My menses came today. Coincidentally, I had an appointment to see the doctor at The Center for Human Reproduction to discuss doing a second round of egg freezing. My first round was 12 months ago and I had harvested 18 eggs. I was concerned that the number of eggs would significantly decrease over the course of a year since I am in my mid-30s. My doctor said that Asians tend to have fewer eggs compared to age-matched Caucasians. I guess that explains why a few of my Asian girlfriends in their late 30s only had 4-5 eggs retrieved per cycle. However, my doctor said that she was actually excited that I was doing another egg retrieval because I had such good success last round, and thinks I would likely be productive again. She was correct - she performed a transvaginal ultrasound which revealed 17 egg follicles! She also drew blood and did a pap smear today.
Generally, doctors prefer to start hormone injections during the first few days of a menstrual cycle to start the process of egg freezing. The injections last about 10 days (depending on how the egg follicles are maturing) and the retrieval occurs 36 hours after the last injection. If I started the hormone injections this week, the retrieval date would occur around Jan 24, a day on which I had an unbreakable commitment. Therefore, the doctor decided to start me on birth control pills (Apri) to better control my menstrual cycle and timing of when I will start hormone injections, and therefore, the retrieval date.
I also discussed with my doctor the possibility of fertilizing the eggs with donor sperm. She said that the chances of egg survival are significantly better if the eggs are fertilized prior to freezing. However, I needed to decide soon since there is the process of choosing the donor sperm, testing and preparing the sperm, transporting it from the sperm bank, etc. In the end, I decided not to fertilize the eggs.
Medications
The doctor ordered the following medications from a specialty pharmacy for my egg freezing:
- Apri (bill control pills): controls my menstrual cycle
- Menopur injection: stimulates growth of ovarian follicles
- Bravelle injection: stimulates growth of ovarian follicles
- Ganirelix injection: prevents ovulation
- Lupron injection: stimulates ovulation and decreases estrogen levels
- Doxycycline pills: antibiotics post-retrieval to prevent infection
Financial costs
My insurance does not cover this procedure since it is elective (there is nothing medically wrong with me, per se) so everything will be out-of-pocket.
- Egg freezing (includes medical visits, ultrasounds, labs, retrieval and freezing) = $6000
- Hospital facility fee for operating room and recovery room = $600
- Anesthesia = $500
- Storage of eggs = $830/year
- Medications = $1800 (I had some medications left over from the first round, so I did not need to purchase as many this time. Otherwise, it would have been $3000.)
- If I decide to obtain sperm to fertilize the retrieved eggs, then there would be an additional $4500, and $830/year for storage of the embryos (which is separate from storage of the unfertilized eggs).
The total cost is approximately $11,000 (if I did not have last year's medication) to freeze my eggs, or $16,000 if I fertilize the eggs. In addition, I would have to pay $830 annually to store the eggs, or $1660 annually to store both the unfertilized eggs and embryos.
January 7-19, 2014 I took the birth control pills at 9 pm every night with food since nausea is a relatively common side effect. However, there were times when I did not take the pill with food, and I was not nauseous. I had more severe menstrual cramps and lower back discomfort than usual. Ironically, taking birth control pills should decrease severity of these symptoms. Fortunately, the cramps and lower back discomfort resolved when my menses finished. My boobs got a little bigger on the birth control pills.
January 22, 2014
Three days after stopping the birth control pills, I got another period which was shorter in duration.
January 23, 2014
I had labs and an ultrasound. I found out my pap smear was normal so the injections could begin.
January 24, 2014 (day #1 of injection)
This was the first night of hormone injections which consisted of 1 Menopur and 2 Bravelle's. (See below for schedule of daily medications and detailed instructions for administration.) I was nervous since it has been a year since my last injection, and I needed someone to be with me for moral support. It took about 20 minutes to prepare the injection and administer it, including 5 minutes to mentally prepare for the actual injection. Shortly after the injection, I felt a twinge under the injection site.
January 25, 2014 (day #2 of injection)
I gave myself the Menopur and Bravelle injection tonight without anyone there. It was fine. The first time is the hardest. Afterwards, you know what to expect which makes it easier. I started to "feel" the presence of my ovaries and uterus. I guess the hormone injections are working!
January 26, 2014 (day #3 of injection)
I went for labs and ultrasound - still 17 follicles (10 in one ovary, 7 in the other)! I was in a hurry that night to give the hormone injection since I got home late, and I needed to give myself the injection before 10 pm. I was in such a time constraint that I did not even have time to be nervous about giving myself the injection - I just prepared the syringe and injected!
January 27, 2014 (day #4)
In addition to the evening Menopur and Bravelle, the doctor said I needed to start Ganirelix each morning to prevent premature ovulation since my estrogen levels were very high. My estrogen level was higher than expected even for the hormone injections, and also higher than last year's level when I had hyperstimulation syndrome. After the labs and ultrasound, I gave myself an injection of Ganirelix in the exam room. My head felt very heavy intermittently throughout the day. I did not have a headache, per se. And I felt bloated.
January 28, 2014 (day #5)
The ultrasound showed that a few of egg follicles were 10-12 mm big, but most were 8-10 mm. The doctor said that they prefer the follicles to be 18-20 mm at the time of retrieval. Because my estrogen level was very high, I had another Ganirelix in the morning, and the doctors decreased my hormone injections at night to 1 Menopur and 1 Bravelle. Now it takes about 7 minutes to prepare and administer the injection.
January 29, 2014 (day #6)
My arm is starting to get bruised from the daily blood draws. The phlebotomists have been drawing from the same vein each day. I am impressed that they could reuse the same vein even though it has been used so often and the area is bruised. The nurse recommended putting pressure on the area for two minutes after the blood draw and to put warm compresses on the area at night. I have a little trouble getting up and bending down due to bloating.
January 30, 2014 (day #7)
I continued the regimen of Ganirelix in the morning, and 1 Menopur and 1 Bravelle at night. It takes 4 minutes to prepare and administer the injection now. My boobs are still slightly bigger but starting to feel tender.
January 31, 2014 (day #8)
The doctor showed me a list of my follicles and their sizes. Most of them are between 10-14 mm. Three were 7-9 mm. The doctor thinks the bigger ones will be usable but is unsure about the three smaller ones.
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February 1, 2014 (day #9) Looking at the ultrasound, the doctor predicts 14 follicles will be usable by retrieval. The follicles are now 13-17 mm in size. The remaining 3 follicles are smaller and will likely not be big enough by retrieval to be used. I feel a little bummed that I cannot maximize the use of all the follicles, but at least 14 eggs is still above average for what women my age harvest (which is about 10 eggs).
February 2, 2014 (day #10)
My estrogen level is high enough such that the doctor wants to retrieve my eggs soon. I gave myself a Ganirelix in the morning, and Lupron at 9 pm so that I would be harvesting 36 hours later. No Menopur or Bravelle needed.
February 3, 2014 (day before retrieval)
My bloating is more severe. I feel the presence of my uterus and ovaries. I can physically feel a bulge on my left side which corresponds to my ovary. Each egg follicle is slightly smaller than an inch, and the left ovary has 10 follicles, so my ovary is very big. I was instructed to take doxycycline (an antibiotic) with dinner, and not to eat or drink anything after midnight. The clinic also recommended that I not wear jewelry (except a wedding band) or contacts (wear glasses instead) to the retrieval. Someone also needs to accompany me to the appointment and take care of me on the day of retrieval.
February 4, 2014 (retrieval day)
Today is the big day! I had my egg retrieval in the morning. I was scheduled for 8 am and asked to arrive an hour early. However, I allotted even more time to get to the clinic in case the roads were bad (from the snowstorm the night before) or there may be an unforeseen accident (my car windshield actually got shattered by snow/ice that fell onto it on the way home -- after the procedure, thank goodness!). I arrived to the clinic at 6:30 am. Once I arrived, the doctor performed an ultrasound to re-examine the follicles one last time before the procedure. I was then taken to the pre-procedure room where I changed into a gown and met the anesthesiologist. In the operating room, I had leads and blood pressure cuff placed for monitoring, and an IV inserted for IV fluid, doxycycline and propofol. I got woozy after getting the anesthesia and quickly fell asleep. No breathing tube was used.
I awoke in the recovery room and my abdomen felt very uncomfortable. The doctor retrieved 17 eggs but I would only know the next day how many are usable, but he estimated 15. I had 18 eggs retrieved last year, and all 18 were good.
Post-discharge instructions
Day of retrieval
- no shower/bath
- no tampons (use maxi pads instead for staining)
- do not go back to work, drive, or drink alcohol
- take doxycycline with dinner
- Tylenol as needed for cramping (but I did not require it). My lower abdomen was sore, and it was difficult getting up and down. It was also uncomfortable when there was increased intra-abdominal pressure during sneezing or coughing. But overall, it was much better than last year. Fortunately, I took today and tomorrow off from work.
Day after retrieval
- can shower/bathe
- can return to work and resume normal activities
- take doxycycline with meals in the morning and night
Days after retrieval
- continue doxycycline with meals in the morning and night until finish bottle (which is 3 more days)
- follow-up appointment with doctor 3 days after retrieval
February 5, 2014 (day after retrieval)
I feel much better physically but am still very bloated. The nurse called and said that 12 of the 17 eggs retrieved were usable. I was a little disappointed and may consider a third round of egg freezing. Twenty eggs results in 1-3 live births and I want to have two children, so I would prefer to have 40 eggs.
However, these two weeks have been taxing, both mentally and physically. Not only does it require getting up earlier each day (including weekends) to get labs and a transvaginal ultrasound before work, but I also had twice daily injections on most days. My friends were there for me during this time, but I still felt somewhat alone and stressed going through this process. I cannot imagine going through IVF, pregnancy and raising a child by myself. I really commend single parents.
Medication schedule
Ganirelix # of Menopur # of Bravelle Other
January 7-19 (pre-injection) No 0 0 birth control pills
January 24-26 (days #1-3 of injection) No 1 2
January 27 (day #4) Yes 1 2
January 28-31 (days #5-8) Yes 1 1
February 1 (day #9) Yes 1 0
February 2 (day #10) Yes 0 0 Lupron
February 3-8 (post-injection/retrieval) No 0 0 Doxycycline
Medication preparation for Menopur and Bravelle
1. Wash your hands and clean the space you will use.
2. Lay out supplies on the table:
- vial(s) of hormone
- one vial of sodium chloride
- sterile syringe and needle (I used a 3 ml syringe with 22 gauge 1.5" needle) or Q-cap
- smaller needle for injection (27 gauge 0.75" needle)
- rubbing alcohol
- gauze
- sharps container
3. Remove vial caps (flick cap upwards with thumb). Wipe vial tops with alcohol.
4. Open syringe package. If using the needle on the syringe, pull back to 1 ml line and uncap the needle. If using Q-cap, twist off capped needle and dispose into sharps container, then twist Q-cap onto syringe and pull back to 1 ml line.
5. Insert the uncapped needle or spiked end of Q-cap into vial of sodium chloride. Push plunger all the way down to transfer air from syringe into vial.
6. Turn vial of sodium chloride and needle/Q-cap upside down and withdraw 1 ml of sodium chloride into the syringe. Remove needle/Q-cap from vial. Flick the syringe or gently tap syringe against a surface to get rid of air bubbles.
7. Insert the needle/Q-cap into vial of hormone. Push plunger all the way down to transfer 1 ml of sodium chloride (and any air) into vial.
8. Gently swirl the vial to mix the sodium chloride with the powdered hormone until the hormone completely dissolves into the clear solution.
9. Turn vial and syringe upside down (or at an incline) and withdraw all the solution (which is still 1 ml) into the syringe.
10. Repeat steps #7-9 for each hormone vial you need to administer.
11. Twist off the needle/Q-cap, and dispose. Open wrapper of smaller needle. Twist smaller needle onto syringe.
Medication injection
1. The injections should be given between 5-10 pm. I try to administer it within the same hour every night.
2. I prefer to use a scrunchie to tie my hair (since my long hair may partly obstruct my view when I look down) and another scrunchie to tie the back of my shirt to hold it up.
3. Clean the injection site with alcohol and allow time to dry. The injection site is the lower abdomen, at the level of the belly button, two inches away from the belly button on either side. I alternate between sides from one injection to the next.
4. Hold syringe with needle pointing towards the ceiling. Withdraw (pull plunger back) slightly and tap syringe so air bubbles rise to the top. Slowly push the plunger up so all air bubbles are pushed out of the syringe and a small drop of solution forms on the needle tip.
5. Hold syringe in one hand. (I prefer putting my index finger on the plunger so I have good control when pushing the plunger down.) Use your thumb and index finger of the other hand to grasp and pull up the skin of the injection site.
6. Hold syringe at a right angle to the skin. (I prefer to take a big breath here.) Insert needle all the way into the skin. Steadily push in all 1 ml of hormone solution. There is pressure as the hormone is being injected, and it can burn a little. (I exhale slowly here and take deep breaths while solution is being injected.)
7. Release skin and withdraw needle straight out. Place gauze over injection site and gently rub. You did it!
8. Recap needle and dispose syringe/needle into sharps container. Discard used vials.
Ganirelix is given in the morning. It is already prepared in the syringe but administered the same way. There is less pressure as the solution is injected but the injection site hurts slightly more afterwards and for a slightly longer time.
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