This week, The Lily will feature the first three episodes of “Should I Freeze My Eggs?,” in which Washington Post filmmaker Nicole Ellis explores using the technology to postpone having children until she’s ready.
Adding to my anxiety: I’m a documentary filmmaker, and the camera was about to start rolling.
In my line of work, I’ve gotten used to throwing myself into other people’s lives, observing my emotional reaction to their stories and then channeling those emotions into crafting a compelling narrative for an audience.
But this time, my life is the narrative and my investigative journey into freezing my eggs was about to begin, legs in stirrups, with a transvaginal ultrasound — filmed for posterity.
For the sake of my sanity — and the quality of the footage — I had asked my colleague and fellow filmmaker Lindsey Sitz to co-produce the documentary with me. We joined The Post’s video department around the same time and, both in our late 20s/early 30s, hit it off instantly. By the end of the first episode, her emotional support would prove more valuable than I realized.
It turned out that the transvaginal ultrasound and blood tests were the easiest part. By the time I left fertility doctor Kate Devine’s office after that first appointment, I had a better understanding of what almost everything in my pelvis looks like and what we can actually measure — as well as what we can’t.
I learned that the two most significant factors that affect a woman’s ability to conceive as she ages are egg quantity and quality. Scientists haven’t come up with a way for us to measure egg quality yet, but we do know that age is the most accurate indicator.
Most fertility doctors rely on three ovarian reserve tests to get a sense of how many eggs a woman has left. These include an antral follicle count performed with the ultrasound and two blood tests: the follicle stimulating hormone (FSH) test and the anti-mullerian hormone (AMH) test.
The antral follicle count refers to the number of follicles inside the ovaries. With the help of the transvaginal ultrasound, the doctor took pictures of my uterus and ovaries, manually counting each follicle. Then it was on to the blood tests.
Follicle stimulating hormone is produced by the brain’s pituitary gland. It uses your bloodstream as a loudspeaker to tell your ovaries to grow follicles. The pituitary gland sizes up your ovaries and decides how much FSH to release based on the number of follicles you have overall. If you have a lot of follicles, it doesn’t take a lot of encouragement for them to grow, and less FSH is released into your bloodstream. As your ovarian reserve diminishes, your brain hikes up the amount of FSH it releases to keep your body churning out eggs every month until you run out. The amount of FSH in your bloodstream provides a general idea of how plentiful or barren your ovarian reserve is.
The anti-mullerian hormone blood test is regarded as the most accurate of the three tests. AMH is produced by follicles, and the amount of it in your bloodstream is directly proportional to the number of eggs you have.
Cross-examining these three tests with egg quality statistics based on age provides a basic sliding scale to measure your childbearing chances against. These factors also help reproductive specialists estimate how many eggs can be harvested with the help of hormone stimulation, which directly affects the cost.
Our eggs are fragile. Between removing them from our bodies, freezing, defrosting and re-implanting, many will die along the way. So it makes sense to freeze as many as possible per cycle.
If the test results indicated that my ovarian reserve was high, I’d be apt to get more eggs per cycle and would require less hormonal stimulation, making the process more cost-effective. If it showed that my ovarian reserve was low, I’d be likely to get fewer eggs per cycle, and it would possibly require more hormones to stimulate my ovaries.
A single cycle of egg freezing at Shady Grove Fertility costs $7,500, and the required medications can cost an additional $3,000 to $5,000 per cycle, a price tag that’s prohibitive for many. Shady Grove recommends that a woman 37 or younger with a normal ovarian reserve freeze 15 to 20 eggs. A woman’s age, her ovarian reserve and her body’s response to hormonal stimulation inform how many cycles it will take to collect enough eggs to increase the odds of having a baby.
The older we get, the odds of a successful pregnancy per egg decrease. My decision to take charge of understanding my fertility is a double-edged sword. The information is a powerful tool for me to have while I’m still young, but I had no idea whether I would be able to afford the number of cycles my test results might dictate.
After my ultrasound and blood tests, Lindsey asked if I was sure I wanted to go through with the second appointment to learn the results. The complex web of variables scared me, but I also realized it was better to know, because I could then exert more control over what to do and when to do it to create a family one day. My choices, in other words, would be informed and intentional.
I returned a couple weeks later with high hopes, believing that my age would at least give me an advantage.
I was wrong. I felt paralyzed as Dr. Devine read my results out loud. Our meeting lasted an hour, but three words echoed in my mind throughout: “low ovarian reserve.” It would take at least three cycles of egg freezing, along with possibly high doses of hormones each time, to give me a decent shot at bearing a child from the frozen eggs down the road.
I could barely process what she had told me. To cope, I threw myself into my work, filling up my schedule with shoots and setting up interviews. It wasn’t until I met with my boss a week later to discuss next steps for the series that my emotions finally caught up to me.
“Are you okay?” she asked.
At that moment, I realized there would be no escaping into work with this story. I was a woman, and this was my life, and I wasn’t okay at all.
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