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      Egg Freezing FAQ

      Fertility

      So, what is fertility exactly?
      Fertility is the ability to produce a child, essentially. For women, it’s producing fertile eggs. For men, fertility means having sperm that can fertilize an egg. Age, genetics, environment, lifestyle, and a variety of other things impact fertility. But we’ll get into all of that!
      What does female egg production look like?
      It looks a little like this: first, the ovaries contain many egg cells, called ova or oocytes. After ovulation, one of these oocytes is transported to the fallopian tube where fertilization by a sperm can occur. The fertilized egg then travels to the uterus. Once in the uterus, the fertilized egg can implant into the thickened uterine lining (called endometrium) and continue to develop. If fertilization doesn’t happen, the uterine lining is shed as menstrual flow. The female reproductive system produces female sex hormones (estrogen and, later, progesterone) that maintain the reproductive cycle.
      What is ovulation and what does one ovulation cycle look like?
      Ovulation is when an egg is matured and released from the ovary, pushed down the fallopian tube, and made available to be fertilized. Ovulation is preceded by a surge of the hormone called LH, and this moment can be detected often by a urine ovulation predictor kit.  Women will often also notice that after ovulation their basal body temperature will get a bit higher. For women looking to get pregnant - the day of ovulation itself is your most fertile window, but you can potentially conceive if you have unprotected sex anywhere from 3 days before and 3 days after ovulation.

      Ovulation cycle can be calculated various ways: either by starting with the first day of the last menstrual period (LMP), by measuring basal body temperature, or other methods. There are a number of apps that enable you to track your cycle easily, but these apps are less helpful if your period is irregular.

      For those of you who love input: the first part of the ovulation cycle is called the follicular phase. The second phase of the cycle is called the luteal phase and is from the day of ovulation until the next period begins.
      When does my fertility start to decline?
      • As you age, the number and quality of your eggs decline
      • Fertility beings to decline at age 32, and accelerates in your mid 30’s
      • By 44, it is exceedingly difficult to conceive, even with advanced treatments like IVF
      * American College of Obstetricians and Gynecologists (ACOG)
      When should I start worrying about my fertile health? When should I start getting fertility assessments?
      For those women who know they want children, or want the option of having children, it’s never too early to start understanding your fertile health. If you’re not planning to have children until your 30s, our doctors advise getting a fertility assessment as early as your late 20s.
      How many eggs do I have left?
      Everyone is a little different based on a number of factors. However, a rule of thumb looks a bit like this: At puberty, you have around 300K to 500K eggs remaining; at 37, around 25K eggs; at 51, the average age of menopause in the U.S., around 1000 eggs.
      * American College of Obstetricians and Gynecologists (ACOG)
      What’s an ovarian reserve?
      Ovarian Reserve is a term that’s used to determine the ability of the ovary to provide egg cells capable of fertilization, resulting in a hopefully healthy and successful pregnancy. A women is born with all the eggs she’ll ever have, and ovarian reserve decreases as she ages.
      • 20%-40% of her ovarian reserve remains during her peak productive years (18-26)
      • A little over 10% of ovarian reserve remains at age 30
      • And only 3% remains at age 40
      “Human Ovarian Reserve from Conception to the Menopause” from the journal PLOS One, published by the Public Library of Science
      What is low ovarian reserve?
      Low ovarian reserve is when there is a decrease in the number of eggs, resulting in an insufficient number to ensure a reasonable chance of pregnancy. Generally, it is caused by aging ovaries. While there are no official numbers, our doctors estimate that low ovarian reserve exists in 5-10% of infertility patients.

      Egg Freezing

      What is egg freezing? What is fertility preservation? What is oocyte preservation
      This is a process in which a woman's eggs (oocytes) are extracted, frozen, and stored to preserve reproductive potential.  This is medically known as “mature oocyte cryopreservation” - egg freezing, if you will.
      When did egg freezing start, and why has it become so popular?
      In the 1960s, early freezing experiments in mammals began. According to the Global Donor Egg Bank, the first report of a frozen egg pregnancy was recorded in 2005. The first “frozen-egg baby” was born in California, with eggs that had been thawed after four years of cryopreservation.

      In 2012, the American Society for Reproductive Medicine recommended that the procedure no longer be considered “experimental”– a huge leap forward in terms of public perception. At that point, egg freezing moved onto the list of standard treatments for infertility, alongside IVF, which helped to ignite the growth of egg freezing.

      One of the biggest advances in egg freezing is vitrification, a solidification process that eliminates the ice crystals that sometimes formed during earlier methods of cryopreservation, frequently causing damage to delicate eggs. Now, with vitrification, the eggs are stored in liquid nitrogen after they’re speed-frozen, and the potential for damage has been greatly reduced.

      Since then, around 20,000 women have frozen their eggs, according to a recent The New York Times article.
      Why should you freeze your eggs?
      Here are a few we hear often…
      • You’re not ready to get pregnant but want to try to increase the likelihood of a biological child down the line.
      • You’re not entirely sure you want a biological child or child at all but want the option to make that decision when you’re ready.
      • You’re undergoing treatment for an illness that might affect your fertility (like chemotherapy).
      What’s the best age for egg freezing?
      To optimize chances of retrieving a good number of healthy eggs, we advise women to freeze their eggs as soon as they’re ready. Younger eggs are generally better eggs. Women in their mid-30s or older may require multiple cycles to generate enough eggs for a strong chance at pregnancy.
      What’s the maximum age for egg freezing?
      It's debatable and primarily depends on the woman's individual AMH level, but our doctors recommend 43 as the upper limit.
      What’s the maximum age to use or transfer your frozen eggs?
      Our doctors recommend 50 and under, and definitely prior to reaching menopause.
      How many eggs should I expect to get ?
      This depends on many factors, such as age, fertility, and overall health. This topic is covered in great detail during the Fertility Assessment after the doctor reviews your test and ultrasound.
      How many eggs do I need?
      We advise retrieving 15-20 eggs for women to have a strong chance at pregnancy.
      How is fertility tested?
      Without question, ovarian reserve (OR) is one of the most common measures of a woman’s fertile health, which is an assessment of egg quantity.

      Here are the individual tests used to help determine a woman’s OR:
      Day 3 Follicle Stimulating Hormone (FSH): The pituitary – a pea-sized endocrine gland situated right behind the bridge of the nose – is responsible for the production of FSH. High levels of FSH, determined through a blood test, indicate that the hypothalamus and pituitary gland are working overtime to stimulate a depleted egg supply. As a basis of comparison, a normal FSH count is well below 10. Because FSH levels fluctuate month to month, additional testing might be warranted if levels are higher than expected.
      Anti-Mullerian Hormone (AMH): This blood test is considered to be the most accurate predictor of a woman’s egg supply, particularly when compared to FSH, which can fluctuate month to month. Anti-müllerian, a protein hormone, is secreted from small pre-antral follicles located in the ovaries. A higher AMH level is indicative of a larger number of pre-antral follicles and a strong ovarian reserve, while a lower AMH may lead to the opposite conclusion – i.e., a low egg count. Still, a low AMH is not cause for alarm, and recently, the notion that a single hormone can determine one’s ability to get pregnant has been debunked.
      Resting (Antral) Follicle Count: Conducted via a trans-vaginal ultrasound at the start of a woman’s period, this test allows doctors to count the number of resting/unstimulated ovarian follicles. Should the patient have a low number of resting follicles, fertility medication may not be as effective. Healthy women with normal ovarian reserve will demonstrate at least 6 or 7 follicles on each ovary.  Good outcomes can certainly be obtained however with numbers both lower and higher than this.
      Estradiol (E2): There are three types of estrogen, all of which are responsible for female sexual development and function: Estrone (E1), Estradiol (E2) and Estriol (E3), and levels are measured by a blood test. Of the three, Estradiol is the most common among non-pregnant women. This hormone is a sign of follicle growth, and is essential to interpret FSH.  On cycle day 2 or 3 it’s ideal to have a level < 80.
      You just mentioned this term AMH, what does it mean?
      Anti-mullerian hormone, or AMH, is a protein made by early eggs in the ovaries. AMH levels correspond to the number of pre-antral follicles, which can be used to indicate the number of eggs available in the ovaries.
      There are a number of at-home or free AMH tests which can give me a good indication of my ovarian reserve. Why do I need to speak to a doctor or get a vaginal ultrasound?
      At Trellis, every client that signs up for a Fertility Assessment has an in-depth conversation with a fertility doctor. While AMH is generally a good indicator of ovarian reserve, sometimes further testing or medical feedback is helpful, particularly if you have other medical concerns. The vaginal ultrasound is a “must” for any women interested in egg freezing as that will indicate how many potential eggs that could be retrieved in a given cycle.
      Who’s a good candidate for egg freezing?
      Women in their 20s to mid 30s. Although there have been live births from eggs harvested from women in their late 30s and beyond, it’s rare – happening in as few as 10 percent of cases. Bottom line: younger, healthier eggs are much more likely to yield a successful pregnancy.
      They’re looking to delay pregnancy by at least a few years. While egg freezing was once reserved primarily for women with cancer, the user profile has changed dramatically in the past decade or so. Today, she’s likely to be a healthy young woman looking to plan her future family, but may not be in a stable relationship. She’s looking for possibility to become a mother if she finds a partner later in life or to become a single mother.
      They’re open to the investment of time and money needed to freeze. No question, freezing requires a commitment. From start to finish, the process takes at least a month. And in terms of monetary outlay, between egg retrieval and storage, costs may climb to about $15K. This is why Trellis offers Multiple Cycle package for up to 4 cycles or 20 eggs.
      Does my egg supply go down because of this procedure?
      No. During a normal menstrual cycle, only one egg will grow and ovulate, and the remaining eggs in that cycle break down and get re-absorbed by the body (i.e. die off). During egg freezing, the medications stimulate all those potential eggs for that cycle so that they can be potentially frozen for use at a later date. Essentially the medications used during an egg freezing cycle will rescue the eggs that a woman would have lost during that particular cycle.
      Will I need more than one egg freezing procedure to preserve enough eggs?
      This is a topic that the doctor will review during the Fertility Assessment based on your test results, age and family history. For clients that want to ensure a strong number of eggs, we offer our Multiple Cycle Bundle.
      What are success rates for egg freezing?
      It’s unclear. Egg freezing has grown significantly. It’s up from 475 women in 2009 to 6,207 women in 2015, according to the most recent data from the Society of Assisted Reproductive Technology. But while more than 20,000 American women have had their eggs frozen, the vast majority (an estimated 85 percent or more) have not had their eggs thawed, the first step toward creating a healthy embryo. However, if the average age of a women freezing her eggs in 2013 (1st year after egg freezing became a standard procedure) was 35. She’s only be 40 right now. At 40 years old with some small amount of ovarian reserve remaining, many doctors counsel these women to try other fertility treatments first such as IUI, IVF and before thawing her frozen eggs as “back up.”

      While only time will tell whether more women will come back to use their frozen eggs, it’s important that IF you decide to freeze your eggs, to choose a board-credited doctor and lab with significant experience freezing eggs. Across the Integramed network over the last 4 years, we have frozen over 78,000 eggs.
      Is egg freezing safe?
      You ask all the right questions. Physically, egg freezing is in general safe. That said, the drugs used to stimulate the ovaries can sometimes, but rarely, cause ovarian hyperstimulation syndrome. The symptoms associated with this range from bloating and dehydration to potentially life-threatening blood clots. Bleeding can happen where the needle is inserted, and there are always anesthesia risks. Other risks are mostly associated with the potential pregnancy itself, as pregnancy becomes more dangerous with age. Major issues like the ones described here happen in less than 1% of all cases. All of the potential risks associated with egg freezing and implantation will be discussed with you here at Trellis, however.
      EGG FREEZING JOURNEY
      What is a follicle vs. an egg?
      In the ovaries there are ovarian follicles, which are a fluid-filled sac that contains an immature egg, or oocyte. During ovulation, a mature egg is released from a follicle. While several follicles begin to develop each cycle, normally only one will ovulate an egg.
      How is egg freezing different from IVF?
      Unlike IVF, egg freezing doesn't require sperm right away. In egg freezing, the eggs won't be fertilized before they're frozen. With IVF, the eggs are generally fertilized with sperm shortly after retrieval, and then may be transferred into a woman’s body or frozen for later use. IVF is for immediate pregnancy, and egg freezing is for a future possible pregnancy. With an egg freezing procedure, the eggs may be frozen for a number of years and then when the client is ready, the lab will thaw the eggs, fertilize them (donor sperm or partner), then transfer for a potential pregnancy.
      How is egg freezing different from embryo freezing?
      The egg freezing procedure and the embryo freezing procedure both start the same basic way: with hormone medications that stimulate the ovaries to produce multiple eggs. During embryo freezing, the eggs are fertilized using IVF before they’re frozen. They develop over a period of several days, into embryos, which are then flash frozen.

      Freezing embryos does in fact give you more information up front. You’ll know how many eggs were healthy enough to fertilize and begin development. But, it also locks you into at least one important decision right now: whose sperm to use.
      Why should I freeze eggs vs. embryos?
      Egg freezing offers more options and simplicity, simply put. Embryo freezing requires sperm to fertilize the egg, and this is a challenge for single women. However, thawing unfertilized frozen eggs tend to be less stable and 10-20% of them are lost during the thawing stage – thereby necessitating 15-20 eggs to be retrieved for a strong probability of pregnancy.
      How is the egg frozen? You mean, what is cryostorage?!
      Egg freezing has come a very long way since 1986, the first year the use of a thawed egg resulted in pregnancy. The first frozen egg births didn’t start happening until much later – the mid- to late 2000s, to be exact.

      In 2012, the American Society for Reproductive Medicine recommended that the procedure no longer be considered “experimental”. At that point, egg freezing moved onto the list of standard treatments for infertility, alongside IVF.

      One of the biggest advances in egg freezing is vitrification, a solidification process that eliminates the ice crystals that sometimes formed during earlier methods of cryopreservation, frequently causing damage to delicate eggs. Now, with vitrification, the eggs are stored in liquid nitrogen after they’re speed-frozen, and the potential for damage has been greatly reduced. “The success rate of oocyte cryopreservation has risen,” states Oxford University Press, “and the increasing use of vitrification has improved outcomes, with IVF pregnancy rates now similar to those achieved with fresh oocytes.”

      When it comes to positive outcomes, the numbers are definitely trending in the right direction. To date, more than 2000 babies have been born, worldwide, using frozen eggs – a number that is only poised to rise, given the inroads in freezing technology gained by vitrification.
      What is egg stimulation?
      Egg stimulation starts with hormone injections you’ll be prescribed for 8–11 days. These hormone medications stimulate your ovaries to produce multiple eggs in one cycle, increasing our doctors’ chances of finding healthy eggs later.

      The first medication is a hormone (follicle stimulating hormone, or FSH)—or combination of hormones (FSH and luteinizing hormone, or LH)—that gets your ovaries working overtime to produce multiple eggs. This medication is normally started on the first or second day of your egg freezing cycle and is injected once or twice daily for 8–11 days. The second medication is called an “antagonist,” because instead of helping to stimulate your ovaries, it actually prevents you from ovulating early and releasing your eggs before the retrieval. The antagonist is usually injected once daily, beginning mid-cycle. The final medication, known as a “trigger,” is injected 36 hours before the retrieval, prepping your body to release the eggs at just the right time.
      What is egg harvesting? What is egg extraction?
      This is the actual process of egg retrieval. This is a very brief, minimally invasive surgical procedure. By using an ultrasound to identify your ovaries, our doctors will gently guide a needle attached to a catheter through the vaginal wall, and the viable eggs will be drawn out. After they are collected, they are then prepped for cryopreservation.
      How do I prep for the egg retrieval process?
      Follow the retrieval directions closely: As with all interactions with anesthesia or IV sedation, patients must refrain from eating or drinking after midnight on the day before retrieval.
      Enlist a friend or family member: Patients will only be discharged from the clinic, post-retrieval, if they have a friend or family member to pick them up and escort them home. (Driving home yourself is a major no-no.) If you need a concierge to be your “buddy” and assist you to get home, we can arrange it.
      Plan and prepare meals in advance for Retrieval Day: With R&R at the top of the post-procedure To Do list, a quick run to the grocery store will not be in the cards. Patients should plan ahead and have plenty of healthy, tasty, easy-to-prepare foods on hand for the rest of the day.
      Round up an eye mask, fuzzy slippers, etc: Rest is critical after egg retrieval. Whether that means deep sleep in bed, or a stint on the couch, TV remote in hand, patients will need to prioritize their recuperation.
      Load up on these other “smart to haves”: Pain meds – typically Tylenol and ibuprofen are sufficient for pain. Patients may also want to have a laxative or stool softener in the medicine cabinet to use as needed for constipation. Light spotting is also a distinct possibility, so panty liners are another great idea. Patient at risk for symptoms of overstimulation may also be prescribed Ganirelix and/or Cabergoline for several days. Occasionally anti-nausea medications are given.
      When can I go back to work after my egg retrieval?
      Within 24 hours of taking it easy, generally patients can return to work and resume their regular activities.
      Does egg freezing hurt?
      No, you’ll be under sedation, so you won’t feel a thing during the procedure. But after the retrieval you may experience PMS-like symptoms like bloating, fatigue and light abdominal cramping.
      What are the side effects of egg freezing?
      Most women don’t experience egg freezing side effects. However, side effects can include PMS symptoms like headaches, mood swings, insomnia, hot or cold flashes, breast tenderness, bloating, or mild fluid retention. You may experience some pain when you wake up, like a little soreness in the vaginal area or some abdominal cramping,

      Occasionally, egg freezing medications can get the ovaries working too hard, resulting in what’s called “ovarian hyperstimulation syndrome” or OHSS. OHSS is associated with swollen, enlarged ovaries and the collection of fluid in the abdominal cavity. In less than 5% of cases, OHSS can require monitoring or bedrest for a few days; in extreme cases (less than 1% of women taking these medications) OHSS can cause medical complications, like ovarian torsion, that might require surgery.

      Risks associated with egg freezing may include:
      • Medication Related: Abdominal bloating, weight gain, or fluid retention is common. Pain, bruising or infection from the injection or blood draw sites, breast tenderness, fatigue and mood changes are possible. Ovarian hyperstimulation, possibly requiring hospitalization or surgery is now very unlikely given new protocols for stimulation. Studies so far do not show an increase in ovarian or other cancers caused by stimulation medication.
      • Procedural: Like all procedures, there is a risk of bleeding, infection, or damage to surrounding structures. Hospitalization or surgery is rarely required. Anesthetic complication is low.
      • Other: Adnexal torsion (ovarian twisting) or cyst formation with possible rupture is rare, less than 1%. Activity restrictions include no heavy lifting or high impact activities (i.e. running/jumping) from the start of injections until after the next period.
      What else should I know?
      The biggest risk of egg freezing is that there is no guarantee that your frozen eggs will results in a pregnancy or livebirth. The pregnancy rates with frozen oocytes (eggs) has markedly improved but cannot be viewed as an “insurance policy”. Even with 15-20 eggs, after thawing, fertilization and waiting for a blastocyst to form, there is no guarantee that there will be a successful pregnancy.
      What questions should I ask during stimulation?
      As for the specific questions to ask, we’ve covered those below, as well as additional information that will help any patient advocate on her own behalf.
      1. What hormones are being tracked?
      • Estrogen, progesterone and LH
      • At the beginning of the cycle, FSH is also checked to ensure the dosage of medication is sufficient

      2. What are their levels vs last time?
      • LH and progesterone should remain low throughout the cycle
      • Estrogen should rise gradually and ideally double every 2 days

      3. What does this indicate?
      • If the performance of the hormones is not as expected, the doctor will likely make medication adjustments. If necessary, the doctor may discuss cancelling the cycle.

      During the ultrasound:
      4. How many follicles do you see on each ovary?
      • FYI: Ideally, right before retrieval, the doctor will want to see that the majority of developing follicles contain a mature egg. Often follicles are hidden behind others, so it’s not possible to see all of them in an ultrasound.
      • The number of follicles present isn’t the only determining factor in a successful egg retrieval. The quality of the follicles is equally important. Although quality is notoriously hard to gauge, it is best predicted by estrogen levels, rate of follicle growth and a woman’s age.

      5. What size are the follicles?
      • Resting, non-stimulated follicles on day 2 or 3will be about 5 mm – 10 mm

      6. What much have the follicles grown and what does that indicate?
      • Most follicles grow with stimulation due to liquid accumulation (“follicular fluid”). They reach ~11-14mm mid-cycle and ~18-24mm at the time of trigger. Follicles grow slowly when they are small and then much faster when after the 12- 14mm range.  It may take 5-6 days for an antral follicle to grow to 11-12mm, but then ~1-2mm of growth daily is anticipated.

      7. What do each of the medications I’m taking do?
      • Gonal-F (or Follistim): stimulates ovaries to make more follicles. Sometime Menopur will also be used for the same purpose.
      • Ganirelix (or Cetrotide): often used starting Day 4 or 5 to prevent the ovaries from releasing follicles prematurely.
      • Ovridrel (or Pregnyl, aka “hCG”): “trigger” shot, taken 35 hours before retrieval. Triggers ovaries to release follicles. Sometimes to avoid excessive bloating, “Lupron” a leuprolide can be used instead as a trigger.

      8. What day do you think I will retrieve?
      • The goal is to get the majority of the resting antrals to grow. So the number of follicles present in the ovaries prior to retrieval depends on a woman’s ovarian reserve. Trigger is typically timed when the majority of follicles are likely to contain mature eggs. Only the mature eggs retrieved will be frozen, the immature ones will be discarded.
      • While we are all big planners and want to prep for that day as early as possible, it’s difficult to confirm the exact retrieval date until 2-4 days prior. It’s important to be patient and flexible. Be patient, knowing that our bodies dictate exactly when retrievals should occur.

      ** Patients should be aware that egg stimulation is a somewhat complex process. The doctor won’t be able to predict exactly how many eggs they will retrieve, or how the patient’s body will react to medications. That’s why patients have repeated monitoring (sonogram and blood tests) to optimize results.
      What is PCOS and how does it affect my fertility?
      Polycystic ovary syndrome (PCOS) is a common hormone imbalance that affects around 1 out of 10 to 15 women. But let’s face it – likely many more suffer from PCOS without a diagnosis. PCOS is one of the leading causes of infertility in women and produces many unpleasant side effects, such as irregular periods and signs of elevated anadrogens (e.g. male pattern hair growth), weight gain, acne, fatigue, and headaches. The associated irregular cycles are the result of less frequent and unpredictable ovulation. Additionally, the hormonal changes associated with PCOS may negatively impact egg quality. Because some of these symptoms affect a woman’s appearance, fertility and day-to-day functioning, they can also lead to anxiety, depression, and self-esteem issues.
      What is Endometriosis and how does it affect my fertility?
      Endometriosis is when endometrial tissue (e.g. the uterine lining) begins growing/is found anywhere outside the uterine cavity. It’s diagnosed in up to 10% of women of reproductive age, but again likely impacts so many more women who are living with the symptoms and uncertain of the cause. Endometriosis may impact egg quantity and quality and cause infertility. It can lead to pelvic scarring and possible obstruction of the fallopian tubes. It may also affect the receptivity of the uterine lining. Above all else, it can create many other unpleasant and debilitating symptoms, like extreme pain, swelling, irregular periods and more.
      Where are my frozen eggs stored?
      For clients that retrieve at Trellis and SIRM-NY Fertility Institute, egg will be stored at SIRM-NY.
      What happens when I want to thaw my eggs?
      This process is the same as in an in vitro fertilization cycle: first, the eggs are thawed in a highly controlled lab environment. Then, they are injected with a single sperm via ICSI (either from a partner or a sperm donor) in individual culture dishes and allowed to develop for 3–6 days. A percentage of the eggs will fertilize and begin to divide, creating blastocysts (embryos) that are ready for transfer back into the woman’s body.

      The embryos will be transferred back to your uterus. In a quick non-surgical procedure, a doctor will use ultrasound guidance to insert a soft catheter through the cervix and into the uterus where hopefully, one will implant.
      When can I get my frozen eggs? How long does it take?
      When you are ready to thaw, your doctor can make a plan with you to time the thawing of eggs to meet your goals (fertilization, transfer etc). Alternatively, we can arrange to transfer the frozen eggs to a fertility facility of your choice.
      How long can I freeze my eggs for?
      In the grand scheme of it all, cryostorage, particularly for preserving eggs, is still new. Recent studies have shown successful pregnancies from eggs frozen for up to 7 years, but eggs can likely remain frozen or stored longer than that. The risky part of egg freezing is the actual freeze and thaw and less so the duration of time the eggs are frozen.
      How much does it cost to thaw and use my eggs?
      While this price varies across each of our locations, the cost in NYC to thaw, fertilize and transfer the embryos would be around $11K. This does not include the price of sperm, from a sperm bank, or genetic testing.
      EGG FREEZING - LIFESTYLE CONSIDERATIONS
      Can I work out during egg freezing?
      We advise not to work out during this time because your ovaries will be larger than normal and prone to causing discomfort, or even ovulation, if jostled by exercise.
      Can I have sex during egg freezing?
      Not during stimulation and up to a week after retrieval. Since you will be stimulating possible dozens of eggs that could potentially fertilize, we highly discourage sexual intercourse at this time. In addition, the physical activity of sexual intercourse, like exercise, might jostle the ovary leading to discomfort or premature “ovulation”. During retrieval - while the goal of egg retrieval is to aspirate the mature egg from every growing follicle, occasionally some eggs may remain within the pelvis. As such these eggs could be fertilized to create a pregnancy if you have sex within a week before or after the egg retrieval.
      Can I drink alcohol during egg freezing?
      As of right now, there’s no conclusive evidence that light to moderate alcohol consumption has a negative impact on egg quality, or the egg-freezing process.

      Still, that doesn’t mean drinking fits into a truly healthy, fertility-optimizing lifestyle. According to “Alcohol’s Effects On Female Reproductive Function” by the NIAAA, even light consumption has the power to disrupt blood sugar levels, alter hormone balances and lower a woman’s fertility. Any woman seeking to safeguard her chances for becoming pregnant might want to drastically cut back.

      And for women preparing or actually going through egg freezing, our stance is better to swap out the alcohol for a green juice, seltzer water or iced tea.
      How long will it take to complete the egg freezing process?
      From the time your cycle starts, the egg freezing process takes up to 11-14 days.
      How far in advance do I need to start changing my diet/ lifestyle to prepare for egg freezing?
      While there’s no mandate that you need to change your diet and lifestyle for egg freezing, you can impact the quality of your eggs with healthier lifestyle choices starting even up to 2-3 months before your cycle.
      How far in advance will I need to go off birth control or forms of contraception?
      We recommend a stint of at least one month off birth control, but longer if you have been on them for a year or more.

      All hormone-based birth control methods (BCPs; depo-provera; vaginal rings; etc.) need to be discontinued and/or washed out of your system before you start the stimulation medications. The exception to this is your IUD; those can remain in place as they are locally active within the uterine cavity and as such should not exert any effects on the egg freezing process.
      How often will I need to go for check-ups?
      Prior to starting the egg freezing cycle, you’ll need to visit our studio 2-3 times to meet with the Fertility Coach, Doctor and conduct the necessary tests. Once you start the egg freezing cycle, you’ll come in every few days, for 10-14 days. And then to SIRM-NY for the retrieval.
      What if I want to donate my frozen eggs?
      Let us know if you think this is a possibility so we can potentially make sure that the additional testing that would be necessary for future donation is put into place before we begin.

      Medication

      What medications will I take during egg freezing?
      • Gonal-F (or Follistim)– Follicle Stimulating Hormone (FSH) to stimulate multiple eggs to grow
      • Low dose hCG or Menopur – contains Lutenizing Hormone (LH) used in conjunction with FSH to stimulate multiple eggs to grow
      • Lupron, Ganirelix, or Cetrotide – provides spontaneous ovulation before egg retrieval
      • Lupron trigger or hCG (Ovidrel, Pregnyl, Novarel) – Medication given about 35 hours prior to egg retrieval; stimulates final maturation of eggs
      What are the side effects of the medication?
      Medication Related: Abdominal bloating, weight gain, or fluid retention is common. Pain, bruising or infection from the injection or blood draw sites, breast tenderness, fatigue and mood changes are possible.
      How much medication will I need to take?
      You will need to take 2-3 injections nightly for the 10-14 week time period.
      I have a new order / need a refill on my egg freezing medication. Who do I call?
      Our main number is (855) 255-5005 to reach a dedicated team of coordinators. Our pharmacy hours are 9 am - 8 pm ET Monday - Friday, and 10 am - 2 pm ET Saturday. For inquiries outside of normal business hours, you can contact us through the Trellis VIP After-Hours line at (855) 410-5107.
      I ran out of my egg freezing medication. What should I do?
      We can work with a local pharmacy to arrange same-day delivery, or process a refill. Please call us at (855) 255-5005 during normal business hours or (855) 410-5107 After Hours.

      Payment

      How much is it to freeze eggs?
      We will work with you to find a plan that meets your needs.

      For single-cycles, we offer financing for as low as $281/month, which includes mediation, stimulation, retrieval, anesthesia and 1 year of cryostorage. It does not include annual follow-on years of storage which is $600/year. This is the price available for financing over 60 months, 7.99% APR available to qualified candidates.

      For those who prefer a one-time payment, our price is $9.850 which does not cover medication which is usually about $3000-$5000/patient. In addition, it does not include the annual follow-on years of storage which are $600/year.
      What is financing?
      Financing is essentially a loan, in which the client agrees to repay the principal amount over time, including interest.

      Studios/Logistics

      Why is Trellis a fertility studio and not a clinic?
      Based on our mission to empower women to own their fertility, Trellis was built on an integrated approach to egg freezing. Through education on fertility and nutrition, we want to empower women with the knowledge they need to preserve their options for having a future family. In addition, our studio is designed for women looking to improve their health, vs a clinic where patients go with a medical problem. Our philosophy is that our clients are not sick, but are rather proactively undertaking a medical procedure to provide them with family planning options later.
      Where are Trellis studios located?
      Our flagship Trellis studio is opening in the Flatiron district of NYC Fall 2018.
      What is IntegraMed and is Trellis’ relationship with them?
      Trellis is a division of IntegraMed Fertility, the largest network of fertility clinics in North America. This gives us access to top-tier fertility doctors, scientific advances and proven cryostorage. IntegraMed has over 28 fertility practices, 103 locations and has been operating over 33 years. Since 2013, IntegraMed has frozen over 78,000 eggs.
      What is SIRM – NY Fertility Institute, and why are you booking appointments there?
      SIRM-NY is a premier NYC fertility clinic owned by IntegraMed Fertility, where Dr. Tortoriello and Dr. Dicken practice. With decades of experience Dr. Tortoriello, an award-winning fertility specialist, will oversee the medical protocol for Trellis clients. In addition, all egg retrievals will take place at this location. Prior to the opening of our NYC location, Trellis will be hosting a limited number of appointments at SIRM-NY.

      Nutrition & Wellness

      Why does my diet affect my fertility?
      While you’re born with all the eggs you’ll ever have, the quality of those eggs is actually the most important aspect of your fertility, a fact emphasized by fertility specialists when they say “We only need one good egg to make a baby.” The best way to ensure getting your best quality eggs is to begin your fertility journey at as young of an age that’s possible - while at the same time avoiding all the known risk factors for egg quality issues, such as smoking, excessive alcohol, or drug usage, and embracing positive factors such as eating healthy, taking certain supplements, sleeping well, avoiding stress, and maintaining a healthy body weight. 

      That’s because they undergo a burst of development before they’re released. In fact, eggs don’t actually fully mature until right before ovulation. In short, there’s a lot you can do to boost the quality of your eggs and optimize your chances for as many eggs as possible during egg freezing.

      "Human Eggs: How Many and for How Long?"; Go Ask Alice / Columbia University
      What should I eat & drink to prepare for my egg freezing cycle?
      These are super handy to keep in mind before and during your egg freezing cycle. However, just before retrieving your eggs, the doctors will provide instructions NOT to eat or drink (including water!) during the 8-10 hours before the treatment.

      • Vegetables: Think kale, spinach and chard (green and leafy!), all of which are high in iron, calcium and folate critical for optimal follicle development.
      • Fruits: Fruits can contribute loads of key vitamins and minerals, antioxidants and fiber. In particular, berries, citrus and pomegranate are chockfull of vitamin C, a big boost to fertility.
      • Plant Protein: Sources like beans, nuts, seeds and hearty grains like quinoa are a much better choice than red meat, poultry and pork. However, low iron can lead to compromised fertility, so the occasional chicken breast or ground turkey can be beneficial. Two to three servings of lean meats per week is plenty.
      • Omega-3 Fatty Acid: this polyunsaturated fat is abundant in fatty fish, walnuts and flaxseeds. Since the human body can’t make these fats from scratch, you have to get them from food.
      • Water: it cushions and lubricates our tissues and organs and is also the conduit for transporting vital nutrients and whisking away wastes.
      • Whole (not Low fat) Milk: According to the authors of “The Fertility Diet,” drinking a glass of whole milk every day “can improve ovulatory function and stave-off infertility.” Many experts recommend whole milk for women looking to boost their fertility and cutting calories elsewhere in their diet. (1)
      • Multi-vitamins: In addition to a nutrient-dense diet, women of childbearing age are advised to take a multivitamin / multimineral supplement with folic acid. The goal is at least 400 micrograms of folic acid every day.
      • Take plain Tylenol for any headaches or pain; however, avoid ibuprofen (Motrin and Advil) and aspirin during this time frame
      • Inform your provider before starting any new prescribed medication

      (1) “The Fertility Diet: Groundbreaking Research Reveals Natural Ways to Boost Ovulation and Improve Your Chances of Getting Pregnant.” Jorge E. Chavarro, M.D., SC.D.; Walter C. Willett, M.D., DR. P.H.; Patrick J. Skerrett. McGraw Hill, 2007.
      What should I NOT eat on a fertility diet?
      • Trans Fats: typically included in most baked goods, along with potato and tortilla chips, anything fried (chicken, French fries, etc.). (1)
      • Animal Protein: As mentioned above – it’s worth swapping out traditional animal protein such as red meat and park for beans, nuts and seeds. Research shows ovulatory infertility was 39 percent more likely in women with the highest intake of animal protein than in those with the lowest. (2)
      • “Fast” Carbs: In contrast to complex carbs that are high in fiber such as oatmeal, brown rice and whole grains, carbohydrates that digest quickly – think white breads and bagels, rice and potatoes) destabilize blood sugar levels, spiking insulin. In addition, they can wreak havoc on hormones, and can contribute to an increase in infertility. When sugar is added, as it is with donuts, cake, cookies and other baked goods, it’s even worse.
      • Low-Fat Dairy + Other Foods: While we’ve been taught that low-fat milk is better for our weight, it isn’t naturally a boost to our fertility. Research shows consuming one to two servings of full-fat dairy products was linked to increased fertility, while low-fat versions showed the opposite trend. (3)
      • Alcohol: the impact of alcohol consumption of one’s fertility is a hotly contested topic and detailed below. While moderate intake of alcohol has not been proven to harm a woman’s chances of become pregnant**, it’s not the smartest thing to do for optimal fertile health. And during egg freezing, we advise NOT consuming alcohol to maximize your results.
      • Soda: Duh - loaded with chemicals and sugar that both spikes insulin levels and packs on the pounds – there’s nothing to justify even occasional use of regular (or diet!) soda.
      • Caffeinated Drinks: While not advised, less than 300 mg of caffeine a day is safe, but no more.

      (1) “Trans Fats May Raise Risk of Infertility”: Harvard Medical School
      (2) The “Plant Protein Rules” chapter in “The Fertility Diet” further explains, in great detail, the authors’ rationale for urging fertility patients to bypass animal protein. It’s a highly recommended read.
      (3) “About NHS ”: Nurses Health Study
      Is there anything I should avoid during my egg freeze cycle?
      Once you begin stimulation medications (injections) we recommend avoiding the following: • DO NOT have unprotected intercourse
      • DO NOT engage in heavy lifting, high impact or strenuous activities
      • DO NOT use a hot tub during this time frame or do HOT yoga
      • DO NOT take any diet supplements, herbal remedies or “natural” medications during your cycle unless cleared by your provider
      Can I drink alcohol while freezing my eggs?
      Not advised. As it relates to fertility, alcohol consumption is a hotly debated topic. As of right now, there’s no conclusive evidence that light to moderate alcohol consumption has a negative impact on egg quality, or the egg-freezing process. (1) Some doctors will say moderate consumption is fine, with “moderate” being deemed as 1- drink per day by The National Institute on Alcohol Abuse & Alcoholism (NIAAA).(2)

      Still, that doesn’t mean drinking fits into a truly healthy, fertility-optimizing lifestyle. According to “Alcohol’s Effects On Female Reproductive Function” by the NIAAA, even light consumption has the power to disrupt blood sugar levels, alter hormone balances and lower a woman’s fertility. (3) Any woman seeking to safeguard her chances for becoming pregnant might want to drastically cut back.

      And there’s something else to consider about alcohol: the “domino effect” of all the bad health decisions it can lead to.

      For example, a young woman decides to meet friends for “happy hour” on a weeknight. She skips a proper dinner beforehand. But she’s a little hungry, so while she’s drinking, she’s gobbling fries, tortilla chips and pizza. That first cocktail leads to 2 more drinks. Once home, she just grabs a little cheese from the fridge and heads to bed.

      Because of all the cocktails, she doesn’t sleep well. (Alcohol is a notorious sleep-disrupter.) and skips out her morning workout. Because she’s slightly hungover, she grabs greasy comfort foods that are loaded with fat and calories.

      See how quickly an innocent “after hours” drink can wreak havoc on a healthy lifestyle? And that’s just one night!

      (1) “Alcohol Consumption and Fecundability: A Danish Cohort Study”: The BMJ (British Medical Journal
      (2) “Drinking Levels Defined”: NIH / National Institute On Alcohol Abuse & Alcoholism
      (3) “Alcohol’s Effects On Female Reproductive Function”: NIH / National Institute On Alcohol Abuse & Alcoholism
      Can I drink caffeine while freezing my eggs?
      Not advised. While not advised, less than 300 mg of caffeine a day is safe while trying to conceive, but no more. Technically, a cup is 6 ounces. Out in the real world, however, that can change. At Starbucks, for example, a “Short” is 8 ounces, while a ‘Venti” clocks in at a whopping 20 ounces.

      “When you drink coffee, tea or another caffeinated beverage, its caffeine quickly courses through your body. It enters the ovary, uterus, and fallopian tubes, along with just about every other tissue. Caffeine has been found in newly fertilized eggs and embryos. “

      The net-net: Consume caffeine with caution.
      What other lifestyle choices can enhance my fertile fitness?
      NORMAL BMI: Obesity is a major red flag for getting & staying pregnant. However, being either overweight OR underweight can impede the egg freezing process by having a negative impact on ovulation. While severe calorie restriction can completely shut down the menstrual cycle, excess weight can trigger the over-production of estrogen, which can lead to the suppression of LH (luteinizing hormone) and FSH (follicle stimulating hormone). Without LH and FSH, ovulation is a no-go.

      KNOW YOUR FAMILY HISTORY: No matter how healthy you eat or exercise, genetic factors can make conception more difficult – such as early menopause, or fertility challenges from your family history.

      MODERATE EXERCISE: When starting an egg freezing cycle, you’ll need to stay away from most forms of strenuous exercise. However, as part of your general lifestyle, exercise is a huge stress-buster AND keeps your weight in-check. EXCEPTION - “Extreme” fitness – hardcore CrossFit training, or vigorous, Orangetheory-style interval sessions per week – can have an adverse effect on fertility. The loss of loss of too much body fat can tip estrogen scales out of whack and lead to irregular or missed periods.

      Other forms of wellness including acupuncture, yoga, and meditation have shown positive results to decrease anxiety,
      Are there supplements or vitamins I should take for my fertile health?
      In addition to a nutrient-dense diet and beverage consumption, women of childbearing age are advised to take a multivitamin / multimineral supplement with folic acid. In fact, they should aim for at least 400 micrograms of folic acid every day. Folic acid is often found in prenatal vitamins. Other key vitamins and minerals are iron, zinc, calcium, vitamin B-6, co-enzyme Q10 and omega-3 fatty acids.(1)

      (1) “Is It Okay To Take Prenatal Vitamins If I’m Not Pregnant?”: Mayo Clinic
      What is folic acid and why is it important?
      A B-complex vitamin, folic acid is found in leafy green vegetables, liver and kidney, it is responsible for several key bodily functions. On the reproductive front, folic acid can help prevent birth defects when taken daily. Research shows that abundant folic acid, along with a well-rounded nutritious diet, can have a positive effect on regulating menstrual cycles and enhancing fertility.*

      * “The Fertility Diet: Groundbreaking Research Reveals Natural Ways to Boost Ovulation and Improve Your Chances of Getting Pregnant.” Jorge E. Chavarro, M.D., SC.D.; Walter C. Willett, M.D., DR. P.H.; Patrick J. Skerrett. McGraw Hill, 2007.

      Start owning your fertility now