Blog Posting about Egg Freezing Complications

You might want to check this post out for some general information about complications in the egg freezing process. The author, Dr. Licciardi works with my RE, Dr. Noyes at NYU. Both are top RE in the field.

http://infertilityblog.blogspot.com/2009/12/some-complications-of-ivf-and-egg.html

You tube Video about Egg Freezing

A blogger sent me this YouTube video about egg freezing. It wasn't that detailed but it gives a general overview of the process.

http://www.youtube.com/watch?v=rH6tBODmmR8

One Year Mark....

It's been one year since I froze my future children :) I still haven't used them yet but looking at the past year and how it went, I am SO glad I did the procedure a I am no closer to having children then I was last year at this time. I have not even taen a step in that direction yet. So, the decision to do it was such a smart one.

I finally recived answers to my questions which I will post in a day or 2 as I filed them away months ago and forgot to list them here. I also received a full copy of my doctor's article. I won't post it as I don't have the rights to do so. You can purchase the article online and I will post how when I leave my next post.

If anyone ever has questions, please feel free to post our comments, questions etc.

Extremely Promising News - An Article Just Published Indicates Babies Born From Frozen Eggs Do Not Have An Increase in Congenital Abnomalities

My RE just published this article in conjunction with two Italian REs showing very promising statistics.

Read the summary here:

http://www.rbmonline.com/4DCGI/Article/Detail?38%091%09=%203971%09

RBM Online

Volume 18, No 6 June 2009

Over 900 oocyte cryopreservation babies born with no apparent increase in congenital anomalies

Dr. Nicole Noyes1,4, Dr. Eleonora Porcu2, Dr. Andrea Borini3
1Dept. of OB/GYN, NYU Fertility Center, NYU School of Medicine, 660 First Avenue, Fifth Floor, New York USA 10016
2Infertility/Reproductive Unit, University of Bologna, Bologna, Italy 40138
3Technobios Procreazione, Center for Reproductive Health, Bologna, Italy 40125
4Correspondence: nnoyes01@gmail.com

Over the past decade, the number of reported livebirths resulting from oocyte cryopreservation has rapidly increased. To appreciate the true number of children born, verified livebirths were tabulated and assessed. A literature search was performed; authors were then contacted to verify birth outcomes and provide updates. A database including all verified liveborn infants was constructed. A total of 58 reports (1986–2008) were reviewed, which included 609 liveborn babies (308 from slow-freezing, 289 from vitrification and 12 from both methods). Additionally, 327 other livebirths were verified. Of the total 936 liveborns, 1.3% (12) were noted to have birth anomalies: three ventricular septal defects, one choanal and one biliary atresia, one RubinsteinTaybi syndrome, one ArnoldChiari syndrome, one cleft palate, three clubfoot and one skin haemangioma. Compared with congenital anomalies occurring in naturally conceived infants, no difference was noted. With more liveborn data accumulating, this procedure may become mainstream as a fertility preservation option, particularly for women diagnosed with malignancy requiring cytotoxic therapy. A registry would help to assure the safest, most expeditious development of this technology.


Reproductive BioMedicine Online 2009 http://www.rbmonline.com/Article/3971 [e-pub ahead of print on 8 April 2009]

Reproductive BioMedicine Online 2009 Vol. 18 No.6. 769–776

Keywords: liveborn, oocyte cryopreservation, pregnancy outcome, slow freezing, vitrification

Buy the article here:

http://www.rbmonline.com/4DCGI/Article/2008/3971/RB3971%20Noyes.pdf

Genetic Testing of Eggs PRIOR to Freezing

I researched this issue a lot before having my eggs frozen and ultimately decided against it. My RE at NYU also advised against it. The reasons she set forth are quite similar to those in this article:

http://socalbodydoc.livejournal.com/2044.html

Understand, I have no background in medicine. However, from what I have read, eggs are fragile enough. Eggs are mostly made up of water. As a woman ages, the eggs are also more prone to genetic abnormalities. The less the eggs are 'handled' prior to freezing, the better.

When eggs are tested for genetic abnormalities, the contents of the polar body, the DNA, is used. The polar body is stored right outside the egg. To 'get to' the polar body, a biopsy of the polar body must be performed. The experiment completed by 'Pasadena Plastic Surgery' shows that there was damage to the egg after the removal of the polar body. PPS doesn't indicate how big this experiment was and what exactly their results were but it stands to reason, it wasn't at all positive. Any damage is not good.

Again, the egg is fragile enough. I don't want anyone touching my eggs before they are frozen unless it is an absolute necessity. To me, this genetic testing is not necessary at this point in the process. I figured that I can test my eggs when my egg becomes an embryo.

Besides, the genetic testing of eggs is still experimental. I surely don't want to toss any eggs unless I am 100% sure something is wrong.

Read the article for yourself......there are also photos which shows the polar body and biopsy.

New article in Medical Journal of Austraila : Oocyte freezing: timely reproductive insurance?

The full article, Oocyte freezing: timely reproductive insurance? is here but requires a subscription:

http://www.mja.com.au/public/issues/190_05_020309/mol10900_fm.html

A synopsis of the article, including information about the 40 year-old woman who just had twins from frozen eggs, after originally freezing her eggs at 37 is included here:

http://babyfertile.blogspot.com/2009/03/single-career-woman-has-twins-using.html

Good News - Woman's cryopreserved egg results in healthy baby

Read the article here on the Proud Parenting Law Blog:

http://www.proudparenting.com/node/2836

Interesting to note, the woman was 27 years old. 17 out of the 18 eggs retrieved were frozen. The eggs were frozen in liquid nitrogen. Two months later, the eggs were thawed and only 4 of the 17 survived. Three eggs were injected with sperm and implanted 2 days later. 39 weeks later, she gave birth to a 7 1/2 pound baby boy. So far, tests have not found any congenital defects.

It's key to remember in this case, the subject was quite young, the eggs were thawed for a short time and only a small percentage survived thawing. This is all worrisome to me but again, this process is experimental.

Lindsay Nohr Beck - Oocyte Cryopreservation - The Patient's Perspective

Ms. Beck founded Fertile Hope (Fertility and Cancer)and just made a presentation regarding her experience as a mom, cancer survivor but most importantly, a egg freezer (8 years ago). It was interesting and definitely worth a listen to:

http://www.ivfpodcasts.com/IVF_Podcasts/Podcasts.php?Oocyte-Cryopreservation-The-Patient-s-Perspective-16

The World's First Frozen Egg Bank - Not too sure about this....

You can read about it here:

http://infertility.suite101.com/article.cfm/the_worlds_first_frozen_egg_bank

The company was originally founded 12 years ago to help women find donor eggs. However, the company now merged with another company to create a Frozen Egg Bank eliminating the need to have your cycle sync with the donor's cycle.

I don't know if I am too happy with this idea since egg freezing is still in the experimental stage but, I guess if you want to try, it's not my place to say no.

New Stats came out about Fertility and Fertility Centers....

....unfortunately, none list the stats for egg-freezing.

It is worth a look though.

http://cancerfertility.blogspot.com/2009/03/new-fertility-clinic-success-rates.html

Individual clinic statistics are here:

http://www.sart.org/find_frm.html

Follow-Up Appointment is Tomorrow! Finally.....

I finally have a set time for my follow-up appointment and I sure do have a lot of questions! My main concern is testing these eggs once I decide to thaw them for chromosomal abnormalities and if this is even an option. I just read the following and it concerned me:

Declining Egg Number
Most women are born with about 2 million eggs in their ovaries. By the time they reach puberty, almost 90% of these eggs have died and by the time she reaches twenty, only about 50,000 of the original 2 million eggs remain. This decline usually continues steadily until around the age of 35, at which point the rate of loss speeds up dramatically. This means that there are increasingly fewer eggs available for fertilization as the average woman ages beyond 35.


Declining egg quality
During a woman's normal cycle, the body selects the 'best' eggs to ripen for fertilization. So, each month at least one healthy egg is passed during menstruation (the monthly period). So gradually, unless a woman conceives, the 'best' eggs are discarded by the body. Those that remain have grown older, and are possibly lower quality, making them less likely to become fertilized and develop into a healthy baby.

Although an older egg can sometimes become fertilized, there is a greater risk of miscarriage or birth abnormalities due to chromosomal defects. It may be that the reduced fertility seen with aging is therefore part of the body's natural 'safety mechanism'.

So far, the remainder of my questions are as follows:
1. How many eggs were frozen using vitrification and how man were frozen using the slow freezing method?
2. How many eggs were spindle positive?
3. Does NYU use a vitrification system with closed containers so as to exclude viruses?
4. Is there any genetic testing for chromosomal abnormalities with the eggs after freezing them/ during or after the thaw? Ask about Reprocure?
5. Can I have a picture of the egg(s)?
6. Has there been anyone over 37 at NYU that used their thawed eggs yet?

Period.....Migraines...Waiting

So, my retrieval was the 28th of November. I expected, from my research, to get my period about 11 days later. On December 8, it came, like clockwork. It came mid-day and starting early in the morning, I had the worst possible migraine I have had in years. I vomited most of the day.

I had no Imitrex so the day was torture for me. I knew my period was coming because usually my migraines come when my period comes and I can easily treat them with Imitrex. I ran out of Imitrex and the pharmacy was not open so early in the AM so the migraine could not be aborted. Thus, I suffered all day. Eventually, when the vomited eased up, I tried Alleve. Thank goodness it worked. It never had worked for me before. I ate that night and felt ok the next morning. Not great but well enough to handle a court case I had.

As for my period, it was not that much more uncomfortable than usual. I just felt a tad more bloated but not much more than usual. It lasted several days and petered out as it usually does. I think I stopped spotting yesterday.

I still await a call from NYU about my follow-up appointment.

10 Days post surgery UPDATE

Just an update on how I have been feeling since the surgery and any new information I received.

I received a call one day after the surgery and was told 23 eggs were retrieved and 21 were frozen. During the 'average' egg-collecting procedure, doctors typically retrieve 10 to 12 eggs so 23 is excellent!

The surgery occured on a Friday and I felt absolutely fine going home and the next day. About Sunday evening, I started feeling nausea and a fullness feeling in my stomach that made it hard to breath. The shortness of breath was the worst I had ever experienced. I stayed in bed a lot. I was tired.

Tuesday night, I had plans (a Court case-if I did not go, my case would be dismissed)that could not be canceled. I felt particularly 'vomity' that night but after having some soup and plenty of sleep Tuesday night, I felt 100% perfect the next morning. Basically, I had about 3 days of feeling yucky, not super yucky, but yucky enough.

My guess is that I had a slight to moderate case of OHSS aka Ovarian Hyper Stimulation Syndrome. I diagnosed myself with this after doing some research. This is what I found.....

What is Ovarian Hyperstimulation Syndrome?
OHSS is a complication associated with ovulation induction. Ovulation induction is commonly performed with IVF and IUI infertility treatment procedures in order to increase your chances of conception. It uses specific types of fertility drugs (including Clomid and gonadotropins) to increase the number of follicles in your ovaries. Sometimes, however, too many follicles begin to develop in the ovaries, causing them to become swollen and enlarged. Known as OHSS, this syndrome can cause severe pain and trigger the release of fluid into the abdomen and lungs.

I am sure, based on the number of follicles produced and my estrogen level at retrieval (over 4K), I had mild to moderate OHSS.

Wiki indicates that mild symptoms of OHSS include abdominal bloating and feeling of fullness, nausea, diarrhea, and slight weight gain. Since Wiki did not mention shortness of breath, I kept searching and found this....

The symptoms of OHSS vary depending upon how severe the condition is. Symptoms typically manifest four or five days after egg collection, and are often associated with pregnancy. Possible symptoms include:

* nausea and vomiting
* diarrhea
* abdominal bloating and distension
* abdominal pain
* sudden weight gain (due to fluid accumulation in the stomach)
* the appearance of cysts on the ovaries
* difficulty breathing

Additionally, depending on the severity of your OHSS, you may experience reduced frequency in your urination as well as dark urine.

Wiki claims symptoms resolve in 1-2 weeks but I had planned a visit to NYU that Wednesday if the symptoms did not resolve. Luckily, the symptoms left as fast as they came.

Wiki indicates that treatment requires reduction in physical activity (check-I was chillin' in bed from Sunday night to Tuesday/Wednesday), closely monitoring fluid and electrolyte balance (I drank a lot of gatorade), and aspiration of accumulated fluid (ascites) from the abdominal/pleural cavity may be necessary, as well as opioids for the pain (luckily I did not need either an aspiration or any type of pain meds). Over time, if carefully monitored, the condition will naturally reverse to normal - so treatment is typically supportive, although patient (moi) may need to be treated or hospitalized for pain, paracentesis, and/or intravenous hydration (again, luckily this was not needed).


Now, I am just waiting for my doctor's assistant to contact me back to have my follow-up visit. I have some questions that hopefully she can answer. I will update once again after this visit.

OD15 - The Party's Over.

So, the Retrieval Day was today. I will start from CD 12 which was Tuesday. That day I took Antagon in the AM and 150 of Gonal F in the PM. Dutifully taken, no problems.

When I went in on Wednesday, CD 13, I was told later that day when the nurse called, my HCG trigger would be that night at 10:30 PM. No more Anatgon. No more Gonal F.

At about 9:30, I started getting ready. I took frozen veggies on a bag and prepared my medications and needles and alcohol swipes. I tried to see if the veggies would be cold enough to freeze my butt area. By 10 PM, the veggies were not doing the trick. I got out a frozen pot pie. That worked better. Better surface area. Since I was at my parents for Thanksgiving, my brother was luckily around. Since he worked in a vet's office, I got super lucky. He was able to give intramuscular shots to any thing and anyone. He agreed to shoot me up.

I mixed the drugs starting 10:15 PM....it took 15 minutes to do it because i was super careful. I went line by line of the instructions that I found on a website that I mentioned in a previous entry. I then prepared a heating pad on my bed and my brother and I went back and forth as to where the right outter quadrent of my ass was. It was hysterical.

With my pants partly down (no whoha showing), my brother and I watched the clock on the computer. At exactly 10:30, he started counting "1, 2...." and then he said he was done.....I was like "HUH". He said he shot it in my ass at the count of 1. I didn't even feel it. It's good I don't have a size 2 ass.

The rest of the night was 100% uneventful. I rubbed the area a bit because I didn't want lumps. The rest of the night....No swelling, no pain, no nothing.

I was a bit scared to be honest and so was my brother. he thought he screwed up. I thought he screwed up. My parents even thought he might have. I would go in the next day to NYU to know whether it was screwed night. Nervous, I went to bed and waited.

The next morning, I went into NYU promptly at 7 AM and only had to do blood tests. I was back in Brooklyn. What a relief not to be done with sonograms and blood tests. At 2:45, I had not heard from NYU so I called to see if the HCG trigger worked. They said it did and advised me that they only call if it did not work. Thank goodness.

This morning, at 730, I left the house for my scheduled arrival time of 8:30. At about 9 AM, I was called in, donned a robe or 2 and got my medical history taken along with blood pressure and temperature. Everyone was super nice.

At about 915 AM, I met the anesthesiologist and he took me in to the OR. I got on the table, a warming blanket was placed on me, placed into stirrups, and given the run-down of the anesthesiology by the anesthesiologist. I met the biologist who made me sign a form and was told the drugs would work in 20 seconds. I wanted to see if I could force myself to stay up but no luck.

The weirdest thing about the surgery was I never met the doctor who performed it. Odd, right? I saw her later in the recovery room but she never spoke with me.

At about 10:15, I was awakened in the recovery room. Again, the nurses were nice, telling me to take a nap but I felt 100% fine. I thought that was very odd. I was hooked up to a blood pressure machine and IV/saline solution drip was still in me. I never took out my contacts (no one asked but I never told - though you are supposed to take them out) so I saw everything. I asked what what my egg retrieval number was and I was told that they retrieved 23. Awesome. I was very excited considering the last number I heard was 12.

At 10:30, I asked the nurse to pee because I felt some slight abdominal pressure and I assumed it was the massive amounts of saline in me. That helped some but not much. It truly was not that bad...about a 2/10 in discomfort, if that. I was given apple juice and graham crackers some time around then and at 10:45 AM, placed in a chair, sitting up. My blood pressure was taken again, I was handed a blue sheet of discharge instructions and was told around 10:50 that I could go. By 10:55 PM, I was in the car with my brother going home.

The discharge instructions listed the number of eggs retrieved was 23 and my estrogen level for yesterday, a staggering 4484. I can only assume that is HSS aka hyper-stimulation syndrome. The nurse did say she was surprised I did so well considering the estrogen levels and my egg count. I was told that tomorrow, I would be called with the number of eggs that were frozen ( and sadly the number of eggs that passed on or didn't make the cut).

I must say, surprisingly, I feel perfectly fine. I took the doxycycline and some gatorade (recommended by one of the nurses) and have napped a bit but otherwise, I am hungry and feel like nothing happened. A let down almost.

I will also add that I took my unopened Gonal F (3 boxes) and unopened Antagon (4 boxes) to the Center. They give them to needy cancer patients. I felt good about that. Otherwise, it would have been well over $3K wasted.

More tomorrow with the exciting freeze results!

Trigger Time!

I was called at 3 PM today and told today is the trigger day....finally. My estrogen hit 3287. My trigger time is promptly at 10:30 PM. I only have a 5 minute window to inject (although the doctor who performed today's sonogram claims it is more like 15 minutes but I will be injecting at exactly 10:30 PM no matter what). I certainly do not want a $9,000 mistake.

Based on my trigger time, my surgery should be scheduled (according to my calculations) for Friday at 9:30 AM. I believe I need to be at NYU one hour before the scheduled surgery time. Luckily, Friday will be a easy day to get into Manhattan since it is the day after Thanksgiving.

I found some websites to show me how to prepare the trigger shot of HCG and also how to inject the HCG. The sites are here (respectively):

http://www.ivf1.com/hcg-trigger/

and

http://www.ivf1.com/intramuscular-injections/

Still growing...

The future kiddies are still growing. Yesterday, I dropped down to 150 IU of Gonal F. Monday night, I took 225 IU. I continue every morning with the Antagon before I leave to go to NYU. The sonograms and the blood work is daily now. It will continue until I go in for retrieval.

My estrogen for yesterday was 2760. It should go up very little in the next couple of days.

The doctor who performed the sonogram today told me that there might be a retrieval on Friday. I went over the HCG shot with her today to make sure I knew how to do it.

The sonogram picture, if I am reading it right, shows a future kid to be almost 22 1/2 mm and another one is almost 20 mm!

CD11 - Getting Bigger!

Here are the future kiddies. I read a blog about a woman who underwent IVF. Post implantation, she called her future child (which she does not even post if all went well as her due date was 10/22/08) Poppy because he/she was the size of a poppy seed when she received confirmation that she was officially pregnant. I have to think of a name for these guys/ girls. I sure hope all of them make it out and get to successfully hibernate.

CD11 - Dropping down to 225 IU

I continue taking the early morning Antagon shot and I left for NYU by 630 AM. I was NYU nice and early this morning and had a sonogram and bloodtest. It was uneventful other than the doctor who did my sonogram today mentioned that my retrieval day might be Thursday or Friday. My personal doctor (who did my sonogram on Saturday) said most likely retrieval day will be Thursday (which is what I am hoping for). I did get sonogram pictures from the visit today which I will post in the morning.

The nurse called as usual in the early after noon advising me of the next days schedule. My estrogen now measures 1645 so it is increasing nicely. Because of this, my Gonal F was decreased from 300 IU to 225 IU for tonight. I will continue to take the Antagon tomorrow morning. I have to head back to NYU in the morning to have yet another blood test and sonogram. Tomorrow muight or might not be my trigger day.

The only thing that I have noticed is the 'bloaty' feeling has gone down (maybe I am used to it). I am exhausted all the time. I take tons of long naps. I also get a bit sick / 'vomity' mid-afternoon since about 2 days ago. The doctor I had the sonogram with today said it is because of all the hormones. I don't get that reasoning because aren't my hormones decreasing now? I have a feeling it has something to do with the Antagon.

Today was a bit different. I actually had my songram done by my doctor. She told me I didn't have 6 eggs but that I had 6 in each ovary approximately. Better news. She said things were going along just as she hoped. She confirmed that my retrieval most likely would be Thusrday. I thought that as extremely ironic. Thanksgiving = future childre. That is a lot to be thankful for!

I also received my estrogen levels and instructions:
My estrogen level this morning was 1366 which is good according to the nurse.
Saturday night I am to take 300 IU of Gonal F. On Sunday evening, I am to take one shot of Antagon. On Sunday evening, I am to again take 300 IU of Gonal F. On Monday, I am to wake up, take Antagon and then go in for a sonogram, and blood test.

Here are the future kiddies!

Not much to report yet.....

Yesterday morning, which was CD 8 (one week since my period started), I took my first shot of Antagon. Antagon suppresses your body from ovulating. It basically keeps the eggs cooking. Last night at about 10 PM, I took 375 IU of Gonal F. The Anatgon is easy to take. It is in a pre-filled (glass) syringe so I don't have to measure anything. The only thing I was told to do by the nurse is pull the plunger back a bit to break the seal. I shot up just as I did with the Gonal F. Both are subcutaneous.

Not much to report other than I still feel bloaty. I certainly am not eating as much as normal. I feel full all the time and once I start eating, I feel even more full and bloaty.

I am heading to bed as I am out of the house by 630 AM so I can be at NYU tomorrow at 7 when they open. I want to go in and get out quick. I have a sonogram and blood test scheduled. Hopefully, my follicles have grown. Maybe I even have some new ones growing.

The sample 'No Lupron EF Cycle' calendar Jennifer from NYU gave me shows that I might have my retrieval Thursday. Thursday is Thanksgiving. Happy Tday to me.