Freezing my egg (embryo?) in the Netherlands at 33 (WIP)

#eggfreezing #fertility #ovarianreserv #amh #babies


This is a work in progress version - guarantee spelling and grammar mistakes - but thought I'd update it as I go through the egg freezing process


A few quick things about me and why I want to freeze my egg

  • I am 32 going on 33 (Dec 29, 1987)

  • I definitely want kids one day - started getting baby fever when my nieces were born. And, I would say I am a conceited person because I think I got good genes. I always tell my friends that if my kids turn out exactly like me - I'd be happy/proud - see: totally conceited! ;)

  • I am not in the best position (career and personal life wise) to have kids in the next two years because 1. Grip is only 8 months old and I would like to focus on growing that; 2. it takes two to tango

  • While I am an adventurous person (quit my job to travel the world type, and now building my own business), I am also very risk-averse - i.e., I like to have back up plans/plans that lower my risk of a 'bad situation'

  • I would like to freeze my egg and if possible embryos as embryos have a higher chance of live birth in the future. With frozen eggs, when you need to use them, you have to first thaw (unfreeze) them, then put the sperm in and hope it will become a healthy embryo.


In the Netherlands, people with ovaries can get egg freezing through public hospitals if

  • they have to undergo treatment that can be harmful to reproduction;

  • they have a reduced supply of egg cells resulting from surgeries due to endometriosis or genetic abnormalities

  • For non-medical reasons, such as wanting to have children with a partner in the future. You have to be between 30 and 40 years (up to and including 39 years). I fall under this category.

  • Note: Don't quote me, but I think for medical-related reasons egg freezing procedures, the cost is covered by the healthcare system. For nonmedical ones, you have to pay for the procedure although the pre-examination part is free if you are over 30.

Egg freezing in the Netherlands

Source: Amsterdam UMC


In Dutch

  • vrouwen die een behandeling moeten ondergaan die schadelijk kan zijn voor de voortplanting;

  • vrouwen met een verminderde voorraad aan eicellen, bijvoorbeeld door operatie's door endometriose of genetische afwijking;

  • vrouwen met een niet-medische reden, bijvoorbeeld kinderwens in de toekomst met een partner. Wij mogen deze behandeling aanbieden aan vrouwen tussen 30 en 40 jaar (tot en met 39 jaar).


Cost of the treatment at Viva Neo (as of Dec 23, 2020).

  • Consultation, examination, and blood work: €0 as it's covered by insurance as I'm over 30

  • The social freezing procedure itself - €1,895

  • Injection meds - €750

  • Detailed Vivaneo 2020 price list here

The rest of this post might be a bit dry and long as I will be documenting my egg freezing journey in a straight forward fact-based timeline.


Please do remember that egg freezing is not a guarantee that you will have a kid, it is just an additional option. It's pretty much a full-on IVF procedure without the final two steps of putting the sperm into the egg and planting it back in your ovary.


Early 2020 - I wanted to freeze my egg in early 2020 but Covid lockdown happened


July 2020 - Lockdown lifted and things started to pick up again.

  • July 6, 2020 - I called my GP to set up an appointment to ask for a referral for egg freezing.

  • July 8, 2020 - My GP called me (covid reason thus call instead of visit in person) and asked whether I wanted to be referred to Amsterdam UMC or a private clinic (Viva Neo). She said according to her system, both have a 28 day waiting period. I chose Amsterdam UMC as I live in Amsterdam. Also, all the materials from Amsterdam UMC are in Dutch - so Google Translate will be a very helpful friend

  • July 9, 2020 - On the same day, I got the referral emails.

  • July 15 - received a physical letter from UMC Amsterdam

  • July 24 - downloaded form from UMC website to fill out and email to cvv@amc.nl, got a response quickly. I called to ask how long the wait is, they said 3 to 6 months for the first appointment. Also, they don’t freeze embryos. So I decided to not wait and called my GP right away to get a new referral to the private clinic VivaNeo. You do not need a referral to go to VivaNeo but if you get a referral, the initial examination cost would be covered - think it's about 200 to 300 euro.

  • July 27 - I got the email from VivaNeo which asked me to fill out a questionnaire (it was in English). I sent in my questionnaire the same day. Tip: Once you send in your questionnaire, call them the next day to make an appointment. I thought they would reach out once I sent in the questionnaire but they didn’t.

  • Aug 3 - I called Vivaneo because they didn't respond to my questionnaire email. On the same phone call, I made an appointment for September 16 (the next available slot) for an intake skype call.

  • September 16 - I had the consultation with Dr. Deen

  • She shared what the procedure would be like. I shared what I would like - freeze eggs + free embryos.

  • She said in NL, for women over 30, the average number of eggs retrieved and successfully frozen for a round is around 8. It's best if you freeze around 15 to 16 to increase the chance of successful live birth in the future. She suggested that if I want to do both egg freezing and embryo freezing - I should do two rounds

  • She also suggests I start taking Folic Acid and Vitamin D 6 weeks ahead (I am really good in the first month but not so good now, literally remembering to take one now as I type/update this blog

  • There are two visits to the clinic before medication and procedure start. First to do a body check - ovary scan and blood draw. The second time the nurse will teach you how to inject (though I think this one can be done virtually, I guess for legal reasons it has to be done in person - not that I had to sign anything).

On the same day (Sep 16), I scheduled my ultrasound and hormone test around Oct 10 - it has to be on the first/second day of your period. I also scheduled Oct 25 for a follow up with Dr. Deen to review the blood test result


Oct 9 - a friend I came into contact with tested positive for Covid - so I ended up having to self-quarantine and couldn't go for the test. Reschedule appointment for Nov 10 (blood test/ultrasound) and Nov 25 - Dr. Deen follow up


Nov 11 - got my period and scheduled an appointment for Nov 12


Nov 12 - I was half hour late as it took me 2 hrs to get to Leidorcorp (I am bad with transportation)- so do plan your trip ahead of time.




I first got an ultrasound - it looks likes the picture below - not very comfortable but not painful - I was told I got 8 follicles on my left and 12 on my right. The average is 6 to 14 on each end. It's normal.


Then I waited 30 minutes for my blood draw - standard, nothing new here. I asked what they looked at but only understood they said HIV and AMH.



Nov 25 - I had my consultation with Dr. Deen. It was a 'fun' (not) day as they got confused about my results and thought I had an active Hep B infection which scared the hell of me as it would disqualify me for egg freezing and also has other complications.. I spent hours googling Hep B and death, Hep B and babies. I end up calling my GP and set up an appointment to get tested for Hep B right away on Nov 26 (luckily on Nov 26 Dr. Deen called and said it was a mistake, I don't have an active infection and I can continue with egg freezing)



My results are as follows - they tested AMH, HIV, Hep B, and Hep C. The AMH value is a lot higher than all my tests from before (the one I did in Singapore, the two I did via Grip). Do note that AMH values do differ especially when the testing method and assays are different from lab to lab. See my Grip test result here

My next appointment is scheduled for Dec 10 Friday to learn how to inject myself apparently the clinic only teaches this M to F. I hope my period also comes on Dec 10 so I don't have to go back a few days later to start the procedure.


Dec 10 (Fri) - I saw the nurse and she showed me how to inject myself. The nurse demonstrated the injection using a stress ball and the actual needles. The injection happens around the fatty stomach area - so it's nice to have a little cushion there so the injection would hurt a bit less.


Dec 13 - My period came and called and scheduled an appointment for Dec 13


Dec 14 (Mon) - I did another echo scan today plus picked up my med. The doctor also shared the treatment plan (injection schedule) with me. Check here for Vivaneo's treatment plan write-up on its website. My first injection happens on the same day. It's 4 days of Gonal F only, then Fyremadel is added on day 5. Then I have a follow-up scan on Tuesday, Dec 22 to see how my eggs are maturing.

There are three types of meds and you have to inject them on a set schedule.

Gonal F is used to promote the growth of hormones. I was prescribed to inject myself a dosage of 225 (you can measure on the needle) a day. The needle is the smallest. You have to inject yourself around the same time every day. I started mine on Dec 14th 9:15 PM.


I had a few friends there to support/celebrate this moment. It's a bit scary to inject yourself so good to have people cheering you on. It didn't really hurt - felt less painful than the first time I tweeze my eyebrows.


Fyremadel is used to prevent the premature LH surge that might cause such a premature release of egg cells. I start this injection on day 5, along with my Gonal F injections. You also inject yourself 24 hours apart. No need to measure as you use the full needle


Fyremadel injection was a bit scarier than Gonal F as the needle is slightly bigger so the sting was a bit more. Right after I inject myself, there was a little bit of blood - but not too bad. I didn't need to use any band-aid post any of my injections.





The final medication is Decapeptyl. It is used to trigger the release of the eggs. I have not started this yet - the doctor has to give you the go-ahead to do it exactly x hours before the egg retrieval.







I also got a needle disposal box to put my used needles.


Dec 15 (Tues) - ~ 9:15 PM injection of Gonal F day 2. Did not feel any discomfort


Dec 16 (Wed) - ~ 9:15 PM injection of Gonal F day 3. Not much discomfort but did feel a bit bloated - not sure if it's psychological. No mood swings


Dec 17 (Thur) - ~ 9:15 PM injection of Gonal F day 4. Not much discomfort but did feel a bit bloated - not sure if it's psychological. No mood swings


Dec 18 (Fri) - ~ 9:15 PM injection of Gonal F day 5 and injection of Fyremadel day 1. Fyremadel stings more than Gonal F. The injections today hurt a bit more than the past couple of days - but not too bad. Not much discomfort after.


Dec 19 (Sat) - ~ 9:15 PM injection of Gonal F day 6 and injection of Fyremadel day 2. Today's injection hurt more, the sting lingered for 30 minutes after the injection. A bit more of a feeling of getting bloated but not too bad.


Dec 20 (Sun) - ~ 9:15 PM injection of Gonal F day 7 and injection of Fyremadel day 3. Similar to the past few days, the sting still lasts 15 to 30 mins after the injection - but completely bearable. Definitely feel bloated - but could also be because I ate quite a bit after. ;). Was getting quite sleepy during the day


Dec 21 (Monday) - ~ 9:15 PM injection of Gonal F day 8 and injection of Fyremadel day 4. Same as the past few days, definitely observed tiredness around the afternoon. I took a 3-hour nap. A little bit of a cramp but not bad compare to the cramp I get every month when I get my period.


Dec 22 (Tuesday) - Follow-up appointment at the clinic to see how my eggs are developing and to see when they might be ready for retrieval.

There were 9 follicles on one side of the ovary and 5 on the other. Currently, the size of the follicle is around 14 (forgot what metric) but they need to be around 17 before we start the third medication. The picture to the left, each black circle is a follicle.

As a result, I was prescribed to do two more days of Gonal F and Fyremadel injection and to come back for another scan Thursday, Dec 24.


On a different note, the appointments are super-efficient - could be a small benefit of Covid as things are very precisely organized.


Not sure if it was psychological, felt quite a bit of movement and a bit of cramp, still not as bad as my normal period one.


So yeah, back to injections.


~ 9:15 PM injection of Gonal F day 9 and injection of Fyremadel day 5. Maybe I am getting really good at this, didn't sting too much today at all.


Also another note, I noticed more vaginal discharge (the normal ones) than normal from around day 6 of the injection.


Dec 23 (Wed) - ~ 9:15 PM injection of Gonal F day 7 and injection of Fyremadel day 3. I was curious so decided to inject into the mole I had on my stomach as it was also around the fatty part - DONT DO IT. The pain was so bad I had to pull the needle out and pick a new spot. Also, another needle spot I picked also hurt more than usual - think in general pick the cushion part below the belly button - and also it seems to hurt less if you have a full and fat stomach - so eat before you inject. I was also really sleepy today from 2 pm on. Seems like even though I don't get mood swings or other side effects, I do get sleepy around the afternoon - is it intensifying my symptoms from slightly elevated TSH (?).


Dec 24 (Wed) - The nap I took yesterday resulted in me being up till 3AM - so my sleeping schedule was likely more due to my habit rather than hormones being impacted?


I went for my appointment at 11:35 - the wait was slightly loner today, didn't see the doctor till 11:50. Dr. Deen is my primary doctor (she did my intake) but your doctor might be booked out - so I had another doctor that did my check.


The scan showed that I have 8 eggs on my left ovary and 8 on my right. A decent number of them are at 17mm but a few are still on the lower end. Initially, the doctor was going to ask me to come back for another echo in 2 days but after looking at my results again she decided to schedule me for retrieval on Sunday, December 27. Exciting!





As such, I was given 1 more Gonal F for today, 1 more Fyremadel for today and 1 for tomorrow, then 2 trigger shots for tomorrow (Dec 25th), 35 hours before the retrieval. The schedule is very important now as it's absolutely essential to inject yourself with the trigger shot (Decapeteyl) 35 to 36 hours before the retrieval is scheduled.


I was also given a contract I have to sign before my procedure. The contract has basic stuff such you must pay to store your egg, guidelines around storing, etc.


I went home excited because a date is finally set!


So 9:15 came around as I was getting ready to inject my Gonal F, I learned that it is out! WTF? So what happens is I had two boxes of Gonal F before and each had enough for 4 shots. When I got the new box, I also assumed it had 4 shots, and I only used 2, and with simple math, I thought I had 2 left. BUT, even though the box was the same volume is not! What a silly mistake on my end. I should've thought it was odd that I pay 600 for 8 shots but only 150 for another 4 shots. The lab also didn't catch it - partly because I was quite confident and told them oh, I still have 2 shots left.


So imagine my panic - so I call Viva Neo's emergency out of office hotline and the lovely person who picked up told me that it was okay. Gonal F is most important in the first couple of days and they continue to work for 5 days after the injection - so even though it is not ideal, it wasn't as bad as I had initially thought. On the other hand, Fyremadel is super important to take as it prevents early ovulation - if you don't take it and the eggs get ready to ovulate, all efforts are gone. Phew.


So yes, please do be extra careful - I thought I was but still a silly mistake - luckily its impact is manageable.


Cheers.


Can't wait for Sunday.


Dec 25 (Fri)

9:30 PM - did my last Freyamedal

10:30 PM - did the two trigger shots Decapeptyl. The needles were slightly bigger than Freyamedal. It didn't hurt more when piercing the skin, but given that the volume was higher, I felt a bit of pain as the injection site seem to be 'filled up' under the skin. Again, nothing unbearable.


Dec 26 (Sat)

No shots scheduled. My stomach/ovary area definitely felt very bloated. Just a bigger stomach, no weight fluctuations.


Dec 27 (Sunday) - D Day

Normally I take public transportation to the clinic but given that today is the Retrieval day, I asked a friend of mine to drive me there, I am glad I did too as the weather was really shit. So big shout out to Frank, thank you for the big favor.


I took two 500mg paracetamol the first thing in the morning as advised. I arrived at the clinic at 9:00, went up at 9:10 AM, 5 mins before my appointment at 9:15 AM. I checked in on the 3rd floor (receptionist floor) and was sent to the 2nd floor (the lab/operation floor).


I was attended by Eloise, the lovely nurse, who verified my profile and checked what meds I took. Then I got an ivy put on my left arm - this is where they inject the morphine before retrieval.


Then I was bought to my resting room (the place I will stay for 2 hours post retrieval) - do remember to bring a blanket. I changed into a fairly comfortable robe (provided by the clinic) - then I waited to be picked up by the doctor.


The doctor came around 9:40 am and asked me the same questions the nurses had asked. Then off we went.


I was given my first shot of morphine, it was the first time I had morphine - it kicked in within 10 seconds, and I felt a bit drunk, but the drunkness feeling slowly faded away.


The retrieval procedure was fairly straight forward, the doctor inserted the ultrasound stick first, then she inserted the needle - you do feel a small pinch / a bit of pressure with the needle. The needle is connected to some suction force and tubes where the eggs and the fluids with it are retrieved. I had quite a number of follicles so the procedure took a bit longer and I needed a second morphine shot.


You do feel pain, and more so than injecting yourself, I'd say 6/10 - so bearable - with morphine.


I believe the whole procedure took 20 mins - didn't check the clock, I was drowsy. The doctor and the nurse were great - they constantly checked in with me to make sure I was okay.


These red fluids inside the tubes hold my eggs. I asked the doctor why the color is so red. She said normally they are urine color but can be red because the needles had to poke through your follicles and in my case, they really poked through.


I was still a bit dizzy with the morphine but the nurse walked me back to the resting room. You will bleed a bit after the procedure - so make sure to wear a pad. I lay there for about 1.5 hours, the nurse came in two times to check my blood pressure and ask me if I had pain. The doctor also came in 45 minutes or so after the procedure and told me they got 23 eggs out - hooray. But we won't know how many are good enough to be frozen till later. It could take up to 2 days to finish the analysis.


I definitely felt that I had a procedure done - I was feeling quite uncomfortable and also walking like a turtle.


I rested another hour or so then was packed up and sent home. I was also given a doc showing what happens after egg retrieval and also another doc in case I need to go to the hospital in emergency cases. I took two more paracetamol then just lay on the sofa the full day. I definitely felt pain, also the ovary was still a bit bloated. When I coughed and sneezed, I also feel pain in my ovary.


I got the email from the lab in the afternoon and they said they were able to freeze 19 eggs. Yay! That definitely exceeded my expectation. With 19 eggs, I have a 75 to 79% chance of live birth shall I decide to use those frozen eggs one day.



My friend came over and stayed with me for many hours, then I took a 6-hour nap - just passed out - too sleepy.


Dec 28 (Monday) - woke up today, don't feel much pain anymore, even when I sneeze, think I'm 85% to 90% back to normal. The clinic called me in the morning to check-in and make sure I was okay - that was quite sweet.


I also scheduled my follow up appointment for January.


So this means I am 95% through the process - just the follow-up procedure and then make sure my cycle gets back to normal.


January 1 (Friday) - Got my period. Heavy flow. Normally I get cramps the day -1 and day 1 of my period but did not feel cramps. Also, my normal cycle (if I didn't do the egg freezing) would have been Jan 10/11 - but since I trigger ovulation, the doctors idd tell me that I would get my period within 1 week after the procedure.


January 2 (Sat) - really bad cramps, heavy flow


Jan 3 (Sun) - nothing


Jan 4 - light flow


Jan 5 - seems to stop


To be continued...


Other

I have to say that I am probably one of the lucky cases where I did not feel any significant side effects at all. I have read quite a few horror stories on other people's egg freezing experience, so make sure you do your researches. My experience is definitely not going to be the same as yours.


There are of course downsides to egg freezing

- It's not a guarantee, even with 19 eggs, my success rate for live birth is only around 75 to 9%

- It's costly. NL is actually probably one of the cheapest places to get it done, I spent less than 3k euros. In the US and the UK it's upwards of 10k. In some countries (e.g., Singapore) it's not even allowed. Taiwan and Thailand it's about 3k USD. Australia 8k AUD.

- You might have really bad side effects - huge mood swings, Ovarian hyperstimulation syndrome (OHSS), lots of pain, etc

- You might get fewer than 5 eggs - then you'd have to do more cycles.



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