Egg Freezing 101
More people are taking charge of when they want to start and grow their families and egg freezing has become an invaluable tool for preserving and prolonging fertility. But what is egg freezing? And who should opt for the procedure? Below, you’ll find an explanation of what oocyte cryopreservation is, what to expect during the egg-freezing cycle, and how egg freezing can fit into your family planning.
What is egg freezing?
The clinical term for egg freezing is oocyte cryopreservation. Oocyte is the scientific name for the ovum or egg. Egg freezing is a process where mature eggs are retrieved from your ovaries, frozen by a method called vitrification, and then stored at a cryopreservation facility until you are ready to begin IVF treatment.
This technology was developed to forestall the effects of aging on female fertility. The reality is that women only have so many years before their fertility begins to decline and are born with all the eggs they will ever have. This is referred to as your ovarian reserve. Egg freezing not only ensures that you will have viable eggs when you want to start having kids, it also saves them from the impact aging has on egg quality.
The National Institutes of Health defines fertility preservation as “the process of saving or protecting eggs, sperm, or reproductive tissue so that a person can use them to have biological children in the future.” Egg freezing is widely used for this purpose. There are medical treatments, like radiation or chemotherapy for cancer, that can damage the reproductive organs and result in infertility. Similarly, if you have been exposed to toxic chemicals or have a disease that affects future fertility, freezing your eggs can preserve your ability to have biological children.
Who can freeze their eggs?
Egg freezing is for anyone who has a healthy amount of eggs left in their ovarian reserve, which is usually determined by their anti-müllerian hormone (AMH) test. However, even with a low AMH, it is still possible to freeze eggs. It may simply require multiple egg-freezing cycles to retrieve a suitable number of eggs. So, in other words, anyone who has enough ovarian reserve to support the egg-retrieval process, and who can afford the up-front costs as well as the yearly storage fees, can freeze their eggs. As egg freezing grows in popularity, more insurance companies are offering full or partial coverage for the procedure, which makes it much more accessible.
The egg-freezing process
What exactly does freezing your eggs entail? First of all, you should know that it isn’t a one-and-done procedure. The whole process, not including initial consultation and fertility testing, can take anywhere from two to six weeks, depending on your clinic’s process. The reason for this is that you will need to take special fertility medication to stimulate your ovaries to produce more than the one mature egg you would usually produce in a menstrual cycle. Below, you’ll find a breakdown of each step of the process.
Consultation and initial fertility testing
Your first step is to meet with a fertility specialist. You can get a referral or find a fertility clinic on your own if you aren’t working with a fertility specialist already. During this appointment, they’ll review your medical history, walk you through the procedure, and answer any questions you have. They will also schedule you for fertility testing.
Basic fertility testing will help assess your overall reproductive health and typically involves blood tests to determine your anti-müllerian hormone (AMH) & FSH levels, and an ultrasound. The blood tests are to determine your hormone levels and to screen for infections. The ultrasound is to check that your ovaries are healthy and to assess your ovarian reserve.
Once your results come back, you will have another appointment to review them with your fertility specialist. At this point, you’ll get a rough idea of how many eggs you can expect to freeze from this retrieval. (However, you can’t know for sure how many you will actually have until they’ve been retrieved.)
When you get your test results, you’ll also be prescribed your personal medication protocol. These are the fertility medications we mentioned above. Typically, ovulation induction agents and gonadotropins are used to stimulate ovulation. These medications will overstimulate your ovaries in order to produce multiple mature eggs.
The medications are taken by injection and orally, and you will be shown how to administer each. You’ll also be given a schedule for when you need to take them and when to start. This part of the process takes about two weeks, and you may have to go in for frequent appointments to monitor how you’re responding to the meds.
When your fertility specialist deems that your eggs have reached maturity, they will administer what’s known as “the trigger shot.” This is a dose of either hCG hormone or Lupron, and it helps to mature the eggs enough that they release from the follicle wall, and to prevent you from ovulating prematurely ahead of your egg retrieval procedure.
Your actual retrieval procedure will be scheduled for 36 hours (about one and a half days) after your trigger shot. The procedure itself can take between 30 minutes to an hour. You’ll be under general anesthesia while your doctor uses an ultrasound-guided needle to aspirate your egg follicles and suction the eggs to be frozen.
By the time you wake up from the anesthesia, your fertility specialist will know the exact number of eggs retrieved. Some eggs may not have matured sufficiently, and they will be cultured in the lab for an extra day to give them time to reach full maturity. At this point, the most important thing you need to do is rest. You’ll need to take the remainder of the day off as you won’t be up to doing much, let alone going to work.
In the days after the procedure, you may experience cramping and constipation, as well as some soreness or discomfort. This is normal and should pass in four or five days. You can expect to get your period between 7 and 14 days after your retrieval.
Frozen egg storage
As mentioned previously, your eggs will be frozen within 24 hours of retrieval. Before this happens, an embryologist will verify that the eggs are mature enough. This is to ensure that each has the potential to become fertilized. Afterwards, your eggs go through vitrification, a method of putting eggs into a deep freeze. They’re then stored in liquid nitrogen tanks in an embryology lab.
When deciding where you’re going to store your eggs, you want to look for a facility that meets the following standards:
- There are around-the-clock monitoring systems with alarms to ensure equipment is functioning properly and the correct temperature is being maintained.
- Manual checks of temperatures are performed.
- There are embryologists who oversee lab operations, as well as a lead embryologist who is certified as a high-complexity laboratory director.
- The facility has been certified by the Clinical Laboratory Improvement Amendments, a government agency that regulates all laboratory testing.
Whether you store your eggs at a fertility clinic or at a dedicated cryopreservation facility, these are widely considered best practices.
How do you use frozen eggs to conceive?
When deciding to freeze your eggs, it’s important to consider what the process will be to use them in future. Freezing your eggs means committing to in vitro fertilization (IVF). This is because the only way to get pregnant using frozen eggs is to have them fertilized in a lab and then transferred into your uterus during your window of implantation (WOI). In fact, the egg-retrieval procedure you will undergo to freeze your eggs is the exact same procedure that women undergo in the first stage of IVF treatment.
What is in vitro fertilization (IVF)?
In vitro fertilization (IVF) is one of the most common types of assisted reproductive technology (ART). It involves retrieving viable eggs that are fertilized outside the body and then transferred to the lining of the uterus for implantation. An IVF cycle typically consists of these five steps:
- Pre-cycle fertility testing for women
Before treatment can begin, testing is done to better understand your fertility status.
- Stimulation of the ovaries to produce several eggs during one menstrual cycle
A regimen of injectable medications is administered over a two-week period to induce the production of multiple eggs in one cycle.
- Retrieval of the eggs from each ovary
An outpatient surgical procedure is performed to extract the mature eggs from your ovaries.
- Fertilization of the eggs in a laboratory by either conventional fertilization or intracytoplasmic sperm injection (ICSI)
Your eggs will be fertilized by the provided sperm sample, and the resulting embryo will be watched over by an embryologist for about five days.
- Embryo implantation into the uterus
Once your embryos have adequately matured in the lab, there is another outpatient procedure to transfer an embryo into your uterus for implantation.
- Freezing of embryos for future use
Embryos can be frozen and stored once they’ve reached adequate maturity. They can then be thawed at any point and used in a frozen embryo transfer (FET).
Frozen embryo transfer (FET)
In vitro fertilization can be done in one of two ways. You can do a fresh embryo transfer, where eggs are retrieved, fertilized, and transferred in the same menstrual cycle. Or you can do a frozen embryo transfer (FET) with eggs or embryos that were frozen after a prior egg retrieval. If you’ve frozen your eggs, you will use this method.
The data suggests that FET tends to have better IVF success rates. This is likely because the medication that stimulates ovarian production can negatively impact endometrial receptivity. By waiting to do the embryo transfer during a different menstrual cycle, you can focus on preparing the lining of your uterus to receive an embryo.
Another benefit of FET is that it’s possible to do it without any hormone medications at all. If you aren’t affected by any of the complications relating to infertility, it’s possible you may not need any extra help in creating the ideal uterine environment to support a pregnancy.
How many eggs should you freeze?
Every body is unique. The number of eggs you freeze is ultimately dictated by your age and the quality of your ovarian reserve. When deciding the number of eggs you want to strive for, there are a couple things to keep in mind. As your doctor will tell you, one egg does not equal one pregnancy. Instead, it is recommended that women aim to freeze 10 eggs per child they wish to have.
This is because not every egg fertilized will develop into a high-quality, viable embryo. While the average number of eggs retrieved in a single cycle varies by age, it is safe to assume that if you want multiple children, you will need more than one retrieval to bank enough eggs.
Are there risks to freezing your eggs?
As with any surgical treatment, there are risks to the egg-retrieval procedure, but they are minimal. There is a slight chance of infection caused by the needle used. However, your specialist will be using ultrasound to guide the needle, so infections are relatively rare and easily treated with antibiotics.
A bigger concern is ovarian hyperstimulation syndrome (OHSS). This is a condition where the body is overly responsive to fertility medications. It can cause the ovaries to become painfully enlarged, among other symptoms. Fewer than 1% of women experience severe cases of OHSS. As part of the monitoring during the medicated phase of egg retrieval, your fertility specialist will be watching for any signs of OHSS. If you do experience OHSS, your symptoms should resolve once you have your period.
How much does it cost to freeze your eggs?
Freezing your eggs can be expensive. There are costs for consultation, testing, medication, and the egg-retrieval procedure. You will also have to pay yearly for storage at a clinic or facility. All of this adds up, with a price tag of between $11,000 and $20,000.
Fertility coverage is starting to include egg freezing, but how much is covered will depend on your insurance and whether you can find a clinic that is in-network. Companies like Lilia have also begun offering egg-freezing packages at a more competitive rate.
When should you freeze your eggs?
When considering this question, it’s important to note that egg freezing was deemed an experimental procedure until fairly recently. As a result, the data that tracks the use of frozen eggs only goes back less than ten years.
That said, the general convention is that women should freeze their eggs between ages 32 and 36. Women in this age range are both young enough that their egg quality is still high and old enough to be the most likely to use the eggs they’ve frozen.
Women who freeze their eggs in their 20s are less likely to make use of their frozen eggs to get pregnant. As more women freeze their eggs, this trend may change.
Why do women choose to freeze their eggs?
The decision to freeze your eggs is a deeply personal one. Even so, there are a few common reasons women cite in their decision. Some haven’t yet found a partner they want to start a family with, and they want to make sure they’ll be able to get pregnant when the time comes. Others want to be more established in their careers when they start having kids. Egg freezing also allows women the possibility of preimplantation genetic testing (PGT) if they have concerns about passing on any hereditary conditions. Whatever your reasons, freezing your eggs will give you the freedom to start and grow your family on your own terms and timeline.