It’s the fertility treatment made famous by Rihanna, Rita Ora, Sofia Vergara and a host of other celebrities. The New York Times reports that “lots of successful women are freezing their eggs,” and Vogue deemed it part of a 2018 “wellness trend.” It seems like everyone is talking about it, but what actually is egg freezing? Put simply: it’s a clinical procedure to preserve some of your eggs. As you get older, your body will lose the ability to make healthy eggs, so freezing your younger eggs gives you an increased chance of being able to start a family at a later time.(1)
In an egg freezing cycle, you inject hormones that stimulate your ovaries. The resulting eggs are then retrieved, frozen, and stored. This is the same ovarian stimulation and egg collection process as for an IVF cycle, but your unfertilized eggs are frozen, instead of being mixed with sperm. If you encounter problems getting pregnant naturally in the future and need to have in vitro fertilization (IVF), thawing and using your younger eggs will increase your chances of having a healthy baby. (2-6)
Taking a step back, what are we actually talking about when we say preserving fertility? In essence, this means reducing the likelihood of you not being able to conceive your genetic child due to infertility. “Infertile” can refer to several things: 1) a disease where there’s something wrong with your reproductive system; 2) problems getting pregnant or staying pregnant; 3) age-related issues, as a function of time where your body naturally ceases to be fertile, which happens to everyone eventually.
🥚Egg 101🥚 The egg is the largest cell in the human body, measuring around 0.1mm in diameter. Millions of eggs can be contained in the ovaries, which are around the size of almonds. An egg has a diameter roughly the thickness of a strand of hair, making it thirty times the size of a sperm cell. Unlike sperm, eggs do not have tails and therefore cannot move independently.
What do women who’ve frozen their eggs say about it?
Egg freezing is different for everyone. Instead of reading the clickbait headlines, hear what real women who have frozen their eggs think about the process and what they got out of it.
“I found it was like a weight lifted off my shoulders. It’s not like anything really changed and I get that there are no guarantees, but I’m so happy I got it done.” - Kyra, 3
“The process wasn’t that bad, it wasn’t as big of a deal as people make it. I did it, I don’t really overthink it now.” - Stephanie, 33
“It helped me focus on what I really want out of life. I wasn’t sure before if I wanted kids, and freezing really gave me clarity on the fact that, yes, I do. If I don’t meet the right guy in a few years I would do it alone.” - Georgina, 37
“When I couldn’t get pregnant and IVF with my fresh eggs didn’t work, we tried using eggs I froze at 39. None of those worked either and it was devastating. I wasn’t prepared for that at all and always viewed those eggs as my fail-safe option. I wish I had taken the facts relating to my age more seriously.” - Jo, 43
“I met my now husband literally one week after freezing my eggs. I can’t describe exactly what changed in my approach to dating, but I felt like I could truly be myself without being obsessive about finding ‘the one.’ For the first time, things just felt easy and natural and everything just fell into place. I hope this means I won’t need to use my eggs, but I can’t help but think that freezing them is what allowed it to happen in the first place!” - Charli, 34
“I feel in control of my life for the first time in a long time.” - Joelle, 35
(Names have been replaced for privacy purposes)
What does an egg freezing cycle involve?
STEP ONE Appointment with specialist (~90 - 120 days):
The first step is to get an appointment with either your gynecologist or a specialist fertility doctor - some women choose to go straight to a specialist fertility clinic, others get a recommendation/referral from their gyne. In order to understand if you are a good candidate for egg freezing, you will have to have certain tests run - these can be done either by the fertility doctor or in advance by your gyne (you can take the results along with you to the fertility clinic consultation so you can have a more informed initial conversation). The tests include hormones, some infectious diseases (required by most states in the US), and a baseline ultrasound. If you get the green light, your procedure can be scheduled.
STEP TWO Preparing your eggs for freezing (~90 - 120 days):
At this time, you can prepare your eggs for freezing by making fertility-friendly lifestyle choices that can optimize your fertility during the three months prior to treatment. This aligns with the window in which your eggs are rapidly maturing and will help your ovaries into the best shape for your egg freezing cycle. Learn more about how to get Fertility Fit™.
STEP THREE Ovarian stimulation phase (~10-14 days):
Once your treatment starts, each day, you’ll give yourself an injection of fertility hormones, which are natural and modified versions of those normally produced in your body. In these higher doses, the hormones stimulate your ovaries to mature multiple eggs rather than the one egg matured during a typical menstrual cycle.
Over the stimulation phase, you will need to go to the clinic anything from four to eight times for monitoring appointments. During these appointments, your doctor monitors how your ovaries are progressing through ultrasounds and blood-work every one to four days and adjusts your medication dosage as needed. Some clinics may do additional blood work such as monitoring your estrogen levels. The actual day of your egg retrieval will be booked in the final few days of stimulation, depending on your progress, so flexibility with your work schedule around that time is crucial. When your doctor thinks the time is right, you’ll take a final injection, referred to as the “trigger shot,” which is injected exactly 35-36 hours before your retrieval surgery. This injection is meant to push your eggs to the final stages of maturation.
STEP FOUR Retrieval procedure (15-30 minutes):
For this step, you’ll need to take a day or two off work. Despite the actual procedure only lasting around 15-30 minutes, you will need to stay at the clinic for at least a few hours for preparation and recovery. Your eggs are retrieved in a minimally invasive surgical procedure during which you will be highly unlikely to feel any pain. In most cases, you will be under intravenous sedation, which is milder than general anesthesia (no breathing tube needed), so you will feel “asleep” and be unaware of any discomfort. Then, your doctor uses a fine, ultrasound-guided transvaginal needle to collect the eggs from each of your ovaries. You should not have any outward facing cuts or scars.
A lab scientist (i.e. embryologist) flash-freezes your eggs in liquid nitrogen into a glass-like state, to be stored in cryotanks until you decide to use them or no longer want to keep them frozen. You will be sleepy when you come around from the sedative and should not drive yourself home. You will probably feel like spending the rest of the day on the couch or in bed. Note that it is a regulation in some US states that a patient who undergoes anesthesia at a hospital or surgery center must be accompanied home by a responsible adult. Even if you live in a state or country where this isn’t mandatory, it’s still a very, very good idea to have a partner, family member or good friend primed to show up and take you home and ideally spend the day with you (the perfect time to binge watch that new series!). If that isn’t possible, hiring a freelance carer or nurse (a trusted professional) to see you back to your home and settle you in would be a good option.
STEP FIVE: Recovery (1-4 days of discomfort & 10-12 days til back to normal)
You should anticipate up to three days of recovery. Most women are back at work the day after the surgery, but others report feeling significant discomfort up to four days after the retrieval. Doctors don’t recommend any disruption or exposure to the vaginal area for 10-12 days after retrieval (that means no sex and no swimming). Nor do they recommend intense exercise that could potentially put your ovaries under strain. There should be no or only minimal bleeding - if you experience more than this, you should call your doctor immediately as something could be wrong. Your period should arrive after these 10-14 days and all should return back to normal.
STEP SIX: In the future
Usually, you will only use your frozen eggs if you try to conceive naturally without success. The advice is generally to talk to your gynecologist or a fertility specialist if you have frequent, unprotected sex but don't become pregnant after a year, if you're younger than 35 years old, or after six months if you're 35 or older. Then, after investigations and depending on the advice from your doctor, you might choose to use your frozen eggs in a process called in vitro fertilization (IVF). In this case, your eggs would be thawed and fertilized using either your partner’s sperm or a donor’s sperm (in a process called intracytoplasmic sperm injection, or ICSI.) Next, the fertilized egg (embryo) would be transferred into your womb. If it implants, then, bingo: you’re pregnant. The same risks of miscarriage apply as for any pregnancy.
For more information, get the book Everything Egg Freezing, the Essential Step-by-Step Guide to Doing it Right. Available on Amazon and other ebook platforms.
REFERENCES:
Can I Freeze My Eggs to Use Later If I'm Not Sick? American Society for Reproductive Medicine website https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/can-i-freeze-my-eggs-to-use-later-if-im-not-sick/?_ga=2.229575068.1026878436.1551424320-891697309.1551424320Accessed January 2019.
Paller AJ. A chilling experience: an analysis of the legal and ethical issues surrounding egg freezing; and a contractual solution. Minn Law Rev 2015;99: 1571–614.
Liu K, Case A. Advanced reproductive age and fertility. J Obstet Gynaecol Can 2011;33:1165–75.Mertes H. The portrayal of healthy women requesting oocyte cryopreservation. FVV Obstet Gynaecol. 2013;5:141–6.
Potdar N, Gelbaya TA, Nardo A. Oocyte vitrification in the 21st century and post-warming fertility outcomes: a systematic review and meta-analysis. Reprod BioMed Online. 2014;29:159–76.
Baldwin K, Culley L, Hudson N, Mitchell H. Reproductive technology and the life course: current debates and research in social egg freezing. Hum Fertil. 2014;17:170–9.
Stoop D, van der Veen F, Deneyer M, Nekkebroeck J, Tournaye H. Oocyte banking for anticipated gamete exhaustion (AGE) is a preventive intervention, neither social nor nonmedical. Reprod BioMed Online. 2014;28:548–51.
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