For generations, women have heard that we cannot have ‘it all’ and that, when it comes to career and family, we simply need to make difficult trade-offs. While I was firmly in camp ‘have it all’ for a long time, spending the last 3 years with African mothers, through my organization Maziwa Breastfeeding, and hearing stories of working mothers trying to juggle breastfeeding with two jobs, loads of housework, and multiple children, has certainly caused me to reconsider.
All that to say, the purpose of this post is to empower more women to learn about their fertility so that they can make more informed choices and feel a greater sense of control over their biological timelines. By sharing my own personal journey, I hope to shed some light on the mysterious process of egg freezing and normalize this procedure for others who are considering it.
A few caveats before I begin:
While I hope to share a relatable story that is relevant for many women, I recognize that my particular journey is a bit strange!
- First, I went all the way to India for my procedure and my little egg popsicles still live there
- I went through this procedure during a global pandemic within a foreign healthcare system
- I was not making my reproductive decisions with a co-parent
- I am a self-employed entrepreneur, who had to pay for this out-of-pocket, and not someone who had sponsorship from a big tech company
I say all this so that you take everything I’ve written with a grain of salt, because I’m sure every experience is unique.
2019: To freeze or not to freeze…
Honesty time: I used to be someone who was secretly judgmental of egg freezing. I thought, “there are so many children who need parents and my DNA isn’t so precious that I need to spend thousands of dollars on spreading my spawn!”
However, as I learned more about adoption and fostering, I realized the complexities and costs associated with this, which only increase if you consider international adoption (rightfully, banned in many countries) or adopting as a single parent, if that happens to be your situation.
Although I was still undecided about egg freezing, I decided to start by understanding my fertility. Potentially a hot take: I would recommend this for all women over 30, who are considering having children. Although I haven’t done genetic tests like 23andMe yet, I believe that having more knowledge can help you make better decisions. I understand the hesitation around this area, because learning about low fertility could be anxiety-inducing; however, it is helpful to know that you have options!
In 2019, I took a test with Modern Fertility, which does at-home fertility testing in the US. I had some trouble getting a sample the first time, so I did have to prick myself twice, but they were great about sending me a new test and giving me clear instructions. My results were relatively normal which was a relief; however, I knew it was possible that things could change over time… *foreshadowing*
2020: When hell froze over…
When the world felt frozen in time during the global pandemic, my freezing plans also started to take shape. COVID-19 had left me grounded at my parents’ home for the first time in 13 years and it felt easier to accommodate the lifestyle restrictions required for the procedure. The only potential hurdle was telling my mom that I was planning to freeze her plans for grandchildren for an extra few years… While perhaps not totally thrilled, she was very supportive — or perhaps just relieved that I had babies on the brain!
I went through another set of fertility tests, which are covered by Canada’s public healthcare plans, including several blood tests and a transvaginal ultrasound. My results were similar to the previous year, though my AMH (Anti-Müllerian Hormone, a key indicator of fertility) had dropped slightly. Although I was referred to and had appointments with several different fertility clinics across Vancouver, after assessing my options and thinking about my long-term plans, the total cost of trying to put a baby in my belly just felt too hard to stomach…
2021: The cold always bothered me anyway!
Since my mom’s family lives in Mumbai, she had the great idea to look into fertility clinics there instead. For those who are able to afford private healthcare, India is known for its great health services. (The stereotype about Indian parents wanting their kids to be doctors checks out.) Medical tourism for elective procedures like laser eye surgery is pretty common. I reached out to my cousin in Mumbai, who recently had kids, and she referred me to a well-known fertility doctor.
We had a couple of phone conversations and the doctor asked me for my previous fertility results. She said the process was fairly simple and about 2 weeks long. She had seen many success stories with her previous patients and reassured me that this was the right time to freeze my eggs.
So, I made the decision to freeze my eggs in a warmer destination!
Three weddings and an egg freezing
Serendipitously, in September 2021, my cousin decided to get married. Although they initially had a small Zoom wedding in Seattle, in true Indian style, their families decided to have, not one, but two more wedding celebrations in India that December! This gave me a great reason to go to Mumbai and combine my fertility procedure with this wedding, as well as some long-awaited travel in India.
Pre-heating the oven
Leading up to the procedure, there was a decent amount of coordination required to prepare for this process.
First, I needed to plan the flight with the beginning of my cycle. Since India had been hit hard with the COVID-19 Delta variant, their government was understandably being strict on tourism. That said, I either had to receive my Oversees Citizen of Indian (OCI) card or get a Medical visa. Meanwhile, my cousins were also trying to determine whether they would even go ahead with their wedding at all! Long story short, after renewing my passport from Nairobi, nagging the Indian embassy to process my OCI, cancelling my flight the day before I was supposed to leave, and rebooking it again the next day, I finally made it to Mumbai just in time.
While I doubt most people will have this much spontaneity in their journey, there is some uncertainty involved with all procedures. In my case, I had to go through another round of fertility tests because it had been over a year since my last round. Even though we were still waiting for my results, I started the first set of hormone injections right away (more on this later).
A couple days later, I received my results and surprisingly, my AMH levels had dropped significantly since my last two readings. For context, the average decline in AMH per year is around 0.2 ng/ml and mine had dropped 0.85 ng/ml. Even though I knew fertility declines over time, I had been expecting my results to be similar since it had only been 1-2 years. The doctor explained that this could be caused by factors such as stress, pollution, genetics, and of course, age.
This meant that it was actually a great thing I was freezing my eggs at this point in my life. It also meant that it would be difficult to retrieve as many eggs as we expected, and it would require higher levels of hormones to do so. While I was taken off guard, I was grateful that I had made the decision to freeze my eggs even though my fertility results had initially indicated that there was no major urgency.
The day-by-day egg freezing process
If you are seriously considering egg freezing, I thought this day-by-day overview of my process could be helpful so you know what to expect:
Overall, I’m glad that I chose to go through this procedure last year. There were a lot of great aspects about doing this in Mumbai and I’d be happy to share my clinic’s information for those who are interested. There were also a few areas that were surprising…
- Choice, control, and ‘freedom’:
I am grateful to be privileged enough to make this choice. For independent, career-driven women, who are accustomed to having choice and control over many aspects of their life, it is difficult to feel helpless when it comes to fertility.
Many people have asked me whether I feel ‘free’ now that I’ve done this… While I can’t wholeheartedly say that, since this process comes with no guarantees, I am proud of myself and I do feel a sense of relief.
- Timing & results:
Timing is everything. This could not be truer in my case. We were able to retrieve 10 eggs and 9 of them matured. This is a generally good/average result, but it was particularly great considering my AMH level. It is possible that my AMH might be slightly higher during another cycle, but it is also very likely that it will continue to decline over time (as it does for most women). That said, I am thankful that I made this choice just in time.
The cost of egg freezing in Canada or the US ranges from $10,000-$15,000 USD per retrieval cycle, depending on the clinic, your hormone medication, and add-on services. The cost of my procedure, all-inclusive, for one retrieval cycle was exactly $4,267 USD: 43% of the cost was for the OPV (oocyte cryopreservation), 34% was for medication, 16% was for the hospital bed, and 6% was for various fertility tests (sonographies, blood tests, anesthesia assessment, and COVID test). It would have been at least double the price in North America, because some estimates don’t include all the tests and consultations.
- Quality of care:
As I mentioned before, India is known for its high-quality private healthcare. Not only was every doctor and nurse I interacted with extremely professional, I was also given a full day to recover from the procedure. I have friends in New York who were wheeled out as soon as they were waking up from their anesthesia. I was put on an IV with antibiotics and painkillers for several hours before being released. I was also given a list of antibiotics, probiotics, and vitamins to take for the next few days. As a result of my thorough recovery, I felt literally no pain after the procedure, unlike some of my friends who felt quite a bit of pain in the days following the retrieval.
- The fertility results:
This is the part of the process that women have the least control over, so it can sometimes lead to unexpected outcomes. Since higher levels of stress are shown to be correlated with lower AMH levels, it is important to keep a level-head when analyzing your fertility reports. As much as I believe in fertility testing and staying informed, it is also important to focus on the things you can control.
Your fertility levels say nothing about you as a woman, your potential as a mother, or anything else meaningful about you or your future. It is sad that many people suffer through fertility challenges in silence and this topic is still taboo. The more we share our experiences, the more we will realize we are not alone.
- The injections:
Oh, the dreaded injections. Surprisingly, it wasn’t the pain of administering the injections on myself that I couldn’t handle, but the precision required to mix the medicines and prepare the syringes. The process of mixing the vials of liquid and powder into a syringe was so finicky that by the time I actually stabbed myself, I had so much adrenaline, I didn’t think about the pain!
The liquid was in glass vials which needed to be broken precisely — or you might cut yourself (which I did occasionally). The powder was in an air-tight vacuum bottle, which you inject the liquid into, mix, and then retrieve . Often, the vacuum would suck the liquid out of the syringe and into the bottle, instead of the other way around. Several times, I spilled almost all the formula after pulling the syringe out of the air-tight bottle too quickly. I have never related to the agony of mothers spilling breastmilk more than when I was sitting on the floor, crying, covered in my extremely-expensive hormone cocktail, surrounded by needles, bottles, and vials of wasted fertility drugs.
I guess the hormones must have been working because after a few days, I had a complete breakdown. My mom and my aunt told me that they refused to watch me torture myself any longer (not that they were even in the same room while I did any of this…) Fortunately, the nearby hospital’s Causality had nurses who could administer my injections for about $3.50 a pop.
Another surprise was the number of injections required. I originally thought there would be 1 injection/day for ~10 days but there were many days I needed 2, sometimes 3, injections. There were also another set of ~*surprise*~ ciscure injections after the retrieval! The first set of hormone injections (HUMOG) stimulate the eggs during the cycle; the next set of injections (Ciscure) prevents premature ovulation; and finally, the ‘trigger injection’ triggers ovulation right before the retrieval. After the retrieval is done, the Ciscure injection also ensures that your ovaries return to a normal size after they have been so heavily stimulated. Not only did I need to increase the amount of hormone injections, I also had to take additional Ciscure injections in order to return to normal before the big wedding weekend. This resulted in a decent increase in the cost of the procedure, as well as the overall effort required to run back-and-forth from the hospital for an extra few days.
- The unexpected costs:
Although this procedure was more affordable in India, there were still a few unexpected costs. It was hard to know whether I was paying a ‘foreigner markup’ but since I am Indian and I was with my born-in-Bombay mom, I think I was able to avoid a lot of the up-charging. However, the real unexpected costs were: 1) additional hormone medications for my AMH level, 2) blood tests, COVID test, and sonographies which were not included in the initial estimate, 3) discharge medicine, including the extra Ciscure injections, 4) the anesthesiologist’s consultation fee, and 5) the hospital’s injection charges. All together, my procedure was about 25-30% more expensive than I had expected. This was still worthwhile given the circumstances; however, I would recommend that you ask for all the associated costs when estimating your budget for the procedure, especially if the base cost is already $10-15k.
- The all-consuming process:
As egg freezing has become more popular, the media has been promoting the idea that it is simple and not intrusive at all. That said, I naively assumed that I would be able to continue working, spend time with family, and enjoy my travel while going through my procedure. However, as much as producing 9 mature eggs in just 2 weeks is still a modern miracle of science, this process is not as simple as it might seem. There were a LOT of appointments, tests, injections, and lifestyle considerations that made it pretty difficult to live normally, let alone jet-set around India. It also took about a week longer than I expected. I don’t say this to scare anyone, but I am flagging it because, in my case, it was a fully immersive process that left little room for much else.
That said, I was extremely fortunate to have the love and support of my family along the way: my mom was an excellent nurse/translator/rickshaw wrangler, my cousin was my resident doctor and advisor, and my dad and the rest of my family provided moral support and encouragement. If you decide to go through this process, be sure to surround yourself with a great support network, whether it’s your partner, friends, or family, because it can be a trying and emotional journey — but one that is very worthwhile in the end.