What to Consider Before Freezing Your Eggs
Egg freezing, a fertility preservation treatment that allows you to store unfertilized eggs for potential use in the future, has grown increasingly popular throughout the past decade. Between 2010 and 2016, the number of U.S. women who pursued the treatment increased by 880%. The trend has continued, with the Centers for Disease Control and Prevention (CDC) reporting that 123,304 egg freezing cycles were successfully completed in 2020 alone.
While egg freezing is a worthwhile experience for many women and people assigned female at birth, it is a deeply personal decision. There are many factors to consider as you evaluate if it’s right for you, including your individual health, finances, and family building goals.
Informing yourself about the process is a critical first step. Here’s an overview of what egg freezing entails — physically, emotionally, and financially.
Why should I consider egg freezing?
Egg freezing is an option for anyone interested in preserving their fertility for personal or medical reasons.
All people with ovaries are born with the total amount of eggs they’ll ever produce — about a million on average. Each person’s egg count decreases with time. While only one egg matures enough to be released from the ovaries during a typical menstrual cycle, thousands of follicles, or potential eggs, are lost each time your body prepares for ovulation. As a result, the quantity and quality of eggs start to steadily decline in the early 30s, with a more significant decline from the mid 30s on.
Though many women successfully conceive naturally after 35, there is a correlation between pregnancy rates and age. By allowing you to try to conceive at a later age with eggs collected earlier, successful egg freezing offers a more flexible timeline for family building, and, in many cases, peace of mind. While many pursue the process with clarity about their reproductive goals — and the intention of a future pregnancy — others are undecided about having children and simply wish to leave their options open.
Egg freezing is also an option for people whose fertility may be impacted by medical factors like the following:
- Cancer treatment: Some cancer treatments, including chemotherapy, radiation therapy, hormone therapy, and surgery of a reproductive organ, can impact a person’s fertility. For this reason, many women of reproductive age choose to freeze their eggs before starting treatment.
- Other health conditions: Many individual health factors can influence fertility. Treatment for conditions like endometriosis or benign tumors may include removal of the ovaries. Women with a family history of ovarian cancer may pursue elective removal of the ovaries.
- Gender-affirming surgery or treatment: The biological process of transitioning can permanently or temporarily impact a person’s ability to conceive. Many transgender men and transmasculine people freeze their eggs prior to hormone therapy or surgery.
What is the egg freezing process?
An egg freezing cycle is physically demanding, with self-administered injections and a minimally invasive procedure to retrieve your eggs.
In most cases the process begins with a transvaginal ultrasound, which allows your doctor to estimate your egg quantity. The following blood tests can provide additional information about the number of eggs in your ovaries:
- The anti-mullerian hormone (AMH) test measures your body’s levels of a hormone associated with ovarian reserve. It is a good indicator of egg quantity, but not egg quality.
- The follicle stimulating hormone (FSH) blood test measures your body’s levels of another hormone associated with your ovarian reserve.
Test results can also help your doctor predict your body’s response to fertility medications and tailor your treatment plan accordingly.
After the initial ultrasound and blood work, your doctor will prescribe stimulation medications to spur the growth of follicles, fluid-filled sacs in your ovaries that potentially contain an egg. These are some of the medications you may take during this stage:
- Gonal-f® or Follistim®
These medications are typically taken as nightly injections.
Ovulation suppression medications
Most ovulation suppression medications are typically introduced around days 5-10. These medications prevent premature ovulation — the body’s natural release of eggs from the ovaries — so that your doctor can retrieve as many eggs as possible.
These are some of the medications you may take at this stage:
- Cetrotide/Fyramedel™ (ganirelix acetate)
While leuprolide is considered a suppression medication, it is typically started at least a week prior to stimulation medications.
Once your eggs have sufficiently developed, your doctor will schedule 1-3 trigger shots to give your eggs a final growth spurt and trigger release.
Medications used for trigger shots include:
If your body doesn’t respond to the stimulation medications or you have a decreased ovarian reserve, your doctor may add one of the following ancillary medications to your protocol to increase your chances of success.
- Omnitrope® — a growth hormone whose main purpose is to help improve the quality of eggs
- Microdose leuprolide injections — a lower dosage of leuprolide used to boost ovarian response to stimulation medications
The final step in a successful cycle is egg retrieval. In this minimally invasive procedure, your doctor will gently guide a thin needle through your vaginal wall and use suction to draw the eggs from the follicles. Your eggs will then be stored in a facility for however long you choose to.
While the retrieval itself takes 15 to 45 minutes, you should plan to be at the clinic for several hours. Many people find it helpful to have a friend or family member accompany them to the clinic for support before and after.
Each cycle typically takes 10-14 days from the beginning of medication use to egg retrieval. You will have regular doctor’s appointments for additional ultrasounds and blood work while taking stimulation and ovulation suppression medications. Your doctor may adjust medication dosages based on your hormone levels.
If and when you decide to use your frozen eggs, they will be thawed, fertilized with sperm, and implanted into your uterus through the process of in vitro fertilization (IVF).
For some women, it is a viable option to freeze embryos, or fertilized eggs. There are several reasons a person might opt to freeze embryos:
- Some studies have found that frozen embryos have a higher thaw survival rate than frozen eggs.
- Embryos can undergo genetic testing, so you can learn of any chromosomal abnormalities before freezing them.
- You will also know that you are freezing an egg healthy enough for successful fertilization.
However, this option requires you to decide whose sperm to use early on in the process.
Hormonal birth control
Your doctor may recommend that you stop taking hormonal birth control before your egg freezing cycle, as it may affect fertility assessment results as well as your body’s response to fertility medications. Non-hormonal forms of birth control, like a copper IUD, should not interfere with the egg freezing process.
What else should I consider before freezing my eggs?
The egg freezing process affects both the mind and body, with physical and emotional side effects. While each person responds differently to the treatment, certain symptoms are common, including:
- Injection site reaction (soreness, redness, or mild bruising)
- Changes in mood such as heightened sensitivity, irritability, euphoria, or depression due to elevated estrogen levels
Alto’s fertility-trained pharmacists can help you navigate egg freezing side effects, with availability on nights and weekends.
Support with injections
Different injectable fertility medications require different administration methods. Most injections are administered subcutaneously around the abdomen. Intramuscular injections are typically administered in the upper, outer part of the buttocks, which can be more difficult to reach when self-injecting.
If your protocol includes intramuscular injections, consider asking for assistance from your partner, a friend, or a family member. If you need to self-administer, try standing in front of a mirror for a better view of the injection site. You can also ask a nurse or another clinic staff member to circle the injection site on your body so that you can find it more easily.
Like any medical procedure, egg freezing has the potential for some complications. Egg retrieval may cause bleeding and infection, though this is unlikely to occur in most cases.
One rare, but serious, complication of the process is ovarian hyperstimulation syndrome (OHSS), an abnormal reaction to stimulation and trigger medications. It is characterized by pain and swelling in the ovaries and sometimes the abdomen. OHSS is treatable, but there are times when a doctor will recommend ending treatment and starting a new egg freezing cycle in the future.
While many women successfully conceive with frozen eggs, it’s important to remember that fertility preservation treatment does not guarantee a successful pregnancy. There are many steps between egg retrieval and pregnancy, including successful thawing, fertilization, implantation, and continued embryo development.
It may also take several cycles to retrieve your target number of eggs, which your doctor will advise you on. An average of 10-15 eggs are needed to achieve a successful pregnancy. Depending on your age and reproductive health, your doctor may recommend freezing more eggs to increase your chances of successfully conceiving.
Not everyone who freezes their eggs will use them. Some women go on to conceive naturally while others decide not to pursue parenthood. As part of your planning, consider what you would do with unused eggs or embryos. Your options include donating them to a person or couple experiencing infertility or to researchers, or having them appropriately discarded by a clinic or storage facility.
Donating eggs will require additional blood work and testing prior to your cycle. Ask your clinic for additional information if you are interested in this option.
Before deciding to pursue egg freezing, it’s important to know how you will pay for the treatment. Egg freezing costs are ongoing, including not only the fertility medications, testing, blood work, and procedures, but also storage fees and in vitro fertilization. (Many clinics store eggs for up to a year as part of the cost of an egg freezing cycle. If your clinic offers this service, you will need to select another storage vendor after a year.)
The total cost of egg freezing depends on various individual factors. Your reproductive health and your age can influence how many egg freezing cycles your doctor recommends. Egg storage duration depends on your personal family building timeline.
It may not be possible to predict the exact total cost of egg freezing, but identifying your reproductive goals and learning more about your reproductive health can help you arrive at a solid estimate. An initial consultation with a fertility clinic is often a helpful first step, providing additional insight into personal health factors.
Some health insurance plans offer partial or full coverage of egg freezing-related costs, including medications and IVF. Note that most insurance plans have separate medical and pharmacy benefits. In most cases, professional services provided by your doctor or clinic will fall under medical benefits, and fertility medications will fall under pharmacy benefits.
A growing number of employers offer egg freezing coverage as part of employee benefits, separate from health insurance. If your employer doesn’t currently cover egg freezing, don’t be afraid to ask. RESOLVE: The National Infertility Association has resources to help you start the conversation.
Some fertility clinics offer financing and payment plans to help you manage or lower egg freezing costs. As you explore your options for clinics, we suggest asking these questions:
- Based on my specific treatment plan, what is the typical all-inclusive cost?
- What is included in the treatment cost and what is not?
- Is a year of egg storage included in an egg freezing package?
- Can you provide a detailed list of procedures and costs?
- What is the typical cost of fertility medications for my treatment plan?
- What financial assistance do you offer?
Additionally, some fertility medication manufacturers offer patient assistance programs to alleviate the cost of these expenses. If Alto is your fertility pharmacy, you are likely taking medications manufactured by EMD Serono or Ferring Pharmaceuticals. Both manufacturers have programs that lower the cost of fertility treatment.
Alto is committed to helping you save as much as possible on your fertility medications. Free same-day delivery makes it easy to manage last-minute changes to your treatment plan, preventing fertility medication waste. We also search for savings options and connect you with programs that require you to apply, like the patient assistance programs above.
A pharmacy partner for your fertility journey
Egg freezing can be a challenging journey, but Alto is with you every step of the way. To ensure that your treatment plan is followed correctly, we offer free same-day delivery of your medications and fertility resources like personalized injection guide videos and one-on-one consultations with fertility-trained pharmacists.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
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