Want to Freeze Your Eggs? Here’s What You Need to Know
The ultimate guide to putting those suckers on ice (erm, in liquid nitrogen).
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Egg freezing has seen increased popularity — and has become more widely talked about — since the start of the pandemic. Whether you want to get pregnant eventually (but just not right now), aren’t certain if you even want to have kids, or are thinking about your fertility due to a recent medical diagnosis, freezing your eggs can prove to be a solid backup plan for anyone who is unsure about, questioning, and/or not ready for parenthood.
To help demystify the process, we turned to local fertility specialists and area residents who have chosen to freeze their eggs. Below, everything to keep in mind about egg freezing — including the science behind it, all the injections, the cost, and info about using your stored eggs.
Why do it?
The simple answer: Your ovarian reserve — the quantity and quality of your eggs — declines with age. Freezing your eggs helps preserve the integrity of your eggs at the age at which you undergo the process, meaning you have a better shot at potentially getting pregnant later on.
It’s a numbers game…
Women are born with all the eggs they’ll ever have. (This is unlike men, who continue to make new sperm throughout their entire life. Cool, cool.) Jeffrey Thorne, reproductive endocrinologist at RMA’s Abington, King of Prussia, and Langhorne clinics, says that at birth, egg count is about one to two million (though a female fetus can have around six to seven million!), then reduces to between 300,000 to 500,000 once menstruation begins. From there, decline in egg quantity accelerates around a woman’s mid-30s — and once a woman hits menopause, less than 1,000 eggs remain.
Remember: Women lose eggs every cycle. According to Anne Hutchinson, reproductive endocrinology and infertility specialist at Shady Grove Fertility Center City, “As a woman cycles every month, the ovary selects a group of eggs to compete with one another to be the one that ovulates that month.” (It’s like the Hunger Games, but for eggs!) “Everybody’s monthly number is different — someone can have two that are competing, but another person could have 50 — and there’s no way you could ever know that about yourself.” The one that “wins” gets selected to grow, and as it gets bigger, it makes estrogen which thickens your uterine lining, and eventually gets released. If that egg meets sperm, it could create a baby.
…that also has a lot to do with fertility.
It’s not just that women lose eggs, but that the quality of remaining eggs deteriorates over time. According to our experts, egg quality refers to the extent to which an egg can maintain the correct amount of genetic material needed for successful fertilization. Basically, all eggs contain 46 chromosomes, which is double the amount that’s needed to fertilize normally, Hutchinson explains. A mature egg is one that is able to kick out half of its chromosomes so that exactly 23 can meet with 23 chromosomes from sperm. But as eggs age, they’re more likely to gain or lose chromosomes, which result in genetic abnormalities that can lead to negative pregnancy tests and miscarriages. (It’s why women over 35 have a higher risk of miscarriage than younger women, with women over 45 seeing the highest risk.)
Plus if you’re having a regular period, that means you have *one* chance every month to get pregnant. That’s a super critical component of fertility because those are the only eggs fertility specialists have access to on a monthly basis. “We can’t access your lifetime’s worth of eggs — just the ones that get wrangled up by the ovary each month,” Hutchinson says.
How the process starts
Your doctor will need to first check your ovarian reserve to see how many eggs you’re recruiting during your current menstrual cycle via a blood test and a transvaginal ultrasound. “The ovary looks like a chocolate chip cookie at the start of your cycle, so you come in on the first day of your period and we can visibly see those eggs — what would be the chips of the cookie — during the ultrasound,” Hutchinson says. “We count them to know how many we’re working with and about how many you can expect to be aspirated during the procedure.”
Thorne says that having a low quantity of eggs doesn’t mean you’re necessarily a bad candidate for egg retrieval and freezing — it just means less of a chance of success. (He defines success as “A handful of eggs that can be thawed and combined with sperm at a future date to become embryos in order to get you pregnant.”) But Hutchinson says that if someone in their early 30s has a low ovarian reserve (like, under five eggs competing), they might go through menopause earlier than their peers. “I have honest conversations with those patients because, while their natural fertility is not impacted by the number of eggs they have, reproductive technology might prove difficult for them if they need it in the future. It’s going to take a lot of cycles to get a meaningful number of eggs, and if they need help in five years, it’s not clear if we’ll be able to pull that off with their current ovarian reserve.”
Yes, you’ll be getting shots every day.
Because the goal of egg freezing is to get as many eggs to grow as possible during one cycle, you’ll inject hormone medications that essentially make your ovaries work overtime. One or two shots are given daily for about 8-14 days, but everyone’s length of time varies depending on how well your eggs are maturing. During this time (what’s called stimulation), you’ll be frequenting the doctor’s office to monitor your progress via ultrasound and blood work. If you don’t want to give yourself shots, do what Midtown Village resident Reyna did when she went through the process in April of 2021: Hire Fertility Home Care — a local husband and wife duo who are both clinical pharmacists — to administer them.
Once the majority of your egg follicles grow to somewhere between 16 to 22 millimeters, you’ll take what’s called a trigger shot, which is the final step of stimulation. “It releases the eggs from the walls of their follicles and helps the eggs kick out half of their chromosomes,” Hutchinson says. “The procedure occurs exactly 36 hours after the trigger shot to prevent the final step of ovulation — egg release.”
What happens during extraction
Both Thorne and Hutchinson explained to me that 36 hours after your trigger shot, you’ll undergo an outpatient procedure in which you’ll be put to sleep (thank goodness) and the doctor will extract the grown eggs from your ovaries. That’s performed via transvaginal ultrasound that features a hollow needle which goes through the vaginal wall and into each of the follicles to aspirate the eggs into tubes.
What happens after extraction
Tubes containing extracted eggs go to the lab, which is typically attached to your fertility clinic’s outpatient surgery suite. You’ll find out the total number of retrieved eggs before going home, but the lab won’t know how many of them are mature until a few hours later. (Hutchinson says that a mature egg can be identified by the formation of a polar body, which essentially looks like a mini Mickey Mouse ear.)
The mature eggs get frozen the same day in liquid nitrogen, or else they’ll disintegrate within 24 hours of extraction. Thorne explains that the current freezing process is different from — and better than — what it used to be: “Until about 10 years ago, the protocol was a ‘slow freeze,’ which gradually decreased the temperature at which the eggs were frozen. The problem with that was eggs have a high water content and would form a lot of ice crystals, and about 50 percent of them wouldn’t survive thawing. Now we do what’s called vitrification, which plunges the eggs into liquid nitrogen — similar to doing a cannonball into a swimming pool.” The current rate of egg survival is about 85 to 90 percent. Score!
They’re frozen! Now what?
Well, that’s up to you! As far as fertility specialists know, eggs can be frozen indefinitely, so they’ll be there for you whenever you want them.
Hutchinson recommends trying to get pregnant naturally first — up to a year if you’re under 35, and up to six months if you’re over 35 — because it’s best to use the eggs you froze for the last child you want to have. “That’s when it’s going to be hardest to use your own eggs, given everything we know about the relationship between age and quality,” she says.
If you decide to use your frozen eggs in the future, they’ll be thawed, then fertilized via your sperm source being injected directly into your eggs in the hopes that at least one embryo forms. (Not every frozen egg will result in a baby.) Thorne and Hutchinson both tell me an embryo is then grown in a culture for about five to seven days until it reaches what’s called the blastocyst stage, or the point at which an embryo naturally implants. This is when you have the option to genetically test your embryo for any abnormalities and to find out the sex.
Then, you’ll go through an embryo transfer cycle where your uterine lining is prepped — Thorne says this can be done either by a combo of oral estrogen pills and progesterone injections or by transferring “naturally” based on when you ovulate — and the embryo is inserted into a catheter, guided to the back of your uterus, and deposited. (You’re awake for that procedure, FYI.) “Hopefully, nine days later, you get a positive pregnancy test,” Thorne says.
Common symptoms and activities to avoid
Because you’re injecting yourself with hormones during stimulation, you may experience headaches, exhaustion, mood swings, or other PMS symptoms. Plus, your ovaries are enlarging, so you’ll likely feel bloating or experience pelvic pressure. Doctors say it’s best to avoid strenuous exercise (opt for low-impact, instead) and not have sex during stimulation because both can contribute to ovarian torsion, which is when your ovaries twist around supporting tissue and ligaments and cut off blood supply — yikes!
You’re also more prone to dehydration during stimulation, so keep that in mind, especially if you’re going to drink a moderate amount of alcohol. “Having a glass of wine will not impact the estrogen levels of your eggs, but you need to keep them hydrated,” Hutchinson reminds. She said you should absolutely avoid smoking, though.
Post-procedure, you’ll want to take it easy for a bit to let yourself rest and recover. Elizabeth, a Fairmount resident who froze her eggs in October of 2019, says she was a bit sore and crampy, but wasn’t in pain. Your period typically isn’t impacted, and you should start yours about two weeks after the extraction. (Though, Elizabeth says she’s now more acutely aware of ovary discomfort and feels more bloated during her cycles.)
Also, Hutchinson says it’s good to use protection if you’re having sex after the procedure (but before your period comes) because there’s a chance that one or two eggs might have been left behind, if they weren’t visible on the ultrasound. “The last thing we want is for someone who has made a very conscious effort to plan for a future pregnancy to get pregnant right after this whole process,” she says.
How much does it cost?
This is going to largely depend on the extent to which your insurance covers and your benefits. (For what it’s worth: Pennsylvania does not require insurance companies to cover fertility preservation, but New Jersey does. And some big Philly employers — including Comcast and Vanguard — cover fertility services, including egg retrieval and freezing.)
In the Philly area, one egg-retrieval cycle (the procedure and doctor visits) costs about $6,500, not including medication which can be several thousands of dollars. So, you could be looking at about $10,000 to $20,000. Plus, you’ll need to pay for the annual egg-storage fee which can reach $800 per year and is almost never covered by insurance. You can opt to have your eggs stored elsewhere for a cheaper cost, but those less-expensive storage centers often aren’t nearby and require your eggs to be transported. Though it’s highly unlikely, there’s always the risk that something will happen en route — a vehicle accident, for example — which is why many people opt to pay more for peace of mind.
Not only is the process expensive, but it involves multiple doctors visits, especially toward the end of your stimulation period when you’ll be going to the clinic nearly every day. “You’ll need to have the time and schedule to accommodate all the appointments, and parking and transportation costs can factor in depending on where you have to go in relation to where you live,” Elizabeth says. Also, keep in mind that you don’t know the exact date of your extraction because it depends on how your eggs are growing, so you have to “be ready for any day toward the end of that two(-ish)-week window,” Reyna adds.
Elizabeth and Reyna both told me that the process brings on many emotions — you’re literally injecting yourself with hormones, after all! Even though every person pursues egg freezing for their own reasons, it’s okay to feel all your feelings, whether sadness, anger, frustration, panic, and loneliness. “When you’re young, you’re never told that things involving your fertility might not go the way you think they will,” Reyna says. “Most people are only told they’ll grow up, get married and have kids and all will be fine. Those expectations angered me because those life plans weren’t a reality for me at the time. Freezing my eggs was my choice, but I was still mad.”
Elizabeth encourages anyone thinking about or actively pursuing egg freezing to advocate for their own health, ask questions, find a support system, and give yourself grace: “It’s a huge investment — physically, mentally, and financially, and the process can be isolating and overwhelming for anyone, partnered or not,” she says. “Having the right care team and a supportive community made a world of difference for me. My friends created a schedule amongst themselves and each night during the timeframe I was giving myself shots, one of them was hanging out at my place with me. They’d bring over food, we’d watch silly movies — it was really nice to not feel alone.”
Also, a major takeaway Elizabeth learned from the process has to do with retrieved egg-count. “The number one question I get asked is, ‘How many eggs did you get?’ I’ve stopped telling people that number because I’ve found it has done more harm than good. If it helps you to talk to people, that’s great, but your body is just that: your body. If you compare your results with someone else’s, you’re setting yourself up for unnecessary stress. Give yourself grace and be kind to yourself.”