I’ll never forget the day I went to see my OB-GYN for my annual exam. I was geared up for a pap smear, a breast exam, a routine checkup and a prescription refill for my birth control, when my doctor dumped some hard truths on me. “You know, you should really consider going off the pill and starting a family now. You’ll never be as reproductively healthy as you are now,” she said while I was spread eagle and completely caught off guard. Oh and I should mention I was 21. I was a senior in college, and while I was in a steady relationship with my then-boyfriend — spoiler alert, 15 years later he’s my husband and the father of my children — I was also an idiotic college kid without a clue about reproductive health and fertility.
As it turns out, my doctor was right. I know, shocker, a medical professional that knows more than a blissfully ignorant 21-year-old. Truth be told, I was clueless. I didn’t know that for most women, fertility peaks at age 24. That at 21 years old 90 percent of your eggs will be chromosomally normal, and you will have a 96 percent chance of conceiving within a year, compared to a woman in her late 30s or 40s who only has a 78 percent chance of conceiving in a year, with her egg quality declining every month.
I was lucky enough to get pregnant and give birth to two perfect children in my late 20s, but from friends and loved ones I know all too well that as a woman gets older it can be harder and harder to get pregnant, and as we age, the health of our eggs declines. The more people I speak to the more I realize that infertility is an issue that plagues so many women and couples, and even if you are not aware of your reproductive health, as time goes by you might struggle to start a family with ease.
Perhaps you are not yet dealing with infertility, but you are just trying to start a family a little later than you might have anticipated; either way, we’re willing to bet the reality of getting pregnant is far from what you pictured when you were younger. Having a baby doesn’t usually go how they describe it in middle school (aka you have unprotected sex once and you get pregnant instantly). And if you are a woman and your biological clock is ticking (yes, it’s a thing) then you’re probably curious if freezing your eggs is something you should consider.
The process of freezing your eggs comes with a lot of emotions and questions — What does it even mean to freeze your eggs? How do you collect your eggs? Is there an endless supply of eggs in your ovaries? Is it painful? Is it invasive? Is it expensive? Where do you start? When do you start? Are you too late?
If you’re nodding your head then know that you are not alone, and you’re asking all the right questions. And while we can’t tell you what to do, and we might not have all the answers, we do have some essential information to help make this reproductive choice and this process a little less overwhelming. If you’re considering freezing your eggs, then you have a big decision ahead of you and a lot to consider. So let’s start with the basics.
The Basics of Fertility
It might seem like a ridiculous topic to cover, because most of us learned this back in Sex-Ed, but nevertheless, let’s talk about your ovaries and your eggs. While men (lucky bastards) get to produce millions of new sperm every single day, women are born with all of the eggs that they will ever have. Typically, a female fetus has about 20 millions eggs, and that egg count begins to decline as early as birth. Female newborns have about 2 million eggs, and then approximately 11,000 eggs die every month prior to puberty. When you first get your period, your egg supply dwindles to only a couple hundred thousand, which is still more than enough since you’re not trying to have hundreds of thousands of babies. But by the time a woman is at her childbearing years, that supply is still declining, and as you age and reach your late 30s, the decline becomes more rapid and aggressive. In addition, the quality and chromosomal health of the eggs you still have also declines, making it harder to conceive a healthy baby.
If you’re strictly looking at fertility and conception as a numbers game and you’re trying to play the odds, then the younger you are when you try to conceive, the more likely you are to get pregnant and carry a healthy baby to term.
But then again, starting a family is not a numbers game. We’re not in Vegas playing the pass line at a craps table. There is so much more to consider than just the health and quantity of your eggs. Which is why so many women, both single women and couples, are considering freezing their eggs to preserve fertility and delay child bearing.
What Does it Mean to Freeze Your Eggs?
Let’s be clear. Freezing your eggs does not mean you literally take out your eggs and stick them in your freezer next to the frozen waffles and ice cream. That said, it’s kinda the same concept.
On a typical healthy month, one follicle will develop in a woman’s ovaries, and that follicle will release a fully mature egg. A combination of female reproductive hormones, including estrogen, progesterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH) signal your ovary to develop that follicle (or follicles in some cases) into a mature egg(s), and then release the egg from the ovary into the fallopian tube for fertilization. That is, of course, assuming everything goes according to plan.
When you freeze your eggs, you will take synthetic hormone medications to stimulate your ovaries to mature and release more than one egg. Those eggs are then retrieved from your ovary (more on that below), collected by your doctor, and after they are harvested they are cooled to subzero temperatures to preserve for future use. So basically, yeah, they are removed from your ovary and frozen, just not in your kitchen.
The Benefits of Freezing Your Eggs
Before we get into the details about the actual process, procedure and ideal timing of freezing your eggs, let’s discuss the benefits, because there are many.
Women and couples will consider freezing their eggs for a wide range of reasons. Some people are just not ready to start a family in their younger years so they want to delay child bearing. Some women have medical conditions and are not physically able to carry children at that time, but they want to preserve their eggs before they decline with age. For cancer patients about to undergo chemotherapy or radiation, it’s important to retrieve, freeze and preserve your eggs before the treatment, which can destroy your eggs. Some women just want an insurance policy that they will still be able to potentially conceive and carry children when they are older.
For women who do suffer from fertility issues such as polycystic ovarian syndrome (PCOS), endometriosis, unexplained fertility or low ovarian reserve (meaning they don’t have many eggs available for maturation each month), the retrieval and preservation of healthy eggs has the potential to boost their chances of conception, whether they use those eggs now or in the future. For women who are not yet in a position to start a family, but who want the option for future years, and want to ensure they have the best quality eggs possible, elective egg retrieval is a smart way to extend their childbearing windows, through a process that has become much more mainstream and routine.
Another benefit — while the entire process is taxing and definitely should not be taken lightly, it’s only moderately invasive, and the whole process only takes a handful of weeks, so once you’ve made the decision to move forward with egg freezing, you can take action relatively quickly in the reproductive world.
How Elective Egg Freezing Works
The process of elective egg freezing can be broken down into various phases, and from start to finish it typically only takes a few weeks. This is probably contrary to what a lot of women think or assume. It’s not months and months of invasive procedures or painful injections. It’s a relatively quick process.
Phase 1: Initial Consultation – Here you’ll meet with your doctor to discuss the process, and will do any pre-retrieval testing including infectious disease testing and ovarian reserve testing.
Phase 2: Work-up And Blood Work – On the 2nd or 3rd day of your period you’ll have a blood test and ultrasound done to make sure you have a good number of immature follicles and your hormone levels are on track to begin stimulation.
Phase 3: Ovarian Stimulation – During the next 9-12 days of your cycle you will begin taking fertility hormone injections (gonadotropins), which help multiple follicles develop into mature eggs. You may also take medications that help prevent premature ovulation, so you can ensure your mature eggs are ready to be retrieved and are not released. You will also get routine blood work and ultrasounds done to monitor how your body is responding to the medications. These injections are generally done subcutaneously (underneath the skin) in your abdominal region, and can be done at home.
Phase 4: Egg Retrieval – When your eggs are ready, you will undergo a quick, minimally invasive outpatient procedure to retrieve your eggs. You will be given sedation (but not general anesthesia) so that you fall asleep and don’t feel a thing, and your doctor will use a small needle guided by an ultrasound to retrieve the eggs directly from your ovaries. It only takes about 15-20 minutes, and there are no incisions, no scars and the most common side effects after the procedure are cramping and grogginess from the sedation. You may also experience bloating due to your enlarged ovaries, but that goes away after your eggs are removed.
Phase 5: Egg Freezing and Storage – The last step is a flash freezing of the eggs once they are retrieved. They are frozen and stored in a laboratory until you need them in the future. At a later date, should you be ready to use your eggs, they will be thawed, fertilized and transferred to your uterus, and that is the beginning of your pregnancy.
All in all the process takes around 2-3 weeks, but the initial consultation and testing phase can really take as long or short as you want based on your schedule. And once your eggs are frozen there really is no limit to how long they can stay frozen, they are essentially preserved at the exact age and date when they were developed and retrieved from your uterus.
Freezing Your Eggs is Pricey
Another aspect of freezing your eggs to consider is the cost associated with the procedure, the medications and the storage of your eggs. While the benefits of freezing your eggs are invaluable for many women, and while you can’t really put a price tag on the knowledge that your healthy, fertile eggs are preserved, if we did have to put a price tag on it, it’s a big one. It’s safe to say it’s not cheap to undergo elective egg freezing. The injectable medications alone can cost upwards of $4,000-$5,000, plus there are additional medical expenses including ultrasounds, blood work, anesthesia for egg retrieval, egg storage and more. It adds up fast and the ultimate tab is an estimated $10,000 or more, most of which, if not all of which, is not covered by insurance.
Of course every case is unique and costs can vary greatly, but no matter how you look at it, freezing your eggs is not cheap, and it’s important to know what kinds of costs you will be looking at before you begin this journey.
If You Are Going to Freeze Your Eggs, When Should You Do It?
This is where the decision to freeze your eggs gets even more complicated, tricky, and very personal. For some women the choice is clear, but the real question is when you should do it. What is the optimal age to preserve your eggs at their peak fertility and give yourself the best possible chance of achieving a successful pregnancy in the future? While no one can tell you exactly when the right time is for you, there are definitely expert opinions and scientific research to give you guidance.
According to Owen Davis, MD, Professor of Obstetrics and Gynecology and Reproductive Medicine and Associate Director of In Vitro Fertilization (IVF) at The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine (CRM) of Weill Cornell Medical College, timing is key with egg freezing. “Elective egg freezing is a reasonable thing, but you have to be careful because some people might jump into doing it who don’t really need it, and for some people it might be too late,” he explains in an article for The Cut.
Reproductive endocrinologist Anne Steiner published a study in the journal Fertility and Sterility that examined the ideal age range for a woman to freeze her eggs to maximize her chances of successfully conceiving a baby, but also reduce her risk of unnecessarily freezing her eggs prematurely. Her study found that the age range that maximizes a woman’s chance of successfully having a baby using frozen eggs, without “wasting” a large sum of money on eggs she might never use, is between 30 and 34. And “at age 37 years, oocyte cryopreservation has the largest benefit over no action and is most cost-effective.” Which means that women over the age of 35 who are considering freezing their eggs are not too late to the game, but it is undeniable that egg quality does decline as you reach your mid to late 30s, so the time to consider your options is now.
If you ask women who have been through the process of freezing their eggs, their advice is a bit more realistic and a lot more personal.
According to Emily* from New York, she waited too long to freeze her eggs, simply because she didn’t know when the right time was, and she wasn’t ready. “My mistake was thinking that egg freezing was an open-ended solution that I could resort to whenever I wanted. I should have frozen my eggs in my early 30s, which is when my family pressured me to do so. But I wasn’t emotionally mature enough to have that conversation then, never mind do anything real about it,” she said. “I ended up waiting until I was 38, after a gnarly breakup, and in the end, sadly none of those eggs were viable.”
Her story echoes that of so many other women struggling with this decision and feeling overwhelmed by the process in front of them. And the best advice we can give to those women is to do your research, talk openly about your concerns, goals and resources, and ultimately go with your gut. Emily’s advice to women in her shoes? “To any woman who is under 35 and wrestling with the idea, if you have the means/resources/support to do it, don’t think twice, and don’t wait.”
* Name has been changed for anonymity.
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