What happens when you're concerned about the dreaded "biological clock" but not ready to have children yet? Alex, a 27-year old medical student pursuing big career goals, shares how and why she made the decision to undergo an egg freezing cycle while she was still in her twenties, and the financial and physical challenges she faced along the way.
Keep reading to hear Alex's story, in her own words.
In this article:
- Uncovering My Passion for Reproductive Medicine
- Feeling Anxious About My Future Fertility
- Finding Support & Exploring My Options
- Am I too young to freeze my eggs?
- The Cost of Egg Freezing
- AMH, OHSS, what does it all mean?!
- The First Step On My Egg Freezing Journey
- Starting My Fertility Medication Protocol
- Preparing for My Egg Retrieval
- The Big Day: Egg Retrieval Time!
- Physical Side Effects After My Egg Retrieval
- Why consider egg freezing?
- More Resources
Uncovering My Passion for Reproductive Medicine
I was diagnosed with Polycystic Ovary Syndrome (PCOS) when I was twenty years old, after I'd returned from studying abroad in New Zealand. Despite all the hiking I was doing in the breathtakingly beautiful, outdoorsy, and mountainous terrain, I still managed to gain 20 pounds in five weeks. Over the past seven years of managing my diagnosis, I have found not just a supportive community in Illume Fertility, but also a family.
I first came to know Illume Fertility back in 2016, when it was still called Reproductive Medicine Associates of Connecticut. Wanting to pursue a near life-long interest in reproductive science, they allowed me to intern with them for a summer.
I shadowed physicians in the operating room watching egg retrievals and embryo transfers, nurses as they created medication protocols and worked hand-in-hand with patients, and the third party reproduction team as they worked to coordinate egg donors with prospective parents. I even followed the marketing team and attended events put on by Gay Parents to Be.
Enthralled by the practice, the employees, and their unique services, I kept in touch with Illume Fertility through my senior year of college and was hired the following summer as an Administrative Assistant. This time, I worked more closely with the Integrated Fertility & Wellness team by helping with smaller research projects.
Feeling Anxious About My Future Fertility
My work at Illume Fertility propelled me into a career in research, both in the laboratory and in the clinic. I began a Master of Science in Reproductive Science and Medicine program at Northwestern University in Chicago. Here, I threw myself into researching the mechanisms driving PCOS at the bench-side.
After graduating, I moved back home to Connecticut to study for the MCAT. Keeping in touch with Illume’s CEO, I communicated that I was back in the area and was hoping to find a part-time clinical research position. Within days, I had signed on to work for the practice again, but this time as their new Clinical Research Coordinator in my final gap year before beginning my medical school education.
It was within this time that the reality and logistics of my future really began to set in. Mapping out my life, as most women my age try to do, it hit me that I wouldn’t be graduating medical school until I was almost 30 years old. 30?! Then, I would begin a 3-4 year demanding residency program working roughly 80 hour work weeks. How will I have time to find a husband, let alone a boyfriend? When will I have time to try starting a family?
These looming questions, my aspirations of becoming a physician (and the path to get there), together with my PCOS diagnosis, all sent me spiraling.
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Finding Support & Exploring My Options
I first talked to Lisa Rosenthal in April 2021 about my qualms regarding my life trajectory and future fertility. If any of you know Lisa, Illume’s patient advocate, you probably love her just as much as I do. Lisa and I became friends working on research together in my time as a clinical research coordinator.
I have always been incredibly open about my journey with PCOS and so needless to say, Lisa already knew the whole story. She encouraged me to look into egg freezing as an option that would allow me to retain my own reproductive autonomy and calm some of my big life questions. I then spoke to my manager, who encouraged me to set up an appointment with Dr. Spencer Richlin to discuss the possibilities.
Having known Dr. Richlin for years, he too was already aware of my upcoming medical school adventure. He empathized with me and made me feel validated and understood, as he has his own accounts of the demands of medical school and the long journey of residency thereafter.
Am I too young to freeze my eggs?
My main question regarding egg freezing was whether I was too young to be doing this. I had heard stories of women in their mid-thirties freezing their eggs and at the time, I was just turning 26. He assured me that I was not too young, and that in fact, the timing would be perfect considering my future career timeline.
My last summer break (having six weeks off from med school) would be June 2022. After that point, it would be hard to find a good chunk of time to dedicate to the 2-3 week egg freezing process. Not only that, but in most cases, age can play a big role in determining the quantity and quality of eggs retrieved—in other words, undergoing this process at my age would be in my favor.
The Cost of Egg Freezing
The last factor I had to consider was the cost of all of this. My insurance provided limited coverage for egg freezing and while I had some money set aside for medical school, I was worried it would not be enough for the procedure, medications, and storage fee for the eggs. I voiced these concerns to Dr. Richlin, who generously offered to work with me to find solutions in overcoming this economic barrier. I never felt alone in navigating my financial concerns throughout the process!
Note: Illume Fertility pairs each patient with an Insurance & Billing Advocate to help you manage the financial aspect of treatment, including offering financing plans and connecting patients with organizations that provide financial support via grants and other means!
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AMH, OHSS, what does it all mean?!
Before starting medical school, I went into the office for some baseline blood work and a scan, including measuring anti-Müllerian hormone (AMH), which is often used as an indicator of ovarian reserve. For example, the higher your AMH level, the more likely it is that you have a high number of follicles in your ovaries. Follicles serve as the functional unit of the ovary. Their job is to house, nurture, and grow each individual egg until it is ready to be ovulated out of the ovary and into the fallopian tube.
My AMH levels were higher than average, which is not abnormal considering my age and PCOS diagnosis. The scan of my ovaries also confirmed this finding, as I had multiple small follicles in each ovary. This was the first time I was made aware of ovarian hyperstimulation syndrome (OHSS), a possible complication of egg retrieval that can occur in some patients with a high number of follicles who have extremely robust response to the medication.
Since my AMH levels indicated a large number of follicles, the Illume team informed me I could be at risk for developing OHSS, but that they would take extra precautions with me to try to avoid this.
Alex at her parents' home; becoming a pro at shots; at our Norwalk, CT location
The First Step On My Egg Freezing Journey
I began the egg freezing process at the end of May 2022. I stayed at my parents' house not far from the clinic – it was important to me to have emotional support nearby and my parents certainly are great cheerleaders! I went in for another baseline scan and was told to begin medications at night.
At this point, I was contemplating having my dad give me the injections as I wasn’t sure I would be able to give them to myself. However, having completed my first year of medical school at that point, I had given vaccines and practiced injecting shots into fake mannequin arms numerous times. I figured it would be better for me to give them to myself instead of trying to teach my nervous dad how to do it.
Starting My Fertility Medication Protocol
Let me start by saying that the idea of stabbing your own belly with an injection is so incredibly unnatural.
The first night, I quickly discovered that my mom should not be allowed to be in the room during the injection. As I’m sure any mother would feel, the idea of her daughter causing herself any kind of pain was unbearable! She wanted to hug me and asked repeatedly, “Are you okay? Does it hurt? Did you do it?” Hearing her concerns while trying to gather the courage and focus to inject myself did not help, to say the least.
Instead, my dad sat next to me quietly, reminded me why I was doing this, and waited patiently for it to be over. The first night, I probably stared at the needle for a solid 10 minutes before actually doing it. Every time I counted down in my head, instinct would freeze my hand, not allowing me to give the injection. I thought this would get better over time, but even on day eight of injections I still hesitated for at least five minutes. The injection itself was basically everything they tell you it will be…a small pinch, maybe some burning and a little blood, but nothing more.
Over the next few nights, if my dad wasn’t available to sit with me, I FaceTimed my boyfriend instead. His approach in supporting me through this was different from my dad’s. It included “motivating” music such as the Star Wars theme song, music from Batman, and even ominous music from Jaws right before you see the great white shark…you know the one. This lightened the mood and made me laugh, relaxing me just enough to brave the next injection.
How to stay balanced during your journey:
Ch-ch-ch-chaaanges (the hormonal kind!)
After the first night of injections, I already felt a change in my body. It started with a few sharp pains in my lower abdominal region, near my ovaries. As the days went on, my belly became bloated and swollen, my breasts felt so tender it hurt to even get dressed, and I had a dull but constant headache. I took Tylenol once or twice a day and made sure to take it easy on myself.
I read books, caught up on TV shows, played with the dogs in the backyard, and laid by the pool. Each time I went into the office for follow-up scans every few days to track the growth of follicles and monitor my estrogen and progesterone levels, the doctors always had the same reaction, “So many follicles!” My ovaries were very busy and were responding well to the medication.
At first, my estrogen levels sky rocketed, which is indicative of many follicles producing estrogen, and also contributed to my breast soreness. They began to level out after my team made some adjustments to my medication protocol.
Three days before my retrieval, I met with Dr. Hurwitz for another scan and blood work. He said at this point, it was a balancing act in ensuring they are able to retrieve a good number of eggs while also being careful not to overstimulate me into OHSS. I returned the day after and was told I was ready to be triggered.
What is a trigger shot? This injectable medication, containing the naturally-occurring hormone human chorionic gonadotropin (HCG) lets your body know that it's time to ovulate, and primes your ovaries to release the follicles (eggs) inside within the next 24-48 hours. The average time from trigger shot to ovulation is around 36 hours.
Preparing for My Egg Retrieval
I was so bloated at this point I was ready for the eggs to be taken out. I had to move slowly and be sure not to put any pressure on my stomach. I was gently reminded that just because they were taking out the eggs, it wouldn’t mean I would immediately start to feel better. In fact, I would likely feel worse before starting to feel better, especially since I had so many follicles.
I began another medication to block the increasingly high estrogen levels, and also was given an injection of Lupron, both in hopes of limiting the possibility and potential effects of OHSS.
What causes OHSS? It is caused by an exaggerated response to fertility medication and elevated estrogen levels. There can be mild, moderate or severe symptoms, but severe cases are quite rare.
It just so happened that my retrieval date would be the day after my 27th birthday. My boyfriend, who is also a medical student, was in town and could finally give me the injections (instead of me having to do it myself - honestly a great birthday gift).
My parents took me out to a birthday brunch and since I was still avoiding alcohol being on medications and going through this process, I was the designated driver for my family who enjoyed mimosas and bloody marys in my honor.
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Follicle check; Alex in the OR Suite; egg retrieval report
The Big Day: Egg Retrieval Time!
The next morning, my mom dropped me off for the egg retrieval. The minute I walked into the OR suite at Illume Fertility, it felt like I was entering a spa. The lighting was soft, and a warm pink gown and cozy socks were all waiting for me. I met with the nurse, the physician, and the anesthesiologist all before entering the operating room.
The last time I had been back here was as a college student, shadowing Dr. Richlin. Now, as the patient, I felt like I had come full circle. I was very calm (more so than I thought I would be); I saw the familiar face of a medical assistant I had worked with and she said, “Well, Alex, we’re basically family now. I’ll be in here the whole time!”
The next thing I knew, I was back with the nurse, awake, and she was asking me what kind of snack I wanted. I told her, “All the sugar, please!” and she returned with graham crackers and apple juice. I drifted in and out of sleep until finally the nurse came back in and handed me a small card that read, “33 ooctytes/eggs were retrieved today.” 33?! I was shocked.
Even though I knew from the start I had a large number of follicles, I was expecting maybe to get 20 eggs, if that. It wasn’t until the next day that I found out 32 of those were mature and would be frozen. In this moment, lying in the bed in the OR suite, all I felt was genuine happiness and relief. I felt no pain and was ready to go tell my mom the good news.
Physical Side Effects After My Egg Retrieval
On that Monday afternoon on my retrieval day, I still did not feel any pain or tenderness. I threw up three times which I attributed to the anesthesia, and slept the day away. The next day, things began to take a turn.
I want to preface this by saying that ovarian hyperstimulation syndrome (OHSS) does not happen to every patient! While there is always a chance, OHSS is fairly uncommon and occurs in less than 5% of patients.
For me, it felt like a never-ending cycle of sleeping, waking up nauseous, throwing up, trying to eat something, and falling back asleep again. This went on for two days, until on Wednesday I called my nurse Christina and communicated the severe pain and nausea I was feeling. The only position that was relatively comfortable was lying flat on my back.
FYI: It is normal to feel tired, nauseous, bloated and crampy after an egg retrieval, but always contact your nurse or doctor if you are starting to feel a swollen abdomen with weight gain of 5lbs or more, pain, vomiting and decreased urination. When you are discharged after your egg retrieval, a nurse will review this with you.
Tylenol and heating pads provided minimal relief. I could barely walk to and from the bathroom because of how painful, sore, and sensitive my stomach was…it often brought me to tears. If I thought I was bloated before, I was really bloated now. My stomach looked like I was nearly three months pregnant. She scheduled an appointment to come into the office that day for a follow-up scan and blood work, with concern that I may have mild/moderate OHSS.
I met with the doctor and reviewed my symptoms. She performed a physical exam and then scanned my ovaries, uterus, and pelvic region. My ovaries had doubled in size and were very enlarged. They had filled with fluid, which was now seeping out into free spaces within my pelvic cavity. I had to keep reminding myself that this was all short-term pain for long-term gain!
A note from Dr. Richlin: Alex had an exceptionally robust response to her fertility medication, which is what led to her more severe symptoms. Most people will not have this type of reaction post-egg retrieval. While it is certainly possible in young women with high AMH, OHSS does not occur in most patients!
She explained that since I had such a robust response to the medication and had 33 eggs retrieved, this was almost an expected finding – it all made sense. She went on to say that my enlarged ovaries were primarily responsible for my symptoms, and that it could take as long as two weeks for them to shrink back to their normal size. With this, she prescribed an anti-nausea medication and a stronger painkiller.
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Recovering From OHSS
The new medications slowly made me feel better. The anti-nausea medication worked immediately and the painkiller helped me walk without pain. By Friday, things were looking up. While I still spent the majority of the day horizontal, I could keep food down and sleep through the night without waking up in pain. Fast-forward to 2.5 weeks post-retrieval day, my stomach was almost back to its normal size and I was beginning to implement exercise back into my routine.
While this was a whirlwind of a process, I am so beyond grateful that I did it and would do it over and over again, knowing the outcome and mild complications. I am even more grateful to my family, boyfriend, friends, and especially Illume Fertility, for all of their support along the way. I am also forever thankful to my parents, for going above and beyond in taking care of me over my 2.5 weeks at home.
Not seen here are the countless motivational conversations I had with my friends via my Snapchat updates. Some sent me chocolate covered strawberries, while others sent ice cream and candy. There was never a moment I felt isolated in this process.
Getting Support From My Care Team
Throughout this two week journey, I was in constant contact with my Care Team - primarily my nurse, Christina, and patient navigator, Amy. The amount of work they do behind the scenes to make you feel cared for is truly one-of-a-kind. A big shout-out to Christina for texting with me as late as 10pm at night and as early as 7am in the morning.
From the friendly faces at the front desk and medical assistants taking blood each morning, to the positivity, comfort, and hope I felt in every scanning room from doctors and nurses, I could not have asked for a better experience or a better team to go through this with. I look forward to continuing my PCOS care and management with Illume’s PCOS team and dietician for all of my future needs.
Since college, I have considered the people who worked at Illume Fertility to be family. From being an intern, to an employee, to now being a patient, I have felt their kindness, support, and compassion in all aspects of my life.
Why consider egg freezing?
If you are anything like me: a young woman striving to have an all encompassing career who doesn’t yet have her life planned out in terms of marriage and children, I encourage you to consider egg freezing, especially if you have the resources. It takes away nearly every worry and stress society forces you to think about including family planning, marriage, maternity leave, being a working mom, etc.
Unfortunately for us, the ovaries are one of the first organ systems to age beginning around 35 years old, which coincidentally may be at the same time as the beginning of a lot of our careers. The timing of big life choices are not always on our side (or easy to plan for), but taking steps to protect your ability to start a family when you want to and when you feel ready, is to me, the most liberating action you can take.
I look forward to remaining an advocate for women below the age of 30 to discuss egg freezing as an option!
Want to explore your own options?
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Alexandra Fontaine, MS, joined the Illume Fertility team back in 2016 when she became an intern at the practice. She went on to become an Administrative Assistant and finally, Clinical Research Coordinator before beginning medical school and navigating an egg freezing journey with Illume in 2022.