There is really no way to stop the aging process. While an unhealthy lifestyle can speed up fertility decline (smoking, for example, ages the ovaries prematurely), healthy living doesn’t slow things down. That said, there is one way to stop the aging process of individual eggs—and that’s with cryopreservation, or elective egg freezing. Eggs frozen in your 20s or early 30s will maintain their “young” status even if they are thawed and used 10 years later. For some women, cryopreservation isn’t about hoping to delay childbearing. Women who are diagnosed with certain cancers and will be undergoing treatments that could damage their ovaries can consider cryopreservation as a way to preserve their fertility, or to have the option of using a gestational carrier so they can potentially have a baby conceived with their own genetic material. To be clear, cryopreservation won’t give you the same odds of getting pregnant as if you had tried naturally at the age of freezing. (Your best odds to get pregnant are via sexual intercourse in your 20s or early 30s.) But those frozen eggs will be much higher quality than any oocytes retrieved years later. Here’s how to freeze your eggs, from choosing a clinic to (hopefully) having a baby.
First, Thoroughly Research Elective Egg Freezing
Deciding to freeze your eggs can be an empowering experience—but only if you go into it with all the facts. Do you understand the risks? Fully understand the costs? Do you know what the success rates are, in general, and, specifically, for your current age? For example, a woman who freezes at age 30 is more likely to have success than a woman who freezes at age 38. One of the most important things to know is that egg freezing comes with no guarantees. Sometimes, egg freezing is referred to as “fertility insurance.” That’s inaccurate. Insurance pays when you make a claim. Your frozen eggs may or may not get you a baby. Before you start looking for a doctor, research the realities of egg freezing. Read from sources that are pro and against egg freezing. It’s a controversial subject, with no clear-cut answers. Also, be aware that while egg freezing informational sessions hosted by fertility clinics can offer you some insight, they are primarily marketing events. They are intended to sell you fertility preservation service. Take in their information, but don’t use them as your only source.
Choosing a Doctor and Fertility Clinic
To freeze your eggs, you’ll need to find a fertility clinic. More specifically, you want to find a fertility clinic with an excellent lab, and you want a doctor who is experienced with working with elective egg freezers or egg donors. Why specifically elective egg freezers or egg donors? Because these are women with good fertility, and they need a different kind of attention and care during ovarian stimulation than infertile patients. Also important—you will want to choose a lab that has the experience and skills to not only freeze your eggs, but also thaw and fertilize them later. Just having experience with freezing is not enough. “I feel pretty strongly that a place that is going to take your money to freeze your eggs should have experience to say we know what to do with your eggs when you want to thaw them, and have the pregnancy results to stand by,” explains Diana Chavkin, MD, a board-certified fertility specialist at HRC Fertility in Los Angeles, California. Finding a clinic with experience is key. “Some clinics offer fertility preservation without having done large numbers of freeze/thaws to make sure they are proficient with the procedure,” says Kevin Doody, MD, a reproductive endocrinologist at the Center for Assisted Reproduction (CARE Fertility) in Dallas, Texas. “It will be years in some cases before some patients know if their eggs survived.” Note that not every fertility clinic will list on their website that they offer elective egg freezing. The American Society for Reproductive Medicine (ASRM) has advised against direct marketing to women for elective cryopreservation. This is why it may not be obvious they offer the service, even if they do and may have been offering it for years. Remember, too, that a lab’s egg-freezing experience goes beyond elective egg freezing. Egg freezing—along with the thaw and fertilization process—can be a part of conventional IVF treatment, an egg donor IVF cycle, as well as part of medically-necessitated fertility preservation. The advice given to infertile patients on how to choose a fertility clinic is similar to those looking for elective egg freezing. That said, here are more questions you should ask:
For how many years has your lab offered elective egg freezing? (Since 2013 is a good answer.)Have you had any pregnancies result from cryopreserved eggs in your your lab?This year, how many egg-freezing-thaw cycles have you done, and out of that total, how many clinical pregnancies occurred?How much does an egg freezing cycle cost?On average, how many cycles do your egg freezers need?
Consultation With the Reproductive Endocrinologist
After you find a clinic (or two) that you’re interested in working with, your next step is to have a consultation appointment with a reproductive endocrinologist (or fertility specialist). This appointment may be free or may have a cost. The primary purpose of this appointment is for you to talk to the doctor about what you’re looking for and provide some of your health history, and for the doctor to describe the egg freezing process, answer any questions you have, give you the (approximate) odds of success, and discuss the possible risks of the procedure. The consultation appointment is there to help you make an informed decision on whether to freeze or not. Don’t be afraid to ask as many questions as you need. Especially make sure to ask what the doctor thinks your realistic expectations of success are, based on your current age. They will be able to give a better idea after some fertility testing.
Discussing the Costs of Egg Freezing
Before any testing or treatments begin, be sure you are aware of the complete costs before signing on. Most clinics will not be able to give you a good idea of the full price until after a consultation appointment and possibly some initial fertility testing. This is because how many cycles you may need is partially dependent on your age and current ovarian reserves. Some of this won’t be known until you’ve gone through at least one cycle. That said, estimates and averages should be available before you even sit down to talk with the doctor. When asking about price, make sure you get a complete quote that includes:
Consultation appointmentsFertility testing (some may be covered by your health insurance)Fertility drug costsMonitoring of the egg freezing cycleThe actual egg retrieval and cryopreservationYearly storage of the eggs
Find out if the price for freezing includes the first year or 6 months of storage, or if that fee is in addition to the price quoted. If you don’t have the full cost information, you can’t compare that to what other clinics may be offering. Don’t be afraid to talk to more than one clinic, but don’t make your decision solely on price either. Your money will be wasted if the clinic doesn’t have the expertise to handle your eggs. On average, one egg freezing cycles is between $9,000 and $17,000. Storage fees range from $300 to $500 per year. You may need more than one cycle to bank enough eggs, and more cycles may be needed if you’re age 35 or older. Some clinics will also offer a set price for the thaw-fertilization-embryo-transfer process up front (this is the part of the procedure that would occur if you decide to use your eggs in the future). Considering inflation and rising costs of medical treatment, this is worth considering when choosing a clinic. You may never need to use that portion of the service. Hopefully you will get pregnant on your own whenever you’re ready to start trying to conceive. However, having an agreed-upon price up front can help you plan and may reduce your costs later, if you need to use your eggs.
Initial Testing Stage
The primary goal of testing before egg freezing is to evaluate your current fertility status and confirm that you have no active sexually transmitted diseases (STD/STIs). If you do have an STD, you can still freeze your eggs. You will just need to have the infection treated first. An active infection could increase the risk of general infection during the procedure, which can put your fertility (and even your life) at risk. Another thing your doctor will be testing is your ovarian reserves. This is done with blood work, looking at your hormone levels of AMH and FSH. You may also have an antral follicle count, which is a specialized ultrasound test. Ovarian reserve testing gives your doctor an idea of how many eggs you have in your ovaries. It’s not an exact count—we don’t have the technology to provide that answer. It also can’t say what your odds are of getting pregnant on your own, without fertility treatment, nor can it tell you “how many years” you have left of natural fertility. What we do know is that if a woman’s ovarian reserves are low, she is less likely to respond favorably to fertility drugs. This means IVF treatment is less likely to be successful, and, in terms of egg freezing, it means that retrieving a good number of eggs is less likely. What happens if your ovarian reserves are found to be low? This is something to discuss with your doctor. This is more likely if you’re in your late 30s or early 40s. “Older women are not good candidates for fertility preservation,” says Dr. Doody. “Their chance of pregnancy is low with fresh eggs and lower with frozen.”
Planning the Egg Freezing Cycle
Once you’ve agreed on the financials, completed all the pre-freeze fertility testing, and asked your questions on the procedure, it’ll be time to schedule your egg freezing cycle. The date will be chosen based on your menstrual cycles. You’ll need to order all the fertility drugs for the cycle before anything begins. These will primarily be injectable hormones. Someone at the fertility clinic will explain to you how to handle and use the fertility drugs. You will be giving yourself the injections (or, you can have your partner or a friend do it for you, if you’re too squeamish to do it yourself). The injections will most likely be into the fatty tissue of your abdomen. You’ll start taking some medication before that next period begins.
Injectable Medications Used During Egg Freezing
Depending on your doctor’s protocol, you may be giving yourself between one and three injections a day. This may vary depending on where you are in your cycle. These fertility drugs have two primary purposes: to stimulate the eggs in your ovaries and to maintain control over the ovulation process so the eggs don’t ovulate before they can be retrieved. Fertility drugs that you may be taking include:
Gonadotropins, which are bio-identical hormones to the ones your body produces during a normal menstrual cycle GnRH antagonists or GnRH agonists, which help your doctor maintain control over the ovulation process
The most common side effects of these medications include headaches, hot flashes, bloating, mood swings, nausea, and dizziness. Your injection sites may be slightly sore or red. Of course, every person reacts slightly differently to the hormones. If you’re concerned about any side effect you’re experiencing, talk to your doctor. A serious risk of fertility drug use is ovarian hyperstimulation syndrome, or OHSS. Up to 10% of women going through IVF or egg freezing may experience mild OHSS. Mild OHSS can cause discomfort, including bloating, mild weight gain, nausea, and diarrhea. In severe cases, OHSS can lead to loss of fertility and even death. Severe symptoms of OHSS include rapid weight gain, several abdominal pain, severe bloating, severe vomiting, trouble urinating, dizziness, shortness of breath, or rapid heartbeat. Report to your doctor if you have symptoms of OHSS.
Monitoring of the Cycle
Another important part of the process is monitoring the egg (or follicle) growth in your ovaries. Your doctor wants to find the sweet spot of stimulating the ovaries to mature enough eggs to bank, but not over stimulating them and triggering ovarian hyperstimulation syndrome (OHSS). Expect to have blood work and transvaginal ultrasounds every few days, and possibly every day, as you get closer to the egg retrieval procedure.
Egg Retrieval and Egg Freezing
The injections and monitoring of your ovaries will take 2 to 3 weeks. Once the follicles reach a certain size and stage of maturity, your doctor will schedule the egg retrieval. You will be under sedation for the egg retrieval. During this procedure, your doctor will use an ultrasound-guided needle to go through your vaginal wall and up to your ovaries. There, your doctor will carefully “suction” each follicle with the needle. Inside each follicle is an egg. The eggs will then be taken to the lab where an embryologist will use vitrification to cryopreserve them. The container with your eggs will be carefully labeled and placed in a storage decide, to keep them frozen and safe until you’re ready to use them in the future. You may experience some cramping and spotting after the egg retrieval. There is a rare risk of infection. If you develop a fever or increasing pain, tell your doctor right away. There are also risks to the sedation, which your doctor should explain to you.
When You’re Ready to Try to Have a Baby
Your eggs can stay on ice indefinitely (as long as you keep paying for their storage). Once you decide you want to try and have a baby, you will first attempt it without the cryopreserved eggs. That may be via sexual intercourse with your partner, or with a sperm donor and insemination. Depending on your age, you may try for 6 months or a year. In some situations, your doctor may recommend that you go immediately to using your frozen eggs. When it is time to use cryopreserved eggs, your doctor will likely do a new fertility evaluation at that time. If you have a male partner, he will need a semen analysis. Remember that your fertility is only half the equation. Then, together with your doctor, you’ll determine a plan of action. For the treatment cycle, you’ll take hormones to control the cycle and prepare the endometrial lining. Some of your cryopreserved eggs will be thawed in the lab. Those that survive the thaw will be fertilized with either your partner’s or a donor’s sperm. The eggs will need to be fertilized using ICSI, or intracytoplasmic sperm injection. Hopefully, you will get a few healthy embryos. One or two of those embryos will be transferred to your uterus. After the embryo transfer, you may need to take progesterone supplementation via injection or vagina suppository. Then, you wait and hope for a positive pregnancy test 2 weeks later.
What Happens If I Don’t Get Pregnant With My Frozen Eggs?
It’s a possibility few women consider, but you may not be able to conceive with your cryopreserved eggs. This may occur for several reasons, including the eggs not surviving the thaw, the eggs not fertilizing, not getting any healthy embryos, or just failure of the pregnancy to “stick.” Once all your cryopreserved eggs are used up, your options depend on your current fertility situation. You may be able to keep trying to get pregnant with IVF treatment, using the eggs in your ovaries at this time. However, if your ovarian reserves are low, or your ovaries have not been responsive to fertility drugs, you may need to consider using an egg donor. Embryo donor IVF is another possibility. Alternative options (outside of fertility treatment) include remaining childfree, foster parenting, or adoption.
What If I Never Use My Frozen Eggs?
Most women will not use their frozen eggs. “I think that many women will not use the eggs that are cryopreserved,” says Dr. Doody. “They will either conceive spontaneously and not need them, or desire to remain childless.” So, what happens to your unused cryopreserved eggs?
You could keep them on ice and continue paying. More realistically, you can have the eggs discarded. Throwing away the eggs is no different from the loss of a regular menstrual cycle. You’re not throwing away embryos, which some have moral or religious objections to. There may be an opportunity to donate them to scientific research. Another possible option is to donate them to an infertile couple and become an egg donor. This isn’t a decision to take lightly, and you should speak to a counselor and reproductive lawyer before making this choice.
If you want to donate your eggs, you may need to have gone through extra testing and information gathering at the time of egg freezing. If you think you might consider donating your eggs in the future, talk to your fertility doctor before you start the egg freezing process.
