If you're thinking about egg freezing, and you've started to do your research, you're probably coming across a lot of information that can be legitimately overwhelming. Don't panic! We're here to help you organize your brain with 8 important facts about this potentially life-altering procedure.
It's not an insurance policy
Let's start with a common misconception (no pun intended) — while egg freezing may take some of the stress off of you in terms of knowing your baby-having timeline right now, it's not necessarily a sure-fire way of guaranteeing your forever fertility. Why? Not all the eggs you freeze are going to be viable; think quality as well as quantity in this situation.
How many eggs survive the warming process and can be successfully fertilized depends on how old you were when you froze them (more on this later), and how many are healthy and viable once they come out of storage. Plus, fertility does change with age, so if you freeze your eggs at 25 and use them when you're 35, you will have to contend with the realities of being pregnant at that age because pregnancy complications increase with maternal age.
These aren't arguments for freezing or not freezing your eggs — only you and your doctor can decide if that's the right decision for you — but you should know going in that it's not a matter of freezing and forgetting.
There's no perfect age at which to do it - but there are better ages
According to the American Society for Reproductive Medicine (ASRM), an optimal time to freeze your eggs is in your 20s and early 30s, while you (presumably) still have a sturdy ovarian reserve (the number of eggs in your ovaries) and those eggs are healthier when you are younger. Having your hormones tested (with, for example, Modern Fertility), can tell you a lot about the state of your ovarian reserve, and help you decide, with the input of your doctor, if you should consider egg freezing. Egg freezing is not recommended for women over age 38.
Egg harvesting or egg retrieval is an intense procedure.
There's a lot that goes into egg freezing, before you even get to the part where the eggs are actually frozen. First, you'll have blood drawn to evaluate your ovarian reserve and screen for infectious diseases. You might also have an ultrasound done to see what's up with your overall ovarian function. Then, you'll take synthetic hormones that stimulate your ovaries to grow a cohort of follicles (the cells that house and protect your eggs), and, at the same time, medicine to prevent you from ovulating before egg retrieval. After an ultrasound has confirmed that your follicles are ready for egg retrieval, you'll give yourself an injection of human chorionic gonadotropin, to help those eggs mature. The retrieval itself happens in a doctor's office, with a transvaginal ultrasound aspiration (yes, you can be anesthetized for this procedure). An ultrasound probe is inserted into your vagina to locate the mature follicles. Then your doctor will insert a long, hollow needle through the vaginal canal to the ovaries, then suction is applied to remove the eggs one-by-one.
You can remove multiple eggs at a time, which is advisable, since it gives you the best chance of getting a healthy egg that can be fertilized. After the eggs are retrieved, they're cooled via a process called vitrification, during which the eggs are flash frozen in liquid nitrogen. Vitrification by liquid nitrogen dramatically increases the survival rate of eggs verses older technology, called “slow freezing.” A 2009 study revealed that eggs frozen via vitrification had a 91% survival rate, versus eggs that are frozen slowly (almost no clinics use slow freezing anymore), which had a 61% survival rate.
There can be side effects
After egg retrieval, you will likely be able to resume your normal activities within a week, but it's vital to note that everyone's body is different. (Write this down and put it somewhere you can see it all the time.) You will likely experience cramping and pain as a result of the retrieval procedure, as well as mood swings, as the result of all those hormones. This is normal, and will abate with time. Avoid making any life-changing decisions immediately after retrieval (you know, other than the one you just made to freeze your eggs). You can also definitely get pregnant during this time, since there could be some eggs hanging around that didn't get retrieved, so steer clear of unprotected sex.
Watch out for symptoms like weight gain and bloating, which can be indications of ovarian hyperstimulation syndrome, a reaction to the fertility drugs that promote ovulation. The likelihood that you'll get ovarian hyperstimulation syndrome is a lot lower than it used to be, thanks to the establishment of risk factors (polycystic ovary syndrome, for example) and by measuring AMH levels prior to ovarian stimulation, and thus individualizing the hormone protocol when prepping for retrieval.
In general, more longitudinal data is needed to really know the long term effects of the egg freezing process. Because long term hormone replacement is linked to increased breast cancer risk, the intense amount of hormones used in order to stimulate the ovaries of young egg donors (who endure the same process of egg retrieval) could potentially increase their risk of breast cancer, but the reality is that, right now, we simply don't know.
It can be a good option if you have certain health issues
You might want to consider egg freezing if you have cancer that requires chemotherapy or radiation (which could affect your fertility), or you need to have surgery that could damage your ovaries, or a condition that could damage your ovaries. Learning that you have a family history of early menopause, Turner's Syndrome (a chromosomal abnormality that comes with a risk of premature ovarian failure), or a genetic mutation (like BRCA, which can predispose one to developing breast and ovarian cancer) that leads to the decision to remove your ovaries, might also be good reasons to talk to your doctor about whether or not you're a good candidate for egg freezing.
It's expensive (and navigating insurance can be tricky)
If you are considering egg freezing, it's a good idea to get acquainted with the costs of the procedure, and what your insurance may or may not cover. According to FertilityIQ, the cost of an egg freezing cycle is between $15,000 to $20,000, and don't forget to take into account the cost of eggs storage, which can run you up to $1200 a year, depending on where you go (sometimes the first year of storage is free!). Should you decide to pull those eggs out and use them, the costs of in vitro fertilization vary, but you could be looking at cumulative costs of $40- 60,000. Many clinics offer shared risk options and packages, as well as loans and other financing options.
Coverage for fertility treatments like egg freezing varies, according to what insurance you have. Sixteen states do require insurance companies to supply coverage for infertility treatments, but that doesn't mean coverage is free; you're still responsible for copays if you have private insurance. You also have to qualify for coverage, and that means meeting the criteria for infertility — unable to conceive after one year of timed, unprotected sex, or, if you're over 35, six months of it, or if you've been unable to carry a pregnancy resulting in a live birth after a year. Be vigilant in investigating details if you live in one of these states (and with insurance in general), as there are nuances in each policy.
Should you freeze eggs or embryos?
First, some 101: eggs are unfertilized, and embryos are eggs that have been fertilized with sperm. Freezing yours eggs offers more options — you don't have to know who's going to fertilize those eggs and you can take some time to figure that out. Embryo freezing is useful if you have a cis male partner or a donor and want to get pregnant with that person via IVF. It's possible that you will end up with more embryos than you might want to use, and find yourself confronted with what to do with them: Discard? Donate? Keep them frozen? What happens to those embryos if you end your relationship with the person whose sperm was used? The same issues — how many will survive freezing, how many result in a successful pregnancy —apply, whether you're dealing with embryos or eggs, so ultimately, the answer as to what to do is between you, a partner (if you have one), and a doctor.
Get informed way in advance
It's easy (and understandable) to feel overwhelmed when making decisions about your fertility. Modern Fertility can help you take concrete steps now, so you can get an idea of whether or not egg freezing is something you might need to consider. For example, learning about what your AMH levels (which indicate your ovarian reserve) are now can help predict how successful ovarian stimulation — that's when you take hormones to generate eggs — might be, should you decide to freeze.
Modern Fertility's test can hook you up important information about your hormones, what they're up to, and what you might expect from them in the future (keeping in mind, of course, that there is no absolute predictor when it comes to this stuff) as well as support you with the means to talk about your results with your doctor, and your partner. You're not alone with your questions and concerns. We're here for you.