Cycle Tracking

So you’re freezing your eggs - congratulations! This is such an empowering step in your life, and we hope that you can experience the process with positivity and hope for the future. 

We know the process can also be confusing and overwhelming, especially when it comes to understanding what activities are safe and not safe during egg freezing. First and foremost, it's important to understand that egg freezing is a medical procedure and should be treated with the same level of care and attention as any other medical procedure. This means that you should always follow the instructions of your provider and avoid any activities that may put your health at risk.

In this article, we will explore some of the things you can and can't do during egg freezing. Let’s go!

Can I work out while freezing my eggs?

Exercise is generally considered safe during the egg freezing process, but it's important to note that you should avoid any intense or high-impact activities. Because your ovaries will be enlarged from being stimulated, exercise could increase the risk of a rare condition called ovarian torsion, when the ovary twists on the surrounding tissues.

Gentle exercise such as yoga or walking is recommended. If you are someone who has a serious workout regime, we recommend talking to your fertility doctor about what’s safe.

Can you go to work during egg freezing?

Working during the egg freezing process is generally considered safe, but it's important to be mindful of any physical demands or stressors that may be associated with your job. Your fertility doctor may recommend taking some time off work to rest and recover if you're experiencing any side effects from the medication used in the egg freezing process. And after the egg retrieval, it’s recommended you give yourself time to rest (although I know women who felt fine enough to go back to work!). Most people are able to return to work within a day or two of an egg retrieval.

Can you drink coffee during egg freezing?

Caffeine consumption is generally considered safe during the egg freezing process, but it's important to be mindful of your intake. Some experts recommend limiting your caffeine intake to less than 200 milligrams per day, which is roughly equivalent to one cup of coffee. While most of the research on the impact of caffeine is on pregnancy, we think it’s better to play it safe during egg freezing too. 

Can you drink alcohol during egg freezing?

Alcohol consumption is not recommended during the egg freezing process. Studies have shown that alcohol consumption can negatively impact fertility and may also increase the risk of certain complications associated with egg freezing. The good news is there are loads of EANABs (equally-appealing, non-alcoholic beverages) these days. Try a soda water with lime and no one will bother you!

What about smoking?

Smoking is not recommended during the egg freezing process (or ever!). Studies have shown that smoking can negatively impact fertility and may also increase the risk of certain complications associated with egg freezing. Smoking can decrease the number and quality of eggs retrieved, and increases the risk of ovarian hyperstimulation syndrome (OHSS), a potentially serious complication of the egg freezing process.

Can you have sex during the egg freezing process?

(Gentle) sexual activity is generally considered safe during the egg freezing process, but it's important to be mindful of any potential risks associated with the fertility medications. After all, your ovaries may be enlarged and sensitive. Some fertility doctors may recommend avoiding intercourse or using contraception during certain parts of the process, due to higher risk of pregnancy. This is one you should definitely ask your doctor about.

Note: If you’re participating in our Split program, where you freeze your eggs for free by donating half of the retrieved eggs to another family, you’ll need to avoid sex entirely, since becoming pregnant or contracting and STD would result in your cycle being canceled.

What can you eat during egg freezing?

Eating a healthy and balanced diet is an important part of overall health and wellness, and it's especially important during the egg freezing process. Eating a diet rich in fruits, vegetables, lean protein, and healthy fats can help support your overall health and may improve the success of the egg freezing process. Once the eggs are retrieved, you can indulge in dessert, a cocktail, and resume your normal diet!

What supplements can I take during egg freezing?

In addition to eating a healthy diet, taking supplements may also be beneficial during the egg freezing process. Folic acid, for example, has been shown to improve reproductive outcomes and is often recommended for women undergoing egg freezing. Other supplements such as CoQ10, DHEA, and omega-3 fatty acids may also be recommended by your fertility doctor. It's important to note that you should always talk to your fertility doctor about what you’re taking – and what you want to be taking – before you start egg freezing, as some may interact with fertility medications.

Can you use a hot tub or steam room during egg freezing?

There’s conflicting info here. Some doctors say hot tubs, steam rooms, and saunas should all be avoided during the egg freezing process, citing that they can cause a spike in body temperature, which can be harmful and may negatively impact the success of the egg freezing process. While others say it’s fine. Knowing that there’s always a small risk that public hot tubs are carrying bacteria or can cause allergic reactions, it’s safest to wait until after the egg retrieval. 

Can you take a hot bath during egg freezing?

This is another controversial one – some fertility clinics say hot baths are fine, while others say you should stick with showers. Some providers even recommend avoiding baths from the day of your retrieval and several days after, in order to allow your body to safely heal. Ask your doctor what they think, or just stick to showers to play it safe!

Summing it up

Egg freezing is such an intense (and often expensive) process. In order to get your best outcomes possible, it’s probably better to err on the conservative side. Always follow the instructions of your fertility doctor, and avoid any activities that may put your health at risk. We are wishing you the best!

‍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.

One of my biggest regrets in life is not freezing my eggs in my 20s – it’s what led me to help co-found Cofertility and make this process radically more accessible. 

Egg freezing, also known as oocyte cryopreservation, is a medical procedure that allows women to preserve their fertility for future use. Whether you're focused on your career, dealing with medical issues, or simply not ready to start a family yet, egg freezing can give you the peace of mind of knowing that you have options in the future. But if you're considering egg freezing, where do you start?

First things first: get educated

The first step towards freezing your eggs is knowing what you’re getting into. We have a wealth of knowledge here that you are free to access. I recommend starting with these articles:

• A Step-by-Step Guide to Freezing Your Eggs
• How Much It Costs to Freeze Your Eggs
• The Egg Freezing Process: a First-Timer’s Overview
• A Breakdown of Egg Freezing Success Rates by Age

You can also talk to friends who have gone through the process, or join a Facebook group to hear from others in your shoes. 

What are the chances it even works?

We measure the “success” of egg freezing in a couple of ways. Since we don’t know if the eggs will turn into a healthy baby many years from now, the goal is to have a large, but safe, number of healthy eggs retrieved in a single cycle. 

Retrieving 10-20 eggs is ideal. That’s because for a woman under 35, she will need nine eggs to achieve a 70% chance of having at least one live birth. If you’re trying to conceive in your mid to late 30s, you may need double as many eggs to achieve that same 70% success rate. That’s because egg quality (along with quantity) declines as we age. 

Read more in How Many Eggs Should I Aim to Freeze?

It's important to note that egg freezing is not a guarantee of future pregnancy, and success rates vary depending on various factors such as your age at the time of freezing and the quality of the eggs. 

Next steps: find the right clinic

Once you get a better idea of the process and decide if egg freezing is right for you, the next steps are to schedule a consultation with a fertility clinic. During this consultation, the doctor will evaluate your overall health, discuss your reasons for considering egg freezing, and review the risks and benefits of the procedure. They will also likely conduct some initial tests (like AMH) to assess the quality of your eggs and your ovarian reserve, which will give you a better idea of your chances of success with egg freezing.

If you work with Cofertility, we will help you schedule an appointment with one of our local partner clinics. If you participate in our Keep program, we can help you get the best prices on clinic fees, medication, and storage.  

Know your AMH

Research has found that AMH is a good predictor of the number of eggs retrieved during egg freezing, independent of age. Because of this, a fertility doctor will use your AMH levels (amongst other biomarkers) to determine the drugs and dosages during the procedure. 

In general, you can interpret AMH level this way:

• Above 1.0 ng/ml (nanograms per deciliter): Normal
• Below 1.0 ng/ml: Showing weakness in the ovarian reserve
• Below 0.5 ng/ml: Showing severe weakness in the ovarian reserve

But know that a very high level of AMH could be a sign of polycystic ovary syndrome (PCOS), which may require treatment and/or specific fertility medications or treatments. When AMH is over 5.0 nanograms per deciliter, for example, it’s worth addressing if there are other potential signs of PCOS. 

Figure out how you will pay for it

Egg freezing can be an expensive procedure, with costs typically ranging from $10,000 to $20,000 for one cycle plus the cost of storage. This varies widely based on the clinic and the medications your provider prescribes. But, there are ways to make egg freezing more affordable. Here are a few options to consider when paying for egg freezing:

• Insurance coverage: A minority of insurance plans may cover a portion of the cost of egg freezing and/or medications. It's always best to check with your insurance provider to see if they cover the procedure, and if so, what the specific coverage details are.
• Employer-provided benefits: Some employers offer coverage for egg freezing as a benefit to their employees. Check with your handbook or HR department to see if this is an option for you.
• Financing options: At Cofertility, we have financing partners which can make the procedure more affordable. 
• Donate half your eggs: Our Freeze by Co Split program allows you to freeze and store your eggs for free for 10 years, when you give half to a family who can't otherwise conceive.

To see if you're eligible for our Split program, take our quiz to tell us more about yourself.

Benefits of working 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:

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. 

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 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.

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

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

Your body produces a different number of eggs at different times

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

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

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

Producing fewer eggs may increase costs

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

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

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

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

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

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

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

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

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

Freezing your eggs should be a positive experience

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

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

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

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

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

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

You could get a heads up about certain reproductive concerns

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

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

You’ll get a better picture of your reproductive schedule

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

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

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

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

Your doctor will find out how many follicles you have

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

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

There will be additional health screenings 

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

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

Getting proactive can save you money

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

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

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

You probably never saw yourself using the words cervical mucus, much less pulling down your pants and checking to see if you’ve got any. But here you are. You’re trying to conceive, and your best friend told you that you’ve absolutely got to start checking it out if you want to figure out the best time for baby-making sex.

It might sound like an old wives tale that refuses to die, but it turns out tracking cervical mucus really can help some women get a better handle on their cycle. Here’s why you might want to start paying attention.

What's cervical mucus, anyway?

If it sounds like the stuff that comes out of your nose when you’ve got a bad cold, you’re halfway right…only this isn’t snot, and needless to say it’s not coming out of your nose.

Your cervix is located at the lower part of your uterus, says David Diaz, MD, reproductive endocrinologist and fertility expert at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif.

Dr. Diaz describes the cervix as a sort of bridge between the vagina and the uterus, and as an entry portal for sperm when a heterosexual couple has sex during the female partner’s most fertile time of the month—when she’s ovulating.  

Now comes the mucus part.

The cervical canal, which Dr. Diaz describes as, “a tunnel passing through the cervix,” is lined with glands that excrete a clear, slippery mucus during ovulation. The mucus actually helps sperm make its journey toward the egg for fertilization. Aren’t our bodies amazing?

Because the mucus is only set up for aiding sperm during ovulation, its consistency changes throughout your cycle. So just like the arrival (and blessed departure) of your period can tell you that you’re absolutely not ovulating, the arrival of the right kind of mucus can tell you when you are. Which leads us to…

Checking your mucus

Some folks ovulate like clockwork, and they don’t need no stinking mucus to tell them they’re fertile. But if you’re not one of those lucky ladies, you may not need to run to the doctor to find out if you’re ovulating. You can try to do a check on your own to see if your glands are pumping out that slippery liquid.

Dr. Diaz suggests inserting two fingers into the vagina and feeling for something wet and slippery. Pull them out, and take a look at your fingertips:

• Totally dry to just slightly damp: This is typical of the days right after your period ends, when fertility is at its lowest for most women.

• Mucus that’s slightly thick and sticky and either yellowish or whitish: Although you’re still not ovulating, this indicates your body is either preparing for ovulation or has just finished.

• Mucus that’s almost totally clear and stretchy: If the mucus has the consistency of egg whites and can stretch a few inches between your fingers, your ovulation window has arrived! It’s time for frequent sex, Dr. Diaz says.

Do you really have to?

So all this is well and good, but do you really need to stick your fingers into your vagina and feel around for mucus to help you get pregnant?

Well, that’s up to you, but consider this: When scientists at the University of North Carolina, Chapel Hill and the University of Utah in Salt Lake City monitored more than 300 women on their fertility journey for a 2014 study, the women who opted to check their cervical mucus regularly were found to have a statistically significant increased chance of conceiving over women who didn’t bother to check. And theirs was far from the first study to find a solid link between tracking cervical mucus and conception! The science on cervical mucus is pretty well-regarded by the experts.

So, if you’re having trouble nailing that ovulation window but don’t yet want to take the plunge into ovulation test kits, this could be just the thing you need.

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

What is endometriosis?

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

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

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

Signs of endometriosis

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

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

How endometriosis can affect fertility

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

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

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

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

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

What your doctor might recommend

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

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

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

Bottom line

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

You might not be looking to get pregnant right now, but if you’re curious how that actually happens when the time comes, you’re in the right place. It’s incredibly important to understand the actual process of how pregnancy occurs because after all, knowledge is power, right?  

But before we jump right into how an egg becomes fertilized, let’s go over the process that happens before fertilization.

The process of fertilization

It all starts with an egg

Females are born with two ovaries that hold millions of immature eggs which all have hopes of one day becoming an embryo, also known as a zygote. Every cycle, a subset of these eggs are ‘recruited’ to the surface of the ovaries and a single egg is selected to grow and ovulate. 

At the time of ovulation during the menstrual cycle, a mature egg leaves the ovary and travels through the fallopian tube where it crosses its fingers (metaphorically) that it will meet its potential match. That match being sperm, of course.

Don’t forget the sperm

Unfortunately, it’s not such an easy task for the sperm to get to the egg. This is a part of natural selection, so only the very best will survive. After ejaculation occurs, the sperm begins to travel along the female genital tract with the end goal being to meet the egg.

As we said, this trip isn’t a simple one. As the various sperm make their way to the egg, they’ll be pushed forward with the help of cervical mucus, but the acidic genital environment and immune cells of the woman can cause some sperm to die. It is up to the strongest spermatozoa to make it to the crown and lining of the egg.

When the sperm meets the egg in the fallopian tubes

This is where the real magic happens. Most sperm try to penetrate the egg, but not all make it through. The strongest sperm will make their way through the ovum, but only the fastest will penetrate the egg and actually fertilize.

When the strongest sperm meets the ovum an acrosomal reaction begins which will release enzymes that will eventually dissolve the outer layer of the egg.

They form an embryo

Now that the egg has found a match, within the next few hours, genetic material from the sperm and egg begin to integrate to create a zygote. This zygote holds a double set of chromosomes which is considered a single-cell embryo.

The embryo travels to the uterus

Now that the zygote has formed, it will then begin to make its way through the fallopian tube and into the uterus. Luckily, the lining of the fallopian tube is  covered in cilia which helps direct the embryo to the uterine cavity. 

Embryo division

Not only does the zygote have an important job of traveling to the uterus but it also begins to divide numerous times in order to become a multicellular embryo which is also known as a blastocyst. The division period starts immediately upon fertilization and can last for up to 3 days. Beyond day 3, the embryo begins to differentiate into two cell types: cells that will one day become the baby, and those that will turn into placenta. This is called a blastocyst stage embryo (from day 5 to 7 post-fertilization).

Implantation in the uterus

When the blastocyst has been established, the embryo must attach to the uterine wall which typically occurs about 6 days after fertilization and is completed around day 9 or 10. Pregnancy is truly achieved once this attachment occurs. 

The adherence to the wall is a crucial step as this is where the embryo will receive its nourishment and oxygen from the mother throughout the development of the pregnancy.

How is the sex of the baby determined?

While you may not find out for a few weeks what the sex of your baby is, you may be surprised to know that this is one of the first defining factors of the embryo during natural fertilization. This is thanks to that one sperm that won the race. 

A zygote contains 46 chromosomes, half of which come from the mother and the other half from the father. The zygote receives the 46 chromosomes due to the fact that each sperm cell holds 23 chromosomes, as well as the egg nucleus.

However, the egg and sperm carry different types of chromosomes. While an egg cell contains only X chromosomes, a sperm cell contains either an X or Y chromosome. When both cells split off to create their own zygote, you may end up with a girl by obtaining an X from the egg and an X from the sperm (X+X), OR on the contrary, a Y carrying sperm may merge with the egg creating a boy (X+Y).

Where does fertilization occur during IVF, IUI, ICSI, and PICSI?

If you’re having trouble getting pregnant naturally, your doctor may suggest looking into In Vitro Fertilization (IVF), Intrauterine Insemination (IUI), or Intracytoplasmic Sperm Injection (ICSI) as other methods of conception. However, instead of an egg becoming fertilized within a woman’s body, it occurs in a lab setting. 

With the use of healthy mature eggs and sperm to fertilize them, fertilization can occur inside a culture dish. Mind blowing, right? For those that struggle with natural fertilization, IVF, IUI, and ICSI are possible routes to explore. 

Throughout the years, these processes have become significantly more advanced and can be a successful way for one to become pregnant. Each process is a little bit different, so it’s important to understand the difference between IUI vs. IVF vs. ICSI.

Learn more about more accessible — even free — egg freezing

Cofertility is a fertility ecosystem that enables women to freeze their eggs for free when they donate half of the eggs to a family that otherwise can’t conceive, providing support and education for everyone involved along the way. Learn more about Freeze by Co!

Maybe you’re ready to start trying to conceive, or perhaps you’re just done with taking hormonal birth control. Regardless of the reason, this can be a super big change leaving you wondering what the heck happens next, especially if you've been on it for a while. Will your skin break out like crazy? Will your cycle get wonky? Rest assured, we're here to answer all your questions about going off birth control.

How birth control works

The type of birth control you're quitting will dictate the type of things to expect when going off it. To understand the potential effects, it helps to understand exactly how the different methods work.

A hormonal method, like the pill, Depo shot, hormone patch, uses hormones to trick the body into not ovulating.

A copper or hormonal IUD makes changes to the cervical mucus and the uterine lining that prevent pregnancy.

A barrier method—think condom or diaphragm—blocks the sperm from meeting the egg and really doesn't affect the human body before or after its use.

Why someone might go off of birth control

There are a few different reasons you may go off birth control:

• Ready for pregnancy. If you're ready to start trying to have a baby, you obviously have no need for that IUD or NuvaRing any more.
• Health risks. We are all for birth control when it’s needed. It’s a beautiful thing! But people taking hormonal birth control are at a slightly higher risk for blood clots, migraine, high blood pressure, and cardiovascular disease. It’s important to keep in mind that in the absence of underlying risk factors (ie. older age, high BMI), most of these complications are exceedingly rare. For example, the risk of having a blood clot on birth control for a healthy, young, non-smoker is significantly lower than the risk of a blood clot during pregnancy. 
• Abstinence. Hey, if you're not having sex, then you really don't need birth control. You probably want to have a plan in case you start back up though.

Whatever the reason, talk it over with your doctor if you're taking prescription birth control. You could get pregnant as soon as you go off it, says Lilli Dash Zimmerman, MD, Fertility Specialist at Columbia University Fertility Center. So you should truly be prepared for that possibility. Some patients go off hormonal methods a few months before they want to try, and that's fine, but you'll want to use a barrier method, like a condom, until it's go time, she says.

Birth control side effects, nasties and other things to expect

It's common for people to experience acne, heavier periods, or irregular periods when they stop hormonal birth control, but those aren't exactly side effects from ditching the pill or patch. Rather, they're much more likely to be things that you experienced before you started birth control, that the medication was actually suppressing, says Zimmerman.

Remember: If you're on a hormonal birth control method, you're not actually getting a period, since you're not ovulating. Instead, any bleeding you get every month is not a true period—it's a withdrawal bleed that happens when you take a week of placebo pills.

"I see a lot of patients that say, 'Oh, well, I've been regular for the past 20 years on birth control pills. Then I came off and only for the past year, I've been having irregular periods,'" says Zimmerman. "Well, their birth control may have been hiding issues with anovulation or irregular cycles because they've been on birth control pills for so long."

Do I have to get off hormonal birth control for egg freezing?

Yes, you will need to stop taking the pill or remove the patch before freezing your eggs. That’s because hormonal birth control is intended to prevent ovulation, but during freezing you want to do exactly the opposite. If you’re on the pill or use the patch, some doctors will have you stop during your egg freezing cycle, and some may have you stop for the month leading up to the retrieval. 

If you have an IUD, you can keep it in. Although if you’ve been meaning to take it out, ask the doctor if they can do it during your procedure. 

Do I have to get off hormonal birth control to become an egg donor?

At Cofertility, our donors freeze their eggs for free when they give half to a family who can't otherwise conceive. This means the egg donation procedure is the same as the egg freezing procedure. As stated above, you will need to get off the pill but an IUD is fine.

Trying to conceive after going off birth control 

Now, we bet you're wondering just how quickly you can become pregnant after going off birth control and the answer is it depends on the type of birth control you've been using.

If it was a barrier method, you can start baby making right away, since the only thing preventing sperm from meeting egg was that physical barrier you've removed.

With a hormonal method, it depends—and it can be tough to predict. Some people's bodies need time to adjust to life without the birth control hormones and so they don't ovulate for about the first one to three months. When it comes to the Depo-provera injection, it is given once every three months, so the hormones stay in the body for about three months. Therefore, it is very unlikely to become pregnant until at least three months after your last injection.

As for the progesterone containing and non-hormonal copper IUD, these methods are immediately reversible. 

The best thing you can do, once you're off birth control, is to track your period to ensure you are ovulating regularly. There are several different apps that allow you to log Aunt Flo's visits. You'll probably want to invest in an ovulation predictor kit, too. This is a pee-on-a-stick test that helps you pinpoint when you're ovulating, which is the time each month you can get pregnant.

Be prepared

For some people, the conception process happens fast. "We see a lot of pregnancies within that first month of coming off birth control," Zimmerman says.

But we know first-hand that others may be in it for the long haul. If your periods are irregular, you don't get them, or you just...have a bad feeling, go with your gut and chat with an OB/GYN or a reproductive endocrinologist. We're rooting for you!

Polycystic ovarian syndrome isn’t just a single issue, but a constellation of symptoms that many women have. And if you have a messed-up menstrual cycle, significant weight gain, or infertility, there’s a chance you may have it. You can thank an imbalance in your male and female hormones (androgen and progesterone) for getting you on this crazy train.

Even if you don’t have PCOS, it’s likely you know plenty of people who do—one in 10 women of childbearing age have the syndrome. And while any woman can develop PCOS, you’re more likely to have it if your mother or sisters had it, or if you’re overweight or obese. For some women, the symptoms start as soon as they get their first period, while others develop the syndrome later on—after significant weight gain, for instance.

Your body on PCOS

PCOS is one of those issues that may require some detective work (and some testing) before you get a diagnosis. Some of the most common PCOS symptoms include:

• Irregular periods: Your period may not follow a set schedule, may not occur often, or it may extend long beyond the typical five to seven days (lucky you). Women may also experience painful periods or pain during ovulation, says Dr. Janelle Luk, medical director and founder of Generation Next Fertility in New York City. 
• Hormonal imbalances: The increased levels of androgen can cause male-like hair patterns—including male pattern baldness, facial hair, and excess body hair—along with severe acne. You may also have a lower than normal level of progesterone, a key female hormone associated with fertility.
• Blood sugar fluctuations: We all get hangry from time to time, but if you have PCOS, this goes one step further. “Sometimes, women may also experience sugar cravings and blood sugar fluctuations that physically manifest themselves in a lack of energy or feeling light-headed,” Dr. Luk says. These blood sugar issues can sometimes lead to weight gain that’s hard to lose. PCOS can also boost your chances of developing prediabetes or type 2 diabetes. 
• Polycystic ovaries: Normally, ovary follicles release eggs during ovulation. But if you have PCOS, the excessive androgen could be working against ovulation. Your ovaries may appear swollen, and may contain several follicles that are holding on to eggs and not releasing them. That said, this isn’t a dead giveaway that you have PCOS. Having cysts alone isn’t enough for a PCOS diagnosis, and your doctor should assess your menstrual cycle (or lack thereof), hormone levels, and weight fluctuation. 

And just because you don’t check the box for every symptom, doesn’t mean you don’t have PCOS or PCOS infertility. You don’t have to have all the symptoms to be diagnosed with PCOS, and sometimes PCOS actually flies a bit under the radar. Your best bet is to head to a doctor who can specifically check for PCOS. 

How PCOS could impact your fertility

If the PCOS symptoms—like that insane menstrual cycle—don’t suck enough, they can also do a number on your ability to become pregnant. According to Dr. Luk, PCOS often creates infertility issues due to its impact on periods and ovulation; if you aren’t ovulating, you aren’t releasing an egg.

PCOS can make getting pregnant challenging, but it’s hardly impossible. While it’s super common, it’s actually one of the most treatable causes of infertility in women. If you know you have PCOS, Dr. Douglas suggests talking to your doctor about proactive steps you can take to balance your hormones and create a plan if and when you decide to try to get pregnant. 

So can I freeze my eggs if I have PCOS?

Absolutely. Like others, women with PCOS may want to freeze their eggs to proactively increase their chances of having children down the road. It’s best to freeze when you are younger, in order to get the most high quality eggs possible. 

You’ll want to make sure you work with the best doctors, because women with PCOS are more susceptible to developing ovarian hyperstimulation syndrome (OHSS) during egg freezing. This is because they are likely to have more follicles, and the more follicles an ovary has the more likely it is to be overstimulated by HCG, one of the drugs used during egg freezing. One study of 2,699 women with PCOS undergoing IVF found that 75.2% had a normal response to controlled ovarian hyperstimulation (COH), while 24.8% developed OHSS.

Interested in freezing your eggs? We can help! Freeze by Co is a better approach to egg freezing, where you can freeze for free when you give half to a family who can't otherwise conceive.

What your doctor might recommend for managing PCOS

Medication is generally the first step to try to get everything moving. If you’re trying to conceive soon, progestin therapy might be used to level out your hormones. Metformin, a medication that is used to treat type 2 diabetes, can also help treat PCOS. Although metformin isn’t FDA approved for the treatment of PCOS, decreasing insulin resistance in women with PCOS has been shown to give spontaneous ovulation rates a boost, says Dr. Marra Francis, MD, FACOG, an OB/GYN in The Woodlands, Texas. 

Some women may need to move on to ovulation-inducing medications, like Clomid, but women with PCOS need to be carefully monitored if they do. If you have PCOS and take Clomid, you may be at increased risk of releasing more eggs than the one or two typically released with each Clomid cycle, which could result in twins. 

If these treatments still can’t help you conceive, your doctor may move onto other protocols. Get ready—here come the injections, like Follitism or Menopur. If the injections alone still don’t get you pregnant, IVF may be your best bet, according to Daniel Kort, associate medical director and practice director at Neway Fertility in New York City.

Summing it up

PCOS can lead to some really crappy symptoms. But fortunately, there are plenty of tools and treatments you can use to combat your PCOS and boost your chances of getting pregnant.

There's something about trying to get pregnant that seems to bring out the worst advice from your friends and family. Sure, they mean well, but when your cousins are swearing up and down that they know absolutely the only thing that will help you conceive, it can be hard to tell truth from fact.  

Take the myth that checking your cervical position will help you pinpoint just when you're ovulating so you can rush to the bedroom for some good old-fashioned babymaking sex. Yes, we said it's a myth.  

Although it's widely touted by some women as "the thing" that helped them tell just when they're ovulating, the fact is the only time the cervix goes through major changes is when a woman's giving birth, says Alyssa Dweck, M.D., an OB/GYN and author of The A to Z for Your Vag. Not to mention, "most women can't even feel their cervix" to determine its position, she says, so if it were to change, it would hardly help folks determine where they are in their menstrual cycle.  

If tracking my cervix won't help, how can I tell when I'm ovulating?

Forget what your cousins, best friends, and that overbearing lady at the supermarket swear will help you tell when it's time to have sex. Here are some bona fide ways actual doctors say you can tell if you're ovulating:

• Cervical mucus changes: Although the cervix doesn't move, it does produce a discharge during ovulation that can be a clear sign that you're at your most fertile, says David Diaz, MD, a reproductive endocrinologist at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif. If you insert a few fingers in your vagina, and they come out with a clear, slippery, stretchy mucus on the tips, it's a good indication you're ovulating.  
• PMS-like symptoms: It doesn't sound quite fair, does it? Double the PMS? For some women, symptoms such as breast tenderness or bloating that many associate with the days before their period arrives may actually show up even earlier…when they're ovulating. The good side of this? If this is you, it may help you get a handle on your cycle.
• Cycle-tracking apps: Technology has come a long, long way in recent years, and many of the cycle-tracking apps on the market may help a woman pinpoint her most fertile period, Dweck says. Not all apps are created equal, so it's best to talk to your provider about your cycle and needs (or check out our guide here) to find out if there is an app they recommend you use.  
• Follicle ultrasounds: Cycles vary. Your best friend might have a 28-day-cycle, while yours might be more like 34 days…or maybe 21. If you haven't been able to nail that ovulation window at home, a reproductive endocrinologist may be able to help using ultrasound technology.    

The net-net

You can skip the cervix checks (and you might want to stop taking medical advice from your cousin). But there are plenty of other methods that may help you figure out the perfect time to schedule some baby-making sex sessions. Good luck!

The AMH (anti-mullerian hormone) test is just one of many tests you may get when seeking answers about your fertility. But we know you’re not about to head to the doctor’s office for a blood draw without understanding what you’re getting yourself into. So here’s the full scoop on what to expect.

The lowdown on the AMH test

Think of the AMH blood test as a peek into a woman’s ovarian reserve. Here’s how it works: The AMH hormone is secreted by follicles in the ovaries. As you may know, follicles are the beginnings of human eggs, and a woman only has a finite number of eggs—the number of eggs decreases with age. This test measures the level of AMH in your blood.

“A higher level of AMH correlates to a higher ovarian reserve, or as we say, ‘the more gas left in the tank,’ says Dr. Joshua Hurwitz, MD, senior physician and partner at Reproductive Medicine Associates of Connecticut (RMACT).

About those eggs...

Unfortunately, women with a lower ovarian reserve may retrieve fewer eggs during egg freezing, so understanding your ovarian reserves is an important step in informing yourself and your doctors about what’s going on in your body. That way, you can make the right plans for you, depending on your goals.

Probably the most common reason to have an AMH blood test is as part of a fertility evaluation for any female patient interested in egg freezing or IVF, says Dr. Hurwitz. Any woman who’s trying to understand her future fertility potential could decide to have her AMH levels tested as well. In other words, you also might want to get the AMH blood test if you fall into any of these categories:

• You’re considering becoming an egg donor
• You might be freezing your eggs
• You’re thinking about getting pregnant and want to know if there’s a reason to act quickly

This isn’t like looking into a crystal ball. While having a normal ovarian reserve gives you a snapshot of what your fertility looks like now, it’s not a guarantee for what will happen in the future. Still, the results could help a woman more confidently decide to wait to try to become pregnant, or to freeze her eggs for potential use in the future, says Dr. Hurwitz.

What AMH do I need to freeze my eggs?

Research has found that AMH is a good predictor of the number of eggs retrieved during egg freezing, independent of age. Because of this, a fertility doctor will use your AMH levels (amongst other biomarkers) to determine the drugs and dosages during the procedure. 

In general, says Hurtwitz, patients can interpret their AMH level this way:

• Above 1.0 ng/ml (nanograms per deciliter): Normal
• Below 1.0 ng/ml: Showing weakness in the ovarian reserve
• Below 0.5 ng/ml: Showing severe weakness in the ovarian reserve

But know that a very high level of AMH could be a sign of polycystic ovary syndrome (PCOS), which may require specific fertility treatment and/or medications. When AMH is over 5.0 nanograms per deciliter, for example, Dr. Hurwitz says it’s worth addressing if there are other potential signs of PCOS. Also, FYI: younger women tend to have higher AMH levels, and older women tend to have lower AMH levels.

What AMH do I need to donate my eggs?

If you are looking to donate your eggs, 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.

AMH as part of a full work-up

It’s important to know that the AMH really isn’t a one-and-done test. It’s often done as part a full fertility evaluation, which may also include:

• Hysterogram (a.k.a. Sonohystogram or SHG), an ultrasound in which saline is added to the uterus (sort of a weird sensation but not so bad), so doctors can see inside and identify any problems with the uterus or fallopian tubes.
• Semen analysis, a test of a male partner’s sperm that gauges sperm count, as well as motility (the way they move) and morphology (size, shape and structure). Guys are so lucky this is their only major test.
• Hysterosalpingogram (HSG), an X-ray of the uterus and fallopian tubes (with a liquid dye in your bod!), which also can help identify or rule out certain problems.

In fact, the AMH probably isn’t the only ovarian reserve test you’ll get. It’s often done alongside:

• FSH blood test, another blood test. This is used to measure a different hormone called the Follicle Stimulating Hormone. FSH is released at the beginning of the menstrual cycle, so you’ve got to have your blood drawn at day 2, 3, or 4 of your period. A high level of FSH is associated with low ovarian reserve, and a low level of FSH is associated with a normal ovarian reserve.
• Basal Antral Follicle Count, an ultrasound in which the doctors will count the number of follicles they can see. The more follicles, the greater the ovarian reserve.

A woman’s age is also a huge factor in ovarian reserve and is really the most accurate way of gauging the quality of the remaining eggs, says Dr. Hurwitz.

It’s painless (mostly)

Since this is just a low-key blood test, there’s really not much to worry about. It can be done at any time during your menstrual cycle, and you don’t need to prep for it by fasting or in any other way. Think of it like getting a blood draw at your annual physical. You’ll have blood taken as usual through a needle into a syringe, and a Band-Aid will be placed on the site. Then, you’ll be able to go about your day as normal.

Dr. Hurwitz says his patients usually receive their AMH test results within a few days up to about a week, and they’re given over the phone by a nurse who can answer any questions they may have about their AMH levels. Then, after all their initial testing is done, the doctor sits down with his patients and discusses the results of all their tests to give a 360-degree picture of their fertility status. 

Plotting your next steps

AMH level alone won’t tell you what your next steps will be. If you’ve had all the ovarian reserve testing done, there isn’t anything further that needs to be measured in that regard.

Remember, AMH level should never be the sole measure of a woman’s fertility. In fact, one recent Journal of the American Medical Association study found that AMH levels didn’t predict which women would get pregnant over the course of a year. This is a reassuring sign for women who have low AMH levels, but Dr. Hurwitz notes that it doesn’t mean that the AMH test results aren’t important. They can help your doctor understand what’s going on in your body.

Taking your AMH results into consideration with all your other test results and health history,  you and your doctor will come up with a course of action. There’s no one answer for what this will be based on AMH level, but a low ovarian reserve might prompt a woman to begin egg freezing sooner. 

Interested in freezing your eggs? We can help! Our Freeze by Co is a better approach to egg freezing, and free when you give half to a family who can't otherwise conceive

The number of people choosing to freeze their eggs has been rising steadily for the past several years. At the same time, antidepressant use in the US has also been on the rise, especially during and after the peak of the COVID-19 pandemic. It goes without saying that given both these trends, many of the people who are freezing their eggs are also people who struggle with mental health conditions. If you’re on any medications for your mental health and you’re considering freezing or donating your eggs, you may be wondering if you’ll need to stop your antidepressant during the process. This is a common question and we’ll be answering it in today’s article so read on to find out. 

What is egg freezing?

Before we dive into the world of antidepressants, let’s briefly talk about what egg freezing even is. In a nutshell, egg freezing (aka oocyte cryopreservation) is a way to collect some of your eggs and preserve them for future use. The process takes about 10-14 days and involves taking hormone medication to stimulate your ovaries to grow mature eggs. The eggs are collected during a 30-minute outpatient procedure called an egg retrieval and then frozen until you’re ready to use them. 

Given how expensive egg freezing can get, you might be wondering why so many people are choosing to do it. There are many reasons but most of them go back to the same core issue: egg freezing is a way to keep your reproductive options open for later by preserving younger, healthier eggs for future use. 

Research has shown that many people are delaying starting their families for reasons that can be personal, professional, financial, psychological, or all of the above. In our own survey of Cofertility users, we asked over 28,000 gen Z and millennial women about their family planning and goals. The majority of responders (73%) said that building their career or going back to school is the most important thing to them right now. This was followed by traveling (53%), finding a life partner (43%) and cultivating new hobbies (32.1%). Additionally, egg freezing has received more and more media attention over the last several years which has certainly helped to increase public awareness of this intervention as a way to keep future fertility options as open as possible.

The low-down on antidepressants

Antidepressants are a group of drugs used to treat depression. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are the 2 classes (or types) of antidepressants that are most often prescribed but atypical antidepressants are another, newer class that are also used in certain cases. Each class of antidepressant has a different mechanism for how it changes neurochemical levels in the brain to improve the symptoms of depression and other mood disorders. When used correctly, they can improve mood, increase energy levels, and enhance overall functioning. Antidepressants as well as other drugs like benzodiazepines have also been found to be effective as anti-anxiety medications, though only two SSRIs are specifically FDA-approved for anxiety disorders.

Use of both antidepressants and anti-anxiety medications has been rising for over a decade in the US. According to the Centers for Disease Control and Prevention (CDC), 13.2% of adults aged 18 and over use antidepressant medications. Women, older adults, and non-Hispanic whites are the highest users.

Overall, during the decade between 2009 and 2018, antidepressant use increased to 14% from 11% and in all age groups, it was higher among women than it was in men. 

Based on these stats, it’s fair to ask why women are more depressed than men. The answer is complicated but women aren’t necessarily more depressed than men. While there is some evidence that fluctuating hormones and more sensitivity to internalized triggers (like relationship drama) may contribute to higher rates of depression in women, there’s also the simple fact that women are more likely to actually go see a doctor to take care of their symptoms. As a result, they are more likely to report depressive symptoms, be diagnosed, and be prescribed appropriate medication. 

Do antidepressants affect cycle outcomes?

Alright, let’s get into the reason you’re here: do antidepressants affect egg freezing or in vitro fertilization (IVF) cycle outcomes? The most commonly used antidepressant (SSRIs) and anti-anxiety medications (benzodiazepines) don’t have any clear, long-term impacts on egg quantity or quality, ovulation, or chances of conception (though SSRIs do have short-term effects on sperm). 

Studies of people using IVF to conceive suggest no effect of SSRI use on hormone levels, number of eggs retrieved, number of eggs that develop into blastocysts, number of embryos rated as “high quality,” or number of embryos transferred. So overall, antidepressants do not appear to affect cycle outcomes.

Let’s dive deeper into this. Since we know SSRIs and other antidepressants often work by changing levels of neurochemicals in the brain like serotonin, there is also the question of whether or not these medications influence reproductive hormones. Unfortunately, there are fewer studies to look at when assessing this (because most studies are done on men in order to avoid the hormonal fluctuations seen in women–lame, we know) but one study did look at almost 1,000 people with ovaries. The study found no differences in menstrual cycle characteristics as a function of SSRI use and no significant differences in pregnancy rates. Other larger studies have had similar findings and showed no differences in chances of conception between people using or not using SSRIs or benzodiazepines.

One thing to note though: there is some evidence that SSRIs increase prolactin levels and very high prolactin levels can mess with your period and prevent you from ovulating. That being said, there are other studies that have not shown this link between SSRI use and prolactin levels and even the studies that do, haven’t shown that prolactin levels are elevated to a high enough level to affect ovulation.

In the context of natural fertility, there is one sneaky, easy-to-miss way that these meds could impact chances of conception — by lowering your sex drive. Having sex less often during your fertile window could definitely lower chances of conception (the general rec is to have sex every 1-2 days in that window). However, how much an antidepressant affects sexual function will be different from person to person and will depend on the specific medication being used.

The CDC and the American Society for Reproductive Medicine (ASRM) consider antidepressant use to be safe during fertility treatments. Other organizations like the American Psychological Association (APA) and the American College of Obstetricians & Gynecologists (ACOG) also  recommend that people do not change their SSRI or benzodiazepine use once they’re pregnant unless instructed to by their provider.

Can you donate eggs if you’re on an SSRI?

This is a pretty common question for people considering donating their eggs. Current use of SSRIs or other antidepressants is considered a “relative exclusion criteria” by the ASRM. This means that it does not automatically disqualify someone from being an egg donor, however, it will be reviewed on a case by case basis by the fertility provider or clinic. Current use of antidepressants may be totally fine with one clinic, but not with another. Many providers feel that common antidepressants are overprescribed in the face of more situational challenges, like the pandemic or other big life changes. Some antidepressant use may also point to another medical condition that would disqualify someone.

Here’s a list of rejection criteria from the ASRM that would automatically make someone ineligible to donate:

• Having been institutionalized for a mental health disorder
• A positive family history of psychiatric disorders
• Two or more first-degree relatives with substance use disorders
• A history of emotional, sexual, or physical abuse without professional treatment
• Excessive stress
• Relationship instability 

If you’re interested in what the psych screening for an egg donor entails, you can find more information about it here.

We’re here to help

There’s a lot to consider when it comes to egg donation–and the psychological aspect of the screening is only one part of a larger process to ensure we’re doing right by you and by the receiving parents. The Cofertility team is here to guide you through every single step. By donating your eggs, you’re doing something remarkable for a family in need. We know that everyone’s situation is different, so our job is to make the process feel equally remarkable for you. Whether you continue or discontinue antidepressants during your own process is going to be a decision you make after weighing the risks and benefits and talking to your fertility provider. Whatever you end up choosing for yourself, our team is here to support you through it.

Can you test your fertility from the comfort of your own home? The answer is a bit complicated. Isn’t it always when it comes to fertility? Yes, there are some tests that both men and women can take at home to get a better idea about some aspects of their fertility. But are they an acceptable substitute for an individualized appointment with a fertility specialist? 

Unfortunately, no—while these tests are often fairly accurate, that’s not really the issue here, says Dr. Jaime Knopman, a board-certified reproductive endocrinologist. It’s all the medical expertise you’re missing out on when you test your fertility at home. 

“The tests we run in our clinic are much more accurate because our job can’t be done completely by machine,” she explains. “It’s not just the tests, it’s the person interpreting them.”

But you still might not live close to a fertility clinic, have insurance that covers fertility appointments or testing, or even feel like you’re really at the point yet in your fertility journey where you need a formal eval from a specialist. We get that.

So whatever your reason for wanting to take an at-home fertility test, here’s what you need to know about what your options are, how they work, and what you can expect to learn.

How can I test my fertility at home: for women

When it comes to the ladies, there are two main varieties of tests you can do at home: you can check your ovarian reserve and you can do a broad panel screening for several different hormones that play a part in fertility health. Here’s the scoop.

Ovarian reserve tests measure the amount of follicle-stimulating hormone (FSH) in your blood with a pinprick. Typically, you collect a sample yourself and mail it back to the company so they can read and deliver your results. Very high levels of FSH can be a sign that you don’t have a lot of eggs, that they’re poor quality, or both, because your body is working overtime to produce enough FSH to release a healthy egg.

• Taking this test feels like a typical finger prick. It hurts for a sec and then you’re over it. You will have to squeeze out some blood into designated spots on a testing card, though, so if you’re blood-averse be prepared.
• The tests themselves can accurately check your FSH level, but there’s more than one way to figure out what your ovarian reserve looks like. Only measuring FSH will give you a piece of the puzzle...but could also cause you to unnecessarily panic about your fertility. Try not to do that! Remember, these tests are useful, but not foolproof.
• FSH levels alone may not be a great way to assess your fertility in the first place. A 2017 JAMA study found that biomarkers like FSH aren’t the best predictors of future fertility in women with reduced versus normal ovarian reserves.

Fertility health screenings capture your FSH level but also a bunch of other hormones that impact your fertility in one way or another. The exact hormones measured in an OTC fertility test differ between companies, but you can usually find out your FSH level and any or all of the following:

• thyroid-stimulating hormone, or TSH a marker of thyroid health)
• estradiol (helps with ovulation)
• anti-mullerian hormone, or AMH (an indicator of egg reserve)
• prolactin (makes breast milk after birth)
• luteinizing hormone, or LH (regulates your cycle, especially ovulation)
• testosterone (helps make follicles, but too much may mess up your fertility)

These tests all work like the ovarian reserve test: you prick your finger, collect some blood samples, send the samples back to the company, and then wait for your results to come in. Usually, you’ll get factual data (like, “your TSH is off”) but also an explanation of what that might mean for your fertility. 

Most companies allow you to see your results online and consult with an on-staff medical professional if you have questions or don’t understand your results. They’re pretty easy to order online, but many aren’t cheap—they’re usually about $150—and you’ll have to pay out of pocket.

How can I test my fertility: for men

The only kind of male fertility test that can be done at home is a sperm analysis. About half of all couples’ infertility problems can be caused by male infertility, so knowing if your swimmers are strong or not is a good place to start if you’ve been trying to conceive for a while. 

There are actually several different kinds of sperm analysis kits; sometimes you collect a sample and send it through the mail for testing, sometimes you put some sperm on a slide and insert it into a testing device, and sometimes you can even use your smartphone (yes, for real!). 

• Testing at home is private and confidential. You don’t have to worry about being unable to provide a sample at an unfamiliar clinic or doctor’s office. 
• The kits you send off to labs via mail can be more accurate, but at the same time, there’s a lot that can go wrong here—like failure to keep the sperm stored at just the right temp, which can cause damage to the sample. At-home tests, while giving quicker results with no middle-man, have a lot of potential for both user and technology errors.
• Male fertility is about more than just the amount of sperm: there’s motility, shape, concentration...the list goes on. If your at-home kit is only looking at the number of sperm, your results may not be that helpful. Try to choose a test that looks at more than one type of factor—this will give you the most bang for your buck. 

Don’t forget about ovulation!

While ovulation predictor kits only tell you if and when you’re ovulating, this can be very helpful if you’re actively TTC. 

These kits work by detecting the presence of LH in the urine, says David Diaz, MD, reproductive endocrinologist and fertility expert. When your LH rises above a certain level, the test strip you’ve peed on will let you know that an ovary is just about to release an egg. This is a good time to get it on, since there’s a good chance that egg could become fertilized. 

According to Dr. Diaz, these tests are about 85 percent accurate and available as digital and non-digital tests. If you have fairly regular menstrual cycles, an ovulation predictor kit can be a useful tool in identifying exactly when your fertile window is, but if your cycles are irregular (because of PCOS, pre-menopause, or even just your personal biology), it can be harder to rely on them unless you’re taking a test every day.

Next steps

Okay, you took an at-home test and got your results back...now what? Well, you might not like our answer, but here it is: you should probably still go see a fertility doctor. Yes, even if your results are “normal.” Why? 

Because, like we told you upfront, a test you do at home gives you important data — but not the expertise and counsel of a doctor who has met you in person and knows your medical history. You’ll have the info, just not necessarily the context...and the context is super important when it comes to your fertility. At-home tests simply can’t paint the same kind of comprehensive picture that doctor-interpreted lab tests can. 

But you’re here because you want to take an at-home fertility test...and TBH, we kinda don’t blame you! We’re curious, too! Just make sure you know what you’re buying, (Dr. Knopman says that you should make sure any OTC test you buy comes from a legit manufacturer with a fertility doctor on their medical review board), what the tests can tell you, and what you’re going to do with the results. 

“Even if you don’t want to do fertility treatments [right now], there is no harm in coming in to talk to us about it,” says Dr. Knopman. “You can make better decisions when you have that information than when you don’t…[and] the worst thing to do is sit at home and ruminate, trying to interpret your own results or diagnose yourself.”

What’s the takeaway here? After taking an at-home fertility test, you might want to plan to make an appointment with a fertility specialist. It can be a simple introductory or informational appointment, and even a virtual one. But hopefully, it will give you peace of mind and — most importantly — answers. 

Read more

• Female Fertility Hormones: Everything They Didn’t Teach You in Sex Ed
• A Step-by-Step Guide to Freezing Your Eggs