Fertility Inc. is a multi-part series by the Investigative Journalism Bureau that delves into the Wild West of the egg-freezing industry, its aggressive marketing, the high cost and the chances of an eventual successful pregnancy.
Megan Robinson, 37, isn’t sure if she wants to have children, but if she does become a mother she hopes it will be with a partner the natural way. In the meantime, as a backup plan, she decided to freeze her eggs.
Still, she faced moments of uncertainty as she jabbed herself daily with painful needles, paying $10,000 out of pocket for the procedure, which is growing in popularity with Canadian women.
Robinson viewed egg freezing as a “break glass in case of emergency” plan if she’s unable to conceive with a partner in the future.
The Vancouver documentary producer invited the Investigative Journalism Bureau to witness her six-week egg-freezing journey — from the $7,632 in hormone medication she took to stimulate her ovaries to produce multiple eggs, to the day when a doctor harvested those eggs for freezing.
The process was not easy or cheap.
Only 25 per cent of the embryos created from frozen eggs and transferred into women’s wombs in Canada have resulted in a live birth, according to statistics from the Canadian Fertility and Andrology Society . But the procedure still gave Robinson a chance, and that was what she wanted.
Two months in advance: Counting follicles
The process begins with a baseline ultrasound to assess a woman’s ovaries, which Robinson did at a Vancouver-area fertility clinic. It showed 10 follicles — fluid-filled sacs that hold immature eggs — in her ovaries, a lower-than ideal number, as the average woman of child-bearing age has around 16.
Her doctor told her it was unlikely she would end up freezing 10 eggs; not all follicles are guaranteed to mature.
Clinic staff explained that the chances of those frozen eggs becoming a live baby decrease with each step: not all eggs will survive thawing; not all eggs will be successfully fertilized with sperm in a lab to create embryos; and not all embryos will turn into healthy pregnancies.
But Robinson told the IJB: “I think it’s worth the risk.”
Days 1 to 26: Priming stage
The start of Robinson’s menstrual cycle marked Day 1, when she began taking estrogen tablets and topical testosterone each morning to help follicle growth and maximize the number of mature eggs to be potentially retrieved.
On Day 20, she added a progesterone pill in the evenings, and kept taking those three medications for six more days.
During that time, she said she felt lethargic and had no appetite, but continued to go to work and train for a marathon.
“I was so tired I could barely keep my eyes open,” Robinson said.
Side-effects from the egg-freezing process are common, but not typically severe, and can include mood swings, hot flashes, headaches, nausea, cramping and mild pain.
Days 27 to 29: Hormone crash
After 27 days of daily medication, she weaned her body off the estrogen and testosterone for three days, which she said resulted in a “hormone crash” that gave her a relentless headache. “The only thing that gave me relief was throwing up.”
On Day 28, Robinson had her first clinic appointment since the process had started. She left with a “very large brown grocery bag full of drugs.”
Of her nearly $8,000 in medication costs, her employer’s health insurance paid for all but $605.
She covered the $9,650 bill for the rest of the procedure, including the first year of her $750 annual egg-storage fee. All of Canada’s 42 known fertility clinics that offer egg freezing charge clients to keep their frozen eggs.
Days 30 to 38: Four needles a day
Every morning, beginning on Day 30, Robinson injected into her lower abdomen a pre-filled pen needle bearing Rekovelle, a prescription hormone medication that stimulates the ovaries to grow extra eggs. Every night, she injected two larger, painful needles filled with additional hormone medications: Menopur for egg growth and Saizen for egg quality.
The nighttime needles required mixing saline with a precise amount of each drug, which came in a powder form, to create a liquid she could draw up into her syringe and inject. The clinic did teach her how to do this, but she was nervous.
“I’m here alone, and mixing drugs and doing these things that I have no experience doing,” she said.
The bigger needles also hurt. As she applied significant pressure to get them all the way into her abdomen, her face contorted with pain.
”It feels like (my body) is rejecting them, like the needles just don’t want to go in,” she said as she did the injections.
While the clinic nurses were largely “wonderful” during her appointments and phone calls with them, she said she was a bit disappointed no one checked how she was doing while administering the big needles.
“I was under the impression that they were going to be in touch more often just to check in,” she said. “I feel like I was misled a little.”
The next morning, on Day 36, she went to the clinic to have her blood drawn. It was a Thursday at 7:45 a.m., and the place was packed.
“It was so wildly busy,” she said. “A full waiting room, lineups to pay, busy bathrooms.”
Also on Day 36, she added a second morning shot of the medication Cetrotide to prevent ovulation, which is when the ovary releases an egg. That brought the daily number of needles to four, a routine she would continue until her egg retrieval.
“The lower part of my abdomen was just covered in green and purple, tiny bruises from all the spots that I’ve been injecting,” she said.
Days 39 to 43: Ultrasound and retrieval
On Day 39, she returned to the clinic for an ultrasound.
Of the 10 follicles spotted at the beginning, only one had matured. Two more had grown, but they were not mature enough yet for retrieval.
“Hoping for seven to 10, and then being told one, maybe three,” she said, “was really disappointing.”
The doctor increased her medication doses, which added an extra $1,400 to her drug costs.
The increased dosage worked. The three eggs spotted on the ultrasound fully matured, and a fourth was growing.
Finally, she took her “trigger shot,” which helps the ovaries release mature eggs in preparation for retrieving them the next morning. It would be the 43rd and final day of her journey.
Typically during egg retrieval, a woman lies on an examination table with her legs in stirrups while a doctor inserts a needle through the vagina and into the follicles to extract the eggs.
For Robinson, the procedure was quick and painless at the clinic. “They give you a very low dose of fentanyl to kind of help you through it, and then they give you local anesthesia. I didn’t feel a thing, and it was over within 15 minutes,” she said.
She then received the best possible news: the clinic was able to freeze four mature eggs. Still, most experts suggest women need more than twice that many to increase their chances of success.
Robinson’s fertility clinic has an online calculator to inform patients of their odds of turning frozen eggs into babies: for those with about five eggs, it was 26 per cent.
While this journey had not been simple, Robinson has no regrets.
“It was a roller coaster. Absolutely, it’s a gamble. I got far less (eggs) than what I had originally anticipated,” she said, but added, “I’m so glad that I did it … It gives me an option.”
Three weeks post-retrieval
Robinson, an ultra trail runner, returned to training after the process. But her recovery took longer than she had imagined.
“I’m still not feeling myself. My hair has started falling out a little bit and I’m feeling sluggish and fatigued,” she said. “The procedure itself was a breeze. But the post-hormone come-down for me has been challenging.”
Her advice to other women considering egg freezing is to reach out to relatives and acquaintances. She was shocked by how many people in her life had experiences with fertility services.
“When you start to go through it,” she said, “it’s really scary, and you can feel a bit like an island. But you are not. So many women in all of our lives have done this process, whether it’s the full IVF cycle or just egg freezing.”
“They are often very willing and open to share, if you just ask.”
— lculbert@postmedia.com, Wclarke@ijbureau.org
How much did Megan Robinson’s egg-freezing procedure cost?
Total drug costs: $7,632
Covered by employer health insurance: $7,026.50
Out of pocket: $605.50
Procedure/retrieval total cost: $9,650
IVF egg freeze setup and monitoring $3,000
Egg freeze cycle OPU, lab work, freezing $5,900
Annual egg storage fee $750
All out of pocket
Total cost: $17,282
Total out of pocket: $10,255.50
The Vancouver Sun’s Lori Culbert is a Postmedia Fellow with the Investigative Journalism Bureau (IJB) at the University of Toronto’s Dalla Lana School of Public Health. The IJB is a collaborative investigative newsroom supported by Postmedia that partners with academics, researchers and journalists while training the next generation of investigative reporters.
Next: The missing data
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