since they also recommend that you take melatonin (contributes to egg quality, as do massive doses of CoQ10, DHA, and Vitamin D), I did this all at night right before bed, so I could just pass out.
DID ANYTHING ELSE HURT?
Besides my soul? Yes. My ovaries did actually hurt. They were tender and sore, and by Day 9 the pain is constant and low-level, with occasional bouts of sharpness. The follicles grow to almost 2 cm in diameter, so it’s like having a bunch of extra marbles in there. The ovaries themselves swell up to nearly 3 times their normal size. And then you retain a lot of water… I’m also very body aware, and I can feel my own blood pressure. It was high for both rounds, and I had a lot of body temperature swings, too.
The first 4 or 5 days of each cycle were not terribly painful physically. By Day 6, the discomfort was fairly constant. It’s a little hard to describe. At first it’s like there were water balloons in my belly, and someone was trying to get just One. More. Ounce of water in them. Occasionally it was slightly sharp, or even prickly, like trying to pull a burr or a cactus out of your skin.
During Round 2 I knew what was coming, so I had less stress about the physical sensations. However, I was more quickly gripped with emotional stress. I had two or 3 solid breakdowns and several bursts of random tears. My boyfriend is a *CHAMP.* That part was pretty challenging for me. All the dark thoughts and fears reared their heads. All the anxieties about life showed up in living color. All the reasons about “why am I doing this” were occasionally suffocating and drowning, and staying on top of it required some serious self-awareness and presence of mind, and I didn’t succeed every time.
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| A flow chart for analyzing random crying. |
But then there’s hope.
A triathlete friend who recently did IVF coached me through Round 1 with pictures of her little baby girl (she’s 41!!!). Around Day 7 or Day 8 of Round 2, the wife (she’s 41 also!!) of one of my boyfriend’s best friends from (not college) sent a video of their 3-month-old baby girl cooing and laughing. Boyfriend hesitated to show it to me, but it was what I needed. Sometimes I would just burst into tears for no reason, and we had worked it out in advance that I just needed to be reminded of why I was doing this, and it was for ALL THE BEST REASONS IN THE WORLD.
Gain 15 pounds? FINE!
Cry my eyes out every other day for no good reason? NO BIG DEAL!
Feel mild to moderate pain in the ovaries for 2 weeks? OKAY!
It’s all worth it. Because there is NOTHING like the feeling of amputating the elephant that had been living on my chest for the past 4 years. The one that left a crushing feeling in my soul whenever I thought about (and feared) never being a mom.
WHAT ABOUT THE RETRIEVAL?!??
The procedure itself was nbd. Look, I’ve had 8 colonoscopies. This was similar in that, “once you have the needle in your arm, it’s all downhill.” Right? I mean, you show up on retrieval day, they stick a needle in your arm, and then you get Fentanyl and Propofol and then you go night night. For my first retrieval, the anesthesiologist willingly gave me morphine. The second time, none at all. Pain set in right away with Retrieval 2, but I had a few hours of reprieve the first time.
Fill the Vicodin in advance. Have lots of electrolyte drinks available. And chicken broth and applesauce. Look, it’s not pleasant. It took about 4 days before I really wanted to leave the house. But it only took about 4 hours before I wanted to sweat. My body had retained so much water that I just wanted to sweat. It. Out. So I jumped on the recumbent bike for an hour or so every day, and by 10 days out from Round 1, I was chasing boyfriend and some of his friends (who are Cat 1 racers) on bikes in Georgia.
(Round 2 recovery is still in progress. :) )
So, Oceanside is too early in the race schedule... But I will be ready by Boulder 70.3.
OKAY, NOW WHAT?
Now what? BACK TO ENJOYING MY LIFE! Building my life with my boyfriend. Getting back to race weight (egg whites and green juice anyone? BRING IT). Training for World Championships. Offering my personal counsel to any and every woman who wants to talk about her fertility, the process, and her options. For real. Just call me.
And then there is adding to the list of unexpected accomplishments. Who knows what’s next? All I know is that there are 37 little frozen oocytes who will NEVER TURN 40 waiting for me when it’s time to give it a go.
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| A few of the retrieved oocytes. :) |
Xoxo,
Abby
