egg retrieval

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.

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

Considering egg donation is an extremely rewarding experience, and one that you may want  to share with your family, friends and significant other. And because of the nature of the entire process — the lengthy application that asks about your family medical history, a psychological and medical evaluation, hormone injections and medical retrieval ( where you will need someone to accompany you after) —   it is definitely not something you should do alone. And donating your eggs doesn't just impact you, it can very well impact your partner, your family and future children.  So, if you’re thinking to yourself, “I am ready to donate my eggs to help out another family. Now how do I tell people I’m donating my eggs?” — we’re here for you.

One of the most important people to start this conversation with is your partner. Having an open and honest conversation is a great way to ensure that both of you are on the same page and have a clear understanding of what donating your eggs means. Here are some tips on how to approach the conversation.

Educate yourself first

Since you have already decided that egg donation is for you, you have most likely already done a lot of research. But, explaining it to someone else can be another story.  Especially if they start asking about how it may impact them in the future. our partner might have questions about the egg retrieval procedure and the potential risks, they may also ask about what happens to your eggs after you donate them, and what happens when that egg becomes a human and wants to meet you.  So make sure you spend some time doing the research for yourself. You can do that by talking to Cofertility, an IVF doctor or fertility psychologist. Ask a lot of  questions. Do your homework.  You want to become an expert so that you’re ready to field those important questions that will be asked.

Start with your partner

Once armed with all your egg donation knowledge, start the conversation with your partner. Having an open and honest conversation is a great way to ensure that both of you are on the same page and have a clear understanding of what donating your eggs means. Here are some tips on how to approach the conversation.

Talk about what this means for your future

Donating your eggs is a huge decision that can have an impact on your life far beyond your retrieval, so it’s important to have an open and honest discussion with your partner about what that might look like. For example, if you’re participating in Cofertility’s Split program (where you donate half of your retrieved eggs and keep half for yourself for for free for your own future use) and you and your partner think you may want to have children of your own in the future, it will be important for those children to know about your egg donation. After all, they’ll likely have at least one biological half-sibling out there that they may be curious about someday. Additionally, when you match with intended parents, both parties will agree on a desired disclosure status and outline what the relationship between you (the donor), the intended parents, and the donor-conceived child will look like. So it will be important for your partner to be in-the-know about the details 

Prepare for their questions

If you think through the possible questions they could ask, you’ll feel more prepared and confident in answering them. This could include:

• Why are you donating your eggs?
• What are the potential risks and side effects of egg donation?
• What is the egg donation procedure like?
• Will donating your eggs impact our ability to have children of our own someday (hint: it won’t)
• What do you imagine our relationship with the recipient family will look like?
• Are there any potential emotional or psychological effects of egg donation?
• Do you think you’ll donate more than once?

Obviously you can’t predict every question that may be thrown your way. And if they ask a question that throws you off, you can just say “Great question, let me think about how to best answer that and get back to you”. 

Revisit the conversation often

A decision as meaningful as donating your eggs should never be a one-and-done conversation, so keep this conversation an ongoing one. It’s likely that your perspectives will evolve over time, so it’s important to keep the conversation fresh so you can address any concerns as they come up. If at any time you or your partner have questions, our team at Cofertility is always here to help.

Summing it up

By donating your eggs, you’re truly making a life-changing impact on another family’s life, by giving them the opportunity to grow the family of their dreams. You should feel 100% confident in this decision before going into it, and having a supportive partner will make the egg donation process infinitely easier. Open and honest communication is key to any healthy relationship, and by involving your partner in this conversation early on, you’ll be setting yourself up for a successful donation experience that you can feel good about.

So, you’ve already taken the first step and decided you want to pursue egg freezing, but now you’re asking yourself, “how do I tell people I’m freezing my eggs?” 

We get it, deciding to freeze your eggs is a huge decision, and talking about it with the people in your life can feel even more overwhelming, especially your romantic partner. However, having an open and honest conversation is a great way to ensure that both of you are on the same page. Here are some tips on how to approach the conversation.

Educate yourself first

Before you try to explain the egg freezing process to your partner, it’s important to have a clear understanding of it all yourself. Your partner is definitely going to have a lot of questions about the process, so make sure to spend some time researching the process, success rates, and cost involved so that you’re prepared to answer their questions. This will also help you approach the conversation with confidence and show that you’re not taking this decision lightly.

Talk about what this means for your future

We know, talking about family-building with your partner can sometimes feel a little uncomfortable, especially if the relationship is still new. However, it’s important to make sure your partner understands what freezing your eggs means for your future family planning (and why you’re choosing to freeze eggs instead of embryos). Whether you know you want to have kids someday or you’re still not sure, freezing your eggs is a great way to give yourself and your partner options down the line. And with Cofertility’s Split program, you can do so without the financial strain, by freezing your eggs entirely for free when you give half to another family. 

Freezing eggs vs. embryos

If you’re in a relationship with a biologically male partner, you may be wondering if you should freeze embryos instead of eggs. While it’s true that thawing success rates can be slightly higher for embryos than eggs (at a 95% survival rate vs 90% for eggs), the downside is that once an egg is fertilized with sperm, there’s no going back, so freezing eggs instead of embryos will give you more options down the line. We know, this might be a little bit of an awkward one to bring up with your partner, but it might come up at some point, so the best you can do is be prepared with the facts.

Prepare for their questions

If you think through the possible questions they could ask, you’ll feel more prepared and confident in answering them. This could include:

• Why are you freezing your eggs?
• What are the potential risks and side effects of egg freezing?
• What if you don’t need the eggs down the line?
• How long can you keep frozen eggs?
• How many eggs should you freeze to maximize your chances of a successful pregnancy?
• How many eggs do you think you’ll get? How many do you want?
• Are there any potential emotional or psychological effects of egg freezing?

Obviously you can’t predict every question that may be thrown your way. And if they ask a question that throws you off, you can just say “Great question, let me think about how to best answer that and get back to you”. 

Revisit the conversation often

Something as important as your fertility and reproductive future should never be a one-and-done conversation, so keep this conversation an ongoing one. It’s likely that your perspectives will evolve over time, so it’s important to keep the conversation fresh so you can address any concerns as they come up. If at any time you or your partner have questions, our team at Cofertility is always here to help.

Summing it up

The decision to freeze your eggs is extremely personal and life-changing in a lot of ways, so it’s crucial that you feel supported in this decision. We know approaching the conversation can be scary at first, but by following the tips we just mentioned, you’ll be able to have an honest, empathetic, open conversation with your partner about your egg freezing journey and your future.