egg freezing

Warning: This article contains spoilers for Season 2 of The Sex Lives of College Girls.

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At Cofertility, we are so thrilled that conversations about reproductive health are making their way into the limelight. From Jennifer Aniston opening up about how she wishes she froze her eggs at a younger age, to the latest season of The Sex Lives of College Girls, where Kimberly decides to donate (or as she refers to it, “sell”) her eggs in order to pay her college tuition, we love to see women becoming more educated on their fertility.

Our team has been watching this season obsessively (and spending way too much time talking about it during our daily meetings), and are overall so appreciative of how Kimberly’s donation journey was portrayed. Creators Mindy Kaling and Justin Noble have taken what has been traditionally portrayed as an overly-clinical, overwhelming process and humanized it — showing the reality of what egg freezing or donation cycles can look like for the modern woman. Here are just some of our team’s favorite aspects of the portrayal of Kimberly’s journey:

You don’t have to put your life on pause.

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The process of donating (or freezing) your eggs involves a medical procedure and should be taken seriously, but as Kimberly shows us (with the help of her roommate, Leighton) in Season 2 Ep. 5, that doesn’t mean you have to put your entire life on hold. 

While there are some things you’ll have to avoid, such as heavy exercise, alcohol, and sex, you won’t be pinned to your couch for three weeks while you prepare for your retrieval. You’ll need to stay local to your clinic for your monitoring appointments, but other than that, keep doing you.

Overall, the medical process of donating your eggs is the same process as freezing your eggs. If you’re curious to learn more about what that looks like, (and even how you can freeze your eggs for free when you donate half) we’ve got you covered.

Egg banks often target women in tough financial situations

Kimberly first learns about “selling” her eggs after getting denied a student loan that she desperately needed. If the thought of this gives you the ick—you’re not alone.

It’s true that the egg donation industry has historically targeted individuals in poor financial situations, and we wholeheartedly agree with the American Society of Reproductive Medicine (ASRM)’s stance that financial compensation for egg donation opens the door for exploitation.

Additionally, $80K for a single cycle is a pretty unrealistic expectation, given that the average compensation is more like $3,500 - $5,000 per cycle. 

However, women who donate their eggs are truly giving intended parents the invaluable opportunity to fulfill their family-building dreams, and that deserves to be recognized. That’s why we created our Split program, which eliminates the icky-ness of financial compensation by instead giving our members the opportunity to freeze their eggs for free for their own reproductive future when they give half of the retrieved eggs to another family that can’t otherwise conceive.

Your squad is everything

Though going through an egg retrieval is considered a low-risk procedure, it’s not something that you should feel like you’re doing alone. On the day of your retrieval appointment, you’ll need to bring a companion with you since you’ll be put under anesthesia, but as we saw in The Sex Lives of College Girls Season 2 Episode 5, having your crew on deck for emotional support makes all the difference in making sure you feel empowered through this epic journey. 

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It’s more than just “selling your eggs”

Donating your eggs is a huge decision—one that goes far beyond a bank deposit after the fact. When you donate your eggs, you’re not just donating your eggs, you’re donating genetic material that will someday be used to bring a new life into this world, so there’s a lot to be considered.

To quote straight from Kimberly’s pro-con list, the possibility that you’ll “run into future kids at a shopping mall” may sound crazy, but it hints at the reality that we live in a world where anyone can walk into their local pharmacy and purchase a DNA test off the shelf for less than $100, and there is really no such thing as a truly anonymous egg donation experience.

At Cofertility, we take a firm stance in our belief that anonymous egg donation is wrong. We have invested in consulting with the donor-conceived community and truly believe that disclosed relationships are in the best interest of all parties involved, especially the donor-conceived children. So if you’re considering donating your eggs, make sure to keep in mind that the child or children conceived from those eggs may want to reach out to you in the future.

Additionally, Kimberly’s pro of “a cute gay couple uses my eggs” is one that is definitely within the realm of possibility, and one that we wholeheartedly support. The way we build families is more dynamic than ever, and at Cofertility, we work with countless LGBTQ+ intended parents to help make their family-building dreams a reality. If you’ve ever considered donating your eggs to a gay couple who needs them, this is a great way to do that.

Summary

At Cofertility, we’re on a mission to make the process of donating and freezing your eggs more accessible, human-centric, and supported. If you’re thinking about this as an option for yourself, we want you to know that we’re here for you. To see if you qualify for our Split program, where you can donate your eggs while freezing half of the retrieved eggs for your own future use, click here to take our free, two-minute quiz.

Intro 

If you're thinking about freezing your eggs and you've started to gather information about it, you're probably coming across a lot of information. This can definitely be overwhelming but there’s no need to panic! We're here to help you figure out if egg freezing is the right choice for you, no matter what age you are.

What is egg freezing?

Before we dive further into this topic, what is egg freezing? Egg freezing, known as oocyte cryopreservation in the medical world, is a technique used to preserve someone’s fertility.  Eggs are collected from the ovaries and frozen so they can be used in the future. If the person is unable to get pregnant naturally, the eggs are unfrozen and used in an assisted reproductive technology (ART) procedure, like in-vitro fertilization (IVF). Whether you know you want to have kids or you aren’t sure and want to give yourself more time to figure it out, think of egg freezing as a way to keep your options open for the future.

Should I freeze my eggs?

There are many, many reasons why someone might choose to freeze their eggs but the decision is a deeply personal one that requires some careful consideration. When making that decision though, it’s important to know that egg freezing is not an “insurance policy” for your fertility. While egg freezing can take some of the stress of having a baby right now off your shoulders, it is not a guarantee that you’ll have a baby in the future. 

Why not? Well, not all the eggs that get frozen will actually be viable. It’s expected that some eggs will not survive the warming process. In addition, the chances of the eggs that do survive being successfully fertilized depends partially on how old you were when you froze them (more on this later). Beyond that, fertility and pregnancy risks change with age. If you freeze your eggs at 30 and use them when you're 40, you'll have to deal with the realities of pregnancy at 40.

This is not to sway your decision one way or another. Ultimately, only you and your doctor can decide if egg freezing is the right decision for you. But it's important to go in knowing that it’s not meant to be a done deal.

Pros of egg freezing

Ok, now that we’ve gone through the basics, let’s discuss the pros and cons.

Perhaps the biggest advantage of freezing your eggs is the fact that it lowers the risk of having children with genetic abnormalities associated with ovarian aneuploidy. Ovarian aneuploidy refers to when an egg has an abnormal number of chromosomes which leads to an abnormal pregnancy. Most people are born with 46 total chromosomes (23 pairs). The most common aneuploidy risk seen by far is Down syndrome. Babies with Down syndrome have an extra copy of one of these chromosomes, chromosome 21. The medical term for having an extra copy of a chromosome is “trisomy” so Down syndrome is also known as Trisomy 21. Freezing your eggs at a younger age decreases (but does not totally eliminate) the risk of an abnormal number of chromosomes.

Another benefit of egg freezing is that it puts the decision-making power entirely in your hands. Whether you’re freezing your eggs because you want to focus on your career or you’re getting a medical treatment that may affect your fertility later on or you’re waiting to find the right partner, freezing your eggs allows you to preserve some of your fertility independently. 

Egg freezing also gives you options in terms of having your own biological children. Of course, there is the obvious option of having the eggs fertilized and the embryos implanted into your uterus. But you also have the option of having those embryos implanted into a gestational carrier or into your partner if they have uterus. 

Finally, freezing your eggs does not affect your ability to get pregnant naturally. The egg freezing process and retrieval procedure simply rescue eggs that would have died with your next menstrual cycle. This means it does not affect your ovarian reserve (the number of eggs in your ovaries). Once you’ve completed the full process, your body will continue to ovulate and release an egg each month like normal.  

Cons of egg freezing

Now, let’s talk about the disadvantages of egg freezing. 

The most obvious downside is the cost. While some insurance plans may cover egg freezing, this isn’t the case most of the time. The out-of-pocket cost of egg freezing varies but it can be up to $20,000 depending on where you are and which clinic you use. This typically includes bloodwork, medications, ultrasounds, and the egg retrieval procedure. This does not include the annual storage fee (which can be up to $800 per year) and any follow-up procedures if you end up using those eggs. Learn how you can freeze for free with Freeze by Co. 

The next thing to consider is the hormone medications and egg retrieval process themselves. These medicines not only require injecting yourself (or having a partner or friend do it) but they can have some not-so-fun side effects. These can include fatigue, nausea, bloating, headaches, abdominal pain, breast tenderness, and irritability. A severe risk of hormone medications is ovarian hyperstimulation syndrome (OHSS). This condition can lead to blood clots, shortness of breath, abdominal pain, dehydration and vomiting. It may even require admission to the hospital to manage. Thankfully, OHSS is rare nowadays, affecting only up to 2% of patients.

The egg retrieval process is quick and the most common symptoms afterwards are pelvic or abdominal pain, constipation, bloating, and spotting. The main concern here is the time you need. One typical egg-freezing cycle can range from 10 to 14 days and during that time you'll be attending doctor appointments almost daily to make sure your eggs are maturing correctly.

If you’re taking any gender-affirming hormones like testosterone, you may need to take a break in order to freeze your eggs. One study showed that transgender men who used gender-affirming hormones and stopped a few months before fertility treatments ended up with the same number of eggs as cis women. But getting off hormones can be hard and could trigger gender dysphoria so the best option is to freeze eggs before transitioning if at all possible.

No one likes to be the bearer of bad news but this is an important one. Egg freezing may mean your eggs stay the same age forever but unfortunately, your body does not. As you age, the risks of pregnancy increase for both you and your potential child. These risks include gestational diabetes, preeclampsia, c-section delivery, preterm delivery of a baby with low birth weight and other risks related to the pregnancy being IVF. However, these risks vary widely depending on many other factors. 

One final caveat to remember is that egg freezing does not guarantee a live birth. It’s likely that not all eggs will survive the thawing process. Some will not fertilize. Others fertilize abnormally, and still others don’t implant successfully in the uterus. A large study at NYU in July 2022 showed a 39% live birth rate for people who used their frozen eggs. The two factors that affected the success rates the most were age at the time of egg freezing and the number of eggs thawed. Specifically, the live birth rate was over 50% for people who thawed at least 20 eggs or who were under 38 when they froze their eggs. Which brings us to our next question: what age is best for egg freezing? 

When should I freeze my eggs? 

Let me start by saying that there is no perfect age at which to freeze your eggs. However, the TL;DR is that the younger you can do it, the better. According to the American Society for Reproductive Medicine (ASRM), an optimal time to freeze your eggs is in your 20s and early 30s, while you have a higher ovarian reserve and eggs are healthier. So whether you’re 25 or 35, you can absolutely freeze your eggs!

A large 2020 study at a fertility clinic that specializes in this area looked at egg freezing cycles for over 1,200 people. It compared the average number of eggs people of different ages were able to freeze versus the “optimal” or goal number of eggs they should freeze. This goal number was based on how many eggs would give them a 70% live birth rate after doing 1 or 2 egg freezing cycles (this rate is calculated using some other numbers and it typically goes up as we age to make up for the lower number of healthy eggs). 

The study found that younger people, unsurprisingly, have an easier time freezing the goal number of eggs in one cycle. As people aged, they needed multiple egg freezing cycles to reach that goal number.

These findings bring up a common question–is it worth freezing eggs after age 35? Well, it depends. The ASRM does not recommend egg freezing for people older than 38, but this isn’t a strict cutoff. Everyone’s fertility goes down at a different rate. Having your fertility hormones checked can sometimes help you and your doctor get a general idea of what your ovarian reserve is. This can better help you decide if egg freezing is right for you.

Egg freezing can be a tricky process to navigate and you are not alone when it comes to questions and concerns around it. Freeze by Co is here to help you every step of the way. With our Split program, people between 21 to 34 years old have the chance to freeze their eggs for free! In a “Split” cycle, you would donate half of the eggs retrieved to a family that’s trying to conceive and freeze the remaining half for yourself. If you’re over 34, you can still participate in the Keep program up to age 40. You would be able to freeze your eggs and keep them all for yourself, on your timeline while having access to an additional valuable resource in our support community, The Nest. This community allows you to engage with other people freezing their eggs at the exact same time! 

Regardless of which path you choose, our team will be there to guide you through the process as we work to keep your family-building options on the table.

You might have heard at some point that freezing your eggs can help you preserve your fertility options for your long term future. But just how many eggs should you freeze? Is there an optimal number for egg freezing?

Let’s take a look at how many eggs you can expect to get during the retrieval process and how many eggs you should be freezing for fertility preservation. 

How many eggs do I have?

Before we talk about the number of eggs you should freeze during oocyte cryopreservation — more commonly known as freezing your eggs — we should probably talk about how many eggs are in your ovaries right now. 

Your fertility doctor may have mentioned the term ovarian reserve a few times. When they do that, they’re talking about the number of eggs in your body. But how many eggs are in that reserve?

There is no exact answer here. On average, women are born with anywhere from one to two million eggs. Some women are born with more. Some women are born with less. 

It may sound like a lot either way, but most of the eggs we’re born with don’t stick around. By the time most of us hit adolescence,we have about 300,000 eggs left. From there, the number of eggs in the body naturally decreases by about 1,000 every year, and the decline becomes more rapid after age 35.  

That’s where egg freezing comes into play. The doctors of the Association of Reproductive Medicine (ASRM) states that planned oocyte preservation is “ethically permissible” because it provides women with more autonomy over their reproductive choices. 

Doctors can get a sense of how large your ovarian reserve is before egg freezing by testing the level of the anti-Müllerian hormone (AMH) in your body. This test looks at both your ovarian reserve and how well your body may or may not respond to medications that will stimulate the ovaries. What it can’t determine, however, is the quality of those eggs. And ultimately, you need both quantity and quality.

How many eggs do I need to freeze?

OK, so you may have a lot of eggs in your ovarian reserve — or maybe not. But how many do you actually need to freeze?

This answer varies from person to person and depends on a few individual factors:

• How old are you right now?
• Do you plan to freeze all of your eggs or do you hope to also donate some to help intended parents grow their family? 
• If you think you may want to have children one day, how many do you have in mind?

This list presents a lot to think about, so let’s dive a little deeper to help you make informed decisions about the number of eggs you freeze. 

The right number of eggs to freeze for your age

Different folks have different reasons for freezing their eggs. Some may be thinking about prolonging their fertility into the future. Others may be freezing some eggs but also hoping to donate some eggs to help others grow a family — something that’s done via our Split program, where you freeze for free when donating half of the eggs to a family that can’t otherwise conceive. 

Either way, studies have found that the optimal number of eggs to freeze really comes down to your age. That’s because the number of eggs in the body isn’t the only thing to decrease as you get older — egg quality decreases too, and egg quality is the number one factor in determining whether an egg can eventually result in a live birth. 

Here are the number of eggs you’ll want to freeze based on your age in order to obtain an optimal live birth rate:

How many eggs are retrieved?

For  egg donors aged 25-29, the average number of eggs retrieved is 18, and that number drops to 16 for people age 30-35 — although it varies from person to person.

Your reproductive endocrinologist will be able to tell you the day of your retrieval how many eggs were retrieved. This number will include both mature and immature eggs, so it’s not necessarily the total number of eggs that can be frozen. 

Immature Eggs

• May be partially or completely damaged or have its quality compromised in some way
• Lower chance of fertilization

Mature Eggs

• Have good egg quality
• Are more likely to be fertilized
• Can be frozen

After your retrieval, all of your eggs will be sent to an incubator to check maturity. The lab technicians will look for eggs to achieve meiosis, a kind of cell division that occurs in egg cells. 

The eggs that achieve meiosis will be frozen, and you will be notified of the total number. 

Should I do multiple egg retrievals?

What happens if you don’t get as many eggs as you had hoped during your egg retrieval cycle? 

If you’ve undergone one round of egg freezing and the number of eggs your reproductive endocrinologist retrieved from your ovaries wasn’t as high as you’d hoped, you may want to talk to them about trying again. 

There is technically no limit to the number of egg freezing rounds a person can undergo, but it’s not recommended that egg donors undergo more than six cycles. If you’re hoping to split your eggs with intended parents (donating half of the eggs retrieved) as part of our Split Program, you may find that additional retrievals help you provide the optimal amount of eggs for a live birth for you and for the intentend parents too. 

Of course, you should talk to your doctor about any risks or benefits that come with additional rounds. 

The right number of eggs to freeze to have multiple children

If you’re planning to have a big family one day, you may want to look at the number of eggs it’s recommended you freeze to achieve one live birth and talk to your doctor about freezing more eggs. 

For example, the studies show that a woman under age 35 will need to freeze about nine eggs to achieve a 70% chance of a live birth. If you’re under age 35 now and thinking you might want to use frozen eggs to conceive twice in your future, you will want to freeze closer to 18 eggs to achieve that 70% chance each time. 

That number will increase with each number of children you foresee — provided your expectation is that each child will be conceived with the use of the eggs you are currently freezing. 

Bottom line

There is no “magic number” when it comes to freezing your eggs. Your age, your future plans, and more all come into play. 

We’re here to answer any questions you might have, and the Cofertility community is also here to lend support as you consider all the important factors to make the choice that is right for you.

It may not come as a surprise to learn that the prime time for freezing your eggs is actually a lot earlier than you think. According to the American College of Obstetrics and Gynecologists (ACOG), freezing your eggs while you’re still in your 20s can help boost your chances of a successful pregnancy—and a 2010 report from the Center for Disease Control and Prevention (CDC) says that those eggs have a higher chance at resulting in a live birth no matter your age when you decide to start your family. 

For many women, that means the best time to freeze their eggs is likely the moment they start wondering when they should start. Read on to see what you need to know about why freezing your eggs before you’re even sure what you want to do with them is the best way to ensure you’ll be able to make the decision for yourself when the time is right. 

Your body produces a different number of eggs at different times

Your late 20s and early to mid-30s are considered the peak time to retrieve eggs—with a 2015 study from the American Society for Reproductive Medicine saying you’ll see the best results prior to the age of 34 — because your body has reached complete development and your eggs are at their most healthy and plentiful point.

That doesn’t mean that the quality of your eggs takes a major dip when you celebrate your 38th birthday. Instead, it means that as you add more and more candles to your birthday cake each year your body begins to produce fewer eggs. This becomes important when you realize how many eggs you’ll need to retrieve when you begin the process of freezing your eggs.  

Take the 2020 study from Assisted Reproduction Technologies (ART) that showed women under the age of 35 were retrieving an average of 21 eggs during their first round of egg freezing while women between the ages of 35-37 were retrieving an average of 17. Four eggs may not seem like that big of a difference at first, but once you take into account how many eggs experts say you should have on hand when it comes time to start fertilization you’ll begin to realize just how quickly those numbers add up. 

Producing fewer eggs may increase costs

The saying less is more doesn’t apply too much in the world of fertility, where your chances of going on to have a live birth increase based on the number of eggs you have on hand when it comes time to fertilize and implant them. 

That 2020 ART study that showed the average number of eggs retrieved each cycle also showed that if you're under the age of 35 you will need 9 eggs for a 70% chance at having a baby. However, if you’re looking to hit that same 70% mark in your later years (think 38-40), you’ll need closer to 18 eggs to have the same chances at a live birth. With women in that age range only averaging 17 eggs per retrieval, that may mean multiple cycles, and with a $10,000-20,000 price tag that can quickly add up.

The best time to freeze your eggs is, unfortunately, usually before you can afford it

Not many people have that much money readily available in their 20s, which is why egg freezing is often financially out of reach for those who would benefit most from it. With programs like Freeze by Co you can take advantage of those peak fertility years even if you can’t exactly swing the costs. 

One program offered by Freeze by Co is Split. Split Members benefit by offsetting the cost of freezing their eggs by donating half of them to a family that cannot otherwise conceive. Split Members match with intended parents, and undergo an egg freezing cycle where half of their eggs are donated to the perfect intended parents (after testing and meeting qualifications, of course). The other half are then stored (for free) for the split member for up to 10 years. 

If you’d rather hold onto all your eggs until you’ve decided what your fertility future holds, you can use Freeze by Co’s Keep Member plan. These members can still benefit from lower costs, thanks to things like reduced medication fees, consultation discounts, and more. 

This is the most cost-effective age to freeze your eggs

With all these numbers flying around you may be wondering where the health benefits and the financial benefits meet. According to a 2015 study published in the journal Fertility and Sterility, the two numbers seem to cross paths at the age of 35.

Women who freeze their eggs at 35 for use by the age of 40 spend an estimated $15,000 less than those who are trying to have a baby at 40. And that’s not the only good news, that math seems to hold up all the way until the age of 38. 

Freezing your eggs should be a positive experience

With the accessibility Cofertility gives women to take control of their fertility process, you can feel empowered to make decisions based on what’s in the best interest for you and your body without having to worry about your bank account. 

Getting an earlier start at freezing your eggs through Freeze by Co (even if you don’t have a partner or aren’t even sure that your dream future includes children yet) will: 

• Give you a higher chance at eventually achieving a live birth even if you wait until your late 30s or early 40s.
• Allow you to wait on making major decisions about your education, career, and future until you’re ready.
• Offer you the freedom to make medical decisions based on what’s right for you instead of what type of coverage your employer offers at the time. 
• Provide peace of mind because no matter what your future family may look like you’ve already taken the first step to making your dreams a reality. 

Even if you’ve missed that peak window into your fertility there are still plenty of benefits to freezing your eggs. With all of the new plans offered by Freeze by Co you’re likely to find one that will fit your current needs while giving you a chance to plan for your future.

Many folks who have made the big (and exciting) decision to freeze their eggs want to improve their egg quality before freezing. But is egg quality really something you can control? What kinds of lifestyle changes should you make before freezing your eggs? Read on for a look at what the research says about egg quality — and what you can do to improve it before the egg freezing process begins. 

What is egg quality?

As you’ve been exploring the egg freezing process, you may have heard your fertility doctor mention that freezing during your 20s can be beneficial because your egg quality will likely be higher. 

It’s annoying, but true: as women age, our egg quality typically goes down further and further. The American College of Obstetricians and Gynecologists (ACOG) estimates a woman’s chances of getting pregnant begin to decrease at age 32 and continue to gradually go down until about age 37 when the decrease becomes more rapid. ACOG links this decrease in what they call fecundity — another word for fertility — to egg quality. 

This is one of the many reasons Freeze by Co partners with local fertility clinics to create opportunities for women in their 20s to freeze eggs more affordably. We want you to have more control over your reproductive choices, even if you’re not looking to get pregnant during this peak egg quality period.

But what does “egg quality” (also called oocyte competence) actually mean? Are doctors being a tad judgmental about a woman’s age? Not at all. 

When fertility specialists use this term, they’re referring to whether your eggs are considered genetically normal or abnormal, and it’s tied pretty closely to the chances that an egg could ever result in pregnancy.  

Euploid vs. aneuploid embryos 

While sperm health is undeniably important, it all starts with the egg. The quality of embryos made from your eggs comes down to two different types:

• Euploid embryos 

• These embryos are genetically “normal.” 
• They contain the right number of chromosomes at 46. 

• Aneuploid embryos

• These embryos are genetically “abnormal.” 
• They contain either fewer or more chromosomes than normal. 
• Embryos created with a low quality egg may inherit either too many or too few chromosomes. 
• Most aneuploid embryos will either fail to implant or result in miscarriage as they are usually not compatible with life. 

There’s also a significantly higher risk that an aneuploid embryo will not implant in the uterus after an in vitro fertilization (IVF) transfer — one study found as much as 96 percent of abnormal embryos transferred into the uterus did not implant. On the other hand, that same study found when euploid embryos were transferred, the pregnancy rate was 82 percent. 

Do I need to improve my egg quality before freezing? 

So if euploid embryos start with healthy eggs, you’re probably wondering: do I need to improve my egg quality before freezing? 

Some factors that affect egg quality such as your personal genetics and the passing of time can’t be controlled. But there are ample steps you can take to influence the health and quality of your eggs. 

Here are some simple changes that research shows may improve egg quality. We recommend you consider making these changes at least three months prior to egg freezing: 

1. Quit smoking 

If you’re using cigarettes, now is a good time to stop. Studies have found that smoking can have a detrimental effect on fertility. Puffing on cigarettes can increase the risk of infertility by as much as 60 percent with negative effects on the menstrual cycle, uterus, and ovaries. It’s the effect on the ovaries that is particularly troubling when it comes to egg quality with smoking damaging the DNA of the eggs themselves. 

2. Avoid marijuana

Although there aren’t a lot of studies on the effect of marijuana on fertility, those that exist indicate THC — the psychoactive ingredient in marijuana — can result in an impaired ability to produce viable embryos. According to a study published in the Journal of the Endocrine Society in 2020, the exposure of oocytes to THC was linked to a “significant decrease in the expression of genes called connexins.” These connexins are an important marker of egg quality. For our Split members, we require them to stop using marijuana products at least one month prior to retrieval.

3. Improve your diet

There is never a bad time to eat a healthy diet, and if you’re planning to freeze your eggs in the near future there are extra reasons to make smart choices at meal time. Eating a diet rich in leafy greens, whole grains, and lean proteins can all help those egg cells. 

Here are some rock star foods you might want to consider adding to your diet when you’ve got an eye on improving egg quality (plus the benefits they bring):

• Fish such as salmon, mackerel, and trout — Omega 3 fatty acids
• Egg yolks — Vitamin D
• Beans, oats, oranges, and cantaloupe — Inositol
• Fruits and veggies of any kind — Antioxidants
• Oysters, beef, chickpeas, lentils, hemp seeds, pumpkin seeds, and pine nuts — Zinc

Before embarking on any major diet changes, check with a registered dietician. They can help you craft a plan that’s just right for your body. 

4. Talk to your doctor about supplements

If you’re not already taking vitamins, you may want to chat with your reproductive endocrinologist about whether you should add Vitamin A, Vitamin B, folate and zinc — or maybe one of the four — to your daily routine. Studies have linked all three of these micronutrients to egg quality over the years, affecting the synthesis of DNA and other factors in oocyte development. 

Your doctor may want to check your vitamin D level with some bloodwork or go over your current vitamin regimen before deciding if adding on additional supplements is necessary. Make sure to bring any dietary changes you’re making into the conversation too — there can be too much of a good thing when it comes to some vitamins!

5. Talk to your doctor about your weight 

Being told you need to hop on the scale when you’re at the reproductive endocrinologist’s office can be frustrating, especially if you’ve struggled to lose or gain weight in the past, or if you have a condition such as polycystic ovarian syndrome (PCOS) that affects your weight. 

Still, the weight conversation is one worth having with your fertility specialist if you’re worried about your egg quality. Both being over and underweight has been linked to egg quality by researchers time and again. 

Obesity in particular has been found to affect the hormones that guide an egg as it matures. On the other hand, being underweight can stop the body from ovulating entirely. 

The “right” weight for your body is one you and your doctor can discuss. If changes are in order, they can help craft a plan for healthy changes — or recommend a dietician who can. For our Split program, there are BMI requirements, which you can read more about here.

The bottom line

The quality of your eggs may not be completely in your control, but you do have solid options when it comes to improving your egg quality before freezing. What you put into your body makes a difference, and making changes now can make a real difference down the line. 

If you’re a female physician in the United States, you may have heard that you’re at a higher risk of infertility than your female friends who took a different career path. It certainly sounds like the kind of “fact’ that gets posted on social media one day and suddenly becomes gospel, whether it’s true or not. 

Unfortunately, we can’t just write this one off as a social media hoax. Researchers have run the numbers, and it turns out almost 25% of female doctors who are trying to conceive are faced with fertility challenges. This is about double the rate of the general public.

“It turns out almost 25% of female doctors who are trying to conceive are faced with fertility challenges. This is about double the rate of the general public. “

So what’s going on? Should you be freezing your eggs now just in case? Is there anything else you can do? Read on for the research into this fertility concern and what American doctors are doing about it. 

Female doctors and fertility

General fertility rates have been trending downward in the US in recent decades with the CDC reporting record low birth rates in 2018 and only minimal increases since. In 2021, the American birth rate was 1,663 births per 1,000 women — not enough to maintain stable population figures in the US. 

And while some of that could be due to personal choice, scientists have found increasing rates of reproductive problems are cropping up in women and men. Miscarriage rates are up about one % every year and so are the rates of gestational surrogacy — an option growing in popularity for intended parents seeking the help of an additional party for conception. 

But the plight of female doctors stands out among all these figures: 

• 1 in 4 — The approximate number of female physicians who were diagnosed with infertility after trying to have a baby, according to a survey published in the Journal of Women’s Health in 2016 
• 11 % — The percentage of American women in the general population have had the same diagnosis. 
• 42 % —The amount of female surgeons who have experienced a pregnancy loss, according to a survey published in JAMA Surgery in July 2021 which reported that 42 % had experienced a pregnancy loss. 

What’s going on?

What makes female doctors so different from the rest of the population? In part, their education. 

There’s no real way to put this nicely: Age matters when it comes to fertility. Extensive medical research on fertility shows that getting older has a major effect on our reproduction system and our ability to conceive.

But many female doctors — surgeons included — delay pregnancy until after the completion of their residency. How long that will take depends on the doctor’s specialty, but this can be another three to eight years after medical school. For surgeons, a residency is a minimum of five years. 

That puts many female doctors into their 30s before they even begin trying to have their first child. In fact, in the 2016 survey, doctors reported they were 31.6 year old on average at completion of medical school and residency and 30.4 years on average at first pregnancy. By comparison, the average age of an American woman giving birth for the first time in the US is 26 years old, according to data compiled for the New York Times in 2018. 

Almost a third — 28% — of the female doctors surveyed in 2016 who experienced fertility challenges said they would have begun trying to conceive earlier if they could have seen what lay ahead. Close to the same number — 29% — said they experienced diminished ovarian reserve, a condition in which their fertility challenge was linked to having fewer eggs in the body. This condition is largely associated with age. 

But delaying reproduction is only part of the puzzle.

Even after adjusting for age, female physicians have higher rates of infertility. Perhaps this is due to female doctors facing high rates of stress at work that put a strain on the body and can affect reproduction as a whole. Those who opt to start a family before residency is complete may face irregular work schedules and long, grueling shifts that can put intense strain on anyone’s body, but prove especially hard for someone who is pregnant.

Together, all of these factors can have a significant impact on the fertility of a female doctor. 

How can female doctors preserve their fertility?

The numbers may seem a little daunting, especially if you’re in medical school or the midst of your residency. So what can women do about it? 

An infertility task force now exists as part of the American Medical Women’s Association to find answers to this problem plaguing women in medicine, and individual doctors around the country have been working to advocate for improved fertility education and fertility insurance coverage for their peers. 

One of the chief criticisms of the current system comes from Dr. Areila Marshall, one of the founders of the AMWA task force, who wrote about the issue in the journal Academic Medicine in 2020 calling for better awareness of egg, embryo, and sperm cryopreservation. 

Marshall echoed a wish expressed by a number of the physicians who took part in the original 2016 survey: 7% of those doctors said they wished they had known to use cryopreservation to extend their fertility. 

For female doctors who don’t know when — or even if — they want to conceive, egg freezing can be a viable option. 

Freezing is not a guarantee that you will have a baby down the line. It simply means that eggs will be there, waiting, if you decide at some point in the future that you wish to explore conception. 

At Freeze by Co, we are committed to giving women the opportunity to have more control over their reproductive choices. Here women have a variety of paths they can choose from when it comes to egg freezing – whether they’re looking to freeze eggs now or have already frozen some of their eggs.  

Members of our Split program even freeze for free when they give half  of their eggs to intended parents who cannot otherwise conceive.

Bottom line

Women should not have to choose between a dream of pursuing a career in medicine and making reproductive decisions on their own timeline. Egg freezing gives women the power to make more choices about her own body.

While in theory, the idea of egg freezing would have many raising their hands to give this a try, practically speaking it may be more complicated. There are real-world factors to consider: Do I need to freeze my eggs? Will I actually need them down the line? Am I a good candidate? And if so, would it actually fit into my budget, and are the logistics really feasible?

No need to wonder. Here’s what you need to know to make egg freezing possible in reality and the sort of programs where you can bring this to fruition.

Affordable egg freezing programs

We at Cofertility are dedicated to the idea that egg freezing should be more accessible. To make it possible for more of those who are interested, we have designed two different programs that prioritize different aspects of egg freezing. Take our quiz to see if you qualify for these programs.

Paying for keeps

With our “Keep” program, it’s about maximizing the number of eggs that you freeze, geared to enabling many people to be able to answer the question, “Can I freeze my eggs?” with a big, “Yes.”

As a member in this program, you get access to discounted prices we’ve negotiated with clinics and pharmacies, as well as a community of women also freezing their eggs at the same time. With this Keep program we give more leeway on exactly who can participate. While we are aware that research shows that fertility starts to decrease considerably after age 35, you can still take part in the program as long as you are under age 40.

This is egg freezing with real world families in mind, with steps taken to make fees more affordable. The idea is to lighten the load and to make budgeting for egg freezing that much easier, while bringing a little more joy and positivity to the process

The Split cycle

With our Split program, it’s all about taking budgeting out of the equation altogether, while helping another family. 

As a Split program member, if you qualify, you don’t have to set money aside for these burdensome costs at all – they are free as part of the program, including up to ten-years of storage. In return, you give half of your retrieved eggs from a cycle to someone who would be otherwise unable to conceive. The family receiving the donated eggs pays for all the costs to freeze and store your eggs, for their use to build a family now, and your use in the future. 

But, because we are splitting the number of eggs here, every single one counts that much more. So, we need to be more stringent in determining who can become a Split member. 

Important X factors

One of the factors that we weigh heavily for the Split program is age. In order to participate, you cannot be over age 34. That’s because data shows that, on average, those over 35 may not respond to fertility medication as well and therefore may not produce as many eggs. Also, research shows that, unfortunately, egg quality declines with age. 

Given the amount of time it may take to do initial testing and to match you with an intended parent, we have aligned our policy with ASRM (American Society for Reproductive Medicine) guidance on this and limit membership here to those who have not yet turned 34. This way if there’s a hiccup along the way, you won’t have to miss out — there should still be sufficient time to participate in the program.

Another factor to consider is what’s known as your anti-Mullerian hormone (AMH) levels. These levels signal how responsive your ovaries are likely to be to medication given to stimulate them to produce multiple eggs. If this number is pretty high, it usually means that your ovaries will respond well to stimulation. 

If at the time of initial screening, your ovarian reserve appears low based on your ultrasound and bloodwork, you, unfortunately, will not be eligible for the Split program, although you can still become a Keep member and achieve your goals that way. The ASRM guidance underscores the importance of considering biomarkers that indicate a donor’s potential ovarian reserve as part of the selection process. Scientists have found the AMH serum range of 2.20 to 6.8 ng/ml to be the one that research predicts will show if someone has enough ovarian reserve. This indicates how you will likely respond during an egg freezing cycle. 

No matter your ovarian reserve, you can still freeze your eggs. You just may not qualify for our Split program. That’s because we want to ensure that enough eggs are produced in the cycle to make it worthwhile for everyone after the eggs are divided, without your feeling that you’ve come up short and won’t be happy unless you do another cycle.

If you’re among those who qualify though, as many in their fertility prime may be able, this can be a golden opportunity. Feel free to read more about qualifications for joining our Split program.

Logistics

There is, of course, also the question of where you’ll need to go to make all this happen. 

If you’re a Split member, your initial physical screening takes place after you are matched with an intended parent. This includes some blood work and a vaginal ultrasound, which helps determine if this program will work for you, and will likely take place somewhere between where you and the intended parent’s locale. If any travel is needed though, our team will help you to make this happen, doing the necessary organizing. But monitoring for the cycle itself can be done at a local clinic right in your own area.

Meanwhile, Keep members have the flexibility to do the testing as well as the cycle locally, where it’s most convenient. 

Can you freeze your eggs? 

So, is this something that could practically work for you? Both of our programs are designed to make this feasible for a wide-variety of women. We try to keep costs down for Keep members while offering added flexibility to pursue their egg freezing goals. Meanwhile, for Split members the financial barriers are removed altogether.

Hopefully, this helps you to see how, practically speaking, you too can raise your hand up high and answer the question, “Can you freeze your eggs?” with a giant, yes, to make egg freezing in reality.

Deciding to freeze your eggs can do more than put you in the driver’s seat of your reproductive journey. Going through the process of retrieving and freezing your eggs can give you insights into your health, offer you peace of mind about how you’ll accomplish your goals, and allow you to create a blueprint for building the family you’ve always dreamed of.

As you and your doctor work together to ready your eggs for retrieval you’ll end up learning valuable information about the state of your fertility and what you need to know before you’re ready to take the next steps. 

You could get a heads up about certain reproductive concerns

As part of the preparation for freezing your eggs your doctor will likely do ovarian reserve testing which uses a blood test called Anti-Mullierian Hormone (AMH). Using a blood sample collected on the third day of your period your doctor will be also able to see how much estradiol and follicle-stimulating hormones are present during this key window in your reproductive cycle.

AMH levels are generally higher during your childbearing years and then they begin to decline as you head towards menopause, becoming almost nonexistant afterwards. 

You’ll get a better picture of your reproductive schedule

According to the Mayo Clinic, after you’ve decided to move forward with the process you’ll begin taking hormone injections. These hormones will have two distinct jobs—ovarian stimulation and preventing premature ovulation—which your doctor will achieve using a variety of medications. 

Your doctor will begin monitoring you and checking two very important levels:

• Estrogen (an increase means your follicles are developing)
• Progesterone (low levels will mean you haven’t ovulated yet)

Not only will you discover how your body reacts to stimulation (giving you a great deal of information about how your egg production is going) but you’ll also have an idea of when you should ovulate. Knowing exactly when the clock starts ticking—your eggs will be ready for retrieval after 10-14 days—will let you know what you can expect for this cycle. 

Your doctor will find out how many follicles you have

Speaking of follicles, these are the sacs where your eggs will stay until they have matured. Your doctor will likely use a vaginal ultrasound to check the status of your ovaries to see how many follicles have developed, indicating how many eggs you’ll likely have for retrieval. That number is going to be very important (and very exciting) for both you and your doctor. 

To give you an idea of why that number matters so much, you’ll need to know how many eggs you need to increase the potential for a live birth. A 2020 study in the Journal of Assisted Reproduction and Genetics found that a woman under the age of 35 averaged 21 eggs on their first round of egg retrieval. At that age, you would need approximately 9 eggs to ensure a 70% chance of a live birth. Once you find out how many follicles you have you might have a better idea of your pregnancy success rate when the time comes. 

There will be additional health screenings 

Another thing you’ll learn about your fertility is whether you have any diseases that you can pass onto a future child, via a genetic carrier screening test. Your doctor will also likely have you undergo an infectious disease screening—which will check for things like HIV and certain varieties of hepatitis—as part of your work up. These tests are different from genetic screenings, which looks for the potential changes in your genetic blueprint indicating heredity conditions that can be passed onto your child.  

Some people who freeze their eggs may do genetic testing ahead of time, whether because they already know that certain conditions run in their family or because they have a limited understanding of their family history. According to the Centers for Disease Control and Prevention (CDC), genetic testing can even give you information about some types of cancers that could impact your reproductive system, making it another important tool in your fertility arsenal. 

Getting proactive can save you money

By being proactive about your fertility journey you not only get to make the decisions about what your future family will look like based on your terms, but you’ll also be able to get an idea of what may lie ahead for you if you decide to have a child.

Of course, freezing your eggs can be expensive. It costs an estimated $10,000-20,000 per cycle. Fortunately, there are egg freezing programs like Freeze by Co that can help you navigate financial pain points that may make planning for that future family a little bit harder by offsetting some of the costs associated with freezing your eggs. Freeze by Co offers members two different options for freezing their eggs. Split Members may qualify to freeze their eggs for free when they donate half of their eggs to other families looking to conceive.

There are even benefits for those who want to use the Freeze by Co’s Keep program. As the name indicates, Keep Members keep all of the eggs collected during retrieval while still benefiting from discounted costs in the way of less expensive medications and more. 

Perhaps the idea of egg freezing is something that you’ve thought about before. For many of us, though, the cost can be a big barrier. You might be hoping to find an affordable egg freezing program that can allow you to freeze your eggs now and store them without breaking the bank, as you pursue your own agenda.

Is this just a pipe dream? With Cofertility, it’s actually…not. Read about how our platform can enable you to give the idea of egg freezing another look, with — wait for it — free egg freezing. And you get to help a family along the way.

A win-win innovation

Egg freezing can cost upwards of $15,000-$20,000, and that doesn’t even count years of storage. We started Cofertility with the dream of giving women more options. That led us to develop what we call our Split program.

With the Split program, if you are eligible, the premise is simple: for each cycle you undergo, you keep half of the eggs for yourself at absolutely no charge, plus ten years of storage and any travel. The other half of the retrieved eggs go to another family who can’t otherwise conceive. The families we help include couples facing infertility, cancer survivors, and gay dads. 

What you get as a Split member

In addition to giving a life-changing gift to another family, as a Split member, you are entitled to the following for free with your egg freezing cycle:

• Care from a board-certified fertility doctor
• Support from one of our Member Advocates
• Access to our community 
• Fertility testing
• Genetic testing
• Any necessary medication
• The egg retrieval
• Egg freezing and storage for 10 years
• Procedure insurance
• Travel

In addition to lightening your own financial load, the good you’ll be doing will be immeasurable.

Am I eligible for the Split program?

To participate in Split, you must meet certain industry- and government-based criteria, including: 

• Age: Between 21 and 33 years old (consistent with ASRM guidelines). Age is a factor that contributes to waning fertility, which, while not true for everyone, tends to decline at age 35. Since the process leading up to egg donation can take time, we cap the program at age 33, as consistent with guidelines set by the American Society for Reproductive Medicine (ASRM). 
• Ovarian health: Possess two ovaries and have no reproductive issues or genetic abnormalities.
• BMI: Between 18 and 29 for optimal medication and retrieval outcomes. Read more about BMI here.
• Lifestyle: Non-smoker and no recreational drug use.
• Health: Good physical and emotional health.

If you meet these requirements, you could be a great candidate for the program. 

Read more in What are the Qualifications for Joining Our Split Program?

Getting started

To find out if our Split program is a way that we can help you reach your egg freezing goals, here’s how the process works:

1. Take our quiz to see if you qualify

First, take our brief quiz to learn more about our Split program and see if you’re a potential fit. It just takes a few minutes. 

2. Apply for join

Then, if you’ve pre-qualified, you move on to the application process. This is your chance to tell us more about your background and create a profile for intended parents to see and hopefully connect with. It will also help finalize your acceptance into the program.

3. Meet with our team

Next, we chat. You get to ask us any questions about the process and get to know us, as we get to know you as well. We’ll walk you through all program logistics and frequently asked questions so you feel completely comfortable with it all. 

4. Screening

During the screening phase, we’ll get a sense of your ovarian reserve and overall physical health to get a sense of whether you’ll have enough eggs available to fairly split for yourself and the intended parents. If your ovarian reserve appears strong enough that splitting the retrieved egg yield has the chance to result in a live birth for both parties involved, and you continue to qualify based on the other physical and psychological screening factors, you’ll be given the final green light.  

5. Find a match

Once you’ve been fully accepted into the program, the matching process begins. When your profile has been selected by intended parents, you’ll have the opportunity to accept the match. If you agree it’s a good fit, then the screening and freezing process can begin.

6. The cycle

Now it’s all about your cycle. This means you’ll start taking injectable medications needed to enable your ovaries to produce multiple eggs. We have loads of materials that can help you successfully manage this.

After close monitoring, when the time is right, you’ll be scheduled for the egg retrieval. During this 30-minute process, the doctor will remove the eggs with the aid of vaginal ultrasound while you’re under light anesthesia.

7. Free storage begins

Then, right away, your half of the eggs will be frozen. As a Split member, this whole process will be entirely free, including up to ten years of storage. In the case of an odd number of eggs, the extra one will be slated for use by the intended parents. However, we ask our clinic partners to save any non-mature eggs retrieved for you, since we don’t know what kind of medical advancements might take place over the next ten years. 

As a Split member, if you feel that it would be beneficial for you down the line, you can always consider doing another cycle. This will allow you to add to what you already have in storage and reap the benefits of additional free egg freezing, making the most of the program.

Why choose split?

• Affordable egg freezing: Eliminate the financial barriers to preserving your fertility.
• Help another family: Give the gift of parenthood to a family in need.
• Comprehensive support: From testing to storage, every step is covered.
• Flexibility: You can undergo multiple cycles to increase your egg reserve.

Adding it up

Our Split program puts egg freezing in reach for all members. It removes what are often the biggest obstacle to taking charge of your fertility timeline — cost — while allowing an opportunity to help another family. 

Once you’ve completed the Split program, you can walk away knowing that not only have you figured out a way to make your goal of storing eggs a reality without the need for scrimping in other areas, but you’ve also succeeded in giving another family a golden opportunity they wouldn’t have had otherwise.

Read more:

• Is Egg Freezing Safe?
• Researchers Followed 921 Egg Freezers; Here’s What They Found
• How to Increase Egg Freezing Chances of Success
• Does Donating Eggs Affect Your Fertility?
• What’s the Best Age to Freeze My Eggs?

Our goal at Cofertility is to match intended parents with Split members who can help them achieve their goal of parenthood.  Because of that, we want to make sure we’re upfront about what might disqualify someone from our Split program. 

Through this program, you can freeze your eggs for free if you donate half to a family who can’t otherwise conceive. But, importantly, several factors may limit your eligibility.  Some of these are official disqualifiers based on regulations by the Food and Drug Administration (FDA). Others are discretionary disqualifications based on recommendations by governing bodies like the American Society for Reproductive Medicine (ASRM). 

While it’s not possible to create an exhaustive list of every reason someone may not qualify for our Split program, this guide outlines some of the most common reasons for disqualification.

Age

To apply to be a part of the Split Program, you must be between the ages of 21-33. This is because you’ll need to complete your retrieval before you turn 35, so because the process can take some time, we don’t accept applicants who are 34 or older. 

The reason for this age limitation is because data shows that, on average, those over 35 tend not to respond to fertility medication as well and therefore may not produce as many eggs. Also, research shows that, unfortunately, egg quality declines with age. Various factors may affect your cycle timing (application paperwork, time to match with a family, and more) and you will need to cycle before you turn 35. We’d hate for someone to apply, get accepted, and then when the time comes for the cycle itself, potentially age out.

If you are 34-39, you are still eligible to participate in our Keep program. With this program, you can freeze your eggs and keep 100% of them for yourself. 

If you are under 21 and you’d like to participate, please reach out and we’ll get back in touch after you turn 21. 

Health-related factors 

As a preliminary step in the process, we’ll review several health-related factors. 

For starters, you’ll need to have two ovaries and you cannot have taken a Depo Provera shot, which can interfere with hormonal medications, within the past 6 months. 

Due to these hormonal medications you’ll need to take during egg freezing, you also cannot be currently pregnant or breastfeeding. However, if you plan to stop breastfeeding within the next six months, you can still go through with your Split application. You’d just need to hold off on your actual freezing cycle until then, and this situation would be communicated to potential match families. 

Additionally, you’ll need to have a BMI of 18-29. Those outside of this range are at increased risk of complications, negative outcomes, and negative side effects from hormonal medications or an egg retrieval. 

You will not qualify if you’ve had a sexually transmitted disease within the past 12 months (but can apply after 12 months of treatment). You also will be disqualified if you’ve been refused as a blood donor due to other infectious disease or medical conditions. Same goes if you’ve ever had a blood transfusion. 

Medical and family history

We will also review your and your family’s medical history. Unfortunately, this means that if you are adopted and cannot confirm your biological family’s medical history, you will not qualify. 

Though not an exhaustive list of every condition that may disqualify a member, when reviewing your personal and family medical history, we look for personal and/or family history of:

• Cancer
• Heart/blood disease
• Neurological diseases
• Mental health disorders
• Thyroid disorders
• Genetic disease
• Fertility issues
• Reproductive disease
• Autoimmune disease
• Respiratory disease
• Metabolic disease
• Gastrointestinal disease
• Kidney disease
• Birth defects

We review your personal and family medical history as a whole with our medical advisors. When reviewing, we consider the severity of the disease/conditions, number of relatives with the disease/condition, age of diagnosis, as well as that relative’s relation to you.

Psychological screening

There are also some psychological questions you’ll have to answer. We don’t expect you to be perfect. But note that certain psychological factors may be more likely to disqualify you than others. 

For example, a history of physical, sexual or substance abuse or having family members with psychiatric disorders that could be passed down may make it more difficult to be approved than, for example, having had some mild depression or anxiety. Per ASRM guidance, we will exclude those with a personal or first-degree (parents, siblings, offspring) family history of: 

• Bipolar disorder
• Schizophrenia
• Schizoaffective disorder
• Severe depression
• History of alcoholism or drug abuse

Genetic screening

As part of the process, you’ll also be required to do genetic testing via blood test or saliva sample. This helps ensure that embryos resulting from your eggs will lead to a viable pregnancy and that a child won't be born with severe disease. 

But even for serious diseases, not all disease-related genes are deal breakers. For example, if we find that you have a copy of a gene that can lead to cystic fibrosis, spinal muscular atrophy, or thalassemia, this may or may not disqualify you; it can depend on the clinic and genes of the intended parents. 

In line with ASRM guidance, in most conditions where carrying one copy of a particular gene won't impact the child themselves, you can still qualify for the Split program. 

Physical screening

In addition to genetic screening, you will have to undergo a physical screening to ensure you are physically healthy and producing a good number of eggs.  

Some disqualifications here are set in stone by the Food and Drug Administration (FDA). If evidence of any of these conditions arises, you will be considered ineligible for the program. These are considered to be non-negotiable.

• HIV
• Hepatitis B
• Hepatitis C
• Human transmissible spongiform encephalopathy
• Treponema pallidum

The following could also be deal breakers: 

• Issues with your ovaries, such as having only one ovary
• Hormone levels outside of recommended limits with concerns about your ability to produce sufficient eggs
• Any issues that would make the egg freezing and donation process risky for your health
• Evidence that you are at high risk of getting a sexually transmitted disease or could already have one. Doctors will look for discharge or ulcerative lesions for this purpose
• Indicators of possible drug use (needle tracks, for example) or exposure to needles in non-sterile conditions—including recent piercings or tattoos within the past 12 months

Anti-Mullerian hormone (ovarian reserve) levels

As you likely know, women have a set egg quantity present at birth. Your eggs mature in ovarian follicles, and each of these follicles produces the anti-Mullerian hormone (AMH). Over time, this hormone level drops; eventually, it drops so low that women naturally develop what's known as a diminished ovarian reserve (DOR).

Your AMH level can help predict how well medication may work to stimulate your ovaries to produce eggs. It also tells doctors what dosage of drugs may be needed to do so. The higher the AMH level, the more eggs generally produced. 

At Cofertility, if your AMH < 2, you are ineligible for our Split program. We only accept Split Members with these higher AMH levels as it helps mitigate the possibility of a second cycle to obtain enough eggs that could result in a live birth down the line (for yourself and for intended parents). Nevertheless, it’s important to note that, even with a high AMH level, there is always a chance that you need to do another cycle to improve the odds of a live birth. In the Split Program, you will receive AMH-reading bloodwork prior to being activated on our platform. 

If it turns out that your AMH levels are below the required minimum threshold, you would unfortunately be ineligible to move forward with egg donation. However, we can still help you freeze your eggs for your own future use through our Keep program.

State-specific qualifications

Some states do maintain their own requirements for women who are donating eggs. These requirements will extend to those in our Split program and would be determined by the location of the clinic at which you would be conducting the retrieval. 

Any state-specific egg donation qualifications will be evaluated at the time of your physical examination. 

Additional disqualifying factors

Lastly, there are a few additional factors that, unfortunately, would disqualify you from our Split program. These include if you:

• Have served jail time for more than two days within the previous 12 months
• Have undergone body piercing and/or tattooing within the past twelve months in which sterile procedures may not have been used
• Have the highest education level of GED
• Have Indigenous American ancestry and are associated with a tribe — this is due to the Indian Welfare Act 
• Currently use any nicotine products regularly, since the ASRM has confirmed an association between smoking and decreased fertility — if you engage in vaping, you will need to quit for 2-3 months before re-applying for Split, but if you only vape occasionally/socially, you will need to quit for one month prior to your retrieval date

If one or more of the above applies to you and you’d still like to participate in our Split program, reach out to us. We’d be happy to chat with you about your fertility options, including your ability to re-apply in the future. 

The net net

We know this sounds like a lot, but these disqualifiers are in place to respect the health and wellbeing of our Split members and intended parents. If you have any questions about Split—including the factors outlined here—don’t hesitate to connect with us. 

You have tons to offer, and whether you qualify for the Split program is in no way reflective of your value. The most important thing is that you feel one hundred percent comfortable in any decision you make. This is a big one, and we’re with you every step of the way.

You may have heard that freezing your eggs in your 20s can help increase your chances of pregnancy down the line, but is there actually any truth to the claim? According to the American College of Obstetrics and Gynecologists (ACOG), there really is, given a woman’s peak fertility years span from the end of her teens to the end of her 20s. 

Read on to learn what you need to know about egg freezing success rates by age.

The best time to think about egg freezing is probably…now 

During these prime fertility years, we’re often focused on other things. In our 20s, we’re finishing school, launching our careers, traveling, having fun…starting a family may not even be a blip on your radar. Unfortunately, that also means that by the time you’re ready to get proactive about your fertility (or starting a family), your prime reproductive years may have already passed. 

This is why we believe that proactively thinking about your fertility is always a good idea for anyone looking to stay in control of their reproductive options. And one major barrier, until now, has been the accessibility and affordability of egg freezing. At Cofertility, we aim to change that, by partnering with local fertility clinics to create opportunities to freeze your eggs more affordably. 

Take our quiz to see what egg freezing options you may qualify for, including our Split program, where you can even freeze your eggs for free(!) if you give half to a family that can’t otherwise conceive and you qualify.

What are the egg freezing success rates by age?

We measure the “success” of an egg retrieval and later vitrification (the process of freezing and storing your eggs) in a couple of ways. Some of the major important milestones in a successful retrieval are: 

• The ability to collect high quality and healthy eggs 
• The ability to collect a large, but safe, number of eggs during a single cycle (between 10-20 is ideal)
• Whether collection takes place at an age where the eggs have a very good chance of surviving both the freezing and the warming process down the line 

Success rates for women in their 20s

Your 20s are by and large the best time to freeze your eggs, with 25 to 27 being the optimal age, according to a 2010 report from the CDC. The report found that eggs frozen during a woman’s 20s will have a 50 percent chance of resulting in a live birth per cycle, regardless of the age of the person carrying the pregnancy once the eggs are used. Women in this age range have fully finished developing (as opposed to someone in their late teens or early 20s who may still be growing and maturing) and are likely to have the healthiest and most robust eggs. 

Not only does it make it easier for eggs collected at this age to go on to become successful pregnancies, but it also makes it the most cost effective period, because you’re likely to get more eggs with fewer rounds of freezing than if your eggs were collected at a later age. 

Success rates for women in their 30s

Success rates in your 30s will depend on if you’re closer to 30 or 40, as well as your AMH levels. One study of 1,241 women found that the average number of eggs retrieved on the first egg freezing round was:

• 21 eggs for women under 35
• 17 eggs for women 35-37
• 14 eggs for women 38-40

Because women in their 30s tend to produce less eggs, at this age you may end up having to either settle for fewer eggs for freezing or undergo multiple rounds to collect enough eggs to have on hand for later implantation. As you can imagine, those costs can creep higher and higher the more rounds you endure. 

Now, you might be thinking: isn’t 14 eggs a lot?  It’s true that eggs retrieved from women under the age of 36 will have a 95 percent survival rate after being thawed.  

But more importantly, not all thawed eggs will become viable embryos and lead to a live birth. As this chart underscores, the probability of a live birth varies with the age of the woman trying to conceive and the number of mature eggs available. In short, the older the woman, the more eggs required to achieve a high probability of a live birth. 

A study in the Journal of Assisted Reproduction and Genetics further supports this point. For example, a woman under 35 will need 9 eggs to achieve a 70% chance of having at least one live birth. If you’re trying to conceive in your mid to late 30s, you may need double as many eggs to achieve that same 70% success rate. 

Success rates for women in their 40s

Because success rates drop significantly as you near the end of your 30s, it’s actually not recommended that women have their eggs frozen past the age of 38, according to the American Society for Reproductive Medicine (ASRM). 

But don’t let that news worry you. If you haven’t had your own eggs retrieved by this point, and are struggling to conceive, you still have some other options (including the use of donated eggs). 

Ask us anything

If you’d like help figuring out when to freeze your eggs, you can contact Cofertility for more information. While every woman’s fertility path differs, we can connect you with reputable clinics who can offer basic guidance about when the time is right for you to freeze your eggs during a consultation or dig into specifics by going through a preliminary exam in a provider’s office.

We understand that the timing may not be right for you to start a family right now, but that doesn’t mean it’s too early to start thinking about what choices will be available to you when that time comes. As you can see, a lot goes into preparing to freeze your eggs.  The earlier you consider your fertility, the more options you’ll have. 

Whether you decide to freeze or not, we’re here for you to answer any questions or talk through any concerns. 

You’ve likely heard about the process called egg freezing (sometimes called “fertility preservation”), where they stimulate the follicles in the ovaries and retrieve unfertilized eggs to preserve them for future use. 

But what exactly does that process look like? And why would someone want to go through it? Read on—we’ll explain everything you need to know about egg freezing. 

The process for freezing eggs

While it may sound like a very intense process—and for some women, the side effects of the  medications used to stimulate the eggs can certainly feel that way—freezing your eggs is actually a safe and minimally invasive procedure. 

1. Take our quiz to find affordable egg freezing options near you, including our Split program (where you can freeze your eggs for free if you give half to another family who can’t conceive) and our Keep program (where you can freeze your eggs more affordably and keep them all for your own future use). If you’d like to participate in Split, you can move forward with that application right away. If you’d like to join our Keep program, we’ll email you your options once you take the quiz.  
2. With Keep, the egg freezing process begins with a consult with your fertility doctor. They will do some initial testing to determine the current health of the eggs your ovaries are producing, both in number and in quality. You’ll undergo bloodwork and  an ultrasound to get a sense of this.
3. Next, you’ll likely undergo some general health screenings to make sure you’re not carrying any viruses that could complicate the process (like HIV or certain forms of hepatitis).
4. Once your health check is through, you’ll likely begin a series of medications, including ones that will stimulate your ovaries and/or prevent early ovulation. You’ll give yourself shots daily. If you freeze with Cofertility, we’ll provide you with step by step videos to ease the transition.
5. Around this time, you can also join the Cofertility Member Portal, where you can connect with (and lean on) other women freezing their eggs at the exact same time! 
6. Your doctor will monitor you during this time to confirm that the medications are working and that your estrogen levels are increasing while keeping your progesterone levels low. You may also undergo a vaginal ultrasound to monitor the condition of the follicles where your eggs will eventually mature.
7. After 10 to 14 days you’ll start a medication to help speed up egg maturity ahead of your egg retrieval. 
8. The retrieval process happens under light sedation and involves using a vaginal ultrasound and a needle with a suction device to retrieve the eggs—this sounds more intense  than it is.his procedure is normally done right in the clinic and takes about 10 minutes.
9. Once the eggs are retrieved, they’re flash frozen and stored in subzero temperatures, normally with a substance like liquid nitrogen to prevent the development of ice crystals. 
10. You can go home after the procedure and rest up!

How your body responds to the process

Everyone’s body will react differently to each step of the egg freezing process. While some women will experience bloating or hormonal responses from the medications that stimulate egg maturation, others may feel much less. You might experience some mild cramping or bloating following the retrieval process as your ovaries continue to remain enlarged from the medications used. 

Additionally, you’ll have an increased risk of pregnancy in the week following your retrieval. Because of this, many doctors suggest avoiding unprotected sex during this time period.

The goals for women who freeze their eggs can differ

Not everyone has the same intentions when they start the process of freezing their eggs. Some women may hope to prolong their reproductive years until they’re ready to have children, while others may be hoping to use their frozen eggs as donor eggs to help someone else who is trying to start a family. 

One thing all of these women have in common is that they’re hoping to improve their chances of those eggs eventually resulting in a healthy baby. To some extent, the more eggs there are, the better the chances of those resulting in a life birth. But we also know that egg quality is important. The number one factor impacting egg quantity and quality? Age. 

A study in the Journal of Assisted Reproduction and Genetics confirmed that the probability of at least one live birth varies with the number of mature eggs available and the age of the woman trying to conceive. For example, a woman under 35 who is trying to conceive will need 9 mature eggs to achieve a 70% chance of having at least one live birth. If you’re trying to conceive in your mid to late 30s, you may need double as many eggs to achieve that same 70% success rate. 

Because women in their 30s tend to produce less eggs, women who are freezing their eggs at this age may end up having to either settle for fewer eggs or undergo multiple rounds to collect enough eggs to have on hand for later implantation. As you can imagine, those costs can creep higher and higher the more rounds you endure, driving up the price tag and the risk of failure. 

Some things to consider about freezing your eggs

There are obviously many factors that go into the freezing process;  but, there are a few points to consider outside of the physical. You’ll also need to account for the cost—you not only need to pay for all of the testing and procedure plus monthly storage fees until you’re ready to fertilize your eggs. To this end, you will likely need to budget an extra $550-$1,000 a year to pay a company to store and monitor your eggs after they’ve been retrieved and frozen.

These procedures can quickly add up to a few thousand dollars—likely anywhere between $8,000 to $20,000. That price can be too high for some, which is why we’ve developed our Split program. With Split, you can freeze your eggs for free, if you qualify and donate half of your retrieved eggs to an intended parent who matches with your profile.

Getting a jump start on your fertility is a wise choice

Deciding to freeze your eggs is a proactive choice and a good idea if you’re not sure exactly when you’ll be ready to start a family (if you even want to). It’s also perfect for anyone who wants to retrieve healthy eggs before undergoing chemotherapy or a surgical procedure that could alter your fertility chances. 

The average age women have become parents has increased over time—with many spending their earlier adult years focused on getting an advanced degree, furthering their careers, or even finding the right partner—however, our biological clocks have remained the same.  

Take a look at your options

At Cofertility, we offer a variety of options for freezing your eggs, including our Split program where we’ll help you through the process of stimulating and retrieving your eggs at no cost as long as you donate half the eggs retrieved from each cycle (if you qualify). If donation is not for you, we also have a Keep Program in which you freeze and keep 100% of the eggs for yourself. Contact us today to learn more - no commitment required, but we’d love to talk through can help you take charge of your future reproductive health.

The egg freezing process can feel like a black box. How do you find a clinic to freeze your eggs? How long will the whole process take? And what is this all going to cost? 

With thousands of women freezing their eggs every year, there are plenty of options out there for you. Here’s a look at how to make sense of the egg freezing process and how to make sure this is the right path for you.  

Breaking down the egg freezing process

Choosing a clinic

The first step in the egg freezing process is choosing a clinic. If you decide to move forward with egg freezing, you will need to visit the clinic for monitoring every few days, so it’s best to choose a facility that’s within driving distance. With Cofertility’s Keep program — where you can freeze your eggs more affordably and keep them all for future use — we’ll help you find a clinic based on your location, their pricing structure, and their success rates. 

Our Split program, on the other hand, allows you to freeze your eggs for free if you give half to a family who can’t otherwise conceive and you qualify.

Consultation 

Once you’ve settled on a clinic, it’s time to meet with a reproductive endocrinologist (REI, or fertility specialist) to talk about the egg freezing process. You’ll get a chance to find out more about how egg freezing works at your chosen facility, discuss any risks of the procedure, and talk through any family-building goals. If kids are still a TBD, no problem!

Note that some clinics will only work with women under 40 when it comes to egg freezing. Research indicates egg quality begins to decrease in a woman’s early 30s and declines more rapidly past age 35. Because of this, you must be under 40 to participate in our Keep program.

Age is only one factor, however. During your egg freezing consultation, the REI will ask questions about your menstruation history, any past pregnancies, and your overall health. 

Evaluation and bloodwork

After (or during) your consultation with an REI, the next part of the egg freezing process is bloodwork and other testing to determine if you are a good candidate for egg freezing. 

This testing may include:

• Ovarian reserve testing: Your doctor will order bloodwork to evaluate your egg supply. These blood tests may screen for anti-mullerian hormones (AMH), follicle-stimulating hormones (FSH) and estradiol. Importantly, these labs can predict how your body will respond to the injectable fertility medications used in an egg freezing cycle. You’ll also do a (painless) transvaginal ultrasound, which will show how many egg-containing follicles your ovaries contain as a baseline.
• Disease testing: Bloodwork will help your doctor assess whether you have any infectious diseases such as HIV, syphilis, hepatitis, gonorrhea or chlamydia.

Connecting with your community

If you’re freezing your eggs through Cofertility’s programs, you’ll be able to utilize our Member portal to connect with other women freezing their eggs at the exact same time. Support one another, ask each other questions, and gain confidence as you begin your fertility journey. 

Medications

Most women’s bodies release just one egg a month during the menstrual cycle. In order to freeze more than one egg, injectable medications will be taken over a period of a couple weeks. These meds will stimulate your ovaries to produce more eggs in a single cycle.

Most women can give themselves the injections, which are needed 1-2 times per day for about two weeks. The medications do carry some side effects, including bloating, headaches and moodiness. About 0.5 - 5% of women develop a condition called ovarian hyperstimulation syndrome (OHSS), in which fluid accumulates around the ovaries and causes discomfort and bloating. While the condition can occasionally be severe, it is  typically temporary with symptoms subsiding about a week after your egg retrieval. 

Medications commonly prescribed in the egg freezing process include:

• Follitropin alfa or beta (Follistim, Gonal-f)— Used to stimulate the ovaries
• Menotropins (Menopur) — Used to stimulate the ovaries
• Ganirelix or Cetrorelix (Cetrotide) — Used to prevent premature ovulation
• Leuprolide acetate (Lupron) — Used to prevent premature ovulation or as a trigger shot to help eggs mature
• Human chorionic gonadotropin (Pregnyl, Ovidrel) — Used as a trigger shot to help the eggs mature

If you choose to freeze your eggs through Cofertility’s Keep program, you’ll be able to take advantage of partnerships and discounts on medication costs to help lighten the load. 

More blood tests and monitoring

Once you’ve started hormone injections, your REI will keep a close eye on you to make sure things are moving along smoothly. You’ll visit the clinic every few days to undergo bloodwork and ultrasound so the doctors can determine how your ovaries are responding to the medication and if it’s time to retrieve your eggs. 

This process usually lasts around two weeks until the fertility specialist determines egg development has reached a point where it’s time for all your eggs to be retrieved. 

During this time, it’s recommended that you abstain from sex or use barrier methods of contraception as the medications can make your body more fertile, increasing your chances of getting pregnant. You’ll also want to decrease exercise during the stimulation phase to prevent ovarian torsion, or twisting. 

Egg retrieval 

Also called aspiration, the egg retrieval process is done right at your fertility clinic where your REI will use a mild sedative or anesthesia. With the help of a guiding ultrasound, your doctor will use a special needle that’s inserted into the ovarian follicles to remove multiple eggs.  

Although you may feel some cramping and general discomfort after the procedure, the egg retrieval is not usually painful. You should plan to have someone with you that day to drive you home from the doctor’s office, but many women are able to return to work within a day or two after the procedure.

Because your ovaries are enlarged, you may continue to feel cramping and a feeling of fullness for a couple weeks. You will also be advised to avoid unprotected sex in the weeks directly after the egg freezing process as your chances of getting pregnant may be higher during this time. 

Cryopreservation

Once the eggs are removed from the ovary, you’ve reached the final step of the egg freezing process. The eggs undergo a process called vitrification.  

Eggs are then frozen to subzero temperatures and can be stored for years to come, ready to be thawed if you decide you want to use them for in vitro fertilization (IVF). With Cofertility’s Keep program, we offer our Members discounts and promotions on various parts of the egg freezing process to help make it more affordable.

A second egg freezing process

Depending on how many eggs were able to be retrieved, your doctor may recommend a second round of medication and another retrieval. 

The number of eggs you should freeze will depend largely on your age — researchers at Brigham & Women’s Hospital in Massachusetts have created a calculator that estimates the likelihood of live birth for elective egg freezing in women. Although it’s not exact, it does supply some probabilities to help you make a decision on whether you should do a second cycle of egg freezing. 

For example, they estimate if a 30-year-old woman has frozen 15 eggs, she has an 83% chance of giving birth to one child from those eggs. She has a 50% chance of giving birth twice and a 22% chance of having a third child with the use of her frozen eggs. 

Costs of the egg freezing process

Another factor to consider when deciding if you want to proceed with the egg freezing process — or undergo a second cycle — is cost. Around the country, the process of freezing your eggs can cost anywhere from $10,000 to $20,000 or even more, and there are yearly costs for storage of eggs after the retrieval process. 

At Cofertility, we’ve made it our mission to make egg freezing more accessible. With discounts, partnerships and promotions, we’re hoping to remove lack of affordability as a barrier to fertility preservation. To get a sense of pricing (and savings!) for our Keep program with clinics in your area, take our quiz to tell us more about yourself. 

Unfortunately, most insurance companies do not pay for many egg freezing costs unless it has been deemed medically necessary for a woman. Cofertility’s offerings, similarly, are self-pay. 

Bottom Line

There’s a lot going on during the egg freezing process and a whole lot to consider. The homework you’re doing now will make all the difference as you move along through the process and can ask all the right questions!

According to the American College of Obstetrics and Gynecologists (ACOG), a woman’s peak fertility years are from their late teens to their late 20s. While these may be the easiest biological years for starting a family, between travel, work, school, life…at that point in your life, family planning might not be your top priority. 

Fortunately, thanks to modern medicine, you have some options. Egg freezing allows you to preserve your healthy eggs at any point in time, without committing to starting a family. Let's talk about what you need to know about freezing your eggs. 

Here’s what you need to know about the process

While there are some big hurdles to clear—like the expenses of going through the process and how (and where) you’ll store your eggs—freezing your eggs is a way to take more control of your future fertility health. 

That being said, it’s important that you think of freezing your eggs not as a guarantee, but rather, a proactive step you can take towards fulfilling potential long-term family planning goals. It is not an insurance policy, but it can help give you more options in the future. 

Research has found that freezing nine eggs while under age 35 leads to a 70% chance of a live birth (studies found that the average number of eggs retrieved for the same women is 18-21). And the more eggs you freeze, the better those odds get. There are always chances that your retrieval could fail, or that implantation down the line may not take. Still, egg freezing in your 20s does offer higher chances of success than having them retrieved at a later age.

Getting ready for retrieval 

Before you can freeze your eggs, you’ll want to ensure your body is producing as many eggs as possible. This means taking hormones that can help stimulate the follicles on your ovaries to produce a larger than normal quantity of eggs.

According to the Mayo Clinic, this may include taking multiple medications or injectables like: 

• Ollitropin alfa or beta (Follistim AQ, Gonal-f) 
• Menotropins (Menopur)
• Leuprolide acetate (Lupron Depot) 
• Cetrorelix (Cetrotide)
• hCG

Your doctor will monitor your progress with blood tests across the 10-14 day period. He or she will tweak any ovarian-stimulating medications you’re given to make sure your estrogen and progesterone levels are where they need to be for a successful retrieval. 

During these visits, you’ll likely also have vaginal ultrasounds. The doctor will use this to check on the development of the follicles where your eggs mature. It might sound overwhelming, but vaginal ultrasounds are usually painless. 

Then, when the time is right—typically 10 to 14 days after you’ve started your medications—you’ll check back in with your doctor and receive a final  injection of something called a human chorionic gonadotropin. This is the final kick to help your eggs mature and prepare them for retrieval. 

Retrieving your eggs

Retrieval is typically done while you’re under a light sedation at a fertility clinic. Your doctor will retrieve your eggs via vaginal ultrasound with suction to remove eggs from follicles. You’ll likely wake up feeling well rested while your medical team has done all of the heavy lifting for you!

While you won’t feel any pain during the procedure, a little soreness afterwards isn’t uncommon.  

Freezing and monitoring

After your procedure your eggs undergo a process called vitrification (AKA: freezing). This process relies on subzero temperatures to cool the eggs for storage. They’re normally stored along with a substance (like liquid nitrogen) that  keeps ice crystals from forming within the frozen eggs. They’re then placed in cold storage for 24/7 temperature monitoring.  

Storage timelines

You may be surprised to learn that your frozen eggs have no expiration date. In fact, in 2021 a child was born from an embryo frozen 25 years prior! Once your eggs have been successfully frozen they cease all biological activity, including aging and deterioration. 

While some countries may have limits on the length of time your eggs can remain frozen, this has not taken hold in the United States. This comes as good news for women who are hoping to freeze their eggs earlier in life and may need more years of frozen storage. 

Our Split program includes 10 years of free storage at a reputable long-term facility, where you'll have access to them whenever you choose to use them. Our Keep program also allows you to store your eggs for 10+ years, though note that the payment will be out of pocket each year. 

How much does it cost?

A lot of women worry about the price tag for freezing their eggs. One piece of good news is that as technology (and availability) of these solutions advances, costs are starting to come down.

Still, you can be looking at a bill for a few thousand dollars for the procedure alone—anywhere between $6,000 to $11,000—plus an annual bill between $300-$1,200 for storage, and up to $5,000 for medications. 

With Cofertility, however, we’ve worked with clinic partners to get you discounts on freezing (think: 75% off initial consults at certain clinics), storage (up to 80% off compared to reputable clinic freezing), and medications (about a 20% savings). 

For those who qualify, our Split program also offers the opportunity to freeze your eggs for free if you donate half of them to a family who can’t otherwise conceive. Yep, zero dollars. 

Split allows you to take control of your reproductive future (while offsetting the costs), and enables you to give someone else the greatest gift of all: a shot at parenthood. But at the end of the day, our mission is to empower women with reproductive choice. If you decide that freezing isn’t for you, we respect that. And most of all, we applaud you for taking this step towards exploring your options and learning more about your own fertility. 

Your uterus creates extra tissue each month to create a cushy home for your potential baby. But if you have endometriosis, your uterine tissue grows wild, and can end up in places you don’t want it to be—including places where it could cause some serious fertility issues. In fact, a recent Journal of Assisted Reproduction and Genetics study estimated endometriosis is to blame for between 25% to 50% of all infertility cases. 

What is endometriosis?

Endometriosis develops when your body grows uterine lining (a tissue called endometrium) in places where it doesn’t belong. Most often, it shows up in areas near your uterus—your fallopian tubes and ovaries, on the outside of the uterus, in the vagina or cervix. In a few rare cases, it can even end up in other places, like your bladder. 

It may feel like you’re the only person in the world dealing with these symptoms, but the truth is, it’s just that people don’t talk about their symptoms. Endometriosis is extremely common. According to the Office on Women’s Health, more than 11% of women between the ages of 15 and 44 have developed it. Of those women, 30% to 50% experience some form of endometriosis infertility challenges. This is most common in women who: 

• Are in their 30s and 40s, especially those with family members who have had it 
• Started their period at a younger age
• Have never had children
• Have extremely long or short menstrual cycles

Signs of endometriosis

The most common red flag that you might have endo is severe cramping and pain, especially during your period. Here are some of the other telltale signs that you’re growing uterine tissue in odd places:

• Pelvic pain: Women with endometriosis often develop chronic severe back and pelvic pain. They may also experience severe menstrual cramps, pain when they pee, and even painful sex (which will definitely be a fertility hurdle). 
• Digestive upset: Stomach cramping, diarrhea, constipation and bloating occasionally accompany endometriosis, especially if you have your period. 
• Heavy periods—and spotting in between them: Women with endometriosis may bleed outside their typical menstrual cycle, or develop heavy bleeding when they have their period. Fun times! 
• Infertility: Scarring and excess tissue can literally cause a roadblock that can keep eggs and sperm from meeting, or even prevent a fertilized egg from implanting in the uterus.

How endometriosis can affect fertility

In case its other symptoms didn’t suck enough, endometriosis can also cause infertility, thanks to the scarring and excess tissue buildup. Ironically, all that uterine tissue that your body is producing for a baby could actually block the pathways to conception. 

“Endometriosis is thought to cause infertility because of the scarring and adhesions that result when endometrium grows on pelvic organs,” says Dr. Nataki Douglas, M.D., Ph.D, director of translational research for the Department of Obstetrics, Gynecology and Women’s Health at Rutgers University in New Jersey. The more extensive the disease and scarring, the greater the negative impact on fertility. “For instance, the adhesions can make it more difficult for an egg to be swept up by a fallopian tube and become fertilized.”

Can and should I freeze my eggs if I have endometriosis?

Absolutely. Some doctors will recommend egg freezing for women with endometriosis, while they're young and the condition is still in the early stages. Because some surgeries for endometriosis can actually worsen fertility by inadvertently removing healthy ovarian tissue or compromising vascular supply to the ovary, egg freezing should be done before any such surgeries.

If you are interested in freezing your eggs, we can connect you with a fertility specialist for a consultation to discuss your specific situation. Our Freeze by Co is making egg freezing more empowering, positive, and accessible — even free — when you give half of the eggs retrieved to a family who can’t otherwise conceive. 

What your doctor might recommend

The good news is, endometriosis can often be treatable. Depending on your situation, treatment might include:

• Hormone therapy: Often in the form of birth control pills, this prevents additional tissue growth and damage. 
• Pain relievers: Over-the-counter pain relievers can help manage the pain that comes with endometriosis at certain points in your cycle.
• A diagnostic workup: Thankfully, some women with endometriosis are still able to conceive, but talk to a reproductive endocrinologist if you don’t get a positive pregnancy test on your own within 6 to 12 months. A full diagnostic workup might be a good idea. Dr. Marra Francis, MD, FACOG, an OB/GYN in The Woodlands, TX, notes that this workup would likely include both diagnostic procedures for endometriosis and a hysterosalpingogram (HSG), which will show if your tubes are blocked. This may prevent pregnancy or increase the risk of an ectopic pregnancy, so you’ll want to work with your doctor on figuring out the best course of action.  
• Surgery: This is one of the most effective methods for treating endometriosis and preserving fertility, according to Dr. Douglas, but also the most invasive. These surgeries can remove adhesions and ovarian cysts, clearing tissue out of the fallopian tubes and making pregnancy a real possibility. 

Still, you might need a little boost to make that baby happen. While there are tons of treatments out there, depending on a host of factors—age, number of years trying, status of fallopian tubes, status of sperm—women can proceed with standard fertility treatments, like oral medication and IUI. However, while it is the most invasive, “IVF has the best results in the majority of women with endometriosis,” says Daniel Kort, associate medical director and practice director at Neway Fertility in New York City. 

Bottom line

Endometriosis can be a real pain—literally and figuratively—and infertility is one of the most common complications associated with it. Fortunately, with a little help from a reproductive endocrinologist, it’s still possible to conceive if you’ve developed endometriosis infertility.