I had just finished speaking on a professional women’s panel and one of my fellow panelists pulled me aside to ask about freezing my eggs. I was the youngest woman on the panel and the only one without kids. Although I was caught off-guard by the seemingly intrusive question, I soon appreciated this woman of color for her thoughtfulness and candor.
Until this point in my life, I had admittedly escaped most of the pressure from those “Where are my grandchildren?” type conversations with my parents. Yet, here I was, having a very nuanced family planning conversation during a networking reception with an almost stranger, and I wondered, how many of my friends were talking about this topic, too?
Even though oocyte cryopreservation, commonly referred to as “egg freezing”, is becoming more mainstream, the conversation around the process still remains quite mute. It has been available for years to women with high-risk medical issues that could impact their ability to have children, like cancer. The technique only recently gained popularity as an elective option after the American Society for Reproductive Medicine declared the process no longer experimental in 2012.
Dr. Tia Jackson-Bey, an Obstetrician/Gynecologist based in Chicago, IL is now pursuing further training in Reproductive Endocrinology & Infertility (REI) to discuss what it means to consider putting your eggs in one (frozen) basket.
“The first step is introspection. You should ask yourself, why do I want to freeze my eggs? What are my family planning and reproductive goals? Am I open to adoption or is it important to me to have my own biological child?” Dr. Jackson-Bey said.
If having your own biological child(ren) is very important to you, but you are not ready or able to have children at this time, the next thing to do is check your overall health.
“As women age, it’s important to focus on your health and stress management, especially before deciding to take this step,” said Dr. Jackson-Bey.
“Keep in mind that black women are 3.5 times more likely to die from pregnancy-related causes than white women. It breaks my heart. Ensuring you are in the healthiest place to start a pregnancy is important- reduce obesity, prevent or control high blood pressure or diabetes, discuss management options for uterine fibroids, optimize mental health, etc,” said Dr. Jackson-Bey.
Once you’ve got your physical and mental house in order, it’s time to figure out your game plan.
When is the right time?
Obviously, biology plays a huge role in the timing of your decision to freeze your eggs. As women, we are born with all the eggs we will have in a lifetime, although the rate at which our bodies deplete our supply depends on genetics.
“I wish the conversation [about family goals, fertility, and freezing eggs] would happen early,” says Dr. Jackson-Bey.
Natural fertility starts to decline in our early to mid-30s and progresses rapidly after 40. This is why timing is key.
“While there is no hard and fast age, you’d be hard-pressed to recommend elective freezing to a healthy 20-year-old. Fertility is high in your 20s, the chances that you will need those eggs are low and the possibility of getting pregnant naturally is more likely. But it’s probably worth starting the discussion in your early 30s, particularly for women whose education or early career advances are occurring during this time,” said Dr. Jackson-Bey.
Essentially your “biological clock” does not start ticking in the 30s and 40s, it has always been ticking as we naturally lose eggs each month during the normal menstrual cycle.
If having your own children is a priority, you should at least be aware of your fertility potential, which can affect both the quantity and quality of eggs to retrieve. Fertility testing can help to shed some light on your reproductive health, but it does not provide a complete picture.
“Unfortunately, for women over 40 seeking fertility preservation, the options decline because it is harder to get enough good-quality eggs,” says Dr. Jackson-Bey, adding, “You would rather be in a situation where you are 42 with eggs from your 30s.”
What is the freezing eggs process like? How long does it take? Does it hurt? Do I need a friend to hold my hand?
The freezing eggs process can be broken down into three phases.
First, a consultation phase to discuss your reproductive goals, make a plan and evaluate what you should expect. During this phase, you will have testing to determine your estimated ovarian “age” and discuss your potential egg yield (i.e. the number of possibly retrievable eggs). These tests can be done with a pelvic ultrasound and blood work.
If you decide to move forward, the next phase is the pre-retrieval medication phase. It starts with 2-3 weeks of pills, often birth control pills to regulate your cycle and minimize ovarian cysts, followed by around 9-12 days of injectable medication to make your eggs develop and grow. Lastly, you will need a “trigger” shot to mature the eggs before egg retrieval.
The medications are trying to mimic the natural menstrual cycle, however, unlike the natural cycle where our bodies produce one egg per month, the injectable medication causes “superovulation” which means your ovaries produce a lot of eggs at one time. During the medication phase, you need to visit the REI doctor for daily ultrasounds and blood work to monitor how your ovaries are responding to the medications (i.e. are the eggs mature enough to retrieve) and to monitor for the risk of ovarian hyperstimulation syndrome (OHSS).
After the medication phase is the egg retrieval procedure. Retrieval is typically done about 35 hours after the “trigger” injection through transvaginal pelvic ultrasound — a small needle is passed through the vagina directly into ovaries (that when stimulated with injectable medications could now be the size of an orange).
“The retrieval process is a same-day procedure. It may be uncomfortable, but you will be under sedation and should not have significant pain. You will want to take it easy on procedure day — take the day off work — but you should feel well enough to return to work the next day. Strenuous physical activity is limited until the ovaries shrink to minimize twisting called ovarian torsion,” says Dr. Jackson-Bey.
Recommendation for a friend or loved one by your side is recommended during this process.
“It is good to have someone who can support you. It doesn’t need to be a romantic partner, but you need a sounding board, whoever your community is. And someone to drive you home from your retrieval procedure,” said Dr. Jackson-Bey.
Also, as far as sexual activity goes, its fine during the medication phase so long as you are comfortable (toward the end of the injectables you will feel bloated so it may be less comfortable). After the retrieval procedure until your next period (about 2 weeks), there remains a risk of pregnancy, even multiples, so abstinence or a barrier method like condoms is recommended.
Ok, so when I think I’m ready to have a baby — what happens next?
When you are ready to have a baby from your retrieved eggs, the next step is to create embryos from those eggs and have the embryo(s) transferred to your womb.
Before transferring into your womb, the eggs are thawed, prepared and inseminated with the sperm you select (partner or donor) to create an embryo. It is possible that only 50-70% of eggs survive the thawing process (according to the Society for Assisted Reproductive Technology (SART), each frozen egg only has about a 4.5% to 12% chance of becoming a baby).
Three to five days after fertilization, the embryos are assessed for quality under a microscope. Some women opt to have additional testing called pre-implantation genetic testing (PGT) to determine whether an embryo is chromosomally normal or to test for a genetic disorder such as cystic fibrosis, Tay-Sachs or a gene mutation that can cause cancer in the future such as BRCA mutations.
Then “good quality” embryo(s) are then transferred to the uterus under ultrasound guidance.
Alternatively, if you decide you don’t want or need the eggs in the future, you can discard or donate them to a friend, relative or cryobank, the latter of which are generally looking for minority donors because they are especially in high demand.
How much does it cost? How am I going to pay for this?
The price to freeze your eggs and subsequently use them can be costly, upwards of $20,000 or more — all before you change your first diaper.
Before the sticker shock sets in, let’s break it down:
Medication: around $5,000 (mostly because these are specialty medications), to cover the injectables and medication to prevent premature ovulation.
Doctors Visits and the Retrieval Process: around $7,000 -$10,000, which includes the ultrasounds, routine office visits, and retrieval.
Egg Storage: depends on the storage facility, but somewhere between $300 to $1,000 each year.
The Future (Implantation): This process costs around $5,000. If you have a male partner, you can use his sperm. If you need donor sperm, there are additional costs, approximately $500 per vial (with a general recommendation to get 2-3 vials).
Pre-Testing: For any chromosome or pre-implantation testing, these costs run an additional $5,000.
Still having sticker shock? Me too, and unfortunately, regular insurance does not cover many of these costs.
Only 15 states have mandates to cover infertility services, but the rules vary from state to state and it is unusual for insurance to cover egg freezing for women who elect to preserve their fertility. This means you will need to come out of pocket or have another plan.
One option is your employer. Some companies, particularly in the technology industry, have started covering the cost of elective freezing as an employee perk. Companies like Apple, Facebook and Google are offering female employees up to $20,000 to freeze their eggs, which Dr. Jackson-Bey said, is a “good strategy to retain young professionals who are not interested in building their families at the time.”
Another option is obtaining a “fertility loan”, which could come with interest rates ranging from 3.99% to 24.99%, or a payment plan directly with a fertility clinic.
Or you could ask the future potential grandparents. “A rising trend is baby boomers using retirement money to help their children give them grandkids,” says Dr. Jackson-Bey.
Yet, even with these advances in technology, there are many medical practitioners who see the entire egg freezing process as preying on women to invest money into something that does not have a high return on investment.
There are success stories, but there is also a fair share of heartbreak resulting from lack of normal embryos, inability to achieve pregnancy, miscarriage or storage failure — for example, at fertility clinics in Ohio and California, massive freezer malfunctions caused the loss of thousands of frozen eggs and embryos over the course of a few days.
Additionally, recent studies suggest that a majority of egg freezing patients never return for the implantation.
The important thing to remember is that freezing your eggs is a family planning option, not a guarantee. Going through the process does not necessarily mean that you will have a child, it simply means you are exercising your right to “preserve your reproductive potential” to build your family.
The takeaway here is to ask a lot of questions and stay informed.
Special thanks to Jazmin Archer, MPH, Stephanie Brown, MD, MPH, and Joy Cooper, MD, MSc for their contribution to this article.