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You may not realize it, but you almost certainly know someone who has considered freezing their eggs. The procedure has <a href="https://www.sciencedirect.com/science/article/pii/S001502822101195X#!" target="_blank">skyrocketed</a> in popularity in recent years, and some employers now <a href="https://www.cnbc.com/2022/03/14/egg-freezing-ivf-surrogacy-fertility-benefits-are-the-new-work-perk.html" target="_blank">cover the cost</a> of egg freezing as a workplace benefit.

According to <a href="https://prod.asrm.org/news-and-events/asrm-news/press-releasesbulletins/egg-freezing-cycles-jumped-31-in-2021/?_t_tags=siteid%3a01216f06-3dc9-4ac9-96da-555740dd020c%2clanguage%3aen&amp;_t_hit.id=ASRM_Models_Pages_ContentPage/_1858efcf-19c5-4f84-97ef-49e9e6c3b870_en&amp;_t_hit.pos=12" target="_blank">estimates</a> from the Society of Assisted Reproductive Technology (SART), the number of egg-freezing cycles reported by SART-affiliated clinics in 2021 increased significantly from 2020, rising from 16,786 to 24,558 total cycles.

 While freezing one’s eggs doesn’t necessarily guarantee a future pregnancy, it can open up options. I spoke to two experts to help demystify the process.

“I think egg freezing makes a lot of sense if a woman is not partnered, knows she does not want to parent as a single person and wants to do something to save some eggs at a younger age for future use,” Elizabeth Ginsburg, a professor at Harvard Medical School and fellowship director of the Reproductive Endocrinology and Infertility Program at Brigham and Women’s Hospital, said in an email. “And hopefully if they need the eggs, they will be there for them and be able to create one or more babies.”

Most  individuals with the potential to become pregnant are candidates for egg freezing, although there are rare circumstances when this isn’t the case. Examples include  people who have gone through premature menopause or who have structural changes in their reproductive organs that would make the egg retrieval process impossible, said Mary Ellen Pavone, associate professor of obstetrics and gynecology at the Feinberg School of Medicine and the director of Northwestern University’s in vitro fertilization program.

So, what is egg freezing, or ‘oocyte cryopreservation’?

Egg freezing refers to the process of stimulating, collecting and storing human eggs “to obtain mature eggs for future use,” said Ginsburg.

Eventually, the eggs can be thawed and, ideally, fertilized to result in a pregnancy. “Planned egg freezing” refers to this process when there is no immediate medical reason that might otherwise dictate timing of the procedure.

One recent <a href="https://urldefense.com/v3/__https:/www.fertstert.org/article/S0015-0282(22)00254-0/fulltext__;!!M9LbjjnYNg9jBDflsQ!BIJqoUipMgd6JY-bQqDyTuYwlLChDTggJ7FRCrZzefMro3sKy2XHSqkMki3kh-dWIv0i_J8L2g2tpIsxrLSS6pMLeBfnWw$" target=_blank>study</a> put the overall chances of a live birth from frozen eggs at an average of just 39 percent. For patients <a href="https://urldefense.com/v3/__https:/www.fertstert.org/article/S0015-0282(22)00254-0/fulltext__;!!M9LbjjnYNg9jBDflsQ!BIJqoUipMgd6JY-bQqDyTuYwlLChDTggJ7FRCrZzefMro3sKy2XHSqkMki3kh-dWIv0i_J8L2g2tpIsxrLSS6pMLeBfnWw$" target=_blank>younger than 38</a> at the time of egg freezing, the chances rose to 51 percent. It’s “certainly much lower than one would hope,” said Ginsburg.

What are the first steps in the egg freezing process?

Start by scheduling an initial consultation with a reproductive endocrinologist (REI). “At that time the REI will review your history. We’ll want that information for our planning purposes,” said Pavone.

Next, it’s bloodwork and ultrasounds. “We’re looking at the ovaries, making sure that they would be accessible for vaginal-ultrasound guided egg retrieval, and also … counting the number of follicles in the ovary,” Pavone said. Follicles are the structures that contain immature eggs. “Along with this we’ll [test] some hormones. … So with all this information we’ll have a better understanding if the person is a candidate for egg freezing as well as medication dosages that we will need to use to get an optimal result.”

If the patient is a good candidate and wants to proceed, medication injections start. The exact timing of the start of these injections may vary based on the protocol your doctor uses, but traditionally they begin on Day 2 of your menstrual cycle. “It’s eight to 14 days of self-administered injection hormones, during which time people come in for monitoring, which is bloodwork and ultrasound. And most people come in about five to nine times over that time frame,” Pavone said. The injections stimulate multiple eggs to mature — in a typical 28-day menstrual cycle, usually only one egg matures. Additional injections are given to ensure that the eggs don’t develop and release too quickly.

Finally, the patient will give themself an injection that causes eggs to undergo the final maturation step. Thirty-six hours after this injection, the egg-freezing candidate goes in for the egg-retrieval procedure, which takes about 10 to 15 minutes, according to Ginsburg.

An <a href="https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/multimedia/egg-retrieval-technique/img-20008644" target=_blank>ultrasound probe inserted through the vagina </a>guides a needle used to retrieve the eggs. “Under ultrasound guidance, there is a needle that goes through the back of the ultrasound probe, through the back of the vagina, and into the ovary. We aspirate all the follicles that we see,” said Pavone. The process is typically done under sedation to help make the procedure pain-free. For a few days afterward, side effects such as mild cramping and light spotting may occur, but you should contact your doctor right away if symptoms linger or worsen.

“We expect about 70 percent of the eggs to have fully matured at the time of the egg retrieval, and those are the ones that are capable of fertilizing. And that’s what’s going to be frozen,” said Ginsburg.

What predicts whose eggs will result in a baby?

<a href="https://pubmed.ncbi.nlm.nih.gov/35597614/" target=_blank>A study</a> by researchers at New York University found that age at time of egg freezing and number of thawed eggs were predictive of live births, but more research is needed.

“Egg age is far and away the main predictor of live birthrate with fertility treatment, or frankly for people being fertile on their own. And that’s because the percentage of eggs that are chromosomally normal drops with increasing age,” said Ginsburg. But, she added, “We still aren’t very good at predicting who’s going to be successful, and who’s not.”

Researchers have developed an <a href="https://www.mdcalc.com/calc/3937/bwh-egg-freezing-counseling-tool-efct" target="_blank">online calculator</a> that helps predict the chances of a live birth by plugging in the number of eggs retrieved and age at egg freezing. But Ginsburg cautioned that this is just a “guesstimate.”

The cost of egg freezing remains a barrier for many people. The <a href="https://www.npr.org/2021/11/18/1056834875/egg-freezing-process-how-much-does-it-cost" target="_blank">typical price tag</a> ranges from $10,000 to $20,000, with variability in cost from clinic to clinic, and even from person to person.

“Average is somewhere around probably about $7,000, plus the cost of medications, which can run another $2,000 to $7,000 depending on how much medication a patient needs,” said Pavone. If you opt for additional cycles, the cost increases.

The amount of medication required plays a major factor in the total price. The lower the estimated number of immature eggs, or ovarian reserve, the more medication the person going through egg retrieval will need, and the more the process will cost. “Our goal is try to frankly get a lot of eggs at once, so that women don’t feel the need to go through this several times and pay over and over again,” said Ginsburg.

On top of this, there are <a href="https://www.washingtonpost.com/business/2023/04/12/egg-freezing-storage-prices/" target="_blank">yearly egg storage fees</a>, which also vary. Ginsburg said the commercial storage facility her clinic works with charges $450 for the first year of storage. A <a href="https://www.washingtonpost.com/business/2023/04/12/egg-freezing-storage-prices/" target="_blank">Washington Post article</a> earlier this year cited storage costs of $500 a year and higher. Planned egg freezing is “usually not covered by insurance,” said Pavone. However, several larger employers have begun to cover the cost.

Do you have to be off all forms of birth control for egg freezing to work?

Not necessarily. It depends on the type of birth control being used. For example, intrauterine devices can stay in, but oral contraceptive pills need to be stopped before injections, according to Pavone. If you are on any form of birth control, you’ll want to discuss that with your doctor at your initial consultation. Patients should also be aware that any form of hormonal birth control may falsely lower hormone levels in the initial testing phase — in particular, <a href="https://my.clevelandclinic.org/health/diagnostics/22681-anti-mullerian-hormone-test#:~:text=What%20is%20anti%2Dmullerian%20hormone,of%20AMH%20for%20their%20development." target=_blank>anti-Mullerian hormone</a>, Ginsburg said. Low levels of that hormone may make it appear as though you need more medication than you do, which can make the process more expensive.

What’s the ideal age to freeze one’s eggs?

There’s no magic number. “That’s such a million-dollar question,” Ginsburg said. “I think the Catch-22 is that the younger the woman is, the more eggs she has and the better the egg quality, but the less likely it is she’ll have infertility and need to use them. So that’s the tricky thing.”

“The egg quality we get is for sure better in young women, but you have to balance that against spending a lot of money for something you may never use,” she added.

Are there health risks associated with egg freezing?

During the injections period, you’ll likely feel bloated and possibly moody, said Ginsburg.

In rare cases, there could be a more serious risk of <a href="https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/syc-20354697#:~:text=Ovarian%20hyperstimulation%20syndrome%20is%20an,to%20swell%20and%20become%20painful." target=_blank>ovarian hyperstimulation syndrome</a>, which results in fluid leaking into places it shouldn’t be, including the abdomen and around the lungs. Although rare — in “about 1 to 2 percent of all cases,” according to Pavone — it can be life-threatening if not caught early. The small risk of OHSS comes from the use of <a href="https://my.clevelandclinic.org/health/articles/22489-human-chorionic-gonadotropin" target=_blank>human chorionic gonadotropin</a> (HCG) to stimulate the final maturation step. Newer protocols effectively eliminate that risk because they rely on a medication called Lupron instead of HCG, Ginsburg said. But some cases still require use of HCG alone or in combination with <a href="https://my.clevelandclinic.org/health/drugs/18166-leuprolide-injection" target=_blank>Lupron</a>.

There are also the risks that come with any invasive procedure, such as “bleeding, infection, damage to organs that are around where we’re working,” Ginsburg said. But “all those are less than  1 percent risk.”

And then there’s a chance the retrieval doesn’t work. “There is a risk of procedure failure, where we basically go in and we don’t get any eggs, or the eggs that we get are not mature and therefore wouldn’t be able to be fertilized,” said Pavone.

Long term, no major risks have borne out, but there’s still limited data. “Most of the data are really not with egg freezing or planned egg freezing, but are really with patients who have had infertility, undergoing IVF,” said Ginsburg.

So, is egg freezing a parenting ‘insurance’ policy?

The short answer is <a href="https://www.washingtonpost.com/news/national/wp/2018/01/27/feature/she-championed-the-idea-that-freezing-your-eggs-would-free-your-career-but-things-didnt-quite-work-out/" target="_blank">not really</a>. “I don’t really agree with the term, ‘insurance policy,’ because there’s no guarantee that the eggs are going to result in a baby,” Ginsburg said. “Just because someone has eggs frozen — even if they have a lot of eggs frozen — there’s no guarantee that they’re going to work.”

What’s an alternative to egg freezing?

Embryo freezing is one. “This means freezing an egg after it has fertilized,” Ginsburg said. The obvious downside is that this requires sperm, which can be provided by a partner or a donor.

“I do talk about the fact that embryos do survive freezing at a higher rate than eggs do. And there seems to be less variability with embryo survival than egg survival,” said Ginsburg. “This adds cost, but no more time on medication for the woman undergoing the ovarian stimulation,” added Ginsburg.

Netana Markovitz is a resident physician at Beth Israel Deaconess Medical Center/Harvard Medical School in Boston.

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Freezing your eggs: Process, cost and what to expect

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