It seems you cannot visit a website or open a magazine these days without seeing something written about egg freezing. There are countless viewpoints on the topic and it’s easy to get lost in the noise. I’ve been working in fertility for several years and I still have a hard time keeping up.
Egg freezing is relatively young; think of it as In Vitro Fertilization’s little sister. The first IVF baby is 41 years old and the first egg freezing baby is about 14 years old. After physicians realized they could freeze embryos (fertilized eggs) for later use, they began to experiment with freezing eggs. The oocyte is not only the biggest cell in the human body, but it’s mostly filled with fluid and freezing and thawing them took some time to perfect. Several years ago, a new type of freezing called vitrification began to be utilized in embryology labs with eggs and embryos. This worked better than the slow freeze method and had outstanding results. Because of studies at many leading fertility clinics in the U.S., the American Society for Reproductive Medicine (ASRM) removed the experimental label from egg freezing in October 2012. The rest is history.
If you’ve been thinking of freezing your eggs or are merely curious about the process, talking to an expert should absolutely be part of your discovery. The NYU Langone Fertility Center is one of the premier fertility clinics and has been focused on egg freezing for quite some time. Due to their expertise, speaking to one of their physicians seemed like the best place to get answers to your burning questions. I spoke to Brooke Hodes-Wertz, MD, a a board-certified Reproductive Endocrinologist practicing in New York City at NYU Langone Fertility Center.
Before we get started, it’s important to know a little bit about female fertility, in case you weren’t paying attention in biology class. Unlike men, who make sperm from puberty until old age, women are born with all the eggs we’ll ever have. As we age, we lose eggs both in quantity and quality. So, not only do eggs die off month over month, but the ones that are left age like any other part of our body. By the time we’re in our late thirties and early to mid-forties, our egg quality has diminished significantly.
Dr. Hodes-Wertz mentioned the first step to freezing your eggs is meeting with a Reproductive Endocrinologist (REI) to talk about your family building goals and the process.
Your physician will order some testing, usually ovarian reserve testing, which includes blood work and ultrasounds. And once you’ve decided to move forward, you’ll start the egg freezing cycle with your next menstrual period.
Dr. Hodes-Wertz said: “There is variability in each patient’s cycle and center protocols, but typically there are about 10-14 days where you are taking daily injections and are coming into your fertility center for blood work and ultrasounds to assess your response to the medication.” Those self-administered medications are making lots of eggs grow during that month, many more than would grow on their own. The REI closely monitors you to make sure all is going well and then sets you up for your egg retrieval, where the eggs that have been growing that month are removed in a minor surgical procedure. The eggs are frozen that day and can be stored indefinitely.
While it is important to remember that this is a medical procedure, most patients have few to no side effects. The risks are minimal, despite the myths that have built up around egg freezing.
So, if there are little risks, what do you need to know about egg freezing before you go for it? Here are some commonly asked questions — and their answers.
1. What is the primary reason people decide to freeze their eggs?
I know that a big driver of egg freezing is fertility preservation for medical reasons — perhaps before chemotherapy or radiation. Those therapies save lives, but they work to kill cells, including oocytes, and can have a negative effect on a person’s fertility.
Dr. Hodes-Wertz explained that medical indications are often an impetus for egg freezing, but there are other preventative reasons to freeze eggs, like preserving your eggs as you age to have children later. She said many aging women freeze eggs, because "often patients haven’t found a partner that they want to conceive with, or they aren’t ready to start family due to financial, educational or career goals.”
2. If you plan to have a family but you’re not quite ready yet, at what age should you freeze your eggs?
Thankfully, we don't need to make this decision when we’re deciding what to major in or getting our careers started. "Ideally, freezing eggs is best under the age of 34," Dr. Hodes-Wertz said. “28 to 34 years old can be a good time to make this decision.”
However, Dr. Hodes-Wertz added that women in their late 30s can successfully freeze their eggs. So, if you’re over 35, it still makes sense to speak to a physician.
3. How do you pick a fertility clinic?
You want to pick a fertility clinic that has demonstrated success at freezing and thawing eggs that have led to a live birth. Dr. Hodes-Wertz said: “Ask about their success rates... It’s important to understand the chance of getting a baby out of this process.”
4. How many eggs is enough?
According to Dr. Hodes-Wertz, the magic number is highly individualized and based on your age, as well as other factors. Talk to your doctor about what number is best for you.
5. Will freezing my eggs affect my future fertility?
Dr. Hodes-Wertz assured me that egg freezing does not hurt your chances of getting pregnant on your own.
“Ovarian stimulation and egg retrieval involves eggs that one’s body would be turning over anyway," she said. "It doesn’t take away eggs from your future and doesn’t do anything to your body to prevent you from conceiving in the future.”
6. How much does egg freezing cost and will my medical insurance cover it?
Egg freezing can be very expensive if you don’t have coverage through your employer. It can cost anywhere from $6,000-$12,000 per cycle and the medications can be an additional $5,000-$7,500. There are often also ongoing storage costs of a few hundred dollars annually. This price is prohibitive for many.
The good news is that many companies are starting to cover egg freezing as if it were any other medical procedure. But if you aren’t able to have this covered through your insurance or employer, you can ask your clinic about financial assistance or lending options for the treatment and medication.
7. What if I freeze my eggs and don’t need them?
Some people who freeze their eggs never come back to use them because they end up having no difficulty conceiving. So, what do they do with leftover eggs? Dr. Hodes-Wertz explained that you can choose to “discard your eggs, donate your eggs to research and even donate your eggs in some cases to another patient trying to conceive.”
8. What if I’ve frozen my eggs and I’m ready to come back and use them?
First of all, yay! You’re ready to start your family and that’s amazing. The first best step is to re-establish your care at the clinic where you froze your eggs. Schedule a follow up appointment and talk about your family building goals. Your doctor may recommend that you try to get pregnant naturally, or even that you give IVF a try before thawing your eggs. If you do thaw your eggs, they’ll be fertilized with the sperm of your choice and cultured in the lab in hopes that embryos develop. If you do have viable embryos, you may choose to have genetic testing performed. Once you have a viable embryo, you’ll undergo what is called an embryo transfer. Your physician will transfer the embryo into your uterus in hopes that it will implant and grow into a pregnancy.
9. What happens if I’ve relocated and I'm not near my clinic?
I recommend speaking to a fertility specialist in your new hometown as well as the clinic who initially froze your eggs. They may recommend that you go to the city where your eggs are stored to have a transfer, but it may also be an option to transport your eggs from one city to another (it’s done all the time).
In short, if you’re curious about egg freezing, do some research. The first place to start is to speak to a physician. You can ask your OBGYN if you’re not sure where to start and reach out to your insurance to find out what your coverage is. And a lot of fertility clinics will offer free consults or educational events, specific to egg freezing. Talking isn’t doing, and a consultation, if nothing else, will give you some great perspective on your own fertility and family-building goals. In ways our mothers and grandmothers never dreamed for us, we’re able to take some control of our reproductive future and that’s so empowering, even if it’s just a conversation.
Lissa Kline, LCSW is currently VP of Provider and Member Services at Progyny. She worked at Columbia University Medical Center for several years in the division of Reproductive Endocrinology and Infertility. Involved in Patient Services and the Donor Egg Program, she loved working with patients while they underwent fertility treatment. Lissa graduated with a Master of Science in Social Work from Columbia University.