Egg Freezing: Who, What, When, Why and How?

By Jessica Joseph, RN, BSN, MHA

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.

In a world where possibilities are endless, egg freezing has emerged as a game-changing option, allowing you to take control of your reproductive choices and embrace the freedom to pursue your dreams without compromising your future fertility. On the surface, this option seems ideal for women who do not want to worry about delaying motherhood and hurting their chance to have children. When digging deeper, it’s important to consider the financial aspects of egg freezing, including costs and insurance coverage (or potential lack thereof), as well as the understanding that a future successful pregnancy is not guaranteed. Success rates for a future pregnancy are determined by a multitude of factors, including: 

• Retrieving an adequate amount of quality eggs for freezing (which can depend on age at freezing)
• Sperm fertilizing the thawed egg(s)
• The embryo(s) developing to the right stage and quality
• Successful embryo transfer into your uterus with implantation

Why Freeze Your Eggs?

Egg freezing, also known as planned oocyte cryopreservation, is a fertility preservation option offered to women who want to keep their future reproductive options open. Your reproductive potential and your ability to have children may decline with age (what’s commonly referred to as the “biological clock”). Egg freezing has become more desirable in the past decade, thanks to the development of an advanced freezing technique known as vitrification. This limits the chance of the eggs collapsing (known as degeneration) during the egg freezing and thawing process, making them viable for future use. 

Women turn to the egg freezing process for both elective and medical reasons. Elective reasons for frozen eggs include not having a partner to have children with at the current time, focusing on achieving other milestones first (such as career goals or educational degrees), or not being ready to have children currently but might be in the future. Medical reasons are offered to women who are about to undergo treatment that can impact their future fertility. Cancer treatments such as chemotherapy or radiation can destroy ovarian tissue and make it hard to conceive in the future. Additionally, women who have a progressive chronic disease, including a blood-clotting disorder such as sickle-cell anemia, or an autoimmune disease such as lupus, may also want to freeze their eggs.

Who Qualifies for Egg Freezing?

Women who have not yet reached menopause can qualify for elective or medical egg freezing.  A fertility specialist (reproductive endocrinologist or RE) will do a comprehensive work-up, including ovarian testing, to try to predict how many eggs may be retrieved and develop the best medication protocol to maximize the number of eggs retrieved. For example, your blood test results for hormones such as follicle-stimulating hormone (FSH) and anti-mullerian hormone (AMH) will determine what dose of medications you should take.

How is Egg Freezing Performed?

Egg freezing is very similar to the fertility treatment in vitro fertilization (IVF), with the most significant difference being that during an egg-freezing cycle, embryos are not created after the egg retrieval procedure. You will have an initial consultation with a reproductive endocrinologist (doctor that specializes in female infertility), at which they will try to determine how many eggs can be retrieved from your ovaries based on ovarian reserve testing. Ovarian reserve testing helps clinicians understand your eligibility for egg freezing and has a few key markers, which typically include:

• Blood work for hormones, including FSH and AMH
• Antral follicle count (the number of follicles visualized on a transvaginal ultrasound during your period)
• Your age at the time of egg retrieval 

After you complete a diagnostic work-up, the doctor will give you a specific protocol tailored to the results of the diagnostic tests. For example, a typical protocol may start by going to your fertility clinic on cycle day three of your period for a baseline visit. During this baseline visit, the phlebotomist (person who draws blood) will check your hormone levels. The doctor, nurse, or ultrasound technician will perform a baseline ultrasound of your ovaries. Based on these results, the doctor will have you start medications (which are often hormone injections) for ovarian stimulation. You will typically take these for roughly 9-14 days. The goal of the medication is for your ovaries to produce many follicles containing eggs.  

Naturally, without medication, your ovaries typically recruit several follicles a month, and you will release one to two of those mature eggs during ovulation. However, while on these medications, you will make multiple egg-containing follicles. You will come in for routine office visits while on these medications to check your hormone levels and measure the size and amount of your follicles. Ideally, the goal is for your ovaries to make between 10-20 follicles (though this varies based on age, number of children you’d like to have, any-preexisting fertility issues, and other factors). Once your hormones are at a certain level (based on blood work results), and the majority of your follicles are adequate in size (based on ultrasound results), the doctor will prescribe you a “trigger shot,” which is an injection to make the eggs mature. 

What Happens During the Egg Retrieval Procedure?

The egg retrieval is a minor procedure that is scheduled according to the time you took your trigger shot. Your fertility team meticulously analyzes the results from each visit, including your hormone levels and ultrasound results. The timing of the trigger shot, which makes the eggs mature, is critical during an egg-freezing cycle. That time dictates the time of your egg retrieval procedure. Typically, the egg retrieval is performed 35-36 hours after your trigger shot (but you will be given exact instructions from your fertility nurse). These instructions include:

• When and how to take your last medications
• Pre-op instructions before anesthesia (when to stop eating and drinking, driving limitations) 
• When to arrive at the procedure
• What not to do before the procedure (avoidance of certain habits, perfume, jewelry, make-up)

Mild anesthesia (sedation) is given before the procedure. No surgical incision is made, as the fertility doctor performs the procedure with ultrasound guidance and inserts a catheter (thin tube) vaginally to aspirate (suction) the egg-containing follicles. Women usually return to “normal” within 24 hours after the procedure. Complete recovery is typically expected one week later.  

Side effects from egg-freezing cycles are rare. One of the most common is ovarian hyperstimulation syndrome (OHSS), in which the ovaries become enlarged and filled with fluid. Common symptoms of OHSS include abdominal bloating, water retention, mild to moderate pain, nausea, and shortness of breath. More severe symptoms of OHSS include difficulty urinating, fever, or vomiting. Your fertility team will monitor your symptoms closely during an egg-freezing cycle and can often adjust your medications to minimize the symptoms or prevent OHSS from occurring. If you stimulate well, meaning you produce many egg-containing follicles during your egg-freezing cycle, your risk for OHSS increases.

When is the Ideal Time to Freeze Your Eggs?

Women in their twenties to mid-thirties are ideal candidates for egg freezing. However, women in their late thirties and early forties can still freeze their eggs, if the fertility specialist determines they are eligible. Not all women above the age of thirty-five will have “poor ovarian testing.”  Adequate ovarian reserve, which may predict or indicate the quantity of eggs, is crucial for egg-freezing success. The quality of eggs (which is hard to determine) will also impact the future successful fertilization with sperm and the ability to have future pregnancies.  Egg quality tends to decline with age, mainly in women above the age of thirty-five. Compromised egg quality might lead to unsuccessful fertilization or early miscarriage. Lifestyle modifications may improve egg quality, such as nutritional adjustments and key supplements.

With advancements in technology and increasing societal acceptance, egg-freezing offers hope and peace of mind to those who want to delay starting a family for personal, professional, or medical reasons. By providing the opportunity to freeze and store healthy eggs, women can pursue their dreams without the anxiety of compromising their future chance at parenthood. It is an empowering option that has the potential to shape the future of family planning and redefine traditional timelines. It is also important to note the limitations of egg freezing, including that it is not a guarantee you will sustain a future pregnancy and achieve a live birth. Rather, it can offer hope and increase the chances, should you delay parenthood. As we continue to break down barriers and promote reproductive autonomy, egg freezing stands as a remarkable tool, opening up a world of possibilities for women around the globe.  

Find more articles like this one on WeAreRobyn.co