egg freezing

As more women prioritize their careers and delay starting a family, egg freezing has become an increasingly popular option. In fact, in 2021 there were nearly 25,000 egg freezing cycles in the United States, up 46% from the previous year. 

For those with a full-time job who are considering freezing their eggs, it may bring up the question: Should I tell my boss? In this article, we'll explore the pros and cons of disclosing your decision to your employer, and provide tips for navigating the conversation.

Talking to your boss about freezing your eggs

The decision to freeze your eggs is a personal one, but it can have professional implications. If you are considering starting the egg freezing process, it's important to think about how it might affect your work schedule and commitments. If you need to shift your schedule for appointments, or if the egg retrieval itself requires time off, it's best to let your boss know ahead of time. But you don’t have to be specific about the egg freezing part if you’re not comfortable doing so. Saying you have a medical procedure coming up that requires XYZ days off

When approaching the conversation, it's important to be clear and concise. If you want to share the specifics, that’s fine. But you don’t have to. Be prepared to answer questions, and provide information about the process if your boss is unfamiliar with it. It may also be helpful to let them know that you are committed to fulfilling your work obligations and that you will do everything in your power to minimize any disruptions.

Use this email template to get time off for egg freezing 

Here’s a template you can use if you are NOT sharing the specific procedure:

Hi [Boss’s Name],

I am writing to request time off work for a medical procedure next month. I have a few pre-appointments that will also shift my work time on [Date / Time], [Date / Time], and [Date / Time]. I will update my calendar accordingly. 

The procedure is scheduled to take place on [Date], and I will need to be absent from work on [Date(s)].

I will do my best to ensure that all necessary tasks are completed before I leave, and I will also arrange for colleagues to take over my responsibilities during my absence. Thank you for your understanding and support during this time. Please let me know if there are any questions or concerns that you may have.

Best regards,

[Your Name]

Here’s a template you can use if you are mentioning egg freezing:

Hi [Boss's Name],

I hope you're doing well! As you may know, I've been considering freezing my eggs as a way to preserve my fertility options in the future. I've decided to move forward with the process and wanted to give you a heads up that I'll need some time off for appointments.

I'm planning on scheduling the appointments for [Date] and [Date] mornings, starting next week and continuing for the next few weeks. I'll do my best to schedule them as early as possible to minimize the impact on my work schedule. The egg retrieval is scheduled to take place on [Date], and I will need to be absent from work on [Date(s)].

I'll make sure to communicate with my team to ensure that everything runs smoothly in my absence. I appreciate your understanding and support as I go through this process. Please let me know if you have any questions or concerns.

Thank you,

[Your Name]

Can I freeze my eggs if I have a full-time job?

Absolutely! Most of the people who freeze their eggs with Cofertility have full-time jobs or are in graduate school. It does require some time and effort, such as attending appointments for ultrasounds and blood work during the egg freezing cycle. However, many clinics offer early morning, evening, and weekend appointments to accommodate busy schedules. 

We’ve found that most employers are supportive of their employees' decisions to prioritize their reproductive health and may even offer benefits that cover some or all of the costs associated with egg freezing. So don't let your job hold you back from exploring this option if it's something you're considering.

Asking about fertility benefits

Some employers offer fertility benefits as part of their healthcare packages, which can include coverage for egg freezing. If your company offers these benefits, it may be worth exploring whether you are eligible, and what the process entails. The first step is to check your employee benefits package, or speak with your HR representative or benefits coordinator to get more information.

If you are part of the majority of Americans who do not have an egg freezing benefit through your employer, there are other options. At Cofertility, we support our members with all the nitty-gritty details of egg freezing – like finding the best clinic, financing the journey, getting discounts on medications, and more. We offer two egg freezing programs:

• In our Split program, you can freeze and store your eggs for up to 10 years for free when you donate the other half of the eggs retrieved to a family who can’t conceive otherwise.
• In our Keep program, you freeze and store your eggs for your own future use, with lower prices on things like storage, as well as access to our community.

Our team is here for you every step of the way, and our online community connects you with others starting their egg freezing cycles at the same time for peer support.

What to do if your boss isn’t supportive

Unfortunately, not all employers are supportive of their employees' decisions to freeze their eggs. Some may be awkward when discussing reproductive health, while others may not give you the flexibility. If your boss is not supportive, it can be a difficult situation to navigate.

First, it's important to remember that you have the right to make decisions about your own reproductive health. If your boss is not supportive, you may want to consider speaking with someone in HR or a higher-up in the company. They may be able to provide more information about the company's policies, or offer support and guidance.

If you feel uncomfortable discussing your decision with your boss, you may also want to seek out support from friends or family members. Having a strong support system can make a big difference during this time.

Can FMLA be used for egg freezing?

Unfortunately no. FMLA is a federal law that allows eligible employees to take up to 12 weeks of unpaid leave per year for certain medical and family reasons, such as the birth or adoption of a child, caring for a seriously ill family member, or a personal serious health condition. Currently, the Family and Medical Leave Act (FMLA) does not cover egg freezing as a qualifying reason for taking leave. 

However, some employers may offer their own fertility or medical leave policies that could potentially cover egg freezing. Check with your employer's HR department or benefits office to find out what leave options are available to you. The good news is that you shouldn’t need more than a few days.

The bottom line

Freezing your eggs can be an exciting decision, but deciding whether to tell your boss can add an extra layer of stress. While it's ultimately up to you whether you choose to disclose your decision, it's important to be prepared for the conversation. By being clear, concise, and respectful, you can help ensure that your boss understands your decision, and that you are committed to fulfilling your work obligations. 

Cofertility is in the “family” business, striving to make egg freezing and third-party reproduction more human-centered and accessible for all. Our Freeze by Co program allows you to freeze your eggs for free, when you give half to a family who can't otherwise conceive.

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Read more:

• What Employers Offer Egg Freezing Benefits?
• A Step-by-Step Guide to Freezing Your Eggs
• Does Insurance Cover Egg Freezing?

Egg freezing, also known as oocyte cryopreservation, has grown in popularity, with a 46% increase in egg freezing cycles from 2020 to 2021 alone! Selecting the right egg freezing clinic is a crucial decision that can significantly impact the success and overall experience of the process. In this article, we will explore the key factors to consider when evaluating egg freezing clinics. Let’s dive in.

Does the clinic report outcomes to SART?

When evaluating an egg freezing clinic, it is important to inquire whether they report their outcomes to the Society for Assisted Reproductive Technology (SART). SART is an organization that collects and publishes data on assisted reproductive technology (ART) procedures, including egg freezing. 

Clinics that voluntarily report their outcomes to SART demonstrate a commitment to transparency and accountability. Reporting outcomes to SART allows clinics to benchmark their success rates against national averages and ensures that they adhere to industry standards. Access to this information can provide you with a clearer picture of the clinic's performance and help you make an informed decision about the quality of care they provide.

Is the doctor dual board certified in obstetrics and gynecology and reproductive endocrinology and infertility?

The expertise and qualifications of the doctor overseeing your egg freezing process are paramount. Look for a fertility doctor who is dual board certified in both obstetrics and gynecology (OBGYN) and reproductive endocrinology and infertility (REI). This demonstrates the doctor's specialized knowledge and training in reproductive medicine. 

Research indicates that board certification leads to better patient outcomes and enhanced communication between doctors and patients. 

Achieving board certification in REI requires extensive training and education, which involves the following key components:

• Medical School: Completion of four years of medical school, where aspiring doctors acquire a foundational understanding of medicine and patient care.
• Residency: Completion of a rigorous four-year obstetrics and gynecology residency program, which focuses on training doctors in the comprehensive management of women's reproductive health.
• Fellowship: Completion of a specialized three-year reproductive endocrinology and infertility fellowship, where doctors gain in-depth knowledge and expertise in the field of reproductive medicine.
• Board examinations: Successful completion of two sets of examinations, including both written and oral components. The first set of exams evaluates knowledge in obstetrics and gynecology, while the second set specifically focuses on reproductive endocrinology and infertility.

By undergoing this rigorous training and successfully passing the board examinations, doctors demonstrate their competence and dedication to the field of reproductive medicine. 

Does the clinic have good outcomes? 

This is easier said than done, but try and assess their success rates and outcomes. You can inquire about the clinic's specific egg freezing success rates and ask for data regarding the number of eggs retrieved, survival rates after thawing, and subsequent successful pregnancies from frozen eggs. But keep in mind that a lot of this data depends on the patient population. 

Another way to gauge outcomes is to look at how many cycles a clinic performs. As with everything in medicine, the more procedures a doctor does, the better patient outcomes. 

So how do you know how many egg freezing cycles a clinic does? You can ask. Or you can look it up on SART. Here’s how:

1. Go to Find an IVF Clinic
2. Type in your zip code
3. Clinic names will show up, click “Success Rates”
4. You can look at Total Cycles or Cycle Starts for women in your age group, and compare across clinics

Unfortunately the data does not differentiate between cycles that are for IVF and cycles just for egg freezing. However, the egg retrieval procedure is the same for both, and a decent measure to compare across clinics.

Another thing to keep in mind is that this is clinic-level data, and does not tell you how many egg retrievals a specific doctor has performed. A clinic with two doctors will not have as many retrievals as a clinic with ten doctors. 

Does the clinic offer individualized care?

Individualized treatments take into account each patient's unique circumstances, medical history, and specific goals. By tailoring the treatment plan to the individual, clinics can optimize the chances of success while considering factors such as age, ovarian reserve, and any underlying medical conditions. This personalized approach ensures that patients receive the most appropriate and effective care for their specific needs, leading to better outcomes and overall patient satisfaction.

Ask how your treatments will be individualized for your specific case. The size and volume of a practice can sometimes be an important factor in how personalized care is delivered. Trust your instincts when you first visit a clinic and meet the staff. 

Do they have a good reputation?

A reputable and trustworthy egg freezing clinic should have positive feedback from former patients. Research patient reviews and testimonials to gain insights into their experiences with the clinic. Look for consistent feedback regarding the quality of care, staff attentiveness, communication, and overall satisfaction. 

Recommendations from trusted sources also go a long way! Ask a friend, colleague, or even your PCP for their thoughts.

If you work with Cofertility to freeze your eggs, we can connect you with our partner clinics who also offer discounts to our members.

Do you vibe with the doctor and staff?

The doctor-patient relationship is a significant aspect of your egg freezing journey, and feeling a connection and sense of comfort with your doctor and care team can greatly impact your overall experience. 

Research clinics by visiting their website and learning about the background, experience, and specific areas of interest for the physician you are seeing. During your initial consultations or meetings, pay attention to how well you communicate with the doctor and if you feel heard and understood. Trust and rapport are crucial in building a collaborative partnership with your doctor, where you can openly discuss your concerns, ask questions, and make informed decisions together. Feeling a positive connection with your doctor creates a supportive environment that can alleviate stress and enhance your confidence in the treatment process. Ultimately, finding a doctor with whom you vibe can contribute to a more positive and empowering experience as you navigate the journey of egg freezing.

Do you like the facility?

The physical environment and amenities offered by the clinic can also influence your overall experience. When visiting the clinic, assess factors such as cleanliness, comfort, and privacy. Take note of the clinic's equipment and technology, as advanced laboratory facilities can contribute to better success rates. Additionally, consider the location and accessibility of the clinic, as frequent visits may be required during the egg freezing process. Choosing a clinic with a facility that aligns with your preferences can enhance your comfort and convenience throughout the treatment.

Is the lab CAP certified?

Another crucial aspect to consider is whether the laboratory of the egg freezing clinic holds certification from the College of American Pathologists (CAP). CAP accreditation indicates that the laboratory meets rigorous standards for quality and safety in laboratory practices. 

CAP-certified labs undergo regular inspections and assessments to ensure compliance with specific guidelines and protocols. Choosing a clinic with a CAP-certified laboratory reassures you that the facility follows best practices in handling and storing frozen eggs, maintaining an optimal environment for their preservation. This certification adds an additional layer of assurance regarding the clinic's commitment to maintaining high standards in their laboratory operations.

How much will it cost?

The cost of egg freezing varies among clinics and geographies. But average egg freezing cycle costs range from $10,000 - $20,000 for consultations, testing, ultrasounds, medications, and the egg retrieval, plus the ongoing cost of annual storage. 

It is essential to understand the financial aspects, including the initial consultation fees, medication costs, the egg retrieval procedure, and storage fees. Some clinics may offer package deals or financing options, while others may provide additional services at an extra cost. Here are some questions to ask the clinic about pricing:

• How much does an egg freezing cycle cost at your clinic?
• How much does egg storage cost per year at your clinic?
• Do you accept my insurance?

Freeze your eggs with Cofertility

Cofertility is a human-first, tech-enabled fertility ecosystem that provides people agency over if, how, and when they have babies — today or someday. We have two programs for egg freezers:

In our Keep program, you can freeze and store your eggs for your own future use, with lower prices on things like storage and medication – as well as our team’s support and access to our community.

The Split program, which offers women a chance to both freeze their own eggs and donate half the eggs to a family who cannot conceive otherwise. If you qualify for the program and decide to donate half of your retrieved eggs, every expense associated with the egg freezing procedure —  medications, supplements, travel if necessary, insurance, and 10 years of storage — are completely free of charge. We don’t even need a payment or credit card up front, as the family you match with covers all the expenses.

The benefits for of working with Cofertility include:

• Power of choice: Freeze your eggs more affordably or, if you qualify, freeze for free when you give half to a family who can’t otherwise conceive.
• Community: Our inclusive online spaces allow you to connect with others going through the process in our private online community.
• Compassion: We’ll always treat you with care, and our Split program gives you the opportunity to make someone’s family building dreams a reality.
• Data-driven: We provide you with trustworthy guidance and evidence-based research so you can make informed decisions about your fertility.
• Free egg freezing: Freeze and store your eggs for 10 years, entirely for free if you qualify for our Split program.

Ready to learn about more affordable (even free!) egg freezing with Cofertility? Fill out this quick quiz to learn about our accessible egg freezing options and see if you qualify for our programs — it only takes one minute.

So you’ve scheduled your appointment with an OBGYN (like me) or fertility doctor, time to relax until the appointment right? Wrong. At some point before that appointment, it is so important that you take a little bit of time to prepare what questions you want answered. 

But what questions should you be asking? Lucky for you, I’m here to give you a curated list of the top questions to ask depending on which specialist you’re seeing and what your goals are. Let’s get into it!

What’s the Difference between an OBGYN and an REI?

So first things first, let’s explain what the difference is between an OBGYN and an REI. OBGYN stands for “obstetrician-gynecologist” and these physicians are considered generalists in women’s health. An OBGYN completes four years of medical school and four years of residency training after college. They take care of both pregnant and non-pregnant adults, so they’re the doctors who deliver babies, do pap smears and checkups, and provide annual breast exams (among other things). REI stands for “reproductive endocrinology and infertility”. An REI physician is an OB/GYN who has completed three additional years of training focused solely on fertility, pregnancy, and hormones. For the most part, this means they only take care of patients who are having difficulty becoming pregnant. Some REIs also specialize in certain hormonal conditions as well.

 Questions to ask your OBGYN

Now that we’re on the same page, let’s start off with questions to ask your OBGYN. An OBGYN is typically able to perform the fertility evaluation process which includes getting your medical history, an exam, labwork, imaging, and/or genetic testing. While they can answer most questions about egg freezing, they often won’t know the specific nuances when it comes to outcomes and statistics. 

Here is a list of some great questions to ask them.

• Can you explain fertility to me? 
• How does my age affect my fertility? What else can affect my fertility?
• How is my ovarian reserve?
• Is there anything from my history or exam that you think could impact my fertility?
• What is egg freezing?
• What does the general process of freezing eggs look like?
• What are the risks and benefits of egg freezing?
• Will freezing my eggs affect my natural fertility?
• Do you think I am a good candidate for egg freezing? Why or why not?
• What’s an ideal age for freezing my eggs?
• How soon do you think I should start?
• How long do you think I can wait if I’m not ready yet?
• Do you have a recommendation for an REI or other specialist I should see?
• What lifestyle choices can I make to improve my health and fertility?
• What is the most common question you get about egg freezing?

Questions to ask an REI

As mentioned before, REIs are specialists who are trained specifically in the field of fertility and hormones. They are the ones who actually manage an egg freezing cycle as well as other infertility treatments like in vitro fertilization (IVF).  They are experts when it comes to outcomes and statistics for all assisted reproductive technologies (ART) so your questions can be very specific.  

Below you’ll find a list of questions to ask them. Since this list includes a lot of specific questions, they’ve been split into different categories.

General

• What is the most common question you get about egg freezing?
• What is the best age to freeze your eggs?
• Will I need to stop my birth control to freeze my eggs?
• Will I need to come off any of my other medications to freeze my eggs?
• Are there any lifestyle changes or supplements you recommend to improve my egg freezing outcomes?
• What are your thoughts about using alternative medicine (acupuncture, meditation, homeopathy) in addition to your treatments?

About the clinic

• How many fertility doctors are there in the clinic? 
• Will I meet with all the doctors in the clinic or just you? 
• Who else will I meet with regularly? 
• Will I be seeing you for all of my monitoring procedures? 
• How does communication work here? 
• Who can I contact when I have questions and what is the response time?
• How does your staff communicate updates to patients? 
• Who should I contact if I have questions outside of office hours?
• What procedures are done here? 
• Do you have a lab onsite? 
• What technology and equipment does your lab use to freeze eggs?
• Do you store eggs and embryos onsite?
• Does the clinic assist in finding sperm, egg, or embryo donors if that’s needed? 
• Does your clinic provide recommendations for fertility specific acupuncturists or mental health support for interested patients? 

About the clinic’s success rates

• What is the clinic’s “Egg Thaw Rate” for egg freezing?
• What are your success rates for thawing frozen eggs and creating embryos?
• What is the intracytoplasmic sperm injection (ICSI) Fertilization Rate? 
• What is the chance that a fertilized egg becomes a "blastocyst" stage embryo by Day 6? 
• What is your ongoing pregnancy rate after one genetically-normal embryo is transferred?
• What is your live birth rate for eggs previously frozen at your facility?

About testing

• What specific tests do you recommend for me? 
• What specific tests do you recommend for my partner (if you’re freezing embryos)?
• Is testing performed in the clinic? 
• How many office visits can be expected?

About treatment cycles

• What are the steps of the egg freezing process at your specific clinic?
• Does your clinic batch cycles or will I be able to start based on my own cycle?
• How long would the wait time be for me to start a cycle?
• How long will I be on fertility medicines before the egg retrieval? 
• Where do the injections go?
• What are the common side effects of fertility medications?
• What time am I able to come in for monitoring appointments?
• Where is the egg retrieval done?
• Can I have sex during my egg freezing cycle?
• Can I work during my egg freezing cycle?
• Can I still exercise during my egg freezing cycle?
• How long after the egg retrieval does it take for your period to return?
• How many eggs should I freeze?
• Do you think I will need more than one cycle to reach this number? How many cycles do you think I will need?
• How many eggs do you think I’ll be able to freeze in one cycle? 
• Where would my eggs be stored after they’re frozen? 

About costs

• How much is one egg freezing cycle?
• What does the price of one egg freezing cycle here include?
• How much are medication costs?
• Can I use my insurance for some or all the costs of my cycle?
• What financial assistance or payment plans does your practice offer?
• How much does storing my eggs cost?

About what happens after your eggs are frozen

• What happens to my eggs if I move out of state?
• How long can my eggs stay frozen after egg freezing?
• What happens if/when I want to use my eggs?
• What do you think are my chances of having a baby using my frozen eggs?

This may seem like a lot of questions but this is not an exhaustive list and not all the questions will be relevant to everyone. These questions should serve as a starting point for you as you prepare for your appointment. Whether you’re scheduled to move forward with egg freezing already or you’re just beginning to think about it, our goal is to make sure that you feel confident and armed with the information you need to help make the best decision for you and your family-building future. For more information on egg freezing, check out our Learn page.

The ability to freeze human eggs has been a major breakthrough in reproductive technology. It has provided egg freezers with the option to delay childbearing, preserve their fertility in the face of medical conditions or treatments, and allow them to focus on their careers or personal goals without feeling so much of the pressure of the "biological clock." 

At Cofertility, we help people navigate egg freezing and make it more affordable (and even free if you qualify for our Split program). One common question we get about egg freezing is how many times you should, or can, freeze your eggs. In this article, we’ll address this question.

Should I do multiple rounds of egg freezing?

As much as we wish egg freezing was a “one and done” thing, for many people, multiple rounds are recommended. The number of times you should freeze your eggs depends on several factors, including your age, ovarian reserve, and desired number of children. The younger you are when you freeze your eggs, the higher the chance of success. Those who freeze in their 20s and early 30s tend to have higher success rates compared to those who freeze in their late 30s and 40s. That’s not to say those in their late 30s or 40s can’t be successful, it just may take more cycles.

So the question really isn’t how many times should you freeze your eggs, but how many times do you need to freeze your eggs in order to get the number of frozen eggs you desire. 

The right number of eggs to freeze for your age

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. 

Studies show that for a woman under age 35, nine eggs give you a 70% chance of at least one child. As medicine and technology advances, we hope to see this number increase even further!

Studies show that for a woman under age 35, nine eggs give you a 70% chance of at least one child. 

Once you’ve decided how many eggs you want to freeze to give yourself a good chance at success down the line, you can back into the number of cycles. The good news is that the number of eggs you’ll retrieve is highly predictable, and your clinic should be able to give you a range based on your follicle count and hormone levels. From there, you can estimate how many cycles may be necessary to get to your target number 

But of course there are other considerations. One is how many cycles you can afford. Egg freezing is expensive, and most of us don’t have insurance coverage.  Read more in How to Pay for Egg Freezing.

You’ll also need to determine how many cycles you can physically and mentally handle. For some people, the procedure is a breeze. But for others it can be hard and exhausting. It’s okay to do one round and decide you don’t want to put yourself through that again.

How long do you have to wait between egg freezing cycles?

You may be wondering how long you’ll need to wait between egg freezing cycles, or if you can do them back to back. It is generally recommended to wait at least one menstrual cycle before starting another cycle. Some people like to give their body a break and wait three to six months between cycles, while others prefer to get it over with and complete back to back egg freezing cycles. We suggest talking to your fertility doctor for guidance.

How many times can I freeze or donate my eggs?

While there’s no limit on how many times you can freeze your eggs, the American Society for Reproductive Medicine (ASRM) recommends that egg donors undergo no more than six cycles of egg donation in their lifetime. At Cofertility, we follow these ASRM guidelines.

Does egg freezing increase the risk of cancer?

There is currently no scientific evidence to suggest that egg freezing increases the risk of cancer, including invasive ovarian and breast cancers. The hormones used to stimulate the ovaries to produce multiple eggs for freezing are similar to those used in fertility treatments and are generally considered safe. However, like any medical procedure, there are potential risks and side effects associated with egg freezing.

If you have concerns about the potential risks of egg freezing, it's important to discuss these with your fertility doctor who can provide you with personalized advice based on your individual health history and circumstances.

Making egg freezing more affordable

One option to make egg freezing better is working with Cofertility. Through our Split program, qualified freezers can freeze their eggs for free when donating half of the eggs retrieved to a family who can’t otherwise conceive. 

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

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

Bottom line

When trying to determine how many egg freezing cycles you should undergo, you’ll first want to answer the question of how many eggs do you want to freeze. Based on your age, ovarian reserve, and experience, it may end up being one or more egg freezing rounds. The good news is that your doctor can help you determine how many eggs you are likely to retrieve based on your antral follicle count and hormone levels. Wishing you an abundance of eggs!

Egg freezing, also known as oocyte cryopreservation, is a medical procedure that has gained popularity in recent years as the desire for greater control over reproductive choices grows. In fact, the number of egg freezing cycles increased 46% in 2021!

Freezing your eggs now means you may be thawing and using them down the line. But how do you know if they will survive the thaw? What is the typical thaw rate of frozen eggs? In this article we will discuss everything you should know about egg thawing.

What is egg thawing?

Egg thawing is a process of warming and rehydrating frozen eggs to prepare them for fertilization. Right after the egg retrieval, eggs are frozen through a process called vitrification, which involves rapidly cooling them to a temperature of -196°C, so they can be stored safely for future use.

When and if you decide it’s time to make embryos, the clinic will thaw the frozen eggs slowly to prevent any damage to their delicate structure. Once the eggs are warmed up, they can be fertilized through in-vitro fertilization (IVF) to create embryos, which can then be genetically tested and transferred to the uterus for pregnancy.

Will my eggs survive the thaw?

Several factors can impact the success of egg thawing, including your age when the eggs are frozen, the number and quality of the eggs, the technique used to freeze the eggs, and the quality of the clinic’s laboratory. 

The quality of the eggs is also a crucial factor in egg thawing. Good quality eggs have a higher chance of survival and fertilization. However, even with good quality eggs, there is no guarantee of success, and the process may need to be repeated to achieve pregnancy.

Keep in mind that thawing is just the first part. The eggs will need to be fertilized and grown into embryos. Then those embryos need to be genetically normal in order to lead to a successful pregnancy. Generally, the younger you are when freezing your eggs, the better the chances of success. Eggs frozen in your late 20s or early 30s have a higher chance of survival and successful fertilization compared to those frozen in your late 30s or 40s.

The egg thawing procedure

The egg thawing procedure involves several steps, starting with removing the frozen eggs from storage and thawing them slowly to prevent damage. Once the eggs are warmed up, they are assessed for their quality and viability.

If the eggs are deemed viable, they are fertilized through IVF using sperm from your partner or a donor. The fertilized eggs are then monitored for development, and once they reach a certain stage, they may undergo genetic testing prior to being transferred to the uterus for pregnancy (fingers crossed).

Cryopreservation vs. slow freezing vs. vitrification

Cryopreservation is the technique used to preserve biological material, including sperm, eggs, and embryos, by freezing them at ultra-low temperatures. The process involves using special cryoprotectants that protect the cells from damage during freezing and thawing. 

There are two main techniques for freezing eggs: slow freezing and vitrification. Slow freezing (also known as equilibrium freezing) is an older technique that involves gradually lowering the temperature of the eggs to -196°C. While this technique was standard in the past, it has been largely replaced by vitrification due to its lower success rates and higher risk of damage to the eggs. 

Vitrification, or “flash freezing”, is a newer technique that involves rapidly cooling the eggs to -196°C, which prevents the formation of ice crystals and maintains the structure of the eggs. Vitrification has been shown to have a higher success rate and a lower risk of damage to the eggs, making it the preferred method for egg freezing and thawing.

Egg freezing thaw rates

Egg freezing thaw rates refer to the percentage of frozen eggs that survive the thawing process and remain viable for use in IVF. The success of egg freezing is dependent on the number of healthy eggs that are preserved and the thaw rates, as not all eggs will survive the thawing process. 

The thaw rates for vitrified eggs are typically higher compared to those for slow frozen eggs, as vitrification prevents the formation of ice crystals that can damage the eggs during thawing. However, even with vitrification, thaw rates may vary depending on several factors, including your age at the time of egg freezing, the number of eggs frozen, and the quality of the eggs. 

So, what percentage of frozen eggs survive thawing? One study from 2009 found that the overall survival rate of eggs from vitrification was 95%, higher than the survival rate from slow-freezing method, 75%.

How do you increase egg freezing success?

There are several things you can do to increase the success of egg freezing. One of the most important factors is age; younger patients typically have a higher success rate when it comes to egg freezing. It is recommended to freeze their eggs before the age of 38, as the quality and quantity of eggs decline with age.

Additionally, picking a good clinic makes a difference. Egg freezing technology has come a long way in recent years, so it's important to choose a clinic that uses the latest equipment and facilities. By finding a clinic with state-of-the-art technology, you can be more confident that your eggs will be frozen and stored in the best possible conditions. 

What happens if I don’t need the eggs down the line?

One study of egg freezing patients at UCSF found that 89% believed they would be glad they froze their eggs, even if they never used them to conceive a child. If you don't end up needing your frozen eggs down the line, there are a few options for what to do with them.

• Keep them in storage. Most storage facilities offer long-term storage options, allowing you to keep your eggs frozen for many years if necessary. This may be a good option if you're not yet ready to use the eggs but want to keep them as a backup plan.
• Donate the eggs to someone else who may need them. Egg donation is a process of donating eggs to another person or couple who needs them, such as LGBTQ+ families or those suffering from infertility. This can be a wonderful gift for those who may not be able to have a child otherwise.
• Dispose of them.  If you decide that you no longer need your frozen eggs and don't want to continue storing them or donate them, simply request that they are disposed of by the clinic or storage facility.
• Donate to science. Many research studies rely on donated eggs to investigate new techniques and treatments for infertility. Ask your clinic if this is an option.

Summing it up

The egg thawing procedure involves slowly warming the eggs to prepare them for fertilization to create embryos for pregnancy. Factors such as age, number, quality, technique, and laboratory quality can all impact the success of egg thawing. The overall survival rate when thawing frozen eggs using vitrification is 95%, compared to 75% for the slow freezing method. 

If you’re ready to freeze your eggs, we’re here to help. Reach out or learn more about our Freeze program.

Read more:

• Egg Freezing: How Long Can My Eggs Be Stored?
• How Many Eggs Do I Need to Freeze?
• How to Freeze Your Eggs for Free

Egg freezing, also known as oocyte cryopreservation, has grown in popularity, with a 46% increase in egg freezing cycles from 2020 to 2021 alone! While egg freezing is generally considered safe and effective, there are potential side effects that you should be aware of before making the decision to undergo the procedure. In this article, we will discuss some of the most common side effects of egg freezing and what you can expect during and after egg freezing.

How does egg freezing work?

Egg freezing is a process by which your eggs are removed from the ovaries, frozen, and stored for your future use. A typical egg freezing cycle is 10-14 days and involves a process called ovarian stimulation, where hormonal medication is used to stimulate the ovaries to produce multiple eggs. Once the eggs have matured, they are retrieved through a minor surgical procedure.

During this time, you’ll have 4-6 appointments at your clinic. For the first, you’ll do some initial testing. Then, throughout the process, you’ll go in for some bloodwork and transvaginal ultrasounds so the doctor can see how your eggs are developing. The last time you go in will be for the actual egg retrieval.

Egg freezing is a low-risk (but not no risk) procedure 

Egg freezing is considered a safe procedure. In a single egg freezing cycle, the risk of a serious adverse event is under 2.5%. Severe OHSS accounts for the majority of complications, occuring in 0.1-2% of cycles. The risk of other acute complications, including pelvic infection, intraperitoneal hemorrhage, or ovarian torsion, is small (<0.5%).

That being said, many women do experience minor side effects – like bloating, constipation, nausea – from the medications and egg retrieval. 

Side effects of egg freezing medication

While fertility drugs for egg freezing are considered safe, they do occasionally cause side effects including:

• Mild bruising and soreness at the injection site
• Nausea and, occasionally, vomiting
• Temporary allergic reactions, such as skin reddening and/or itching at the injection site
• Breast tenderness and increased vaginal discharge
• Mood swings and fatigue
• Ovarian hyperstimulation syndrome (OHSS)

The biggest risk to ovulation induction medication is ovarian hyperstimulation syndrome (OHSS) – a serious complication that can occur with the use of these medications. OHSS occurs when the ovaries become swollen and painful due to the overproduction of eggs. 

Fortunately, severe OHSS is rare (0.1%–2% of cycles) and can usually be prevented by carefully monitoring hormone levels and adjusting the dose of medication as needed. Women who experience symptoms of OHSS should contact their healthcare provider right away.

If you are at high risk of OHSS, your doctor may prescribe a trigger medicine called leuprolide instead of hCG, which can prevent OHSS. Another medicine called cabergoline also can help reduce the fluid accumulation. Or they may give you extra IV fluids at the time of egg retrieval. 

Side effects and risks of the egg retrieval

The egg retrieval is the final culmination of the egg freezing process. During an egg retrieval, you will be under twilight anesthesia as the eggs are removed from the ovaries. This is done with a thin needle that is inserted through the vagina and into the ovary, guided by ultrasound imaging. Fluid is gently suctioned through the needle to remove the eggs from the follicles. 

Anesthesia is generally safe, but like any medical procedure, it does carry some risks. The type and severity of the risks depend on the individual patient and the type of anesthesia being used. Some common risks associated with anesthesia include allergic reactions, breathing problems, and blood pressure changes. However, these risks are rare and the benefits of anesthesia typically outweigh the potential risks.

The procedure itself can cause common side effects such as constipation, bloating, cramping, spotting, and pain. These symptoms can typically be managed with rest, over-the-counter medications like Tylenol and stool softeners, and staying hydrated. For those experiencing cramping or pain, heating pads can be beneficial. In the case of bleeding, it's important to use pads instead of tampons for easier monitoring of the amount.

Most people can resume normal activities by the next day. However, it is advisable to take it easy and rest at home for the remainder of the day with the presence of another adult just in case. 

There are some post-retrieval red flags to look out for:

• If you notice any of the symptoms below, report them to your healthcare provider asap:
• Temperature above 101 F
• Severe abdominal pain or swelling which does not improve with over the counter pain medications
• Severe nausea or vomiting that doesn’t go away
• Heavy vaginal bleeding (soaking through a pad in an hour; some light bleeding is normal)
• Difficulty urinating, or painful urination
• Fainting or dizziness

If you experience any of the above symptoms, reach out to your doctor immediately. 

Emotional side effects

Egg freezing can be an emotionally challenging experience for some people. Especially for those freezing their eggs because they are concerned about their ability to have children in the future, the procedure can be a source of anxiety and stress. Not to mention the hormone medication used in egg freezing can cause mood swings and emotional instability.

It is important to have a strong support system in place during the egg freezing process. This can include friends, family, and healthcare providers who can provide emotional support and guidance. If you freeze your eggs through Cofertility, you’ll be connected with a cohort of others freezing their eggs at the same time. We offer an online support group, and our entire team of experts will be behind you the entire time. 

Will I gain weight during egg freezing?

Weight gain can also be a potential side effect of egg freezing. The hormonal medication used in the egg freezing process can cause fluid retention and increased appetite, which can lead to weight gain in some patients. However, in just two weeks, it’s unlikely you’ll gain noticeable weight. 

Not all those who undergo egg freezing will experience weight gain (some end up losing weight due to nausea or anxiety). Strategies such as regular exercise and a healthy diet may be recommended to help you feel good during this time.

Rare side effects and complications of egg freezing

While rare, there are some potential complications of egg freezing that can be more serious. These acute complications occur in under 0.5% of egg freezing cycles:

• Ovarian torsion is when a stimulated ovary twists on itself since the ovary is heavier from more follicles, cutting off the blood supply. Surgery is required to untwist the ovary, or in severe cases, to remove the ovary. 
• Intraperitoneal hemorrhage happens when the egg retrieval needle accidentally punctures a blood vessel, causing bleeding within the abdominal cavity.
• Infection can occur if bacteria enter the uterus or ovaries during the egg retrieval procedure.

Your fertility doctor can tell you more about your individual risks based on your health history, and we encourage you to talk to them and ask lots of questions!

Long-term side effects

There is currently no scientific evidence to suggest that egg freezing or donation increases the risk of cancer, including invasive ovarian and breast cancers. The hormones used to stimulate the ovaries to produce multiple eggs for freezing are similar to those used in fertility treatments and are generally considered safe. 

If you have concerns about the potential risks of egg freezing, it's important to discuss these with your fertility doctor who can provide you with personalized advice based on your individual health history and circumstances.

Summing it up

Egg freezing is generally considered safe and effective, with mild and temporary physical side effects being the most common. The most common side effects include bloating, cramping, and breast tenderness. These symptoms are typically caused by the hormonal medication in the lead-up to egg retrieval. These hormones stimulate the ovaries to produce multiple eggs, which can cause swelling and discomfort in the abdomen. Emotional side effects can also occur, but with proper support and self-care, can be managed. 

Some patients may also experience bleeding or spotting after the egg retrieval procedure. This is normal and should not be a cause for concern. However, if bleeding persists or is heavy, let your fertility doctor know right away.

Serious complications such as severe OHSS, infection, intraperitoneal hemorrhage, and ovarian torsion occur in under 2.5% of cycles, and it’s important to understand the symptoms and red flags.

The ability to freeze human eggs has been a major breakthrough in reproductive technology. It has provided egg freezers with the option to delay childbearing, preserve their fertility in the face of medical conditions or treatments, and allow them to focus on their careers or personal goals without feeling the pressure of the "biological clock." However, many people wonder how long they can actually keep their frozen eggs in storage. In this article, we'll explore this question in more detail.

First off, what even is egg freezing?

Egg freezing, also known as oocyte cryopreservation, is a process where a patient’s eggs are extracted from the ovaries, frozen, and stored for later use. This procedure is typically done for those who want to preserve their fertility but are not yet ready to have children. It may also be recommended for patients who are facing medical treatments that could affect their fertility, such as chemotherapy.

The process of egg freezing typically involves hormone treatments to stimulate the ovaries to produce multiple eggs in one cycle. Once the eggs are mature, they are retrieved using a needle that is inserted through the vaginal wall under ultrasound guidance. The eggs are then frozen and stored in a special solution until they are ready to be used.

When you’re ready to use the frozen eggs, they are thawed and fertilized with sperm in a laboratory using a technique called ICSI (intracytoplasmic sperm injection). The resulting embryos are then implanted into the uterus (either yours, your partner’s, or the uterus of a gestational carrier) in the hopes of achieving a successful pregnancy.

What is vitrification?

Vitrification is a newer and more effective method of freezing eggs that has largely replaced older methods such as slow freezing. With vitrification, eggs are quickly frozen using a high concentration of cryoprotectants and then plunged into liquid nitrogen for storage. This process creates a glass-like state that preserves the eggs in a nearly perfect condition. In fact, vitrification ensures a very high rate of survival of the eggs, typically 95% or above.

Compared to slow freezing, which can damage the eggs and reduce their viability, vitrification has a higher success rate of producing healthy embryos for later use. It has become the preferred method of egg freezing for most fertility clinics and has allowed more patients to successfully preserve their fertility.

If you have any doubts about your clinic, you can ask them what type of method they use for egg freezing. It's important to do your research and choose a reputable fertility clinic with experience in vitrification if you're considering egg freezing.

So, how long can I keep my eggs in storage?

The length of time that frozen human eggs can be stored depends on several factors, including the quality of the eggs, the storage method used, and the regulations of the country or state where the eggs are being stored.

Scientifically, if you work with a good clinic in the United States using vitrification, you can keep them stored indefinitely. However, some countries, such as the United Kingdom have a cap on the number of years you can store eggs (for the UK, it’s now 55 years). Currently there is no limit in the United States.

Typically, I see patients that store their eggs for two to five years. With newer freezing methods, such as vitrification (described above), the chances of damage during storage are usually quite low.

How much will it cost to store my eggs?

The cost of storing frozen eggs varies based on the location of the storage facility, the amount of time you pay for (you can often get discounts for paying for more years upfront), and the transportation fees between the storage facility and your clinic. Egg storage is usually an out-of-pocket expense, ranging from $500 to $1,500 per year.

If you become a Split member at Cofertility, you can freeze your eggs for free when you donate half of the eggs retrieved to a family that can’t otherwise conceive. In this program, the cost of egg storage is completely covered for up to 10 years.

When should I plan on freezing my eggs?

The ideal time to freeze your eggs depends on a lot of things… including your age now, your overall health, and your personal goals.

Generally, I advise patients to consider freezing their eggs before the age of 35. This is because fertility declines as you get older, as the quality and quantity of eggs decrease. By freezing your eggs at a younger age, you may be able to preserve a greater number of healthy eggs for future use. It’s a bigger bang for your buck. 

However, every situation is unique, and there may be individual factors that influence your decision to freeze eggs at an earlier or later age. For example, if you have a medical condition or are undergoing a treatment that may affect your fertility, your doctor may recommend freezing your eggs earlier than age 35.

It's also important to consider your personal goals and timeline for starting a family. If you're not yet ready to have children but know that you want to in the future, freezing your eggs at an earlier age may give you more flexibility and options down the road.

Read more in When Should I Freeze My Eggs?

What happens if I don’t need the eggs down the line?

One study of egg freezing patients at UCSF found that 89% believed they would be glad they froze their eggs, even if they never used them to conceive a child. If you don't end up needing your frozen eggs down the line, there are a few options for what to do with them.

• Keep them in storage. Most storage facilities offer long-term storage options, allowing you to keep your eggs frozen for many years if necessary. This may be a good option if you're not yet ready to use the eggs but want to keep them as a backup plan.
• Donate the eggs to someone else who may need them. Egg donation is a process of donating eggs to another person or couple who needs them, such as LGBTQ+ families or those suffering from infertility. This can be a wonderful gift for those who may not be able to have a child otherwise.
• Dispose of them.  If you decide that you no longer need your frozen eggs and don't want to continue storing them or donate them, simply request that they are disposed of by the clinic or storage facility.
• Donate to science. Many research studies rely on donated eggs to investigate new techniques and treatments for infertility. Ask your clinic if this is an option.

What happens to my frozen eggs if I die?

This is something you will determine with the clinic before your egg retrieval procedure as part of your egg freezing agreement. If you have frozen eggs and pass away, the fate of your eggs will depend on this agreement. The options are generally that they are designated a beneficiary (such as your partner if you are married at the time), or discarded. 

If for some reason you didn’t state your preference up front, your eggs will likely become part of your estate and subject to the same rules and regulations as other assets you may leave behind. 

Summing it up

Newer egg freezing technology allows human eggs to be frozen indefinitely, although some countries like the UK have a limit of 55 years. Vitrification preserves the eggs in a nearly perfect condition, with a very high rate of survival of 95% or above.

While you can technically store eggs for your entire lifetime, it may get expensive. At some point, you may decide that you don’t want to use those eggs for yourself and instead donate them to another family, donate them to science, or have them discarded. Ultimately, the decision of how long to store your frozen eggs should be based on your personal goals and circumstances.

Anti-Mullerian hormone (AMH) is a hormone produced by ovarian follicles. It is commonly used as a marker of ovarian reserve and can be measured in the blood. A high AMH level is often associated with polycystic ovary syndrome (PCOS), but it can also have other causes. In this article, we will explore what a high AMH result means and answer some common questions about AMH testing.

First off, what is AMH?

AMH is a hormone that is produced by the granulosa cells in the ovarian follicles. It plays a role in the growth and maturation of ovarian follicles in females. AMH levels are relatively stable throughout the menstrual cycle and can be measured in the blood.

AMH is commonly used as a marker of ovarian reserve, which is a rough number of eggs that a female has remaining in her ovaries. Since females are born with a fixed number of eggs, this number naturally declines over time. 

What are normal AMH numbers?

What is considered a “normal” AMH level depends on your age, as well as the lab where you take the test. Since there is no international standard, it’s best to use the reference ranges included on the test results (your doctor can share those with you if you did a test through a clinic). 

In general, however, an AMH between 1.0 and 3.5 ng/mL suggests a “normal” range that is likely to have a good response to egg freezing.

If you are looking to donate your eggs, however, minimum AMH requirements may be slightly higher. For example, with Cofertility’s Split program, we require a minimum AMH of 2.0, though clinics may have their own unique requirements. This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.

What AMH level is considered high?

In healthy females of reproductive age, higher levels of AMH mean that the ovaries have a larger supply of eggs. This means one would be expected to have better than average outcomes for egg freezing. 

Remember, there is no universal standard for AMH, so it can vary depending on the lab where the test is run. Your test results will include if your range is “normal”, “low”, or “high” and the cut-off can differ. For example, Atlanta Fertility considers over 4.5 ng/mL high. Advanced Fertility considers anything over 4.0 ng/ml high. While RMA would consider an AMH over  3.0 ng/ml as “very high”.

With high levels of AMH, you may be at higher risk for ovarian hyperstimulation syndrome (OHSS). This means your doctor may choose a specific protocol and/or do extra monitoring to decrease the risk of complications during egg freezing.

What AMH level is considered too high?

Again, this question depends on the lab. Your test results will come with a reference range, and will indicate if your number is high for your age. If your doctor considers your levels abnormally high and has concerns, they will discuss the results with you. 

Common reasons for high AMH

The most common reason for high AMH is that you are very fertile and likely to retrieve more eggs in an egg freezing cycle.  

But a high AMH level may also indicate PCOS, which is a hormonal disorder that affects 8–13% of females of reproductive age. Those with PCOS typically have high levels of androgens (male hormones) and may have irregular periods, acne, and excess hair growth. Patients with an average AMH level ≥ 4.45 ng/ml have a 9.35 times higher likelihood of developing PCOS, but not all patients with a high AMH have PCOS.

In rare cases, abnormally high AMH could be a sign of an ovarian tumor. Certain types of ovarian tumors, such as granulosa cell tumors, can produce high levels of AMH. 

Does high AMH always mean PCOS?

While an increase in AMH levels has been reported to be associated with PCOS, high AMH alone is not enough to diagnose PCOS. 

Not all patients with PCOS have high AMH levels, and not all patients with high AMH levels have PCOS. Diagnosis of PCOS requires a combination of symptoms, hormone levels, and imaging studies, such as ultrasound.

Does high AMH mean good egg quality?

Not necessarily. While a high AMH level is often associated with a larger number of ovarian follicles and eggs, it does not necessarily mean that the eggs are of good quality. Egg quality is determined by factors such as your age, genetics, and environmental factors, and cannot be measured directly by AMH levels.

Am I ovulating if my AMH is high?

AMH levels do not indicate if you’re ovulating or not. Ovulation is the release of a mature egg from the ovary and can be confirmed by monitoring the menstrual cycle and/or performing ultrasound studies.

Will I get a lot of eggs if I have a high AMH?

The success of egg freezing outcomes largely depends on the number and quality of eggs retrieved. Studies have shown that AMH levels can be used as a predictor of egg quantity, and can thus help to predict the potential success of egg freezing. Those with higher AMH levels tend to have better outcomes with egg freezing, as they are likely to have more eggs retrieved and a higher chance of success in future fertility treatments. 

But by no means does a high AMH level guarantee a lot of eggs during an egg retrieval procedure for fertility treatments. The number of eggs retrieved during an egg freezing cycle depends on several factors, including your age, ovarian response to stimulation medications, any other underlying medication conditions, and the skill of the doctor performing the procedure.

What is a good AMH level for egg freezing?

Research has found that AMH is a good predictor of the response to ovarian stimulation and the number of eggs retrieved. Because of this, fertility doctors typically use your AMH levels (along with other biomarkers) to determine the drugs and dosages you will need to maximize your response to ovarian stimulation. 

Now, what about a correlation between AMH and actual babies born (live birth rate)? Well, while AMH does seem to have some association with live birth rates after IVF, its ability to actually predict a live birth is not that great. This is especially true for younger people. A 2021 study found that AMH is a good predictor of live birth in older (>39 years old), but not younger, people. They found that younger participants (≤38 years old) could get pregnant even with low AMH levels as long as they had frequent egg retrievals. 

Freeze your eggs with Cofertility

One option to make egg freezing better is working with Cofertility. Through our Split program, qualified freezers can freeze their eggs for free when donating half of the eggs retrieved to a family who can’t otherwise conceive. 

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

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

Summing it up

A high AMH level is generally a good sign for your ability to successfully freeze your eggs. But for some, it can also be one indicator of PCOS. While a high AMH level is often associated with a larger number of ovarian follicles and eggs, it does not necessarily mean that the eggs are of good quality (egg quality is more dependent on age). 

AMH levels are commonly used as a marker of ovarian reserve and can be helpful, in conjunction with other measures, in predicting the number of eggs that can be retrieved during an egg freezing cycle. However, it is important to keep in mind that egg quality is determined by several factors and cannot be measured directly by AMH levels. If you have concerns about your fertility or AMH levels, it is important to speak with a fertility doctor for personalized advice and treatment options.

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Read more:

• Which Matters More for Fertility: AMH or Age?
• What AMH Level Do I Need to Freeze My Eggs?
• Do’s and Don’ts During Egg Freezing: Alcohol, Baths, Exercise, and More

This article was medically reviewed by Dr. Samuel Pang

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More than half of transgender men (those who were assigned female at birth and identify as a male) say they want children one day. But those who are considering or have undergone hormone replacement therapy (HRT) or gender affirming surgery may wonder about their future ability to have biological children. In this article, we’ll review how egg freezing works, and if it’s possible for transgender men.

Egg freezing for transgender men

Egg freezing, also known as oocyte cryopreservation, is a process that involves extracting and freezing eggs for potential use in future. Before extracting the eggs from your ovaries, they are matured using hormonal stimulation for about two weeks. This leads to increased estrogen hormone levels, which may be difficult for some transgender men as it can exacerbate gender dysphoria. 

The extracted eggs can then be cryopreserved and stored for many years, and when you’re ready to become a parent, the cryopreserved eggs can be thawed, inseminated with sperm in a laboratory.  This is known as in vitro fertilization (IVF). If the eggs fertilize successfully and develop into embryos, the embryos may potentially be transferred into the uterus attempt to achieve pregnancy. This may be your uterus, the uterus of your partner, or a gestational carrier (surrogate). 

It is important to note that not all cryopreserved eggs will survive the freeze/thaw process and only those which survive can be inseminated with sperm.  Furthermore, not every egg that is inseminated will fertilize successfully and not every egg which fertilizes will develop into an embryo which is suitable for transfer into the uterus.  And not every embryo that is transferred into the uterus will result in a successful pregnancy or live birth of a healthy baby.  In other words, freezing 10 eggs does not mean that you can have 10 babies.  Freezing your eggs provides you with the opportunity to have biological children, but does not guarantee that you will definitely be able to have biological children from the frozen eggs.

When is the best time to freeze my eggs, before or after transitioning?

It is generally recommended to freeze your eggs before you start hormone therapy or undergo any gender-affirming surgeries, as these treatments can affect your egg production and quality.

In fact, the World Professional Association for Transgender Health (WPATH) and Endocrine Society both recommend that all transgender patients be counseled on options for fertility preservation (egg freezing) prior to transition. The American Society of Reproductive Medicine (ASRM) also put out a statement that providers should offer fertility preservation counseling to individuals before gender transition.

Can I freeze my eggs if I’ve started transitioning?

It may still be possible to freeze your eggs after transitioning, but it largely depends on the medical procedures you have had done. We’ll discuss those in more detail below. 

Can I freeze my eggs if I have started hormone therapy?

If you have already started hormone therapy, such as testosterone (T) therapy, it may still be possible to freeze your eggs. However, your doctor will likely recommend discontinuing testosterone before you proceed with the egg freezing process.  

Stopping hormone therapy, even temporarily, is easier said than done. Transgender men who stop testosterone to freeze their eggs have reported both physical and mental difficulties. These challenges can include fatigue, alterations in voice and body odor, and the return of menstruation, potentially leading to feelings of increased femininity and heightened gender dysphoria.  This is one of the reasons why it is preferable to freeze your eggs before you start  testosterone therapy.

While it has traditionally been recommended that transgender men go off testosterone to freeze their eggs, this may be changing. In 2022, UCSF reported that two transgender men were able to have their eggs retrieved without stopping testosterone. The researchers suggested more studies to confirm the findings, because it is unknown what impact the on-going use of testosterone may have had on these eggs, and whether these eggs will ultimately result in viable embryos or healthy children.  We may not have answers to these questions for many years.

How does testosterone (T) therapy impact fertility?

Testosterone (T) therapy affects fertility by leading to an anovulatory state and amenorrhea, meaning you no longer ovulate or have menstrual periods. But this is usually reversible when you stop testosterone (T) therapy. 

While more research is needed, one study from Boston IVF found that transgender men who froze their eggs have just as good outcomes as cisgender patients. More than half of the transgender male patients in the study had been on testosterone (T) therapy before egg freezing, and all of them stopped taking testosterone for an average of four months before starting their treatment cycle.

Another study out of Israel found the same thing: there was no difference in the number of eggs retrieved between transgender men and cisgender women. The authors concluded, “Transgender men have an excellent response to ovulation stimulation even after long-term exposure to testosterone.” 

One study from Boston IVF found that transgender men who froze their eggs have just as good outcomes as cisgender patients.

Can I freeze my eggs if I’ve had gender affirming surgery?

It depends on what was involved in the surgery. If the ovaries were removed (an oophorectomy or total hysterectomy), you will not be able to freeze your eggs. This is because egg freezing requires the ovaries to produce mature eggs, which are then retrieved and frozen for potential use in future. If the ovaries have been removed, then egg freezing is no longer an option.

However, if you have not had your ovaries removed, egg freezing may still be an option.

Can transgender men get pregnant?

Say you freeze your eggs now and are wondering if you can still get pregnant down the line. Transgender men who have a uterus may be able to become pregnant and carry a pregnancy to term. This is because testosterone therapy does not usually have an irreversible impact on the uterus. However, you would need to discontinue testosterone therapy in order to be pregnant, as you cannot take testosterone during pregnancy.  In addition, transgender men would face the same issues as cisgender women in becoming pregnant and carrying a healthy pregnancy, like age and overall health. 

Even if you cannot or do not want to become pregnant, it is still possible to have a genetic tie to your future child by freezing your eggs. Those eggs can potentially be fertilized and cultured into embryos in an IVF laboratory, following which they can then be transferred either to the uterus of a partner or a gestational surrogate to carry the pregnancy. 

What is ovarian tissue cryopreservation?

Ovarian tissue cryopreservation is an experimental technique involving the removal and freezing of a small piece of ovarian tissue from the ovary. The frozen tissue can later be thawed and transplanted back into the body, allowing the ovaries to produce eggs and potentially enabling the patient to conceive a biological child. This strategy has mostly been used to preserve fertility potential in cisgender women who need to undergo treatment for cancer which would negatively impact the eggs in the ovaries.

While ovarian tissue cryopreservation is still considered an experimental technique, it has shown promising results in several studies and has already resulted in at least 60 live births worldwide.

We can help you freeze your eggs

If you’re interested in freezing your eggs, it is important to find a doctor who can provide sensitive and affirming care for your journey. Our Freeze by Co platform makes egg freezing more accessible, and we can help connect you with our partner fertility clinics that have experience working with transgender men. Learn more.

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In recent years, egg freezing has become an increasingly popular option for those who wish to preserve their fertility. In fact, in 2021 alone, egg freezing cycles surged by a staggering 46%, marking a stunning upward trend that has quadrupled since 2017.

While the process of egg freezing has improved dramatically over the years, there is still some concern about whether those who choose this option will regret their decision later on, especially given the high price tag. There have been several studies and surveys that shed some light on if people show regret after freezing their eggs. In this article, we will explore the findings of these studies and ultimately help you answer the question: Will I regret freezing my eggs?

First off, what is regret?

Regret is a negative emotion that arises from the perception that a different choice or action might have resulted in a better outcome. In the context of choosing to do egg freezing, regret could stem from a variety of factors.

One possible cause of regret could be related to the decision-making process itself. Those who feel pressured to freeze their eggs by societal or familial expectations, rather than making an informed choice based on their own personal values and priorities, may be more likely to experience regret. Similarly, those who do not fully understand the risks, benefits, and limitations of the procedure, or who have unrealistic expectations about its success rates or the ease of future pregnancy, may be more likely to regret their decision.

Another possible cause of regret could be related to the actual experience of undergoing the egg freezing process. Patients who experience physical discomfort, emotional stress, or financial strain as a result of the procedure may be more likely to feel regret. Similarly, those who feel that they were not adequately supported or informed throughout the process, or who experienced complications or unexpected outcomes, may be more likely to regret their decision.

While some people do regret egg freezing, the vast majority have no regrets (more on that below). In my conversations with hundreds of women in their 30s and 40s, I have heard more regret from those who did not freeze their eggs than those who did.

Let’s take a look at six studies on the topic

We looked at six studies around the world that retrospectively surveyed egg freezers about their experience. Here are the summaries: 

1. To freeze or not to freeze: decision regret and satisfaction following elective oocyte cryopreservation

The study: A 2018 retrospective survey of 201 patients who froze their eggs at UCSF between 2012 and 2016. The researchers surveyed them at various intervals after their egg freezing procedure to assess their satisfaction with the decision and whether they experienced any regrets.

Key findings: Overall, the study found that the vast majority of egg freezers (81%) reported no regret at all.  And 89% affirmed they will be happy they froze eggs, even if they never use them.

2. What do reproductive-age women who undergo oocyte cryopreservation think about the process as a means to preserve fertility?

The study: A retrospective survey of 183 patients who froze their eggs between 2005-2011 at New York University Fertility Center. The researchers sought to better understand the beliefs, priorities, and attitudes toward egg freezing and to track the reproductive paths of women who chose to undergo oocyte cryopreservation treatment.

Key findings: Most (79%) of the women reported that they wished they had undergone egg freezing at an earlier age. Half of the patients (53%) believed that the experience was empowering, 36% found it empowering as well as anxiety producing, and only 6% believed that it was purely anxiety producing.

3. Perceptions, outcomes, and regret following social egg freezing in the UK; a cross-sectional survey

‍The study: A retrospective survey of 85 patients who froze their eggs between 2008-2018 at a UK fertility clinic. The aim of this study was to investigate the motivations of women who have undergone social egg freezing, identify their perceptions following treatment, and assess potential feelings of regret.

Key findings: 91% had no regrets over their decision to undergo social egg freezing.

4. Decision regret and associated factors following oocyte cryopreservation in patients with diminished ovarian reserve and/or age-related fertility decline

The study: A cross-sectional survey study of 162 patients with diminished ovarian reserve (DOR) and/or age-related fertility decline who froze their eggs between 2014 and 2019 in two clinics in Istanbul, Turkey.

Key findings: Egg freezing does not seem to cause high decisional regret. In the study, 31% had no decision regret, 52.5% had mild regret, and 16% had moderate to severe decision regret.

5. Assessing the quality of decision-making for planned oocyte cryopreservation

The study: A retrospective survey study of 98 patients who froze their eggs between 2012 and 2018 at a Canadian academic IVF center. Researchers aimed to examine the quality of egg freezing decision-making in the domains of decision change, decision difficulty, decision regret, and informed choice.

The findings: The vast majority (88%) of egg freezers said it was a good decision. 61% said they would have made 'exactly the same' decision without any change, and 35% would have made a 'similar' decision, but with option-related changes and process-related changes. Some stated their only regret was not doing it sooner.  

6. Exploring women’s attitudes, knowledge, and intentions to use oocyte freezing for non-medical reasons: A systematic review

The study: This 2020 systematic review by researchers in the UK analyzed 35 studies (including a few of the studies above) explored women's experiences of elective egg freezing. 

Key findings: The review found that those who froze their eggs tended to report high levels of satisfaction with the decision, and only a small portion felt regret after freezing their eggs. Those who said they received more adequate information and emotional support during egg freezing were less likely to report regret.  

Most people do not regret freezing their eggs

As you can see, the rates of regret reported in these studies vary, and may have depended on factors such as the sample size, study design, and the follow-up period. However, taken together, these studies suggest that the vast majority of those who freeze their eggs do not have regret. And there appear to be factors that reduce the chances of regret, including feeling fully informed beforehand, and getting adequate support during the egg freezing process. 

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Those who regret egg freezing had a few things in common

It's worth noting that the patients who experienced regret tended to have certain characteristics in common. For example, they were more likely to be over 37 years of age, single, and have no children. Additionally, those who froze their eggs for non-medical reasons (such as to delay childbearing for career or personal reasons) were more likely to experience regret than those who did so for medical reasons (such as prior to cancer treatment).

However, it's important to note that the vast majority of patients in these studies did not experience any regret after freezing their eggs. Furthermore, many of the patients who did experience regret reported that it was temporary and ultimately resolved over time. In fact, the UCSF study found that 89% of the women who reported regret at the one-year follow-up no longer felt that way at the three-year follow-up.

Reducing the chances of regret 

It's worth noting that these studies are several years old, and the process of egg freezing has improved significantly in recent years, making it an even more viable option. Advances in technology, like vitrification, have made it possible to freeze eggs more effectively and with a higher success rate. 

When deciding whether to freeze your eggs, it's important to consider your own unique circumstances and goals. Do as much homework as possible (our blog is a great resource!) so you feel prepared and empowered. Studies also have shown that having a support system decreases the chances of regret. If you freeze your eggs with Cofertility, we’ll make sure you have all the support you need.

Freeze your eggs with Cofertility

Cofertility is in the “family” business, striving to make egg freezing and third-party reproduction more human-centered and accessible for all. Our Freeze by Co platform empowers women to take control of their fertility timelines by making egg freezing more accessible. We offer two egg freezing programs: 

Our Split program enables women to freeze their eggs for free(!) when they donate half of the eggs retrieved to a family who can’t conceive, including LGBTQ+ parents, couples facing infertility, and those with other fertility-impacting medical challenges, like cancer.

Our self-pay Keep program allows women to freeze their eggs and keep them all for their future use. Through Keep, we offer our members partnerships and discounts to lighten the financial load of egg freezing, as well as access to our member community.

Regardless which program you join, we offer:

• Our Freeze by Co community: a safe space to connect with others freezing their eggs at the same time. 
• Education: Our library of resources provides proactive education around fertility, hormones, egg freezing, and egg donation that women can’t find anywhere else. We believe knowledge is power, especially when it comes to our bodies and our options.
• Empowerment: By making egg freezing easier and more accessible, our programs further strengthen the American Society of Reproductive Medicine (ASRM)’s Committee Opinion that egg freezing can help promote social justice and strengthen equality of men and women.

Summing it up

The decision to freeze one's eggs is a deeply personal one that comes with a range of emotions, risks, benefits, and limitations. While the possibility of regret is possible, it's helpful to remember that the majority of those who undergo egg freezing do not experience this regret. 

If we can be helpful on your journey, don’t hesitate to reach out!

OHSS, or Ovarian Hyperstimulation Syndrome, is a rare but potentially serious complication of egg freezing and egg donation. OHSS occurs when the ovaries become swollen and painful as a result of the hormonal medications used to stimulate egg production during fertility treatment. If you are considering egg freezing or donation, you may be wondering if you are at risk for OHSS. In this article, we will discuss everything you need to know.

What is OHSS?

OHSS is a condition that can occur as a result of fertility treatment, particularly after egg freezing. During this treatment, patients receive hormonal medications to stimulate the ovaries to produce multiple eggs for retrieval. In some cases, the ovaries may become overstimulated and produce too many eggs, causing them to become swollen and painful.

OHSS is a rare complication of egg freezing, but it can be serious if left untreated. In some cases, OHSS can lead to hospitalization and require medical intervention. Severe OHSS can cause complications such as blood clots, kidney failure, and fluid buildup in the lungs.

Ultrasound image of severe OHSS (Source)

How common is OHSS?

Data suggest the incidence of mild OHSS is 20%–33%, moderate OHSS is 3%–6%, and severe OHSS occurs in 0.1%–2% of cycles. In rare cases, OHSS can be life-threatening, so it's important to be aware of the potential risks and to inform your doctor of any symptoms (severe abdominal pain, bloating, and nausea). 

The incidence of OHSS has decreased over the years due to a better understanding of the risk factors and evidence-backed data on how to prevent OHSS. 

How do you know if you are at risk for OHSS?

The risk of developing OHSS depends on several factors, including: 

• Previous history of OHSS in past cycles
• High number of follicles during treatment puts you at an increased risk of developing OHSS
• Medications: The dosage and duration of hormonal medications can impact the chances of developing OHSS
• Age: Patients under the age of 30 are at a higher risk of developing OHSS 
• Low body weight puts you at a higher risk of developing OHSS
• Polycystic ovary syndrome (PCOS) increases your risk of developing OHSS due to the increased sensitivity to fertility medications
• Elevated hormone levels, including elevated serum estradiol (E2) concentrations and increased anti-Mullerian hormone (AMH) levels are risk factors for OHSS

Ask your doctor if they think you might be at higher-than-average risk for OHSS. If you are at high risk of OHSS, they may choose a specific protocol which utilizes the leuprolide trigger instead of hCG, which can prevent OHSS. Another medicine called cabergoline also can help reduce the fluid accumulation, or they may give you extra IV fluids at the time of egg retrieval. Most clinics will do extra monitoring of patients at risk of OHSS to decrease the risk of complications.

How many follicles put you at risk of OHSS?

Follicles are small sacs in the ovaries that contain eggs. During fertility treatment, patients are given medications to stimulate the ovaries to produce multiple follicles, which can increase the chances of achieving pregnancy down the line. However, when too many follicles develop, the risk of OHSS increases.

Ultrasound scans and blood tests are used to monitor the number and size of follicles, as well as hormone levels. There is no set number of follicles that puts you at risk of developing OHSS, as the risk varies depending on other factors such as age, body weight, and response to medications. However, as a general guideline, having more than 20 follicles on an ultrasound scan is considered a high risk for OHSS. If you are deemed to be at high risk of developing OHSS, your doctor may adjust your medication dosages or cancel the cycle to prevent OHSS from developing.

There is no set number of follicles that puts you at risk of developing OHSS. However, as a general guideline, having more than 20 follicles on an ultrasound scan is considered a high risk for OHSS.

Symptoms of OHSS after egg retrieval

Most people who undergo egg freezing do not develop OHSS. For those who do, the severity of the symptoms can vary from mild to severe and may include:

• Abdominal pain or discomfort: Patients with OHSS may experience abdominal pain or discomfort, which can range from mild to severe. This pain may feel like bloating, cramping, or a fullness in the abdomen.
• Bloating and fluid retention: OHSS can cause fluid to accumulate in the abdomen, leading to bloating and a feeling of fullness. Patients with OHSS may also experience swelling in the hands and feet due to fluid retention.
• Nausea and vomiting: Some patients with OHSS may experience nausea and vomiting, which can be caused by the swelling of the ovaries and the accumulation of fluid in the abdomen.
• Difficulty breathing: In severe cases of OHSS, the accumulation of fluid in the abdomen can cause pressure on the diaphragm, making it difficult to breathe.
• Rapid weight gain: People with OHSS may experience rapid weight gain due to the accumulation of fluid in the abdomen and other parts of the body.
• Decreased urine output: OHSS can cause a decrease in urine output, which can be a sign of dehydration and electrolyte imbalances.
• Fatigue: Patients with OHSS may experience fatigue, which can be caused by the body's response to the hormonal medications and the strain on the body's systems.

If you are undergoing egg freezing and experience any of these symptoms, it is important to contact your clinic immediately. Early recognition and management of OHSS can help to prevent the condition from worsening and ensure the best possible outcome.

How long after the egg retrieval are you at risk for OHSS?

The risk of OHSS typically peaks around five to ten days after egg retrieval. During this time, the hormones that were used to stimulate your ovaries to produce multiple eggs are still in your system, and your ovaries may continue to produce hormones even after the eggs have been retrieved. This can lead to excessive fluid accumulation and swelling in the body.

If you have undergone egg retrieval, it is important to be aware of the signs and symptoms listed above and report any concerns to your clinic right away.

Can you prevent OHSS after an egg retrieval?

Fertility doctors can identify your risk factors and take action to reduce your chances of getting OHSS in the first place. But there are also steps you can take to help prevent OHSS after egg retrieval. Here are some tips:

• Stay hydrated: Drinking plenty of fluids, especially electrolyte-rich fluids like coconut water or gatorade, can help flush out excess hormones and prevent dehydration, which can contribute to the development of OHSS. Aim for at least eight to ten glasses per day, or as directed by your doctor.
• Eat a high protein diet: A healthy, high protein diet is an important component of preparing for egg freezing.
• Rest and avoid strenuous activity: After the egg retrieval, it is important to take it easy and avoid activities that could increase your risk of developing OHSS. This includes exercise, lifting heavy objects, and sexual activity. Your doctor will likely recommend that you rest for at least 24 to 48 hours after the procedure.
• Monitor your symptoms: Be aware of the signs and symptoms of OHSS, such as those listed above. If you experience any of these symptoms, contact your clinic right away.
• Take prescribed medications as directed: Your doctor may prescribe medications, such as pain relievers or hormone supplements, to help prevent OHSS after egg retrieval. It is important to take these medications as directed and not to skip any doses.
• Attend follow-up appointments: Your doctor may schedule follow-up appointments to monitor your progress and check for signs of OHSS. Attend these appointments as scheduled and report any symptoms or concerns you may have.

While OHSS can be a serious complication, taking these steps can help reduce your risk and ensure the best possible outcome after egg retrieval. Be sure to discuss any concerns or questions you may have with your doctor, as they can provide personalized recommendations based on your individual needs and medical history.

How is OHSS treated?

Mild cases of OHSS can usually be treated with rest, increased fluid intake, and pain medication. More severe cases may require hospitalization and treatment with intravenous fluids, electrolyte replacement, and other supportive measures.

If you develop mild to moderate OHSS, your clinic may recommend close monitoring to ensure that your symptoms do not worsen. This may involve regular check-ins, blood tests, and ultrasounds to track your progress and check for signs of complications.

One of the most important treatments for OHSS is rest and hydration. This can help relieve symptoms such as bloating, abdominal pain, and nausea, and prevent complications such as dehydration and blood clots. Your doctor may recommend bed rest and increased fluid intake, and may also prescribe medications to manage your symptoms.

Your doctor may also prescribe medications such as pain relievers, anti-nausea medications, and diuretics (medications that help remove excess fluid from the body) to manage your symptoms and prevent complications. In some cases, medications such as cabergoline or GnRH agonists may be used to reduce the production of hormones that contribute to OHSS.

If you do develop severe OHSS, you may need to be hospitalized for close monitoring and treatment. In the hospital, you may receive intravenous fluids and medications, and may undergo procedures such as paracentesis (the removal of excess fluid from the abdomen) to relieve symptoms and prevent complications.

Does OHSS affect egg quality?

OHSS is caused by an overstimulation of the ovaries with fertility medications, which can lead to a higher number of eggs being produced than normal. However, the quality of those eggs is usually not affected by the presence of OHSS. In fact, one small study of 42 patients who developed severe OHSS during IVF found that while the fertilization rate was lower, the quality of embryos and the pregnancy rate were the same. 

The quality of the eggs retrieved during egg freezing is more dependent on your age and other factors, such as hormonal imbalances or underlying medical conditions. 

Does OHSS mean more eggs?

OHSS may mean more eggs, but only because having more eggs means a higher chance of OHSS. One of the main causes of OHSS is the use of medications called gonadotropins, which stimulate the ovaries to produce multiple eggs. Patients who produce a large number of eggs, usually more than 20, are at a higher risk of developing OHSS. 

In some cases, OHSS may indicate that a patient has produced a larger number of eggs than average. However, this is not always the case. Mild to moderate cases of OHSS can occur even when fewer than 10 eggs are retrieved.

Keep in mind that the number of eggs retrieved is not always an indicator of success. Other factors, such as the quality of the eggs, your age, and your overall health can all have an impact on the success of the treatment.

The goal of egg freezing is to produce a sufficient number of high-quality eggs for fertilization down the line, while minimizing the risk of complications such as OHSS. If you are undergoing egg freezing and have concerns about the number of eggs or the risk of developing OHSS, it is important to discuss your options with your doctor. They can provide guidance on the best course of action based on your individual circumstances and can help you make informed decisions about your fertility journey.

Summing it up

Egg freezing is becoming an increasingly popular option for those who want to preserve their fertility for future use. This process involves harvesting and freezing your eggs, which can then be thawed and used down the line when you are ready to start a family. However, like any medical procedure, egg freezing is not without its risks. One potential complication that can occur during the process of egg retrieval is OHSS.

While OHSS is a potential risk of egg freezing, the good news is that it is a relatively rare complication. Plus, the risk of OHSS can be reduced by carefully monitoring your response to the fertility medications and adjusting the dosage as needed. If you are worried about OHSS, we recommend talking to your doctor to discuss what can be done to reduce the risk.

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References:

1. Aboulghar M. Prediction of ovarian hyperstimulation syndrome (OHSS). Estradiol level has an important role in the prediction of OHSS. Hum Reprod. 2003 Jun;18(6):1140-1. doi: 10.1093/humrep/deg208. PMID: 12773437.
2. Fiedler K, Ezcurra D. Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment. Reprod Biol Endocrinol. 2012 Apr 24;10:32. doi: 10.1186/1477-7827-10-32. PMID: 22531097; PMCID: PMC3403873.
3. Kol S, Itskovitz-Eldor J. Severe OHSS: yes, there is a strategy to prevent it! Hum Reprod. 2000 Nov;15(11):2266-7. doi: 10.1093/humrep/15.11.2266. PMID: 11056117.
4. Namavar Jahromi B MD, Parsanezhad ME MD, Shomali Z MD, Bakhshai P MD, Alborzi M MD, Moin Vaziri N MD PhD, Anvar Z PhD. Ovarian Hyperstimulation Syndrome: A Narrative Review of Its Pathophysiology, Risk Factors, Prevention, Classification, and Management. Iran J Med Sci. 2018 May;43(3):248-260. PMID: 29892142; PMCID: PMC5993897.
5. Nelson SM. Prevention and management of ovarian hyperstimulation syndrome. Thromb Res. 2017 Mar;151 Suppl 1:S61-S64. doi: 10.1016/S0049-3848(17)30070-1. PMID: 28262238.
6. Sansone P, Aurilio C, Pace MC, Esposito R, Passavanti MB, Pota V, Pace L, Pezzullo MG, Bulletti C, Palagiano A. Intensive care treatment of ovarian hyperstimulation syndrome (OHSS). Ann N Y Acad Sci. 2011 Mar;1221:109-18. doi: 10.1111/j.1749-6632.2011.05983.x. PMID: 21401638.
7. Soave I, Marci R. Ovarian stimulation in patients in risk of OHSS. Minerva Ginecol. 2014 Apr;66(2):165-78. PMID: 24848075.
8. Sun B, Ma Y, Li L, Hu L, Wang F, Zhang Y, Dai S, Sun Y. Factors Associated with Ovarian Hyperstimulation Syndrome (OHSS) Severity in Women With Polycystic Ovary Syndrome Undergoing IVF/ICSI. Front Endocrinol (Lausanne). 2021 Jan 19;11:615957. doi: 10.3389/fendo.2020.615957. PMID: 33542709; PMCID: PMC7851086.

Vaping has become a popular alternative to traditional smoking in recent years. But while it’s been marketed as a healthier option, the long-term effects of vaping are still not fully understood. One area of concern is the impact of vaping on fertility, especially for those who are considering freezing their eggs for future use. In this article, we’ll dive into the research on if vaping is okay for egg freezing and donation.

Impact of vaping on fertility

Several studies have found that vaping can have negative effects on reproductive health, including decreased fertility and increased risk of miscarriage. According to the American Society of Reproductive Medicine (ASRM), infertility rates in male and female smokers are twice as high as infertility rates among nonsmokers, with infertility rates rising with the number of cigarettes smoked daily. The main ingredients in e-cigarette liquids, such as nicotine and propylene glycol, have been shown to have toxic effects on the ovaries and the eggs they contain.

Nicotine has been shown to reduce the quality and quantity of eggs in the ovaries. It can also lead to decreased blood flow to the ovaries, which can negatively impact the development of the follicles, the structures in the ovaries that contain the eggs. Despite needing more medication during the egg freezing process, smokers often have fewer eggs available for retrieval during an egg freezing cycle, as well as 30% lower pregnancy rates compared with nonsmokers.

Propylene glycol, another common ingredient in e-cigarette liquids, has been shown to have a toxic effect on the ovaries and eggs. The same study has linked propylene glycol to oxidative stress, which can lead to damage to the eggs and decreased fertility. In addition, propylene glycol has been shown to cause DNA damage, which can affect the quality of the eggs.

How vaping may affect egg freezing outcomes

Egg freezing is a process where a woman's eggs are retrieved, frozen, and stored for later use once she is ready to fertilize them and start or grow her family. The more eggs that are retrieved, the better the chances of a live birth down the line. 

While the effects of vaping on fertility are still largely unknown, many fertility clinics advise their patients to quit vaping in an effort to improve egg freezing outcomes related to quality and quantity based on the above research on smoking. Lower quality eggs with a higher DNA damage rate could impact the success of a future pregnancy using these frozen eggs, as these eggs may be less likely to fertilize into embryos (or result in a successful implantation). In addition, fewer eggs retrieved from those who vaped may result in fewer options for future use, which can increase the likelihood of needing additional egg freezing cycles.

Our programs offer the opportunity to freeze your eggs in a way that’s more empowering, positive, and affordable — even free. Take our quiz today to see if you qualify for Split, our free egg freezing program. 

Can I donate my eggs if I vape? 

If you are considering applying for our Split program, where you can freeze your eggs for free when you donate half of the eggs retrieved to another family, please note that you will not be considered eligible if you currently use any nicotine products, including vaping. If you engage in vaping regularly, you will need to quit for two to three months before re-applying for the program. If you only vape occasionally/socially, you will need to quit for one month prior to your retrieval date.

Summing it up

In conclusion, while data is somewhat limited, it appears that the effects of vaping on fertility can have an impact on women who are considering egg freezing. The ingredients in e-cigarette liquids, such as nicotine and propylene glycol, have been shown to have negative effects on reproductive health, including decreased fertilization rates and increased risk of miscarriage. In addition, it is possible that vaping can lead to a lower number of eggs retrieved during an egg freezing cycle and a higher rate of DNA damage in the retrieved eggs. 

Our recommendation? Safe is better than sorry — in the interest of the best cycle outcome, it’s probably a good idea to hold off on the e-cigarettes leading up to and during your egg retrieval. 

If you’re considering egg freezing, consult with a fertility specialist or take our quiz to learn more about how you can preserve your fertility.

Has anyone ever told you that freezing your eggs will affect your ability to conceive naturally in the future? If you’ve heard this before, it’s understandable that it would make you think twice about pursuing egg freezing or donation. While this is a common question, it’s actually a misconception. Read on to learn more about why this is a myth and what egg freezing actually does for your fertility. 

The truth about egg freezing (or donation) and fertility

Let's get right to it—does freezing or donating eggs impact your ability to get pregnant on your own in the future? The short answer is no, egg freezing won’t lower your egg reserve and it won’t affect your chances of getting pregnant naturally when you’re ready to do so. To understand why this is, let’s talk about the ovulation process. 

What happens when you ovulate?

At the start of each menstrual cycle, when someone is on their period, their pituitary gland (in the brain) will release follicle stimulating hormone (FSH). FSH triggers fluid-filled sacs in both ovaries to grow. These sacs are called follicles and they each contain an egg. The follicles grow until a second signal from the brain forces only one follicle (the “dominant” follicle) to continue to mature and eventually release its egg. That egg being released is what we call ovulation. 

Now that that single egg has been ovulated, what happens to all the other eggs in those other follicles? Well, since those follicles weren’t chosen as the dominant follicle, they stop growing and the eggs inside of them die. This is known as atresia. So, it’s basically survival of the fittest in each ovary every month — yikes!

So what does all that have to do with egg freezing?

Let’s briefly review what the egg retrieval process is for egg freezing, donation, and in vitro fertilization (IVF). The hormone medications used during all three processes prompts your ovaries to allow all of the eggs in a single cycle to mature (instead of the usual one) so you can freeze them for if and when you might need them later on. 

Once the follicles have reached an appropriate size, the eggs are collected during a quick procedure in the office. This retrieval process happens under light sedation and involves using a vaginal ultrasound and a long needle with a suction device to retrieve the eggs. I promise this sounds much more intense than it actually is! An embryologist (an expert in the science of egg freezing) looks at each egg and grades their maturity before freezing them. If you’re doing IVF, they’ll go through fertilization instead of being frozen.  

Can I get pregnant unassisted after egg freezing?

What you may have noticed from what was just explained is that egg freezing actually rescues all the other eggs that your body would otherwise allow to die during a normal menstrual cycle. So the process of egg freezing doesn’t take anything away from your egg reserve, it actually helps you save some extra eggs! And since during each cycle, your body goes through the ovulation process again with a new set of competing eggs, your chances of getting pregnant unassisted in the future also aren’t affected by egg freezing. 

What egg freezing does do is give you additional options for if and when you’re ready to start growing your family.

Egg freezing actually rescues all the other eggs that your body would otherwise allow to die during a normal menstrual cycle. So egg freezing doesn’t take anything away from your egg reserve, it actually helps you save some extra eggs!

Can egg freezing damage my ovaries?

Like any other procedure, there are risks and side effects when freezing eggs, including risks of anesthesia, bleeding, pain, and infection. Thankfully, the majority of people who go through with it deal with side effects for a few days at most. When it comes to the ovaries themselves, they generally recover quickly. While there isn’t a lot of data specific to egg donors (as opposed to people freezing their eggs for themselves), the overall data indicate that the potential risks of surgical complications from egg retrieval are generally very small. However, in people with a history of endometriosis, pelvic inflammatory disease, pelvic adhesions or previous pelvic surgery, the risks are slightly increased so make sure to speak to your doctor about your medical history if you fall into any of these categories.

In terms of complications down the road, there are really two main ways by which egg retrieval might conceivably affect future fertility. The first way is by bleeding and infection from the procedure leading to adhesions (scar tissue) and the need for further surgeries. The second way is through trauma to the ovaries causing the creation of antibodies that may make fertilization of an egg more difficult.

Fortunately, there is no data that supports either possibility. According to one large study of over 7,000 IVF cycles, the rates of both infection and need for surgery to treat a pelvic abscess was 0.03% (about 1 in 3,000 IVF cycles). As for the scar tissue and antibodies, researchers have not found a higher rate of adhesions among people who have had an egg retrieval compared to those who haven’t nor have they found evidence that antibodies interfere with sperm’s ability to fertilize an egg. 

It’s up to you!

If you decide to go through with egg freezing, Freeze by Co is here to help. Our Split program allows those who qualify to freeze their eggs for free! In a Split cycle, you donate half of the eggs retrieved to a family that can’t otherwise conceive and freeze the remaining half for yourself. 

If you don’t want to donate, you can still participate in the Keep program, where you’ll be able to freeze your eggs and keep them all for yourself, on your timeline. In addition, you’ll have access to our online support community. This valuable resource lets you engage with other people freezing their eggs at the same time! 

Whatever you choose, our team is here to support you as you determine which family-building options are right for you!

Donating eggs can be a generous and life-changing decision for both the donor and the intended parent. If you have been interested in donating your eggs, you may be wondering if there’s an age cut-off. The short answer is, yes, there are age restrictions when it comes to donating eggs. In this article, we will discuss how old you have to be to donate your eggs and what factors may affect your eligibility.

What is the minimum age for egg donation?

American Society for Reproductive Medicine (ASRM) suggests that egg donors be at least 21 years of age at the time of donation. Most clinics and agencies follow this suggestion to ensure the donor is mature enough to understand the procedure and follow through on the commitment. 

To be part of our Split Program, where you freeze your eggs for free when donating half to a family that can’t otherwise conceive, you must be at least 21 years old. And while we do not accept Split members who are under 21, please reach out and we’ll get back in touch after you turn 21. 

What is the maximum age for egg donation?

While there is no legal maximum age to become an egg donor, ASRM recommends that donors be under the age of 34 and most clinics follow this guideline. 

At Cofertility, we require our Split program members to be 33 or under, as it can take some time to match with intended parents and complete your cycle. 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. 

Why are their age requirements for egg donation? 

Because donor egg IVF is already so expensive and time consuming, families and clinics want to do everything they can to increase chances of success.

One factor that can predict success is age. Women in their 20s typically have a higher quantity and quality of eggs, making them ideal candidates for egg donation. 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. Research also shows that, unfortunately, egg quality declines with age. 

Are there exceptions?

There are cases where a clinician may accept a known donor outside the recommended age range. For example, if someone wanted their 35-year-old sister to donate and she had recently undergone a successful egg retrieval, the doctor may approve her donation. 

Conclusion

Egg donation is a serious commitment and involves a significant time and energy commitment from the donor. The process typically involves several weeks of hormone injections, frequent doctor's appointments, and a minor surgical procedure to retrieve the eggs. 

While 21-34 is the recommended age for egg donation, keep in mind there are additional eligibility criteria. It is important for potential donors to carefully consider the risks and benefits and to ensure that they meet all of the eligibility criteria before making a decision.

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Egg freezing, formally known as oocyte cryopreservation, is a medical procedure that allows you to preserve your fertility by retrieving, freezing, and storing your eggs for future use. 

Egg freezing is an exciting and empowering option for those who want to take control of their fertility and pursue their life goals on their own timeline. But where should you start? In this article, we’ll share some factors to consider when selecting an egg freezing clinic that will give you the confidence and support you need throughout the process.

Reputation

When it comes to choosing an egg freezing clinic, reputation is key. It’s not just about the clinic, it’s also about the doctor you will work with. There are a few ways to find out the reputation of a clinic and specific doctor. You can research online, read reviews, and ask for recommendations from your doctor or friends who have undergone the procedure.

If you work with Cofertility to freeze your eggs, we have a list of vetted fertility clinic partners we will share to help you make a confident choice.

Experience and outcomes

Now that you’ve narrowed down the list, you can use the Society for Assisted Reproductive Technology (SART) website to look up data on specific fertility clinics. SART data provides detailed information on the number of cycles performed, age of patients, and success rates for various fertility treatments, including egg freezing. By reviewing the SART data, you can gain insight into a clinic's expertise and quality of care for egg freezing. Here’s how:

1. Go to SART's website at www.sart.org.
2. Click on "Clinic Data" in the top menu and select "National Summary Report."
3. Choose the year for which you want to view the data.
4. Use the search bar to find the clinic you are interested in.
5. Click on the clinic's name to view their data.
6. Look for the section titled "Egg Freezing Cycles" to see the clinic's success rates for egg freezing.
7. Review the clinic's success rates for egg freezing and compare them to the national average.

Keep in mind that success rates alone may not give a complete picture of a clinic's quality. SART may also not be helpful when looking up newer clinics, as the data takes about two years to post. If you’re working with a newer clinic, you can look up the doctor’s previous clinic to learn more about their past track record.

Accreditation and certification

To ensure that you receive the highest quality care, look for clinics that are accredited and certified by respected organizations. These certifications demonstrate that the clinic has met rigorous standards for safety, quality, and performance. Specifically, look for:

• The Joint Commission (JCAHO) is an independent, non-profit organization that accredits and certifies healthcare organizations in the United States. A fertility clinic that is accredited by the Joint Commission has met rigorous standards for quality and safety.
• College of American Pathologists (CAP) is a professional organization that accredits laboratories and pathology services. A fertility clinic that is accredited by the CAP has demonstrated proficiency in laboratory techniques and quality control.
• Society for Assisted Reproductive Technology (SART) reporting, as described in the section above. 

At Cofertility, we only partner with clinics that report outcomes to SART and have a CAP certified lab.

Technology and facilities

Egg freezing technology has come a long way in recent years, so it's important to choose a clinic that uses the latest equipment and facilities. By finding a clinic with state-of-the-art technology, you can be more confident that your eggs will be frozen and stored in the best possible conditions. Plus, a modern and comfortable clinic environment will help you feel relaxed and at ease during the process.

Here are some questions you can ask the clinic to get a better idea of their capabilities:

• What type of equipment do you use for egg freezing?
• How long have you been using this equipment, and how often do you update it?
• What is the success rate of your egg freezing procedure?
• Do you use vitrification or slow freezing? (You want a clinic that uses vitrification)
• What measures do you take to ensure the quality and safety of the eggs during the freezing process?
• Can you provide details about your laboratory and facilities for egg freezing, including any recent upgrades or renovations?
• Do you participate in research or clinical trials related to egg freezing?

By asking these questions, you can get a better sense of the clinic's commitment to using the latest technology and techniques for egg freezing, as well as their focus on quality and safety. A reputable and modern clinic will be happy to answer your questions and provide you with information to help you make an informed decision about your egg freezing journey.

The team

The staff at an egg freezing clinic can make all the difference in your experience. Look for clinics that have a team of knowledgeable, caring professionals who will guide you through every step of the process. The best clinics offer ongoing support and counseling to ensure that you feel confident and empowered throughout your egg freezing journey. During a consult, you’ll get to meet with the doctor and see if you click before moving forward.

Plus, if you work with us, you’ll get access to our team to help you every step of the way. 

Cost 

And last, but definitely not least, cost is an important consideration when choosing an egg freezing clinic. There’s no way around it, egg freezing is expensive. The typical egg freezing cycle can cost anywhere from $10,000 to $20,000 plus the cost of storage. A few clinics list their pricing on the website, but for most clinics, you will need to ask. Keep in mind that the price from the clinic does not usually include medications or long-term storage.  

Read more in How to Pay for Egg Freezing.

Cofertility can help

Freeze by Co offers women a chance to freeze their eggs for free when they donate half of the retrieved eggs to a family that can’t otherwise conceive. The cost of the entire process, including 10 years of cryopreservation, is fully covered. 

Or, if you want to freeze and store your eggs for your own future use without donating, Freeze by Co offers lower prices on things like consultations and storage, along with access to our community of women going through the process at the same time. ‍