Why track blood sugar?

Blood sugar tracking is important for anybody who is diagnosed with diabetes, whether type 1, type 2, or gestational diabetes. Your healthcare provider should let you know how often to test your blood sugar. The frequency of testing usually depends on the type of diabetes you have, and how much insulin you use.

Tracking your blood sugar helps you understand how different foods, medications, illness, and activities affect your levels. This allows you and your provider to develop the management plan that’s best-suited for you.

What do the numbers mean?

Blood sugar levels are represented as milligrams of sugar per deciliter of blood (mg/dL). The normal ranges of blood sugar are as follows:

• Before meals: 80 – 130 mg/dL
• Within 2 hours after meals: Less than 180 mg/dL

Everybody is different, and the American Diabetes Association recommends that healthy people under 60 aim for lower levels than these. You should speak with your healthcare provider about the ideal blood sugar levels for you.

Sources

CDC: https://www.cdc.gov/diabetes/managing/managing-blood-sugar/bloodglucosemonitoring.html

Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628

American Diabetes Association: https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/checking-your-blood-glucose

Your mental and physical health is a series of connections working together to keep you going. At the center of it is our heart. Maintaining your heart health is crucial to your wellbeing. Understanding how the heart functions, its role and the risk factors you may face are key to getting on the path toward keeping it as healthy as possible.

How your heart works with the rest of your body

The heart is a muscle that works in connection with the rest of the body through the circulatory system. As the heart pumps blood throughout the body’s circulatory system, it operates in a coordinated effort with the lungs (pulmonary circulation) to exchange carbon dioxide for oxygen and with the rest of the body (systemic circulation) to deliver oxygen-rich blood.

Our heartbeat is the heart’s rhythmic contractions, regulated by electrical impulses. These contractions ensure continuous blood flow, support bodily functions and maintain stable body function. The heart speeds up in response to movement, physical activity and hormone signals to meet the body’s demands.

Heart health’s connection to family history

Family history can significantly impact heart health. Genetic predisposition can increase the risk of many cardiovascular diseases, including coronary artery disease, high blood pressure, and congenital heart defects. 

Genetics also have a role in terms of high cholesterol and increasing your risk of developing diabetes- both of which are risk factors for heart disease. While you can’t change your genetics, awareness of your family history can guide preventive measures, lifestyle choices, and early screenings to mitigate these risks.

Cardiovascular health and its unique effects on women

Cardiovascular health can affect women uniquely due to several factors. Women may experience different heart attack symptoms than men, such as nausea, dizziness, and back or jaw pain. Also, pregnancy, reproductive conditions, mental health and hormonal factors increase the risk of heart disease among women.

Reproductive health and the heart

In many ways, pregnancy is like a stress test for the heart, as many signs of heart disease show up during pregnancy or in the postpartum period, including:

• Preeclampsia greatly raises the risk of developing hypertension and/or diabetes later in life. It also increases the risk of a stroke.
• A gestational diabetes diagnosis raises the lifetime risk of developing diabetes. About 50% of women with gestational diabetes develop type 2 diabetes.

Risk factors for heart disease

Many risk factors can increase the likelihood of developing heart disease, including:

• Lifestyle factors: Smoking, physical inactivity, unhealthy diet, and excessive alcohol use.
• Health conditions such as high blood pressure, high cholesterol, diabetes, obesity, and chronic kidney disease.
• Genetic factors: family history of heart disease, especially at an early age
• Age: the risk of developing heart disease increases with age.
• Gender: Men are generally at higher risk at a younger age, but the risk for women increases and can surpass that of men after menopause.
• Ethnicity: Certain groups are at higher risk, such as African Americans, who have a higher risk of high blood pressure and South Asians, who have a higher risk for heart disease. 

Understanding these aspects of heart health is crucial for helping you manage your health. Preventive care such as regular check-ups, a health-focused lifestyle, and managing risk factors can help maintain heart health and prevent cardiovascular diseases.

Reviewed by the Ovia Health Clinical Team

Read more

Connective Matters: Heart Health | Steps Towards Preventive Care

Sources:

• National Heart Lung and Blood Institute (NHLBI). How the Heart Works: The Heart. https://www.nhlbi.nih.gov/health/heart
• Center for Disease Control (CDC). Prevent Heart Disease. cdc.gov. March 21, 2023 https://www.cdc.gov/heartdisease/prevention.htm#:~:text=Eating%20foods%20high%20in%20fiber,prevent%20or%20help%20control%20diabetes.
• American College of Obstetricians and Gynecologists (ACOG). Heart Health for Women. acog.org. https://www.acog.org/womens-health/faqs/heart-health-for-women#:~:text=Lack%20of%20physical%20activity%20can,of%20heart%20disease%20and%20stroke
• The Mayo Clinic. “Strategies to prevent heart disease”. www.mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease-prevention/art-20046502

Your health is important to your body’s ability to function and keep you going daily. Your heart, the center of your cardiovascular system, is crucial in maintaining your overall health. Unfortunately, in the United States, heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups. More than one in three women is living with some form of heart disease.

Taking preventive measures is essential to maintaining good heart function and another act of self-care from which we can all benefit. Below are steps towards preventive care to help support your heart health.

Stay informed and proactive in your healthcare

Preventive care can begin the next time you meet with your healthcare provider. Have a shared discussion about the factors that can contribute to your heart’s health.

• Monitor blood pressure, cholesterol levels, and diabetes screenings to catch any potential problems early.
• Early detection and management of elevated blood pressure, high cholesterol, and diabetes can prevent heart disease or its complications.
• Know your family history of heart disease and discuss it with your healthcare provider to personalize your prevention plan. 
• Follow your healthcare provider’s advice, including taking prescribed medications as directed to manage conditions affecting heart health.

Adopt a heart-healthy diet

Eating nourishes us, gives us energy and generally tastes delicious. Taking a heart-healthy approach to food can provide a better defense against cardiovascular issues.

• Eat plenty of fruits, vegetables, whole grains, and lean proteins to provide essential nutrients for heart health.
• Limit saturated fats, trans fats, cholesterol, sodium, and added sugars to reduce the risk of heart disease.
• Incorporate healthy fats from sources like fish, avocados, nuts, and olive oil, which can help improve blood cholesterol levels.

Maintain a healthy weight

• Balance calorie intake with physical activity to prevent obesity, a significant risk factor for heart disease.
• Be aware of your body mass index (BMI) and waist circumference as healthy weight and risk indicators.

Engage in regular physical activity

Anywhere from 10 to 20 minutes of activity and exercise daily can get your heart pumping and your body moving. And your heart will love it.

• Exercise helps control weight and reduces blood pressure, cholesterol levels, and the risk of type 2 diabetes, all of which are risk factors for heart disease.
• Aim for at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous exercise per week. 
• Add muscle-strengthening activities two or more days per week as recommended by health authorities to support your heart health.

Avoid smoking and limit alcohol consumption

Cigarette smoking and excessive drinking of alcoholic beverages can lead to many health issues, including certain heart diseases.

• Stopping cessation significantly reduces the risk of heart disease by improving heart function and blood circulation.
• Limit alcohol intake to moderate levels (up to one drink a day for women and up to two drinks a day for men) to avoid high blood pressure and other heart risks that arise due to excessive drinking.

Manage stress

Stress can affect your health in many ways, so look for ways to address and manage it. Managing stress can help reduce behaviors and factors that increase heart disease risk, like high blood pressure and cholesterol levels, physical inactivity, and overeating.

• Engage in stress-reducing activities such as meditation, deep breathing, and physical activity.
• Speak to your healthcare provider about managing your mental health as well as studies show that your mental health can also affect your heart’s function.

Sleep well

Sleep recharges your body, so working towards better sleep is another great way to support healthy heart function.

• Aim for 7-9 hours of quality sleep per night, as poor sleep can increase the risk of high blood pressure, obesity, and diabetes.
• Establish a regular sleep schedule and a relaxing bedtime routine to improve sleep quality.

Taking these preventive measures can significantly reduce the risk of developing heart disease. It’s about creating a balanced lifestyle that supports heart health and overall wellbeing. 

Reviewed by the Ovia Health Clinical Team

Read more

Connective Matters: About Your Heart

Sources

Center for Disease Control (CDC). Prevent Heart Disease. cdc.gov. March 21, 2023 https://www.cdc.gov/heartdisease/prevention.htm#:~:text=Eating%20foods%20high%20in%20fiber,prevent%20or%20help%20control%20diabetes.

American College of Obstetricians and Gynecologists (ACOG). Heart Health for Women. acog.org. https://www.acog.org/womens-health/faqs/heart-health-for-women#:~:text=Lack%20of%20physical%20activity%20can,of%20heart%20disease%20and%20stroke

The Mayo Clinic. “Strategies to prevent heart disease”. www.mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease-prevention/art-20046502

According to the American Thyroid Association, over 12% of the American population will develop a thyroid condition in their lifetime, but many may be unaware of their condition. Some people are born with a poorly developed or poorly functioning thyroid. Others develop thyroid disorders later in life due to autoimmune dysfunction, cancer, or damage to the thyroid from medications, radiation, or surgery. Thyroid conditions can also develop with no clear cause. These conditions can impact anyone, but they are most common in women. So what should you look out for?

Some signs and symptoms of hyperthyroid (too much thyroid gland activity) include:

• Agitation, anxiety, or irritability
• Feeling restless, fidgety, or hyperactive
• Fast heartbeat, pounding heart, or palpitations
• Sweating and sensitivity to heat
• Insomnia
• Weight loss
• More frequent bowel movements
• Irregular periods in women

Some signs and symptoms of hypothyroidism (not enough thyroid gland activity) include:

• Fatigue
• Depression
• Slow heart rate
• Feeling cold
• Dry skin and hair
• Weight gain
• Constipation
• Irregular periods in women

Some signs of thyroid cancer can include:

• Lumps or bumps on the front of the neck
• Changes in the voice or hoarseness
• Trouble swallowing or breathing
• Persistent cough without another cause

Anyone with concerning signs and symptoms should discuss them with their primary healthcare provider and consider blood tests of thyroid function.

Routine screening: if I don’t have any worrying signs or symptoms, should I still get a thyroid test?

In general, routinely testing the thyroid function of all adults is not standard. That’s because there’s no evidence that testing everyone has any benefit. However, for those with symptoms or with certain risk factors, testing may be beneficial and is encouraged. Risk factors can include having any of the following: an autoimmune disorder, a history of goiter, a family history of thyroid disease, previous radiation treatment, or taking medications that could affect the thyroid.

Is there anything I can do to protect or support my thyroid?

Many things that are good for your overall health are also good for your thyroid. For example, eating a nutritious, well-balanced diet that’s high in whole foods and low in processed foods is one helpful step. One particularly important nutrient for thyroid health is iodine, which is naturally found in most kinds of seafood and animal proteins. In the US, most of us get enough iodine from our diet, but you can also support your iodine intake by using iodized salt, which can be especially important for vegetarians and vegans.

Reviewed the Ovia Clinical Team

Source: General Information, Thyroid, American Thyroid Association. American Thyroid Association. Jan 2024. https://www.thyroid.org/media-main/press-room/

Many studies have shown that physical activity is linked with lower breast cancer risk. The American Cancer Society recommends that adults get at least 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous-intensity activity each week. A combination of these activities spread throughout the week would be ideal.

Avoid or limit alcohol

Alcohol increases risk of breast cancer. Even drinking small amounts of alcohol has been linked with an increase in risk. It is best not to drink alcohol at all. For women who do drink, they should have no more than 1 alcoholic drink a day. A drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits (hard liquor).

Breastfeed if possible

Mothers who breastfed are less likely to get breast cancer. Mothers who breastfed for a lifetime total of more than two years get the most benefit.

Limit hormone therapy

Postmenopausal hormone therapy can increase the risk of breast cancer. If you must take hormones to manage menopausal symptoms, try to use the lowest dose that works for you and for the shortest time.

Know and explore your options

If breast cancer runs in your family, talk to your doctor about considering genetic counseling and testing. Testing will show if you have an inherited gene mutation that increases your risk of breast cancer. If genetic test results show you a gene mutation, you can consider drugs that can lower your risk or surgery.

Reviewed by the Ovia Health Clinical Team

Let’s start with the basics, how often should someone be STI tested? Can you tell us a little more about what exactly to expect?

The guidelines are that everyone who is under 25 and sexually active should be tested at least once a year for gonorrhea and chlamydia. Many STIs can be asymptomatic (particularly in women), so it’s important to make testing part of your annual care. Every annual preventive visit should include a conversation about STIs. Certain people may be at higher risk and require more frequent screening. 

Women 25 years and older with risk factors such as new or multiple sex partners or a sex partner who has an STI should also be tested for gonorrhea and chlamydia every year.

All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.

Everyone who is pregnant should be tested for syphilis, HIV, hepatitis B, and hepatitis C starting early in pregnancy. Those at risk for infection should also be tested for chlamydia and gonorrhea starting early in pregnancy. Repeat testing may be needed in some cases.

Are there other options for testing besides at a primary care visit?

Yes. Urgent care is an option, as are retail health clinics, community clinics and OB/GYN providers. Home tests are also available.

Can you tell us more about specific STIs and how they’re tested for?

Gonorrhea and chlamydia are tested with a urine sample, a cervical sample, or a swab. 

HIV, hepatitis, and syphilis can be tested for with blood tests. 

We’ll test for herpes (HSV1 and HSV2) with a swab of the lesion if you have symptoms. 

What are your recommended best safe sex practices with a new sexual partner?

It’s great if both people can discuss STI testing before they forgo using barrier methods like condoms. This way you know where you’re starting out. 

And what if someone doesn’t feel comfortable having those conversations with a new or more casual partner?

These can be hard conversations, especially early on in a relationship. 

To start off, everyone can empower themselves and at least get testing for themselves. These conversations can certainly sometimes put pressure on relationships about the future of the relationship or expectations around monogamy. If you’re not there yet, that’s a good reason to continue using other methods to protect yourself. Then when you both feel comfortable you can test again. 

What are some common symptoms of STIs to pay attention to? 

Women and people with uteruses will typically experience symptoms like pain with urination, vaginal discharge, and painful bumps or sores. 

Gonorrhea can also infect the throat, this can be asymptomatic or cause a sore throat. 

HIV can look like an acute illness with viral symptoms — think swollen lymph nodes and a fever. These symptoms are often missed because they can be mistaken for another type of virus. 

Can you get an STI from oral sex?

Yes. We commonly see gonorrhea which can present as a very painful sore throat. The good thing is that providers are more informed and educated about this symptom as a potential sign of an STI, so they should be taking a swab and testing. 

Herpes (HSV) is often spread during oral sex as well.

Which STIs are treatable vs. curable?

Gonorrhea, chlamydia, trichomonas, and syphilis are all curable. We give medication and we may recommend a test for cure. HIV, as we know, is a chronic infection, which is treatable and we have great therapies and treatments, but it requires lifelong treatment and monitoring. 

An initial outbreak of HSV is treated with a high dose of an antiviral treatment, which shortens the amount of time a person is symptomatic, and most likely the time they’re infectious as well. And then depending on how often a person has outbreaks, we may recommend that they go on suppressive therapy, which is a daily antiviral medication. This can be a lifelong medication.

After a number of years of being on antiviral medication, most people have very low rates of outbreaks. I say that because when people are told that they have HSV, it can be very upsetting. They might be worried about navigating conversations with sexual partners given some stigma that’s still lingering around HSV. People also worry that they might pass it on if they’re pregnant. But we have great medication that is safe and generally has minimal side effects, so most people can go back to living a normal life. We do recommend that they tell new sexual partners. 

Any tips for how to have these conversations with a partner?

HSV is transmitted through skin contact. And we know that there can be transmission of HSV even when a person doesn’t have an outbreak or an outbreak that’s visible to them. This is particularly true right before they have an outbreak, when there can be a high level of virus. And condoms don’t protect anyone 100%. 

These conversations can be hard with a new casual partner before you have any sexual contact. You might say, “I just wanted to let you know that I tested positive for HSV [X] years ago. I’m on suppressive therapy, which reduces the risk, but I just wanted to let you know.” 

Because it’s such a common virus, many people are in this situation, so hopefully the conversation is met with kindness and appreciation that you disclosed it.

HIV can be a more challenging conversation, but it’s similar in many ways. This is a conversation to have earlier rather than later. In relationships with two people who have discordant HIV infection, the partner who is not HIV positive often chooses to go on PrEP therapy to prevent their chance of being infected. Also, here condoms are very effective, because HIV is not transmitted through the skin. 

There is a lot less stigma than there used to be, but these conversations can be hard.

How long should someone be on suppressive therapy before it kicks in?

Those who are HIV positive need to wait until they’re controlled before having sexual contact. Their HIV specialist or internist will help them manage their treatment plan. 

And for other STIs, how should we think about testing timelines? 

If you were sexually active with a new partner recently, your current testing might not reflect your status. It’s good to get tested when you haven’t been with anyone else for 6 weeks, so waiting until you’re 6 weeks or so into a relationship can make sense. This is because it can take 6 weeks for the body to mount an antibody response to the virus so that it can be detected in blood work. 

Certain STIs have recommendations for follow up — in those cases, we recommend that people get tested for cure to make sure they’re fully treated. If both partners are positive for an STI, both should be treated at the same time and there should be no sexual contact during treatment to prevent transmission back and forth.

Any tips if you don’t feel comfortable talking to your provider about sexual health?

There are on-demand tests that you can use, which can be a great option. You can also email or message your provider to ask for certain tests/labs if you don’t feel you can ask in person. We like to minimize barriers for testing for important health issues.

Read more

• 5 Things you should have learned in sex ed class
• The complete glossary on sexually transmitted infections

While medicine may have expanded fertility options, it can feel like there are so many more decisions to make about when to start a family or how to preserve fertility. If you’re wondering: should I freeze my eggs? you’ve come to the right place. Make sense of egg freezing and why it might be an option to consider.

What Is egg freezing?

Known in official medical circles as mature oocyte cryopreservation (OC), egg freezing is the process by which a doctor takes eggs (oocytes) from your ovaries. These eggs can then be frozen and stored until you decide you’re ready to use them. At that point they are thawed, mixed with sperm in a laboratory, and re-inserted into your uterus (womb) through your cervix, hopefully leading to pregnancy.

Who’s freezing their eggs in the U.S.?

Nationally, the number of egg freezing cycles increases every year. The Center for Disease Control (CDC) reports there were more than 22,000 egg freezing cycles in 2019, up from around 18,000 in 2018 and 14,500 in 2017.

• It’s becoming more common for people under the age of 35 years to preserve their fertility through egg freezing.
• White patients freeze their eggs more than people of color, although more minority groups are freezing their eggs, especially Asian women.
• University-educated or professional people are more likely to pursue elective egg freezing.

Why might you want to freeze your eggs?

People choose to press pause on becoming a parent or growing their family for many reasons. Elective egg freezing is now safer, more affordable, and more common. Some of the reasons people give for choosing electively to freeze their eggs include:

• Not being in a relationship with a partner they want to parent with 
• Wanting to be financially stable before starting a family
• Working in a demanding career where being pregnant could come at a professional cost
• Having access to employer-subsidized egg freezing benefits

Other people may turn to egg freezing because they have a medical condition that threatens their future fertility. One out of five women in one study reported choosing egg freezing because of underlying health conditions. Women and their health care providers may consider egg freezing if they:

• Have a condition impacting fertility such as sickle cell anemia, autoimmune diseases such as lupus, or premature ovarian failure
• Have a cancer diagnosis or other illness and need to receive chemotherapy or radiation that could harm their ovaries

Egg freezing also helps LGBTQ+ people keep their parenting options open. Gender-affirming surgery or medical treatments can limit fertility so some transgender men choose egg freezing before beginning their transition.

When should I freeze my eggs?

According to the American Society of Reproductive Medicine (ASRM), elective egg freezing is most successful for women younger than 38 years. The more eggs you can harvest and freeze, the better your chances for pregnancy down the road. As you get older, it gets harder to harvest enough high-quality eggs. Here’s what the science tells us:

• Egg quality peaks between 16 and 28 years old
• Women in their mid-reproductive years (29 to 37 years old) produce enough high-quality eggs to make egg freezing cost effective
• People who freeze their eggs before age 34 have the highest overall live birth rates.
• One 2015 study found that the biggest difference in live birth rates between people who did and didn’t freeze their eggs was at age 37. At younger ages, the differences in live birth rates in people who did and did not freeze their eggs were smaller.
• There is little benefit (no comparative increase in the number of live births) for women ages 25-30 to freeze their eggs

From a straight biological perspective, the younger you are when you freeze your eggs, the better your chances for good egg quality and number harvested.

Egg freezing and deciding what’s right for you

Decisions about fertility and parenting are individual and personal — egg freezing is no different. It can be helpful to think of egg freezing as an insurance plan rather than a guarantee for a baby. It is a way to increase your chances of being able to be a parent, without being limited by your biological clock or life circumstances. That said, it can be very expensive and so is not a good option for everyone.

Reviewed by the Ovia Health Clinical Team

Read more:

• Egg freezing step by step
• Egg freezing FAQ

Sources 

• Katler QS, Shandley LM, Hipp HS, Kawwass JF. National egg-freezing trends: cycle and patient characteristics with a focus on race/ethnicity. Fertil Steril. 2021 Aug;116(2):528-537. doi: 10.1016/j.fertnstert.2021.02.032. Epub 2021 Mar 30. PMID: 33795141.
• Inhorn MC, Birenbaum-Carmeli D, Birger J, Westphal LM, Doyle J, Gleicher N, Meirow D, Dirnfeld M, Seidman D, Kahane A, Patrizio P. Elective egg freezing and its underlying socio-demography: a binational analysis with global implications. Reprod Biol Endocrinol. 2018 Jul 23;16(1):70. doi: 10.1186/s12958-018-0389-z. PMID: 30037349; PMCID: PMC6056999.
• Mayo Clinic Staff. “Egg Freezing.” Mayo Clinic. Mayo Foundation for Medical Education and Research. April 23, 2021. https://www.mayoclinic.org/tests-procedures/egg-freezing/about/pac-20384556. 

• “Assisted Reproductive Technology (ART) National Data.” Centers for Disease Control and Prevention (CDC). CDC. 2019. https://nccd.cdc.gov/drh_art/rdPage.aspx?rdReport=DRH_ART.ClinicInfo&ClinicId=31&ShowNational=0. 
• Kylie Baldwin, Lorraine Culley, Nicky Hudson & Helene Mitchell (2019) Running out of time: exploring women’s motivations for social egg freezing, Journal of Psychosomatic Obstetrics & Gynecology, 40:2, 166-173, DOI: 10.1080/0167482X.2018.1460352
• Amato, Paula. “Fertility Options for Transgender Persons.” UCSF Transgender Care. University of California, San Francisco. June 17, 2016. https://transcare.ucsf.edu/guidelines/fertility. 
• “Can I Freeze My Eggs to Use Later If I’m Not Sick?” ReproductiveFacts.org. American Society for Reproductive Medicine. 2014. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/can-i-freeze-my-eggs-to-use-later-if-im-not-sick/. 
• Mesen, Tolga B et al. “Optimal timing for elective egg freezing.” Fertility and sterility vol. 103,6 (2015): 1551-6.e1-4. doi:10.1016/j.fertnstert.2015.03.002

Step 1: Choosing your fertility clinic or doctor

The American Society for Reproductive Medicine (ASRM) suggests scheduling a consultation with prospective fertility clinics to ask about their egg freezing methods, success rates, costs, storage, and policies for disposing of unused eggs. Most importantly, you should choose a doctor you feel comfortable with and trust. 

Step 2: Your baseline fertility evaluation

Once you choose your doctor, you will have several appointments and evaluations. These include appointments for:

1. Consultation with your fertility doctor (aka reproductive endocrinologist)
2. Transvaginal ultrasound to count the number of eggs (follicles) on your ovaries. (If this baseline testing is encouraging, you might decide to opt out of egg freezing completely or to delay egg harvesting.) 
3. Blood test examining your fertility hormones
4. Follow-up appointment several weeks later to review lab test results and your ovarian stimulation protocol

Ovarian stimulation protocol is the name for the sequence of medications you will give yourself over the next 3 to 4 weeks to stimulate your ovaries to produce multiple mature eggs.

Step 3: Ovarian stimulation

In a normal monthly cycle, your ovaries form multiple fluid-filled sacs called follicles, but only one mature egg, which your ovaries release when you ovulate.

Ovarian stimulation medications mimic your natural menstrual hormones (estrogen and progesterone), but fool your ovaries into growing multiple mature eggs simultaneously.

Most of the medications used for ovarian stimulation must be injected with a needle. You or your partner or family member can do this. You will have another appointment with a nurse to review the medicines, how to mix them and inject them, and to review the timeline and plan for your egg retrieval process.

Where you are in your cycle, timing, and the results of your fertility evaluation determine the best protocol for you. Here is a typical ovarian stimulation protocol and commonly-used medications:

1. A short course (1-2 weeks) of birth control pills, estrogen, Lupron, or Aygestin (a form of progesterone) before starting injections. 
2. Self-administered hormonal injections medications for the next 9-12 days. The injections will most likely be some combination of follitropin alfa or beta (Follistim AQ, Gonal-f) or menotropins (Menopur) to stimulate your ovaries.
3. Hormonal injections on days 9-12 to prevent your ovaries from releasing an egg too soon. Medications could include leuprolide acetate (Lupron) or cetrorelix (Cetrotide).
4. A trigger shot 36-37 hours before your scheduled retrieval procedure time to complete the “ripening” of your eggs. These injections are usually Lupron (leuprolide acetate) or hCG (human chorionic gonadotropin), sold as Ovidrel or Novarel. 

The purpose of the first 1-2 weeks of medications is to help align your follicles so they all start maturing simultaneously.

During days 9-12 of the fertility injections, you can expect to have 5-7 monitoring appointments with blood tests and vaginal ultrasounds to evaluate your response to the medications. These appointments typically take about 30 minutes.

Step 4: Egg harvesting

Your doctor will schedule your egg harvesting or egg retrieval appointment once ultrasounds and bloodwork show that you have enough mature eggs. Egg retrieval is usually 9-12 days after starting the fertility injections in a typical cycle.

The actual harvesting procedure only takes about 15 minutes and is not painful. You will be given anesthesia and pain medication to keep you comfortable and very briefly asleep (conscious sedation). Next, your doctor will use ultrasound to safely direct a special suction needle through your vagina to remove mature eggs from your ovaries.

Clinics usually monitor you for one to two hours after the procedure before sending you home to rest. Plan on taking the rest of the day off from work and avoid heavy lifting or intense exercise for the next week to protect your ovaries.

Step 5: Flash freezing your eggs

After harvesting, your eggs are quickly frozen in a process called vitrification. Vitrification prevents harmful ice crystals from forming and results in higher egg freezing success rates. Eggs will be stored at subzero temperatures until you are ready to use them.

Once you’re awake, your care team should tell you how many eggs they retrieved. It will probably take 24 hours to know how many mature eggs were frozen.

When the time is right, your eggs can be thawed, and hopefully fertilized with sperm in a lab, and implanted in you or a gestational carrier’s uterus through in vitro fertilization (IVF).

Step 6: Live your life and plan your future fertility

The decision to freeze your eggs is as complicated as all the steps in the egg freezing process. Egg freezing can offer you more options, but it does not guarantee you a future baby. If you have more questions about the egg freezing process, head over to our FAQ. 

Reviewed by the Ovia Health Clinical Team

Read more

• Should I freeze my eggs
• Egg freezing FAQ

Sources

• “Transvaginal Ultrasound: Medlineplus Medical Encyclopedia.” MedlinePlus. U.S. National Library of Medicine. April 1, 2022. https://medlineplus.gov/ency/article/003779.htm. 
• Mayo Clinic Staff. “Egg Freezing.” Mayo Clinic. Mayo Foundation for Medical Education and Research. April 23, 2021. https://www.mayoclinic.org/tests-procedures/egg-freezing/about/pac-20384556.

When should I freeze my eggs?

According to the American Society of Reproductive Medicine (ASRM), elective egg freezing is most successful for women younger than 38 years. Elective egg freezing is when you voluntarily choose to freeze your eggs as a type of insurance plan against natural aging — not because you have a medical condition such as cancer that might harm the eggs in your ovaries (called oocytes).

With age, the likelihood of problems with the chromosomes inside your eggs increases. Chromosomes are the building blocks of your DNA or genetic information. Egg freezing allows you to use “younger” eggs when you want to get pregnant. With age, there are:

• Higher rates of infertility
• Fewer eggs can be harvested
• Lower IVF success rates
• Increased rates of miscarriage
• Higher rates of congenital disabilities
• Higher-risk pregnancies for people who are pregnant when they are older than 35 increase

People who freeze their eggs before age 34 have the highest overall live birth rates. So, while egg freezing does help you slow down your biological clock, you can not push pause forever. Data from fertility centers indicate that most women 38 and younger can expect to harvest 10-20 eggs per cycle. The more eggs your doctor can collect, the higher your chances of a successful live birth. So, the ideal window for egg freezing is somewhere between 34-38 years old.

How much does egg freezing cost?

You can expect to pay $30,000-$40,000 to freeze your eggs. The average cost per cycle of just the medical procedure (harvesting) ranges between $10,000-$20,000. It will cost $500-$600 per year to store your eggs.

Costs will increase or decrease depending upon how many cycles you need to do to freeze the recommended number of eggs (usually around 10). The average person must go through about two cycles to reach this number. The older you are, the more likely you will need multiple cycles, and your medication costs may increase. 

Some commercial health insurance plans will cover the cost of some of the prescription medications used to stimulate your ovaries. However, without any insurance coverage, drug costs can run $2,000-$5,000 per cycle.

Where you live in the country can impact how much egg freezing will cost you, and costs vary even city by city within the same state. If you live far from medical centers, lost wages due to medical appointments and transportation costs can add up quickly.

Employer-financed egg freezing or fertility benefits changed many people’s financial calculus for egg freezing. As of 2020, about one out of every five (20 percent) US companies offered coverage for egg freezing. Apple and Facebook pay their employees up to $20,000 for egg freezing.

Egg freezing costs do not include the cost of thawing and implantation via in vitro fertilization (IVF), which as of 2019, ranged from $10,000-$15,000 per IVF cycle, according to the Society for Assisted Reproductive Technology (SART). Some people will also need to factor in the potential purchase of donor sperm (around $1,000), other assisted reproductive technologies (like assisted hatching or ICSI treatment), or embryo freezing ($200-$800 annual storage fee).

How long does the egg freezing process take?

One egg freezing cycle takes approximately 3-4 weeks. This includes:

• 1-2 weeks of birth control pills or other medication to temporarily turn off your natural hormones
• 9-10 days of hormone injections to stimulate your ovaries and ripen multiple eggs.

During the ten or so days of hormone injections, you will have to make frequent visits (usually at least five appointments in ten days) to your fertility clinic or doctor for vaginal ultrasounds to monitor your eggs and find the right time for harvesting.

The actual egg retrieval procedure takes only about 15-30 minutes, however, you will need to spend several hours after your retrieval at your clinic for observation before you can head home. People report that they usually can return to work and other normal activities within 1-2 days.

It takes most people 2-3 cycles to harvest the recommended 10-20 eggs for freezing. So, depending on your baseline fertility, age, and response to the ovulation stimulation medications, you can count on your egg freezing endeavor taking somewhere between 9-12 weeks, best case scenario.

Is egg freezing safe?

The actual procedure to harvest your eggs is a very low-risk surgical procedure. Egg harvesting carries about the same amount of risk as undergoing IVF. Surgical procedures like egg harvesting and IVF have small risks such as:

• Problems with the anesthesia (the medicines used to put you to sleep for the procedure)
• Injury from the needle passing through your vaginal wall to remove the eggs from your ovary
• Infection after the surgery

The main risks associated with egg freezing come from the regimen of fertility medications you take before egg harvesting (the ovarian stimulation protocol). These medications send your ovaries into overdrive, stimulating multiple eggs to develop simultaneously.

Fertility medications can cause something called ovarian hyperstimulation syndrome (OHSS). If the medicines over-stimulate your ovaries, they can swell, become painful, and cause fluid to build up in your belly, making you nauseous and bloated. One out of three women has symptoms of mild OHSS during controlled ovarian stimulation, but very few women go on to develop severe OHSS, which requires hospitalization.

Egg freezing also carries the emotional risk of undergoing a complicated and uncertain medical procedure. Many fertility medications can cause mood changes. The stress of navigating complex medication injections, multiple doctors’ appointments, and the unpredictability of the results can take a mental toll.

Navigating fertility or infertility can have psychological, financial, and socio-cultural consequences and it’s essential that you look out for your mental wellbeing. 

How many eggs should I store?

This calculation is based upon the biological reality that not every egg makes an embryo, not every embryo makes a pregnancy, and not every pregnancy makes a baby. Eggs are lost at each stage, from thawing, to fertilization, to development into an embryo, to transferring the embryo into a womb. And so, the chance that a single frozen egg will lead to a live birth is about 2 to 12 percent, according to the American Society for Reproductive Medicine. 

So what is the magic number? Fertility experts and clinics worldwide seem to land on the number ten. Research shows you may expect to retrieve about 14 mature eggs on average if you’re 36 and under, about ten if you’re 37-39, about nine if you’re 40-42, and about seven if you are 43 or older.

How long can eggs stay frozen?

Babies have been born from eggs frozen for as long as 14 years. Most people store eggs for five to 10 years. In vitrification, scientists remove the fluid from your eggs and replace it with a chemical version of antifreeze that increases successful fertilization, implantation, and live birth rates.E mbryos do tend to thaw better than unfertilized eggs. If there is a partner in the picture or already a plan to use donor sperm, it’s worth considering freezing embryos. It’s possible to do a mix of both embryos and unfertilized eggs.

The bigger time limits on egg freezing are age and the cost of storage. As people become older (in their 40s and 50s), IVF success rates decline, and they are at higher risk for miscarriage and other pregnancy complications. The chance of becoming pregnant after implantation is roughly 30 to 60 percent, depending on how old you are when you freeze your eggs. Some people opt for a surrogate, which carries a separate set of considerations and costs. 

Your egg freezing decision

The decision to freeze your eggs can seem almost as big as deciding whether you want to become a parent. Egg freezing is one option that can buy you some time as you consider parenthood. However, it’s not for everyone. If you’re in the process of making this decision, speak with your provider for guidance and to your community for support. 

Reviewed by the Ovia Health Clinical Team

Read more

• Should I freeze my eggs
• Egg freezing step by step

Sources

• Mesen, Tolga B et al. “Optimal timing for elective egg freezing.” Fertility and sterility vol. 103,6 (2015): 1551-6.e1-4. doi:10.1016/j.fertnstert.2015.03.002. 
• Cil AP, Bang H, Oktay K. Age-specific probability of live birth with oocyte cryopreservation: an individual patient data meta-analysis. Fertil Steril. 2013 Aug;100(2):492-9.e3. doi: 10.1016/j.fertnstert.2013.04.023. Epub 2013 May 24. PMID: 23706339; PMCID: PMC3888550.
• “Cost of Egg Freezing.” USC Fertility. University of California, San Francisco. January 27, 2019. https://uscfertility.org/egg-freezing/cost/. 
• Carnegie, Megan. “More Companies Offer Fertility Benefits. It’s Only the Beginning.” Wired. Conde Nast. December 1, 2021. https://www.wired.com/story/fertility-benefits-work/. 
• “Frequently Asked Questions.” SART. Society for Assisted Reproductive Technology, https://www.sart.org/patients/frequently-asked-questions/. 
• “Ovarian Hyperstimulation Syndrome (OHSS).” Reproductive Facts. American Society for Reproductive Medicine. 2014. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/ovarian-hyperstimulation-syndrome-ohss/. 
• Kumar, Pratap et al. “Ovarian hyperstimulation syndrome.” Journal of human reproductive sciences vol. 4,2 (2011): 70-5. doi:10.4103/0974-1208.86080. 
• Hasanpoor-Azghdy, Seyede Batool et al. “The emotional-psychological consequences of infertility among infertile women seeking treatment: Results of a qualitative study.” Iranian journal of reproductive medicine vol. 12,2 (2014): 131-8.
• Vaughan DA, Leung A, Resetkova N, Ruthazer R, Penzias AS, Sakkas D, Alper MM. How many oocytes are optimal to achieve multiple live births with one stimulation cycle? The one-and-done approach. Fertil Steril. 2017 Feb;107(2):397-404.e3. doi: 10.1016/j.fertnstert.2016.10.037. Epub 2016 Dec 1. PMID: 27916206.
• R.H. Goldman, C. Racowsky, L.V. Farland, S. Munné, L. Ribustello, J.H. Fox, Predicting the likelihood of live birth for elective oocyte cryopreservation: a counseling tool for physicians and patients, Human Reproduction, Volume 32, Issue 4, April 2017, Pages 853–859, https://doi.org/10.1093/humrep/dex008
• Mayo Clinic Staff. “Egg Freezing.” Mayo Clinic. Mayo Foundation for Medical Education and Research. April 23, 2021. https://www.mayoclinic.org/tests-procedures/egg-freezing/about/pac-20384556. 
• “Can I Freeze My Eggs to Use Later If I’m Not Sick?” ReproductiveFacts.org. American Society for Reproductive Medicine. 2014. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/can-i-freeze-my-eggs-to-use-later-if-im-not-sick/. 

Here are some common triggers to look out for and some guidance on how to find relief

Triggers

Migraine triggers are different for everyone. The way they work is complicated and involves the blood vessels, neurons, and chemicals, in and around your brain. What sets off a migraine for you may not be the same thing that sets it off for someone else. That being said, here are frequently reported triggers.

Stress

Stressful situations can often set off a migraine for a number of reasons. During stressful events, chemicals are released in the brain. These chemicals can start a cascade within the brain that results in dilated blood vessels that throb, and increased sensitivity in the pain receptors in the areas affected. Feeling anxiety or worry can also increase muscle tension, making a migraine more severe. 

Hormonal changes

Some women notice that migraines are more prevalent during certain times in their cycle. The abrupt dip in estrogen before your period can lead to a migraine. Other hormonal changes such as starting birth control pills, entering menopause, and beginning hormone replacement therapy can also cause more frequent migraines. 

Sleep changes

The link between sleep and migraines isn’t completely clear. But in one study, over 50% of participants reported lack of sleep or sleeping in late increased their chances of getting a migraine. Poor quality sleep has also been associated with increased migraines. And at the same time, many people report that sleep helps relieve their migraines once they’ve started.

Sensory stimuli

Harsh, flashing lights, as well as loud noises, can prompt migraines. Some people even find that certain smells such as strong perfume or smoke are triggers.

Food

Additives in food such as preservatives, aspartame, and nitrates are also common triggers. You may find that eating foods you are allergic or sensitive to may also cause migraines. 

Weather

People who suffer from migraines can be very sensitive to weather changes. For some, weather changes lead to changes in serotonin and other chemical levels in the brain, which can induce a migraine. Weather-related triggers include:

• Bright sunlight
• Rain or stormy weather
• Extreme cold or heat
• High humidity
• Dry air
• Barometric pressure changes

While these triggers are the most common ones, people report all sorts of things that lead to migraines such as physical exertion, decreased caffeine intake, and certain medications. It can be helpful to keep a migraine journal and jot down when you get a migraine. You can get to the bottom of your triggers by detailing the date and time the headache occurred and information about what you did or experienced in the hours leading up to the attack.

Tips for managing migraines

The best way to deal with migraines is to prevent them from happening altogether. Once you know what sets off your migraines, try to avoid those things to the best of your ability. Here are some lifestyle changes that can mitigate migraine attacks:

Sleep

Try to get a consistent eight hours of sleep every single night.

Stay hydrated

Make sure you are drinking the recommended eight glasses of water a day.

Eat regular meals

Eat when you’re hungry and be careful to not skip meals to help control the frequency of migraines.

Try acupuncture

According to research conducted by Cochrane, patients who tried traditional acupuncture to relieve chronic migraines found the frequency of their headaches was cut in half compared to those who did not receive traditional acupuncture. 

Minimize stress

This may be easier said than done, but minimizing stress in your life will definitely help ward off migraines. Don’t know where to start? Try Ovia’s Daily self-care checklist in the “More” menu. 

Finding relief

Sometimes, you are unable to avoid a migraine trigger, or you don’t notice the warning signs of an impending migraine until it hits you. Here are some ways to find relief when a migraine strikes.

• Have some caffeine: Small amounts of caffeine can help reduce pain and can help over-the-counter pain medications such as acetaminophen work better.
• Reduce noise and light: Migraines often lead to increased sensitivity to light and sound. Even regular lighting and noises can amplify the pain of a migraine, so the best thing to do in that situation is to get into a dark, quiet room.  
• Place a cool cloth or ice pack on your head: Many people find the cooling sensation of a dampened cloth or ice pack relieves some of the throbbing pain. 
• Drink water: Since dehydration can lead to migraines or make them worse, taking slow sips of water can help ease some of the tension from a migraine. 
• Medication: There are two categories of migraine medications: preventive and abortive. People who suffer from four or more migraines a month may get a recommendation from their healthcare provider to take preventative medication. Those who have migraines less frequently may be prescribed abortive migraine medication that they take when they feel a migraine coming on. 
• Sleep: We can’t stress the importance of sleep enough! Sometimes, the best way to deal with a migraine is simply to sleep it off. 

Reviewed by the Ovia Health Clinical Team

Sources

• Michael J. Arnold, MD and Jeanette M. McIntyre, MD. “Acupuncture for Migraine Prevention.” Am Fam Physician. July 1, 1996. https://www.aafp.org/afp/2017/0701/p23.html.
• Jerry W. Swanson, M.D. “Migraines: Are they triggered by weather changes?” Mayo Clinic. Mayo Clinic. May 10, 2019. https://www.mayoclinic.org/diseases-conditions/migraine-headache/expert-answers/migraine-headache/faq-20058505.
• “Migraine Headaches.” Cleveland Clinic. Cleveland Clinic. March 3, 2021. https://my.clevelandclinic.org/health/diseases/5005-migraine-headaches.
• Mayo Clinic Staff. “Migraine.” Mayo Clinic. Mayo Clinic. July 2, 2021. https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201.
• F Michael Cutrer, MD. “Pathophysiology, clinical manifestations, and diagnosis of migraine in adults.”UpToDate. UpToDate. November 5, 2020. https://www.uptodate.com/contents/pathophysiology-clinical-manifestations-and-diagnosis-of-migraine-in-adults.