Egg Freezing With Endometriosis: What You Need To Know

For the 190 million people affected by endometriosis, family planning may look a little different. Endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus, can impact fertility in various ways - from altered ovarian function to changes in egg quality. Recent medical advances have made egg freezing (oocyte cryopreservation) an increasingly reliable option for this population.

This article explores how endometriosis affects fertility, when to consider egg freezing, and what research tells us about success rates. We'll examine the specific challenges that people with endometriosis face during the egg freezing process, and provide evidence-based information to help inform your decision-making process.

Understanding endometriosis and fertility

Endometriosis affects between 2% to 10% of people, with rates as high as 50% among those experiencing infertility. The condition can impact fertility through several mechanisms, including inflammation, altered pelvic anatomy, and compromised ovarian function. These changes can affect both natural conception and assisted reproductive treatments. 

The chances of getting pregnant each month are approximately 10-20% for people without endometriosis, compared to 1-10% for those with surgically documented endometriosis.

Endometriosis and egg quantity

When it comes to egg freezing, people with endometriosis often have diminished ovarian reserve and fewer eggs retrieved. Research has found that this reduction is exacerbated after endometriosis surgery. 

Endometriosis and egg quality

Beyond affecting how many eggs are available, endometriosis can also impact egg quality. The chronic inflammation that comes with endometriosis can create an environment that may impact the health of your eggs. While standard testing can tell us about egg quantity (your ovarian reserve), there’s no single test that can measure egg quality before fertilizing them to make embryos. 

if you decide to use your frozen eggs in the future, the process of fertilizing the eggs to create embryos may give some insight into egg quality factors. People with endometriosis may experience lower rates of fertilization and have more difficulty developing normal embryos. It’s worth nothing that even fertilization results don’t tell the complete story about egg quality, as multiple factors can influence whether eggs fertilize and develop appropriately. 

This is why having a conversation with your fertility doctor about both egg quantity and potential quality concerns is important when you’re planning your fertility preservation goals. Many people with endometriosis do successfully create healthy embryos, particularly when eggs are frozen at a younger age. 

When to consider egg freezing if you have endo

If you have endometriosis, you may be wondering if you’re a good candidate for egg freezing. Research suggests that certain situations make egg freezing particularly worth considering for people with endometriosis:

• Those with large endometriomas (endometriosis cysts on ovaries)
• Those with bilateral endometriomas affecting both ovaries
• Before surgical treatment - some surgeries for endometriosis can affect fertility by inadvertently removing healthy ovarian tissue or compromising vascular supply to the ovary

Younger patients (under 35) with good ovarian reserve, particularly those who haven't yet undergone ovarian surgery, often see the best results. The best way to know if you’re a good candidate or if now is the right time to freeze your eggs is to talk to a fertility doctor. 

Success rates and research findings

A 2024 study published in Best Practice & Research Clinical Obstetrics & Gynaecology offers encouraging data. Among people with endometriosis who used their frozen eggs, 46.4% achieved live births. This may sound low, but there are two things to keep in mind.

First, this figure represents success only among people who actually returned to use their frozen eggs. This group was more likely to have additional fertility challenges beyond endometriosis - after all, they needed to use their frozen eggs rather than conceiving naturally. 

Second, for perspective, the overall live birth rate for a first IVF cycle across all people (regardless of diagnosis) is under 30%. This means people with endometriosis who froze their eggs achieved better outcomes than the general IVF population, even though they may have been dealing with multiple fertility challenges.

The study found that younger people (under 35) had better outcomes, and people without prior ovarian surgery had higher numbers of eggs retrieved.

The number of eggs frozen significantly impacts success rates. The study found that 22 frozen eggs yielded an 89.5% cumulative live birth rate, with people under 35 achieving a remarkable 95.4% success rate. Those over 35 still saw promising results with a 79.6% success rate.

The egg freezing process with endometriosis

The procedure follows similar protocols to standard egg freezing, but there are special considerations for people with endometriosis. Before starting, you'll need detailed ultrasound evaluation, hormone level testing, and discussions about timing relative to any planned surgeries.

The stimulation protocol uses hormonal medication and takes on average 10-14 days. Your medical team will carefully monitor your response and may adjust medications as needed. Some people are prescribed antibiotic prophylaxis during egg retrieval to prevent infections, as the retrieval needle passing through tissue affected by endometriosis may cause an increased risk of pelvic infection compared to patients without the condition. 

Cost considerations

People with endometriosis should be prepared for some financial differences in their egg freezing journey. Those with endometriosis may actually require more stimulation medications - one study found that people with endometriosis needed, on average, 20% more gonadotropins (the hormones used during the process) compared to people without endometriosis. Additionally, you may need multiple egg freezing cycles to reach the recommended number of eggs for good success rates.

The investment in egg freezing can be substantial, but many people with endometriosis find that the peace of mind and preserved fertility options are worth considering, especially given the progressive nature of this condition. 

Learn more about how to freeze your eggs for free through egg sharing with Cofertility.

Can I donate my eggs with endometriosis?

The answer depends on the severity of your endometriosis and your treatment history. People with mild endometriosis (Stage 1 or 2) may still be eligible to donate eggs, though acceptance is determined case by case and depends on ovarian reserve testing results along with other qualifications.

However, people with severe endometriosis (Stage 3 or 4) or those who have undergone surgery for endometriosis usually cannot donate eggs. This is because severe endometriosis and related surgeries can damage ovarian tissue, potentially reducing the number of eggs that would be retrieved during the donation process. Ultimately, it’s up to the fertility doctor screening your application. Egg sharing programs like Cofertility aim to maximize success rates for intended parents and egg donors while ensuring donor safety. 

Summing it up

If you have endometriosis and are considering egg freezing, here are the key points to remember:

• Timing matters: Consider freezing eggs before any planned surgeries for endometriosis, as surgery can impact ovarian reserve.
• Age is significant: people under 35 see the best success rates, with live birth rates over 95% when freezing enough eggs.
• Numbers count: Research shows having about 22 mature frozen eggs gives you the best chance of future success.
• Multiple cycles may be needed: people with endometriosis often require more than one egg freezing cycle to reach optimal egg numbers
• Consider your stage: If you have severe endometriosis or have had ovarian surgery, discuss your specific situation with a fertility doctor who can evaluate your ovarian reserve
• Success is possible: Recent research shows people with endometriosis who freeze their eggs have good outcomes.

While egg freezing isn't a guarantee of future pregnancy, it's an important option for people with endometriosis who want to preserve their fertility. Working with a fertility doctor who has experience treating patients with endometriosis can help you determine if and when egg freezing might be right for you.

Freeze your eggs with Cofertility

We’d love the opportunity to support you on your egg freezing journey.

Through our Split program, qualified freezers can freeze their eggs for free when donating half of the eggs retrieved to a family who can’t otherwise conceive.

Through our Keep program — where you keep 100% of eggs retrieved for your own future use — we offer exclusive discounts on expenses, such as frozen egg storage. Keep members also still gain free access to our Freeze by Co Community, a safe space for those engaging in the egg freezing process (or gearing up for it) to connect and lean on each other.

By making egg freezing easier and more accessible, our programs further strengthen the American Society of Reproductive Medicine (ASRM)’s Committee Opinion that egg freezing can help promote social justice and strengthen gender equality.