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April 17, 2008

The Baby Dilemma: Hope in a Tank

Anxious about her fertility, 30-something Sarah Elizabeth Richards took $13,000 out of her savings account to freeze her eggs.

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Can tanks like these bring peace of mind to writer Sarah Elizabeth Richards?

Photo Credit: Erin Patrice O'Brien

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“So what brought you here? A birthday? A breakup?” I was in a session with psychologist Georgia Witkin; counseling is one of my fertility clinic’s requirements before they’d agree to freeze my eggs. I thought for a moment, took a deep breath, and gushed: “Well, I know I want kids. But my boyfriend isn’t sure, and in any case, I don’t want them for a couple of years. I’m turning 37 soon — ”

“How does he feel about egg freezing?” she interrupted. I looked at her, dumbfounded, wondering why the answer wasn’t obvious. “He’s thrilled,” I responded. “It takes the pressure off both of us.”

I was lucky, she said. Some men feel threatened or, worse, expendable. The women, on the other hand, talk of being empowered. They no longer have to rush to find a partner. Egg freezing allows them to separate procreation from romance, she said. “There’s something about having those eggs in the freezer.”

I needed that something. I hoped it would silence my noisy biological clock. After sorting through the ramifications in an article for Marie Claire last May, I decided to get my eggs harvested and frozen. Since my egg quality supposedly had started to decline at 35 — and the eggs might self-destruct by my early 40s — I wanted to get them into the freezer as soon as possible.

While I couldn’t rush my relationship or reason away fears about having a baby, I could do this: inject my rapidly aging self with hormones, then have my eggs sucked out, frozen, and stored in liquid nitrogen in a facility outside Boston until I was ready to be pregnant.

After weeks of research, I found my way to Reproductive Medicine Associates (RMA), a posh Manhattan fertility clinic. Although more than 220 American clinics now offer egg freezing — the majority just in the last year or two — most haven’t yet thawed those eggs to get their clients pregnant. The procedure is still so new that only about 500 babies have been born through thawed eggs. I liked the fact that RMA had produced at least some babies; according to a recent study, they had gotten three of four clients pregnant. And part of me liked that the clinic was located on Madison Avenue, near excellent shopping and gelato.

Although the technology is rapidly improving, egg freezing is still experimental and not widely recommended as a tool to put off having children. But I was in a deadline crunch. I hoped to have kids the regular way, but in case I couldn’t, I wanted an extension.

Egg freezing, I soon learned, is no quick fix. I couldn’t get an appointment at the clinic for three weeks. Then, I would have to wait until the third day of my next period so they could measure my follicle-stimulating hormone and estradiol levels. If they were too high, the whole deal was off. After a “prep” month of hormone pills and blood tests, I could finally start the hormone shots. That was more than three months away! My eggs would need a walker at that rate — if I had any money left to buy one.

The Madison Avenue clinic I chose charges $13,000 (excluding storage or IVF to implant the thawed eggs). At first, I thought no price was too high for a chance to cheat biology. But when I had to leech my life savings, it began to sink in that I was buying just that: a chance — not a fix at all.

During my consultation, Dr. Tanmoy Mukherjee, my reproductive endocrinologist at RMA, spouted the best statistics he had: Some eggs would not survive freezing or thawing or be successfully fertilized, but the remaining embryos had a 30 percent chance of implanting.

I rationalized that I simply needed lots of eggs, and I wrote the check. I was thrilled to finally be on the freezing fast track. But the hope was tinged with a big dose of doubt.

Of course, there was the unsettling chance that I was infertile at this very moment. At the clinic, however, I learned that my hormone levels were normal, and I saw my ovaries on an ultrasound: They looked like cookies made with mini chocolate chips — each dark bit representing an egg. “They look good,” Mukherjee declared. With that, I left in search of folic acid. It all seemed so easy.

That was until I attended the mandatory class that taught two other freezers and me how to administer the twice-daily hormone shots we’d need for more than a week. When the nurse saw me eye a needle big enough to spear a lamb kebab, she giggled and explained it was simply to mix some of the meds that came in powder form with water. We would inject with a thinner, shorter one that barely hurt. Right.

Even though these were serious drugs, I didn’t want to think about concerns I’d heard that they might raise my risk of getting cancer. I was more concerned about the effects on my mood. I’m so sensitive to hormonal shifts that when I switched birth-control pills last year, I collapsed in tears on my boyfriend’s floor because I had forgotten my face cream. I had no idea how I would react to this hormonal typhoon or to the side effects of breast tenderness, bloating, and irritability. I was told I probably wouldn’t feel like having sex, and I couldn’t drink to take the edge off — or go for a run, lest I jiggle my ballooning ovaries too much.

Three days after the start of my next period, I began giving myself the injections. I grabbed some belly fat, wiped it with alcohol, clenched my teeth, and jabbed. The needle sank in smoothly, as if entering a hunk of cheddar. It hurt a little, but it was bearable.

But there was still another hurdle. I had to wait three days to see if the drugs were activating follicles that would produce eggs. I bit my lip as Mukherjee inserted the ultrasound probe. Show me some eggs! I thought. I studied the monitor and saw that the chocolate chips had grown into dark cherry orbs. “I see six on this side and six on that one,” he said, satisfied. “See you in a couple days.”

“That’s it?” I blurted. I felt relieved and crushed at the same time. I had wanted to stash away a couple dozen — enough for lots of chances, and maybe even a family of four. “That’s normal for your age,” he said. “I was expecting anywhere from eight to 12.”

I walked home stone-faced. “Normal for my age” sounds good, unless you’re almost 37 and talking about babies. It didn’t matter that I exercised, wore sunscreen, and ate lots of squash. The hard truth was that my egg supply was dwindling. I was hurtling toward 40, which, in egg years, is not the new 30.

By the fifth day, the hormones were starting to take their toll: I was sluggish, had a headache, and could feel my ovaries pulsating. And I was sick to death of talking. It seemed like every female over 30 I met wanted to know “all about it.” Or they had a friend who did and would be contacting me shortly. My mother had been cheering me on — but now she asked how long it would take to get her grandbabies “out of the freezer.”

All I cared about was my egg count. By the 10th day, I was down to nine. My arms were bruised from all the blood draws, and I was so bloated I actually looked pregnant.

As I left the clinic that morning, I started to tear up in the elevator. (Yes, the hormones were working.) “Why are my eggs dying?” I sniffed. Then I wiped my eyes and braved the streets of the Upper East Side until I saw a toddler coming toward me. I noticed her matching yellow dress and hair bow, then thought about what I wanted for lunch. A block later, I stopped. This was big! For the past few years, I had felt pangs of regret whenever I encountered a cute child, as if I were watching my own chance at motherhood fading away. But now I was thinking of salad.

“This is it!” I whispered to myself. “This is the value of egg freezing.” For once, I didn’t have to be that anxious girl trying to beat some fertility expiration date anymore. I could simply admire a baby and wonder what mine might look like someday, the way I used to before the biological clock started. I also got to stop ruminating about where my relationship was going. (I still wanted to know, of course — just not every week.) I realized that the decision of when and whether to have kids wasn’t dependent on the wishes or acquiescence of some guy right now. It could be about — get this — the relationship. We could nail that part before bringing in kids. If it didn’t work out, I still had my eggs.

On retrieval day, my boyfriend sat with me until I was led to a table and an IV was inserted. I asked when it was going to start, but the 10-minute procedure was already over. I was slightly groggy and felt a dull soreness that would last a few days.

The clinic later sent me a picture of eight glistening blobs — those were the eggs that were good enough to freeze.

Eight was enough to make a handful of embryos, but my doctor estimated it would take 12 to 14 (fewer if you’re younger) to have a “good chance of success.”

Now, I wanted an insurance policy on my insurance policy, and I was hopeful when I heard that many women produce more eggs on different drug protocols. I resolved to find a way to pay for another cycle.

As I listed my options, I listened to my friends try to be encouraging, but I could hear a tone in their voices. It seemed to say, “How far are you going with this, Sarah?” I wanted to dismiss them as self-righteous or envious, but they all had a point. I could freeze myself right into bankruptcy, and there were still no guarantees I would take home a baby.

I got that. The surprising part was that it was starting not to matter. I’d already gotten my money’s worth. Egg freezing may not lead to babies, but it has let me put panic on the shelf and be excited about my future again. It has helped me get closer to my boyfriend and have tear-free Sunday summits about the pros and cons of parenting. It has restored my confidence that I will continue to make good, not rushed, choices.

With any luck, when I’m ready to be a parent, my eggs will work like they should. Or I’ll find another way to be a mom. But the point is, I’ll be ready.

I think I got a good deal.

Read Richard's first story on egg freezing

Egg Freezing 101


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