Thawing Out the Facts: What does the Egg Freezing Process Look Like?
By Melissa Gokhman, Fertility Coach at Fertility Outreach
The views and opinions expressed are those of the authors and should not be considered medical advice. Always consult your doctor, or a mental health professional, for the most appropriate treatment.
Egg freezing, also known as oocyte cryopreservation, is a procedure that offers individuals a chance to preserve their eggs for future use. Freezing eggs can be an empowering and valuable choice for those who wish to delay pregnancy for personal or medical reasons. Some examples of why someone may consider fertility preservation are preparing to undergo cancer treatments like chemotherapy, navigating career or relationship changes, or just not being ready to grow their family now (but have concerns about the natural decline of fertility with age). Other situations where egg freezing might be pursued are for those who suffer from fertility-related conditions that may impact overall fertility, such as endometriosis or polycystic ovarian syndrome (PCOS).
Let’s review the step-by-step process of egg freezing.
Step 1: Choosing to Freeze Your Eggs
Egg freezing has become an increasingly more common, and even popular, option for aspiring parents for various reasons. Some may seek to preserve their fertility to pursue other life goals, such as advancing their education or career. It is also an option to consider for those needing to undergo medical procedures or treatment like chemotherapy or radiation, which can negatively impact someone’s fertility and make it more challenging to conceive naturally after cancer treatment.
Egg freezing is also an option for transgender men who might undergo the removal of their female reproductive organs while transitioning. According to the American Society for Reproductive Medicine (ASRM), freezing eggs before transitioning may allow for the creation of embryos using those eggs, which will then eventually allow for the transfer of a biologically related embryo to a partner or gestational carrier in the future.
Egg freezing allows us to take control of our future fertility and reproductive choices. Women (assigned female at birth) are born with all the eggs they will ever have, and the number of eggs available (our fertility) naturally decreases with age. With age-related fertility decline, as women get older, the eggs are also more likely to have chromosomal abnormalities.
So, how exactly does the egg freezing process work? Let’s explore the science behind this process and what happens when someone takes this brave and proactive next step in their fertility journey.
Step 2: Scheduling an Appointment with a Fertility Specialist
After you’ve decided that you want to explore egg freezing, the next step is to schedule an appointment with a fertility specialist (also referred to as a reproductive endocrinologist or RE) to help determine if egg freezing is in fact a good option for you. An RE is highly trained, educated, and experienced to evaluate your medical history and personal needs. The egg freezing cycle must be monitored by an RE, and an RE also performs the procedure (egg retrieval), so establishing care with one is an essential part of the process. Once scheduled with your RE, they will perform necessary fertility workup tests and develop a custom treatment plan based on your family-growing goals, medical history, reproductive health, age, and fertility testing results. Your RE can also answer any specific questions or discuss any concerns you may have about freezing your eggs.
Step 3: Starting an Egg Freezing Cycle
Once a protocol treatment plan is created, you will work closely with your nurse coordinator to review and order your medications and sign needed consent forms.
You will also discuss fertility related finances with your clinic’s billing department. The cost of an egg-freezing cycle can vary from clinic to clinic and depends on many different factors, such as your age and medical history. Confirm with your clinic what costs are expected, when they are due, and if they offer any discounts or payment plans. You can also ask if they work with any loan programs directly.
You’ll want to talk to the billing department, along with your insurance provider, about any coverage you may have for fertility treatments and specifically egg freezing. If you find that you either don’t have insurance coverage at all, or don’t have fertility coverage available, there are other options available to help navigate the financial aspect of moving forward with egg freezing, such as fertility grants or scholarships.
Each month, women typically produce one and sometimes two eggs during a natural cycle. When you start your egg freezing cycle, you will begin medication to stimulate the ovaries to produce multiple follicles in hopes that those follicles contain a mature egg. While on these ovarian stimulation medications, a patient must be monitored closely to keep an eye on the development of the follicles, along with hormone levels. This will include several ultrasounds (to check the size of the follicles) and bloodwork (to check the response of certain hormones) in order to see if you are responding to the medications, and also to check for and time ovulation.
Step 4: Doing an Egg Retrieval
After about 10-14 days of stimulation medications, once the follicles reach a specific size, the eggs will be ready to be retrieved from the ovarian follicles. At this point, the RE may advise to take one last medication, known as an “hCG trigger shot,” that will help trigger ovulation and the maturation of the eggs. Thirty-six hours later, the patient will undergo an egg retrieval procedure, typically done at the fertility clinic or surgical center. This procedure is done under light sedation to avoid any discomfort to the patient. During this procedure, your RE will use a long, thin needle to penetrate the ovaries through the vaginal wall in order to aspirate the fluid (and egg) in each follicle. This is done with ultrasound guidance, and the procedure is typically quick and fast, lasting only about 20-30 minutes. The egg freezing process up to this point is very similar to the process aspiring parents go through during in vitro fertilization (IVF), except that once the eggs are retrieved they will be frozen, and embryos will not be created at that time.
Tip: if you have a partner or are considering being a single parent by choice in the future, talk to your RE about embryo freezing versus egg freezing.
Possible Side Effects and Risks
Talk to your RE about all side effects and risks that you might experience throughout the egg freezing process so that you’re prepared. Some side effects that may come with stimulation medications may be due to hormonal changes, such as bloating, nausea, vomiting, breast tenderness, mood swings, or fatigue. Some may experience bruising, redness, itching, or soreness at the injection site. In rare cases, some may develop a condition called ovarian hyperstimulation syndrome (OHSS) due to fluid buildup. This can cause difficulty breathing, shortness of breath, abdominal pain and discomfort, decreased urine output, and dehydration. This is why frequent and close monitoring is so important during steps 3 & 4 above!
Some risks associated with the actual egg retrieval procedure include pelvic or abdominal pain or discomfort during or after the procedure. This typically goes away after a few days and can be relieved with pain medication and heat. There is also a risk of injury to the ovaries, surrounding organs, or pelvic infection. Always discuss your pain or any unusual side effects with your RE for guidance.
Your RE and care team will inform you of any risks specific to your treatment plan, any restrictions you might have leading up to or following the procedure, any symptoms to watch for, and when/how to reach out if you have concerns leading up to or following your egg retrieval.
Step 5: Freezing the Eggs (Vitrification)
After your retrieval, the embryologist (a medical professional who evaluates and monitors the eggs from retrieval to freezing) will be able to let you know how many eggs were retrieved. Usually a day or so later (keeping in mind your clinic may have certain protocols when giving results, and weekends or weekends may affect this), they may be able to let you know how many of the retrieved eggs were mature and how many of those mature eggs they were able to freeze (vitrify). The maturing of eggs is essential, as these eggs can be used later to create embryos. The selected eggs are rapidly frozen using a technique that replaces the water in the eggs with a protective solution (cryoprotectant) to prevent the formation of ice crystals, which can damage the eggs during freezing. The eggs are frozen in a liquid nitrogen tank in a secure IVF laboratory until they are ready to be used.
Note: Before deciding to free your eggs, you will need to consider and give consent for how long they will be stored, and instructions for discarding them if and when you choose to do so
The Benefits and Limitations
Egg freezing can offer significant benefits, including peace of mind, a chance to extend fertility, and having biological kids of your own in the future. However, it is essential to understand its limitations, most importantly that not all frozen eggs lead to a successful pregnancy. To date, there is minimal research on success rates, as there have not been a significant number of women who have cryopreserved their eggs and have gone on to use their vitrified eggs.
How Many Eggs to Freeze
The number of eggs recommended to freeze depends on many different factors. Regardless of the number, starting the process by your early 30’s is generally recommended, as the risk of chromosomal abnormalities increases with age, decreasing the egg quality and eventual embryo’s viability. Being past your early 30’s does not mean you can’t freeze your eggs. Having an appointment and evaluation with an RE will help you better understand why egg freezing may or may not be an appropriate option for you at any age.
Step 6: Thawing the Eggs
Egg freezing is an empowering option for those looking to preserve their fertility, offering hope and flexibility for future family planning. While the process involves careful preparation, advanced technology, and precise timing, it ultimately can provide a chance to take control of your reproductive future.
Consulting with a fertility specialist (reproductive endocrinologist/RE) can help determine whether egg freezing is the right choice for those considering this option. Remember, having an appointment doesn’t mean you need to put a down payment on an egg-freezing cycle, but it may equip you with the necessary information to make informed decisions for your family-building goals. Connect with a fertility coach through Fertility Outreach for personalized support and guidance throughout your egg freezing journey!
