Health and Wellness Body What No One Tells You About Freezing Your Eggs At 38 From the cost to the dreaded BMI convo, here’s what I wish I knew going into the process. By Maressa Brown Maressa Brown Instagram Twitter Website Maressa Brown is a journalist and astrologer who's a regular lifestyle contributor and resident astrologer for InStyle. She has nearly two decades of professional experience writing, reporting, and editing lifestyle content for a variety of digital and print consumer-facing publications including Parents, Shape, Astrology.com, and more. InStyle's editorial guidelines Published on November 2, 2022 @ 05:38PM Pin Share Tweet Email Photo: Getty Images/ Kelly Chiello When I got married at 29, I figured I’d be a mom by my mid-30s. Instead, I got laid off from what was supposed to be my dream job, got separated, left NYC and started a new life in L.A., and eventually, got divorced. As adaptable as I pride myself on being, it was still rough to deal with the onslaught of curveballs and question marks in my path — especially because my desire to have a child has never wavered. But at 38, in the midst of a pandemic, moving in together, pursuing hectic and fulfilling careers, and initially not being on the same page on family plans, my then-boyfriend and I were just not there yet. Meanwhile, all anyone hears in their late 30s is a cacophony of warnings that there’s no time to lose, given that egg quantity and quality decrease with age and certain risks (such as chromosomal abnormalities and pregnancy loss) are statistically higher among birthing parents over 35. The Good News About Your Fertility On a more optimistic note, the over 40 set has been the only age group in which the birth rate has gone up in recent years, so clearly, I’ll be in good company! Turns out, when I came up with the idea of contending with my conundrum by undergoing egg freezing — an 11-ish day process in which you take hormone injections to spur the growth of, ideally, mature eggs that can be retrieved under anesthesia and then cryopreserved (aka frozen) with the hope that they could be fertilized down the road — I was also in good company. In 2021, Kindbody, a national fertility, gynecology, and wellness service provider, saw egg freezing cycles (as well as embryo freezing and in vitro fertilization, or IVF) increase by an average of 20% each month. Also last year, TIME reported that East Coast-based clinic Shady Grove Fertility had seen a 50% increase in women freezing their eggs since 2019. And increasingly, savvy companies have begun offering the expensive investment — which, nationally, averages anywhere from $11-$20K for care, medications, and storage, according to FertilityIQ — as a perk for employees. In 2020, 19% of U.S. employers with over 500 employees covered egg freezing versus just 5% five years prior, according to a Mercer survey. At the same time, celebs like Rebel Wilson, Rita Ora, Halsey, and Kourtney Kardashian have publicly sung the praises of egg freezing. From not having found the right partner to wanting to preserve fertility in the case of complications from a condition like endometriosis, these stars have cited copious reasons a person might want the insurance policy for future parenthood. The Founders of Chick Mission on Making Parenthood Possible for Cancer Survivors These conversations have reframed egg freezing not as something you have to do out of fear or panic but because it’ll allow you to expand your reproductive options. As Jessica Ryniec, M.D., an ob-gyn and reproductive endocrinology and infertility specialist in Boston, puts it, egg freezing is “great for people who know that they want to become a parent one day but aren’t ready to do that right now for whatever reason.” Embracing this only empowered me to take the leap. But one of the things I hated the most about researching egg freezing before actually doing it was finding endless tales — and sometimes, horror stories — about one person’s experience. Sure, the process is standardized to a point, and there will always be details that are universal, but everyone’s body, mind, and emotions are different, so of course, their journey will be too. That said, here are just a few lessons that could be helpful for anyone diving in themselves about what to expect from the process — physically and emotionally. Getty Images You will feel like you’re getting a report card on your baby-making potential. The egg freezing journey kicks off with a fertility assessment — which kind of feels like getting graded on something you can’t exactly study for. The assessment involves checking various hormones involved in the ovulation process, including your AMH, aka anti-mullerian hormone, which is produced by your ovarian follicles that release eggs, and can therefore give your doctors a sense of your ovarian reserve, or full bank of eggs. “Your AMH, your ovarian reserve, does not tell me whether or not you can get pregnant right now, and it doesn't tell me if you start trying whether or not you will be successful,” says Dr. Ryniec. “The real use of these tests is to see how you would respond if you do egg freezing.” You’ll also get a transvaginal ultrasound (don’t worry, if you’ve endured a pap smear, you’ll be just fine) to take a look at your ovaries and follicle count. These diagnostics give your doctors an idea of how much medication they should prescribe. From there, you’ll chat with a nurse practitioner or reproductive endocrinologist (RE) about what you can roughly expect in terms of final egg count. Given how much anxiety and confusion can come up at this point, it absolutely helps if you feel like you can be vulnerable and connect with your health care providers. I felt super-lucky that my nurse and I hit it off so well that she said she wished we could go out for a glass of wine sometime, and much later in my fertility journey, the Kindbody RE who did my egg retrieval offered a shoulder to cry on when I was struggling with post-op symptoms. To be fair, not every provider you meet along the way is going to feel like they could easily be your bestie, but overall, it was crucial to me — as it should be to anyone going through this — to feel seen and heard. You’ve gotta prepare your bank account for a blow. Cost is also obviously a must-know for anyone considering or diving into the process. (Full disclosure: I did receive a press discount.) Kindbody’s egg freezing cycles start at $6,950 and medications will run you anywhere between $3,000 to $6,000, depending on the dose you’re prescribed (there’s generally a bunch of trial and error to find what dose works best for stimulating your follicles) and the pharmacy you buy them from. And the amount you can expect to pay for your eggs’ “rent” — or, more technically, cryopreservation storage — is about $600 per year. Depending on where you live, you can expect to spend, on average, $16K on medical care, medications, and storage. Let’s just say it probably helps that my partner and I had yet to get engaged when we went through this, because paying for a fertility cycle while also trying to save for a wedding — or literally any other big ticket expense — is the stuff of nightmares for anyone remotely debt-averse. Stimulation can feel like being on a roller coaster —physically and emotionally. If you want to move forward, you and your doctor will decide when it would be best for you to “cycle” — meaning begin regular injections that will stimulate your follicles and promote the growth of as many mature eggs as possible. Then, Day 1 of your period is usually the kick-off for an initial ultrasound, which can feel pretty momentous because you’re finally getting the process going, but it can also be majorly nerve-wracking. My ultrasound tech made note of how many antral follicles I had, and that number was marked down as the number “observed” — aka the number of follicles that they can literally see at that moment. And that number doesn’t necessarily translate to the number of mature eggs you’ll end up being able to freeze. That was something I had been told but really struggled with, because the number observed was somewhat lower than what they had seen in a previous ultrasound, during a completely different cycle. So I walked out of that visit feeling a bit bummed and worried that I wasn’t going to end up with as many eggs as I had thought. Throughout your cycle, you’ll also pop into the clinic for ultrasounds and bloodwork every two to three days. These visits are necessary for your doctor to see how your follicles are growing and how your estrogen levels (which is tied to follicle growth) are progressing, so they can adjust the doses of your meds accordingly. Lo and behold, the number of follicles the ultrasound techs saw became more consistent for the most part — with the exception of a visit or two in which something as common as a gas bubble obscured the view, making for hazier results. And when that happened, I had to remind myself not to catastrophize, but the not knowing what the hell the end result would be often set off spiraling thoughts. Thankfully, I dealt with those by crying to my partner, texting my therapist, or jumping on the phone with my acupuncturist. (Uh, yeah, having your support network is a must.) Getty Images Your BMI will come up (even if it’s a BS measure of health). Ahead of beginning my cycle, I learned that while my AMH, antral follicle count, and other hormonal numbers were within a range that made both my providers and me pumped, there was a number that became a thorn in my side: the one on the scale. (Unsurprising, as this has been an issue my whole life. Thanks, genetics and hormones.) A bit of pandemic weight gain mixed with the fact that I’m 4’11” meant my BMI had crept up to a range that fueled lots of questions and repeat weigh-ins related to the kind of anesthesia that the clinic uses when they perform an egg retrieval: monitored anesthesia care (MAC). “Different surgery centers have different abilities to provide different levels of anesthesia,” explains Kristin Bendikson, M.D., a reproductive endocrinologist and my main provider at Kindbody. While a hospital can provide general anesthesia and have more technology at their disposal to keep patients safe, those options are limited when you’re doing your procedure in an outpatient facility. And without those tools, anesthesiologists get more concerned about BMI, which has been associated with airway obstruction during retrieval. In the end, my BMI was thankfully not an issue. “We know that BMI is not a perfect measure of someone's health — or even what their body looks like,’” says Dr. Ryniec. But given the fact that it is still used as a measure in this case, it’s important to make sure your clinic and doctor will support you, she notes. Which brings me to this important point: Whether BMI or any other concern is on your mind, it’s worth taking the time to be sure you’re comfortable with a particular clinic and their health care providers. Dr. Bendikson recommends asking yourself questions like, “How do you feel when you walk away from that conversation? Did they listen to you? Did they answer your questions? Did you get the information that you needed, such as details on what the process is like?” Why Getting Pregnant Feels Like a Competition — and What to Do About It Injecting yourself sucks and makes you feel like you could be throwing hundreds down the drain. During my initial visit, I was told I’d be shooting myself in the belly nightly with injections that I’d have to mix on my own, which was not exactly comforting. (Let’s just say I did not do very well in chemistry.) Preparing and injecting myself with the follicle-stimulating meds was undoubtedly the step that most unnerved me — and Dr. Bendikson reassured me that it was completely normal. This is pricey medication we’re talking about, so you’re terrified you’ll mess up and waste it. Plus, hello, you’re using needles! So unless you’re a trained medical pro, you’re afraid you’ll end up with excess bruising or some other kind of unexpected issue. But the more you do it, the easier it gets. By night three or four, you kinda feel like a pro. Chrissy Teigen even nodded to this, posting on Instagram in the middle of an IVF cycle, “Honestly don’t mind the shots… They make me feel like a doctor/chemist." On the flip side, if you find that you’re just completely freaked out by the idea of injecting yourself or botching the prep, you can hire a concierge nurse (which costs about $200/day) to help you. Potentially matching the stress around injections is of course concern about potential symptoms, which are so individual. Over the course of the 11 days I was on injections (my retrieval was on day 12), I personally felt increasingly tired and a smidge bloated. Contributing to my sluggishness and moodiness? I stopped seeing my personal trainer, as higher-impact exercise is ill-advised as it could result in ovarian torsion. Low-impact, like going for a walk or doing gentle, prenatal yoga, is OK — and recommended to keep your sanity! Can a 'Fertility Diet' Actually Improve Your Chances of Getting Pregnant? The whole process is a moving target — and a complete mind f*ck. The main thing I've learned through this process is that an egg freezing journey is brimming with endless variables. From your AMH to your baseline hormone levels to your age to the observed follicle number and ultimately, the final number of mature eggs you’ll end up being able to freeze, you’re basically going to be swimming in question marks until you know exactly how many mature eggs could be frozen. Even then, your doctor will remind you that not all of your frozen eggs will withstand the thawing process or fertilize normally, so you gotta live with the fact that there will likely be even more question marks down the road. (Not the easiest thing for anyone who has even the mildest control freak tendencies.) Despite my “PCOS-ish” picture and hypothyroidism (both of which can throw off reproductive health), my labs and ultrasound painted an optimistic picture — that I could realistically expect to retrieve and freeze enough eggs to make it a worthwhile investment in fertility preservation. Still, I was politely warned that although AMH and other hormonal levels as well as age factor into your potential results, nothing is ever set in stone. In fact, the main takeaway I learned every step of this process is that every diagnostic is hugely individual — and variable even within one cycle (and certainly from cycle to cycle, if you were to do more than one). But the retrieval — and overall process — isn't as scary as you think. I had been worried about post-retrieval side effects, which in rare cases might take a turn for the extreme and result in ovarian hyperstimulation syndrome, or OHSS (an exaggerated response to the injections). However, when I woke up in the recovery area, I was surprisingly alert, optimistic, and super calm. I was offered a snack basket that rivaled JetBlue’s and water while awaiting a debrief with my doctor. When she came in, she shared that she was able to retrieve more eggs than the follicles they had seen in that initial ultrasound, and of those, 80% were mature and frozen. (And in fact, that’s the percentage of eggs that, on average, for most patients, end up being mature.) I was just a bit sluggish, bloated, and mildly achy for about a week afterward. As Dr. Bendikson had pointed out, post-op symptoms might be more tolerable when you feel good about your results. I feel beyond fortunate that was the case for me. Given my positive experience, I’m already working toward doing an embryo freezing cycle to further maximize my now-fiancé’s and my chances of conception. Turns out, empowered by more reproductive options, I’m actually up for more curveballs and question marks. With hope, facing them head-on is exactly what will lead me to motherhood.