egg freezing

If you’re preparing to freeze your eggs, you’ll be learning all about female fertility hormones, including estradiol. It’s one of the key hormones your medical team tracks throughout the process, and it plays a major role in how your body responds to the medications used during ovarian stimulation. 

This article breaks down what estradiol actually is, when and why it’s tested during your cycle, and how doctors use those numbers to make decisions along the way. We’ll also cover what different estradiol levels might suggest about how your ovaries are responding, what those levels tend to look like, and what to know if your levels come back higher or lower than expected. Whether you’re just starting to explore egg freezing or already in cycle, understanding estradiol can help you feel more confident in the process.

What is Estradiol?

Estradiol (E2) is the primary form of estrogen, the main female sex hormone. It is produced by the ovaries, specifically by the granulosa cells of growing ovarian follicles, and plays a central role in the menstrual cycle. 

Estradiol helps regulate the cycle and prepares the uterus for pregnancy by promoting the growth of the endometrial lining. In a normal menstrual cycle, estradiol levels rise during the follicular phase and peak just before ovulation, signaling that a mature egg is ready to be released. 

In an egg freezing cycle, injectable medications are used to stimulate the ovaries to mature multiple follicles simultaneously, and these growing follicles produce estradiol. So when your doctor checks your estradiol levels during a cycle, they’re using it as a real-time snapshot of how your ovaries are responding.

Each follicle contributes to your overall estradiol level. More follicles usually mean higher estradiol, which is why this hormone is so helpful for estimating how many eggs might be maturing. It doesn’t replace ultrasound (your team will still count and measure follicles via imaging), but together, these tools give a more complete picture of how your cycle is progressing.

Normal estradiol numbers during an egg freezing cycle

Estradiol is measured in a simple blood test throughout your monitoring appointments. Along with ultrasound measurements of follicle count and size (AFC), estradiol tracking helps the medical team gauge your response. These numbers can vary significantly depending on the number of follicles growing and how your body responds to the medications.

A note on letrozole and E2 levels: If your doctor is using letrozole (an aromatase inhibitor) as part of your stimulation protocol, be aware that this medication intentionally lowers estradiol levels in the bloodstream by blocking the conversion of androgens to estrogen. Because of this, your E2 levels may be significantly lower than the standard ranges described in this article—even if your follicles are growing well and your cycle is progressing normally. In these cases, estradiol is still monitored, but ultrasound findings take on even greater importance in tracking your response. If you’re taking letrozole, your care team will interpret your E2 values within that context.

Baseline: under <60-80 pg/mL

You’ll typically have your estradiol tested multiple times during your cycle, starting with a baseline blood test on day 2 or 3 of your period. At that point, your estradiol should be relatively low, usually under 50–60 pg/mL. A low baseline tells your doctor that your ovaries are quiet and ready to begin stimulation. If your baseline estradiol level is elevated, it may suggest a residual cyst from a previous cycle or indicate lower ovarian reserve. In those cases, your fertility doctor may postpone the cycle or monitor more closely.

Early stimulation: <300-500 pg/mL

As stimulation begins, you’ll take injections of hormones like FSH (follicle-stimulating hormone), which encourage your ovaries to mature more follicles. Clinics usually monitor estradiol every few days, especially around days 5, 8, and 10, as they adjust medication doses and decide when to schedule your trigger shot. 

Early in the cycle, E2 levels are very low, but as the follicles develop, estradiol rises exponentially because each growing follicle secretes estrogen.

Mid-cycle: under 500-1,000 pg/mL

By mid-cycle, estradiol increases to 500-1,000 pg/mL, reflecting the growth of multiple follicles (each follicle adds to the total estrogen output).

This rapid increase is an indirect measure of ovarian response – a stronger response means more follicles producing estrogen, leading to higher E2 levels. Doctors typically check estradiol and follicle measurements around the middle of stimulation (e.g. day 5 and day 8) to adjust medication doses if needed, and then more frequently as you approach the “trigger” day, to ensure estradiol (and follicle growth) is on track.

Trigger day: 1,500–3,000 pg/mL or higher

The final estradiol measurement is often on the day of the ovulation trigger (the injection that matures the eggs before retrieval). By this point, estradiol levels are at their peak for the cycle. 

Typical values can vary widely depending on how many follicles have grown. In a “normal” responding cycle, peak estradiol might be on the order of ~1,000–2,500 pg/mL. If you have an especially positive response (common in younger women with high ovarian reserve), E2 might exceed 3,000 pg/mL. 

In contrast, a poor or low response might only see a peak E2 in the low hundreds (<1,000 pg/mL). Clinicians use these levels in real time to guide the trigger timing and type. For instance, if estradiol is very high, indicating lots of mature follicles, they may opt for a special trigger (like a GnRH agonist trigger) to reduce the risk of ovarian hyperstimulation syndrome (OHSS). If estradiol is lower than expected, it might confirm a low-yield cycle, and the team might counsel whether to proceed to retrieval or consider canceling if the response is extremely poor. 

After the trigger shot, estradiol isn’t usually monitored immediately (because at that point the focus shifts to retrieving the eggs), but the peak level you reached is a useful summary of how well the ovaries responded to the stimulation medications.

Estradiol and egg yield: Is it predictive? 

Yes, there is a clear correlation between estradiol levels and the number of eggs retrieved. One often-cited rule of thumb is that each mature follicle contributes about 200–300 pg/mL of estradiol. So, if your estradiol is around 2,000 pg/mL on trigger day, you might expect about 8 to 10 mature follicles, and likely a similar number of eggs retrieved.

Several studies back this up. A 2021 study found that estradiol levels on trigger day strongly predicted both the number of oocytes retrieved and the number that reached maturity. Other research has found that higher estradiol levels are associated with greater egg yields and higher embryo formation rates in IVF, even across different age groups.

However, estradiol alone doesn’t tell the full story. For example, some patients may have high estradiol levels but still retrieve only a few eggs. This can happen if estradiol per egg is unusually high—something that’s been linked to poorer ovarian efficiency or lower egg quality, especially in older patients. That’s why estradiol is always interpreted alongside ultrasound findings and other hormone levels like LH and progesterone.

Most importantly, the number of follicles that measure 17mm or larger on ultrasound—the ones considered “in range”—is actually the most reliable predictor of how many mature eggs will be retrieved. Estradiol levels provide helpful supporting information, but it’s the follicle count and size that offer the clearest view of likely egg yield.

Fast vs. slow responders 

Estradiol should rise as you take stimulation meds. There’s no single “right” value mid-cycle, since protocols vary, but steady upward momentum is usually what we want. In general, doctors look for estradiol levels to roughly double every two days—a sign that your ovaries are responding appropriately to the medication.

For example, one guideline defined a “fast responder” as someone whose E2 topped 300 pg/mL by about day 5, whereas a slower responder might take until day 8 to reach 300 pg/mL. Don’t fixate on any one early number – it’s the trend that counts. 

If E2 is very slow to rise, the clinic might increase your medication dose or extend stimulation a bit. If it’s skyrocketing quickly, they might adjust doses downward or start preparing to trigger a bit sooner to avoid overshooting. Don’t be afraid to ask your clinic about your results; they will tell you if your hormone levels are as expected or if any changes are needed.

Interpreting “low” estradiol

If your estradiol never climbs into the four digits by trigger day, it may indicate a lower-yield cycle. Don’t be discouraged – quality matters too! But know that a peak E2 of, say, 600 pg/mL might translate to only a few eggs retrieved. 

In an Extend Fertility study of egg freezing patients, those with peak E2 below 1,000 pg/mL (low responders) did have fewer mature eggs and a lower maturation rate compared to higher-E2 cycles. Your doctor might have a candid conversation about whether to proceed or consider another strategy if the response is very low. 

For women under 35, true low response is less common, but it can happen and may warrant investigating underlying factors. On the flip side, remember that even a low-yield cycle can still be valuable – each egg is a chance, and younger eggs (even if few) have high pregnancy potential. Your care team will help put this in perspective based on your goals.

The bottom line

Estradiol is your friend in the egg freezing process – it’s evidence that your ovaries are doing what we want them to do. By understanding the typical patterns (low at baseline, rising through stimulation, and peaking at trigger), you can better follow along with your cycle monitoring. 

Rather than getting anxious over an isolated lab number, look at the big picture: Is your estradiol increasing appropriately? Approximately how many follicles does it suggest? Your fertility team will interpret these values with the nuance they require. High or low, the estradiol levels guide your doctors in optimizing your cycle. And as an empowered patient, knowing what estradiol signifies helps you ask informed questions. For example, if you hear your E2 value, you might now recognize “Okay, that sounds like a strong response” or “Hmm, that’s on the lower side – what does that mean for my egg count?” 

Remember that every woman’s ovaries are unique and every cycle is unique. Use these numbers as informative benchmarks, but always discuss specifics with your doctor, who can correlate estradiol with your ultrasound findings and overall plan. With an evidence-based, well-monitored approach, you can feel confident that your estradiol levels – and the precious eggs they reflect – are being managed to give you the best possible outcome for the future.

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Sources:

• Deadmond A, Koch CA, Parry JP. Ovarian Reserve Testing. [Updated 2022 Dec 21]. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279058/
• Huang, W., Wei, L., Tang, J. et al. Impact of relative estradiol changes during ovarian stimulation on blastocyst formation and live birth in assisted reproductive technology. Sci Rep 15, 15617 (2025). https://doi.org/10.1038/s41598-025-00200-5
• Malathi, A., Balakrishnan, S. & B. S., L. Correlation between estradiol levels on day of HCG trigger and the number of mature follicles, number of oocytes retrieved, and the number of mature oocytes (M2) after oocyte aspiration in ICSI cycles. Middle East Fertil Soc J 26, 34 (2021). https://doi.org/10.1186/s43043-021-00080-5

When people think about choosing an egg freezing clinic, they often zero in on success rates, technology, and cost—and with good reason. Experience and outcomes absolutely matter. You want a clinic that knows what it’s doing, with a proven track record and a solid lab. But once you’ve narrowed it down to a few top-tier options, something more subjective can make all the difference: how the clinic makes you feel.

Clinic culture shapes your entire experience, from the way you're greeted at the front desk to how a provider handles your questions and concerns. It’s about whether you feel respected, rushed, dismissed, or truly supported. And since egg freezing is already a significant decision—one that touches on your body, your future, and your finances—it’s worth thinking about who you want by your side during the process.

This article explores what clinic culture actually looks like in practice, how to spot the good (and the not-so-good), what to do if you find yourself torn between a great doctor and a not-so-great clinic—or vice versa—and how to advocate for yourself along the way. We’ll also share how Cofertility can help you find a partner clinic that checks both the technical and emotional boxes.

What we mean by “clinic culture”

Clinic culture goes beyond mission statements and Instagram presence. It shows up in the details: how the front desk answers the phone, whether your provider gives you space to think, how questions are handled, and what’s prioritized in your consult. It's the difference between being treated like a partner in your care versus a sales lead on a spreadsheet.

Some of it is tangible—provider diversity, clear pricing, and how welcome you feel in the clinic. Some of it is harder to pin down, like the tone a doctor uses or whether the clinic feels collaborative or transactional.

If you’ve ever walked out of a medical appointment feeling unsure why you felt “off,” even when nothing was technically wrong, that’s culture in action.

For many egg-freezers, culture isn’t just a nice-to-have

Freezing your eggs is a medical procedure, but it’s also a personal experience. Feeling dismissed, judged, or pressured—even when everything goes “well” on paper—can leave a sour taste that lingers. On the other hand, feeling supported and heard can make the entire process feel more manageable, especially if you’re facing uncertainty. It can give you the confidence to advocate for yourself and achieve the best possible outcome. 

Research shows that patient satisfaction and trust increase when people feel emotionally safe and respected by their providers. That doesn’t mean you need a clinic with mood lighting and yummy snacks in the waiting room (though that doesn’t hurt). 

It means you want a place where you can ask questions without being made to feel naïve or annoying. A place where your concerns are met with clear information, not eye rolls or scare tactics.

Signs of a supportive clinic culture

There’s no universal checklist, but here are a few markers that can help:

• During your consult, the provider asks about your goals—not just what they think you should do.
• Pricing is transparent and accessible, without buried fees or surprise upcharges.
• You’re encouraged to take your time with the decision, not rushed into a multi-cycle package.
• The clinic offers emotional or counseling support, or at least acknowledges that egg freezing is more than just a transaction.
• Materials and communications are inclusive and don’t rely on fear-based language.

Likewise, watch for red flags like aggressive upselling, dismissive answers, or pressure to commit immediately. The way you're treated during a consult is often a preview of how you'll be treated throughout the process.

What if it’s the right doctor but the wrong clinic?

This happens more than you’d think. Maybe you’ve found a provider you click with, but the clinic feels disorganized or impersonal. Or the clinic has a stellar reputation, but your doctor brushes off your concerns. It’s a frustrating position to be in.

If you love your doctor, it’s worth seeing if they also practice at other clinics in the area—some occasionally do. If it’s the clinic you’re drawn to, consider asking for a second consult with a different provider there. One person doesn’t always represent the whole culture, and sometimes a different match can change your whole impression. Don’t ignore your gut. If something feels off, ask questions and advocate for what you need. 

Quality comes first, but your experience matters too

Let’s be clear: the most important thing is choosing a clinic with strong experience and good outcomes. That’s non-negotiable. But once you’re choosing between two or three clinics that are all technically excellent, culture becomes the tiebreaker.

In other words, you shouldn’t pick a clinic just because it has nice branding or a friendly receptionist. But if two clinics are equally reputable, the one where you feel more supported, heard, and safe is worth prioritizing.

At Cofertility, we partner with clinics that meet high standards for both medical quality and patient experience. If you’re unsure where to start—or you’ve had a consult that didn’t sit right—we can help connect you with options that align with your values and goals.

Bottom line

You’re not being high-maintenance for caring about how you’re treated. Egg freezing is about your future, but it’s also about your now—and the clinic you choose will shape both. The right culture won’t make a difficult decision easy, but it can make it a lot less stressful.

You deserve a clinic that sees you as a person, not a procedure. And if you're looking for one, we’re here to help.

Freeze your eggs with Cofertility

We’d love the opportunity to support you on your egg freezing journey.

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 gain free access to our Freeze Community, a safe space for those engaging in the egg freezing process (or gearing up for it) to connect and lean on each other.

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.

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Read more:

• What to Look For in an Egg Freezing Clinic
• How to Increase Egg Freezing Chances of Success
• Researchers Followed 921 Egg Freezers; Here’s What They Found

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Thinking about egg freezing? It can be an empowering option for many women, offering the ability to better preserve your fertility by storing your eggs at their current state. It puts more control in your hands—allowing you to choose the right time to start a family, find the right partner, or focus on your career and personal aspirations without the added pressure of a ticking biological clock. That said, egg freezing is also a deeply personal and significant decision. It can stir up a range of complex emotions, from hope and relief to uncertainty and stress. That's why many women find therapy to be a valuable resource during this process—offering support, clarity, and emotional grounding as you explore what’s right for you.

As a therapist specializing in reproductive mental health and founder of Calla Collective, I work with many women exploring egg freezing. I often find that there are some big decisions to think about when exploring the option to freeze your eggs. Working with a therapist can help you unpack all of the complexities to make sure you are making the right decision for yourself!  

Some helpful areas to explore

1. Exploring and Understanding Your Motivation:

This might seem simple, but taking the time to delve deep into your reasons for freezing your eggs is crucial. It's a big commitment, involving multiple injections, medication management, doctor appointments, and uncertainty. Are there external pressures influencing your decision, such as medical factors, age, career, relationship status, or societal expectations? Understanding these motivations will help you make informed decisions that align with your personal values and goals.

‍2. Grappling with Cost and Accessibility

Egg freezing has traditionally been out of reach for many women due to cost—often totaling upwards of $15k or more when you factor in medications, procedures, and storage. That financial burden alone can make the decision feel overwhelming or even impossible. Fortunately, there are emerging models that are increasing access. Cofertility, for example, offers a program where you can freeze your eggs for free and store them for 10 years when you donate half to a family who needs them. This option can be incredibly meaningful and financially freeing—but it also requires that you feel emotionally and ethically aligned with the idea of egg donation. Working with a therapist who specializes in reproductive mental health can be a helpful way to navigate the decision making that comes along with egg freezing, and can help clarify your personal needs and values if you’re contemplating egg donation as a means to do so.

3. Addressing Feelings of Uncertainty and Grief:

For many women, egg freezing is an empowering experience, symbolizing control over their reproductive destiny. Yet, for others, it can also evoke feelings of uncertainty about the future, grief over the loss of particular timing for family building, not having the partner they hoped or imagined they would have at this stage of life, or guilt related to societal expectations to want or have children. Acknowledging and processing these complex emotions is vital in making a well-informed decision. Therapy can provide a safe space to explore these feelings and develop strategies for coping and decision-making.

‍4. Sharing Your Decision with Your Support System:

It’s exciting that more people are talking about egg freezing, and more women are getting access to this incredible medical resource.  That said, openly discussing egg freezing with your family and friends can be challenging. Some people may not understand, or may judge your decision. Finding ways to introduce the topic with sensitivity and understanding is important. These conversations can often lead to deeper discussions about your desires and the emotional journey you're undertaking. A therapist can guide you in communicating effectively and building a supportive network.

‍5. Considering the Potential of Unused Frozen Material:

Freezing your eggs is an insurance policy, offering flexibility in family planning. However, it's essential to consider the potential outcomes. What would you do if your frozen eggs weren't used? Would you discard them, donate them to research, donate them to families in need, or transfer the ownership? This is a significant decision, and taking the time to reflect on your feelings will ensure you make choices that align with your values.

Egg freezing is a powerful choice that can offer women greater control over their reproductive journey. It's important to explore all aspects of this path, including your motivations, potential challenges, and support systems. Therapy can provide a valuable framework for navigating these complexities and making informed choices that are right for you.

Final Thoughts

If you're considering freezing your eggs, Cofertility is a great resource to help you explore your options. Their Split program allows you to freeze your eggs for free when you donate half to a family in need, while the Keep program offers the ability to self-fund and keep all your eggs—with access to discounts that help ease the financial burden. Click here to learn more, and visit calla-collective.com to learn more about their therapy services to support you along the way.

Deciding if, when, and how to start a family is one of the most personal and important decisions one will make in their lifetime. For those who are passionately involved in high-demand careers, this decision becomes even more complex. Women athletes face unique challenges in balancing their careers with family-building goals. From demanding training schedules, to the physical toll of pregnancy on one’s body, to lack of support for athlete-mothers, women athletes often feel forced to choose between their careers and their family-building goals. At Cofertility, we believe these women deserve better.

In honor of National Girls & Women in Sports Day, Cofertility, in partnership with &Mother and professional athletes such as Maria Sharapova, Missy Franklin, Alexi Pappas, Chelsea Sodaro, Carly Patterson, and more, launched an initiative called Level the Playing Field. Our goal is to create a world where women in sports can compete, thrive, and plan their futures on their own terms, without compromise. We conducted a study across hundreds of women athletes spanning various sports and levels of competition, and their voices are clear — it’s time for change.

Women athletes want options

We asked our survey participants where they currently are on their family-building journeys. Out of participants who have already begun having children, 82% of them had their first child by the time they were 35. However, of those who have not yet had children but plan to in the future, only 62% plan to do so in the same age range. Additionally, of all survey participants, 70% stated that they’ve postponed having children due to their careers. 

Delayed family-building is not a new concept, and an increasing number of women athletes are following this trend. For many women, the optimal window to start a family is closing before they feel ready, and they lack the support needed to navigate their options.

Women athletes need support

Women athletes are often competing against outdated systems that don’t support career excellence and motherhood. An overwhelming 95% of women athletes surveyed believe that having children negatively impacts their earning potential, while 90% feel it hurts their ability to succeed in their athletic careers. When asked about the biggest barriers they face, financial concerns were most commonly noted. Income disparity between female and male athletes is well-documented. The average woman athlete receives only 18% of their total income from salary, with 82% coming from endorsements. In contrast, male athletes receive on average 63%  of their income from salaries and 37% from endorsements. However, only 10% of total partnership dollars are directed toward female athletes. Paired with the woeful lack of paid parental leave offered by professional sports organizations, it’s not just about the impact on their ability to perform physically, but also a lack of financial support.

Women athletes deserve better

Fertility concerns weigh heavily for women athletes with nearly 90% expressing concern about their future fertility, but few are provided with support to address these concerns. Only 7% of women athletes surveyed reported receiving fertility support from their organization — a stark contract to the broader workforce, where 42% of US employers now offer fertility benefits. 

Due to this lack of support, egg freezing, a potential solution, remains out of reach for many. 65% of those who have not pursued egg freezing cite the cost or lack of education about the process as the reason why they have not. Additionally, 35% cite their athletic career as a barrier, noting that they would be unable to take the necessary time off from work to undergo the process, or that they don’t feel supported by their organization to do so.

It’s time to level the playing field

Women in sports — and everywhere — shouldn’t have to choose between their careers and family building goals. Out of all women athletes we surveyed, nearly 100% of them are unsatisfied with the level of support they receive from their organization. It’s time to build real solutions to empower these women to thrive: which is exactly what &Mother and Cofertility strive to do every day. 

It’s time to level the playing field for women athletes. To get involved in our mission, visit leveltheplayingfield.co.

About Cofertility

Cofertility is on a mission to increase access to egg freezing by breaking down the biggest barrier to entry: cost. With our Split program, those who qualify can freeze their eggs entirely for free when they donate half of the eggs retrieved to a family that can’t otherwise conceive. For those who don’t feel that egg donation is right for them, we also offer our Keep program, in which those interested can take advantage of exclusive perks and discounts to make their egg freezing journey more affordable, while keeping all of the eggs retrieved for their own future use. To learn more, visit cofertility.com/freeze.

About &Mother

&Mother, founded by olympic medalist Alysia Montaño, envisions a culture where motherhood is not a limiting factor in how women succeed professionally or personally. They are dedicated to breaking the barriers that limit a woman’s choice to pursue and thrive in both career and motherhood. To learn more, visit andmother.org.

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For professional and elite athletes, performance is everything. Every training session, competition, and recovery strategy is carefully optimized to maintain peak condition. Egg freezing provides women an incredible opportunity to thrive in their careers without compromising their family-building dreams and many athletes wonder if undergoing fertility preservation will impact their performance, either in the short term or long term. The good news? With the right approach, you can prioritize both your career and your family-planning goals.

The egg freezing process & your body

Egg freezing is a multi-step process, with the most physically demanding phase often being ovarian stimulation. In general, here’s what you can expect from a typical egg freezing cycle:

Screening (1-3 days)

A comprehensive hormone and physical screening  is done prior to beginning the process. Screening includes hormone testing, ultrasound, and physical exam.

Hormonal stimulation (10-14 days)

‍Daily hormone injections encourage the ovaries to mature multiple eggs. You may experience bloating, water retention, and temporary shifts in energy levels. During this time, you’ll also attend regular monitoring appointments with your care team to ensure everything is progressing as expected.

Egg retrieval (1 day procedure, 1-3 day recovery time)

‍A short outpatient procedure is performed under light sedation to collect mature eggs. While minimally invasive, some athletes may need a few days to recover before resuming full training.

What to expect physically

Egg freezing is generally considered to be safe, but no procedure is 100% risk-free. While every body responds differently, here are some common side effects to be aware of:

Increased bloating & water retention

Temporary weight fluctuations due to hormonal stimulation can occur.

Fatigue & recovery

‍Some athletes report feeling slightly more tired during stimulation, though normal activity can usually continue.

Temporary training adjustments

‍High-impact workouts may need to be modified to avoid ovarian torsion, a rare but serious complication.

When can you resume training after an egg retrieval?

Most athletes can return to light training within a few days post-retrieval, with full intensity resuming in one to two weeks. The key is to consult with your care team regarding your unique body and circumstances, and to listen to your body in order to allow for proper recovery.

Performance & long-term impact

One of the most common misconceptions is that egg freezing permanently alters your body. However, once the hormone medications leave your system, your body returns to baseline function. There is no evidence that egg retrieval negatively affects long-term strength, endurance, or agility.

Balancing fertility & athletic goals

Egg freezing is a temporary process, but your athletic career and family-building plans are long-term. By timing the procedure strategically and working with professionals who understand your physical demands, you can take charge of your fertility—without compromising your performance.

Benefits of egg freezing for women athletes

Everyone deserves the opportunity to pursue their careers and their family-building goals without compromise. Women athletes face unique challenges when it comes to this, due to the fact that their career and their fertility are often peaking at the same time, leading to many athletes believing they have to choose one path or the other. Egg freezing is an incredible tool that has allowed countless women to live life on their own terms. At Cofertility, we’re on a mission to create a world where anyone who wishes to pursue egg freezing can do so freely, without barriers.

With our Split program, we give members the opportunity to freeze their eggs entirely for free when they donate half of the eggs retrieved to help another family grow. With our Keep program, members can self-fund their egg freezing journey at a discounted rate with access to our network of partners and perks. With both programs, members get access to our members-only community to connect with others going through the process at the same time.

To learn more about how Cofertility supports women athletes, visit leveltheplayingfield.co

To apply for our egg freezing programs, visit quiz.cofertility.com

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Family-planning decisions are deeply personal, and for women athletes, there are many added layers of complexity. From rigorous training schedules and competition seasons to the physical demands of maintaining peak performance, many athletes choose to delay family-building. Egg freezing is an attractive option for many, giving women athletes the gift of time while allowing them to focus on the demands of their career. However, navigating the process can be a challenge. If you’re in this boat — this article is for you. Keep reading to learn more about the ins and outs of egg freezing as a woman athlete, allowing you the opportunity to take control of your reproductive future without sacrificing your career goals.

Why should women athletes freeze their eggs?

It is well-recognized that female fertility declines with age, beginning in one’s early 30s and more rapidly accelerating at age 35. Both egg quality and quantity start to decrease, making child-bearing more difficult the longer we wait. Given that many athletes extend their careers well into their 30s, egg freezing provides optionality for future family-building to female athletes who are prioritizing their professional careers during their peak reproductive years.

How to schedule an egg freezing cycle as an athlete

One of the biggest concerns for athletes considering egg freezing is when to do it. The process typically takes about two weeks, during which intense physical activity is often prohibited. This can make it challenging for those in physically-demanding careers, such as athletes, to find time to schedule their cycle. However, with proper planning, freezing your eggs as a woman athlete is very possible. Some considerations are:

• Off-season planning: Consider scheduling your egg freezing cycle during the off-season. That way, you’ll have time to focus on your retrieval without the added stress of balancing your training and competition demands.
• Recovery time: While egg freezing is a minimally-invasive procedure, it’s normal to experience mild to moderate symptoms post-retrieval, such as bloating, fatigue, or cramping. Giving yourself ample time to rest is key — so be prepared to take time off to recover.
• Impact of hormone injections: The process of freezing your eggs includes taking a series of injectable hormone medications in order to stimulate your ovaries to produce multiple mature eggs. When taking these medications, it is often advised to avoid high-impact physical activity, in order to reduce the rare-but-serious risk of OHSS. While most will be able to return to their full training quickly, it’s important to work directly with your care team on a plan to safely navigate cycling with your work schedule.

How to pay for egg freezing as an athlete

Having a plan for how you’re doing to pay for your egg freezing is an important planning step in your journey. A typical egg freezing cycle can cost anywhere from $11,000 - $15,000, in addition to storage fees. Considering that the majority of women athletes do not have access to fertility benefits, you will likely have to fund your egg freezing journey on your own — but you have options. Options like Cofertility’s Split program — in which members freeze their eggs entirely for free when they donate half of the eggs retrieved to a family that can’t conceive — help eliminate financial barriers while giving you the opportunity to help another family grow at the same time. Additional options include financing options through companies like Sunfish or using an HSA or FSA account.Give yourself the gift of optionsNavigating egg freezing as an athlete requires planning, but it’s an empowering step toward preserving future family-building options. If you’re considering the process, talk to a fertility specialist and map out a plan that works with your training schedule. Because every athlete deserves the ability to compete today—without sacrificing the family-building goals.

As the 2024 election approaches, reproductive rights have become one of the most pressing and widely discussed issues in the US. In fact, recent survey data found that 90% of American women are concerned about potential restrictions on fertility treatments. While much of the conversation has focused on abortion rights—especially with the overturning of Roe v. Wade—other areas of reproductive healthcare, including fertility treatments like egg freezing, could also be influenced by the election.

At Cofertility, we know our members care deeply about the future of reproductive health. As this election season unfolds, we’re closely monitoring how political shifts could impact egg freezing and other family-building options. While egg freezing itself may not be directly restricted, increased regulation on in vitro fertilization (IVF)—a vital next step after egg freezing—could influence access and affordability. In this article, we’ll walk you through what these changes could mean, so you can make the best choices to protect your options for the future.

Issues facing egg freezing and reproductive healthcare access

As the election nears, policies impacting reproductive healthcare access are top of mind for many of us, especially in states where abortion restrictions have already been passed or are under consideration. Fertility treatments, including egg freezing, could see indirect effects from these policies, as new legal rulings and proposed legislation raise questions around oversight, accessibility, and insurance coverage. Given these changes, it’s more important than ever for patients to stay informed and providers to remain adaptable to keep services like egg freezing accessible.

Understanding state-level impacts on egg freezing 

While egg freezing has not been specifically targeted by state legislatures, some worry that restrictive laws around abortion could spill over. In certain states, legislation such as personhood bills—like the recent Alabama Supreme Court decision granting human rights to fertilized eggs—could increase legal considerations for providers, potentially affecting service availability or affordability. In response, some fertility doctors and OBGYNs are moving their services to states with strong reproductive protections, leaving those in red states with decreased access to reproductive care. 

High costs and insurance gaps

Egg freezing comes with high costs and is rarely covered by insurance, leaving most patients to pay out of pocket. With cycles costing tens of thousands of dollars, many find the financial burden to be a barrier. Additionally, laws around insurance mandates for fertility benefits vary widely across states, with the vast majority of Americans having no insurance coverage for egg freezing.

While approaches like Cofertility’s egg-sharing model—where you can freeze your eggs for free when you donate half to intended parents who otherwise cannot conceive—are helping make egg freezing more accessible, discussions in the current election about healthcare access could result in policies that address critical cost barriers and potentially reshape insurance mandates for fertility preservation benefits.

Impact on LGBTQ+ individuals and family planning

Access to fertility treatment varies, and the LGBTQ+ community often faces extra hurdles, especially when insurance coverage is limited to heterosexual couples. These gaps make family-building even more challenging for LGBTQ+ families, adding financial and logistical stress. Additional restrictions on fertility treatments could widen these disparities, making it harder for many LGBTQ+ individuals and couples to grow their families.

This election season, inclusive policies that support equal access to fertility care are especially important. Policies that improve insurance coverage and access to family-building options for everyone—regardless of gender, sexual orientation, or marital status—could help make fertility care more supportive and accessible to LGBTQ+ families.

Egg freezing access amid political changes

Despite the intense political focus on other areas of reproductive healthcare, egg freezing has largely remained out of the spotlight and unaffected by restrictive legislation. For those considering egg freezing, this can be reassuring. 

Unlike other treatments, egg freezing is less likely to face regulatory scrutiny, allowing services to continue uninterrupted even in states with stricter reproductive health policies. In fact, some states are even expanding insurance coverage for egg freezing, acknowledging its vital role in family planning and long-term reproductive health.

However, for those who choose to freeze their eggs with plans to use them for future family building, additional considerations come into play as IVF has been more directly impacted by political shifts. To safeguard your options, completing your care in a state with strong protections for reproductive healthcare can help ensure you have the support and access you need when the time comes.

What to watch for this election season

As you consider your own family planning journey, here are a few key areas to keep an eye on this election:

1. Healthcare policy and reproductive rights: Any shifts in reproductive rights, particularly those affecting fertilized eggs, could have downstream effects on IVF and egg freezing. Even when specific treatments aren’t directly targeted, related legislation could influence healthcare providers’ ability to offer certain services.
2. Insurance and cost coverage: Some candidates may focus on expanding insurance mandates for fertility treatments, aiming to ease the financial burden for those seeking these services. Understanding candidates’ positions on healthcare mandates can offer insight into future coverage possibilities.
3. State-by-state differences: With much of the control over reproductive health laws being managed at the state level, where you live can have a huge impact on your access to family planning services. Following the election, it may be helpful to monitor your state’s legislative landscape for changes.
4. Access for LGBTQ+ families: Policies addressing the definition of infertility and coverage criteria could affect who qualifies for fertility treatments. For LGBTQ+ individuals, this remains an important point of advocacy, as inclusive access to family planning is essential for equity in reproductive healthcare.

How Cofertility can support you 

Reproductive health rights are at risk in the United States. Whether it’s abortion, IVF, or even egg freezing–there are policymakers who do not believe women should be able to make decisions about their own body. 

If you’re considering egg freezing, it’s helpful to be aware of broader policy implications that could affect your options. At Cofertility, we’re committed to supporting you throughout your journey, offering resources to help you understand your choices and advocating for accessible, value-aligned family-building options.

To further support our members, we’ve taken proactive steps including partnering with storage facilities in states with strong reproductive protections. Additionally, our clinic-agnostic model allows us to expand our reach in states with more open reproductive access, ensuring flexible, secure options for everyone.

This election, as you weigh your options, we encourage you to consider policies that align with your values and goals and to vote with those priorities in mind. Your voice—and your vote—can help create a future where everyone has the opportunity to build the family they envision.

Embarking on the egg freezing journey is a significant and deeply personal decision, often accompanied by a mix of hope, uncertainty, and anxiety. While it can feel empowering, the experience can also feel overwhelming due to the complex medical procedures, emotional ups and downs, and the many decisions along the way. Having the right kind of support—whether from medical professionals, a community of peers, or loved ones—makes all the difference in navigating this important chapter of your life.

Medical support: Your guiding light

When undergoing a medical procedure as intricate as egg freezing, timely and accurate medical support is crucial. Your nurses, doctors, and fertility specialists are the backbone of your support system, providing the knowledge and expertise to ensure your safety and well-being throughout the process.

Medical support is not just about managing the logistics of injections and appointments—it’s about having a trusted team to turn to when questions arise. Whether you're wondering, "What side effects should I expect?" or "Which needle should I use for my injection?" These are the kinds of questions that require prompt, clear answers. Unfortunately, doctors and medical teams can often have limited availability. Reaching out directly to a Cofertility member advocate, or becoming a member of  Conceive, a digital health platform that offers 24/7 fertility support services like text coaching, community support groups, and more, can help you get your questions, no matter how small, answered immediately. For those embarking on this journey for the first time, or anyone with lingering questions, resources like these can often provide added peace of mind.

Moreover, fertility journeys can be emotionally taxing. The uncertainty, the waiting, and the inevitable questions about the future can weigh heavily on your mind. Seek out a compassionate, communicative care team that can help provide you with reassurance and clarity and help to alleviate some of that emotional burden. You should feel informed and confident at every step of your journey.

Community support: The power of shared experiences

While medical support is essential, it's not the only kind of support you’ll want to lean on during your egg freezing journey. Connecting with others who are going through the same experience can be incredibly comforting. 

Being part of a community of people who are also freezing their eggs means you’re never truly alone. Sharing your experiences, exchanging advice, and offering each other encouragement creates a sense of belonging. This support provides a space to discuss the highs and lows openly, without fear of judgment. It's a reminder that what you're going through is significant and that others understand it on a deeply personal level.

In addition to emotional support, communities often become a source of practical advice. From tips on managing side effects to staying organized during the medication phase, the insights shared within these groups can be invaluable. They also serve as a reminder that the challenges you face aren’t unique—others have faced them and successfully come out the other side.

Through Cofertility’s Circle community, members connect with others who have gone through or are currently going through their program. It’s a safe space to exchange experiences and find support from those who truly understand the complexities of egg freezing. Conceive also offers an additional layer of support through intimate community groups, creating an environment where you can share experiences, receive tailored advice, and build lasting connections with people at a similar stage in their fertility journeys.

Personal support: Finding your anchor

For many, navigating the egg freezing journey is a deeply personal experience. While some may find comfort in family support, others choose to pursue this path independently or with a select few trusted friends or partners. It’s important to create a support system that feels right for you, whether that means leaning on close friends, a partner, or drawing strength from within.

As you navigate the decision to freeze your eggs, discussions about your future often come into focus. Whether your goals involve eventual motherhood or simply preserving your fertility options, it’s important to have people in your corner who respect and support your choices. These conversations—whether shared with a close friend, partner, or even a fertility coach—can help solidify your resolve and remind you why you embarked on this journey in the first place.

Recognizing that the need for support can come unexpectedly and at any time, Conceive provides 24/7 access to expert guidance and reassurance, ensuring you have the help you need as you plan for your future.

Embracing support on your journey

Egg freezing is a journey that’s as much about emotional resilience as it is about medical science. Having a solid support system in place—whether that support comes from your healthcare team, a community of peers, or your family—can give you the strength and reassurance you need to navigate this process with confidence.

With services like those offered by Cofertility and Conceive, you don’t have to go through this journey alone. With the right care and a strong support network, you can turn this experience into an empowering chapter of your life—one where you’re not just preserving your fertility but also nurturing your sense of self, strength, and future possibilities.

Your fertility journey can be both exhilarating and complex and you may be looking for guidance on navigating the process of transporting your frozen eggs or embryos to a storage facility. We get it, and we're here to help.

Here are some important things you need to know about safely shipping your frozen eggs and embryos and what to consider as you weigh your storage options.

First things first—what is an offsite storage facility or  “biorepository”?

A biorepository is a facility that catalogs, stores, and maintains biological specimens – in this case, your eggs and embryos. The purpose of a biorepository is to store and preserve these specimens at extremely low (cryogenic) temperatures. Following a retrieval, you may choose to transport their specimens to a long-term storage facility, particularly if you plan to have them in storage for several years. 

What is the process for shipping frozen eggs and embryos to a biorepository? 

The shipping of frozen eggs and embryos involves the following steps:

1. Decide and indicate storage facility: Choose a long-term storage facility and inform both the clinic and the storage provider of your decision.
2. Clinic coordination and preparation: Notify your clinic that you want to move your specimens and find out what is required by the clinic to make this happen. Typically this includes: paying any outstanding balances, signing medical releases and consents, formally deciding where to ship specimens, and providing a point of contact information. 
3. Choose a courier: There are several shipping providers that specialize in shipping frozen eggs/embryos. Your clinic and/or storage provider may have recommendations or preferred specialized couriers.  
4. Specimens ship: Specimens begin the journey to your indicated storage facility and remain frozen in transit. 
5. Specimen storage confirmation: Receive confirmation from your storage provider that your specimens are safely stored.
   

What should I consider when deciding where to ship and store my specimens? 

Traditional cryostorage systems rely heavily on manual and analog processes. Cofertility has partnered with TMRW Life Sciences to provide our members access to one of the highest standards of care in offsite storage for frozen eggs and embryos in the US. TMRW is modernizing the management and storage of frozen eggs and embryos with cutting-edge technology that helps reduce the risk of specimen mix-up and loss.

Here are a few questions you can ask storage providers when evaluating different storage options:

1. Do you use digital labels and RFID tags to track and identify my frozen eggs/embryos? (Hint: not just handwritten labels)
2. Do you keep specimen storage data in a digital database, with a recorded audit trail of transactions? (Hint: not notecards, binders or Excel datasheets)
3. Do you use proactive monitoring -- thousands of digital daily checks + remote and in-person human monitoring? (Hint: not relying solely on reactive alarms that go off after there is a problem)
4. Do you help facilitate shipping and coordination with my clinic? (Hint: not having patients complete complicated documents without any guidance)

Is it safe to transport my eggs/embryos? Will my eggs or embryos be thawed in the process?

The process of shipping frozen specimens is safe and commonplace in the fertility space. With proper quality controls in place, specimens remain frozen throughout the duration of the shipment process. They are shipped in specialized cryogenic containers designed to maintain optimal cryogenic temperatures during shipping. 

If you choose to store your specimens with TMRW, as added security, both TMRW and its trusted shipping partners require the use of active, continuous temperature and GPS telemetry to monitor specimens during transit. Once specimens arrive at the TMRW Biorepository, all specimen handling is carried out by experienced embryologists who adhere to the highest standards in the US with strict quality control policies.

What are the key components of safely shipping frozen eggs and embryos?

The safe shipping of frozen eggs and embryos involves the following best practices,  which you should look for in a shipping provider:

1. Accurate documentation and labeling: Proper specimen documentation and package labeling is crucial to correct handling and tracking. 
2. Specialized shipping containers: Cryopreserved specimens are transported in a special shipping container called a vapor shipper - ideally suited for the transportation of frozen specimens. Liquid Nitrogen is added and retained in an absorbent material and the cold nitrogen vapor is released to maintain the specimen temperature below -150°C during transport.
3. Secure shipping process: A specialized medical courier service is scheduled to transport the vapor shipper, including monitoring temperature and location in real time.
4. Safe intake and verification: The receiving facility checks the container's integrity and verifies temperature before confirming specimen inventory and transferring the eggs or embryos to their final storage destination inside a specialized storage tank.

If you choose to transport your specimens to TMRW, our care team guides you through every step of the shipping process, helping you coordinate with your fertility center and/or through a trusted third-party shipping provider. TMRW has local delivery options and partners with specialized medical couriers for shipping.

What does it cost to transport my frozen eggs or embryos? 

The cost to transport your specimens is typically based on mileage, weight, and the quantity of eggs or embryos within the shipping container. This cost can vary widely depending on the courier company of your choice, typically ranging from about $600-$1200.  For all Cofertility members who choose to store specimens with TMRW, shipping to TMRW is included in the storage fee. 

Does insurance cover specimen shipping and/or storage costs?

Typically, specimen shipping services and specimen storage fees are out-of-pocket expenses. However, some insurance providers are beginning to include specimen shipping and/or storage in their coverage. It's important to check with your insurance provider to see if these services are covered and/or eligible for reimbursement.

After my eggs and/or embryos are stored in long-term storage, what do I need to do to move them to the clinic of my choosing when I’m ready to use them for treatment?

When you decide to send your frozen eggs or embryos back to a fertility clinic for treatment, you will contact your long-term storage facility to initiate the transfer process. For Cofertility members storing specimens with TMRW, TMRW’s team will collaborate with the fertility clinic of your choice to coordinate the shipment, preparation, transfer, and tracking of the requested specimens.

For more information on TMRW Life Sciences, visit their website at https://tmrwlifesciences.com. For more information about the TMRW Biorepository, please visit their Frequently Asked Questions or complete an inquiry here.  

If you are a Cofertility member ready to transfer your frozen eggs or embryos to TMRW, you can begin the storage intake process here - don’t forget to use your preferred partnership discount code! 

If you're considering egg freezing, you've likely come across information about ovarian hyperstimulation syndrome (OHSS). While OHSS is a potential complication of the egg retrieval process, its occurrence has decreased significantly in recent years, thanks to improved protocols and preventive strategies.

This article will explore how fertility doctors work to minimize your risk of OHSS during egg freezing cycles, ensuring a safer and more comfortable experience.

What is OHSS?

Before diving into prevention strategies, let's first understand what OHSS is and why it occurs.

Ovarian hyperstimulation syndrome (OHSS) is an exaggerated response to the hormonal medications used to stimulate egg production. In OHSS, the ovaries become swollen and fluid can leak into the abdomen and sometimes the chest. This can cause a range of symptoms from mild bloating and discomfort to, in rare severe cases, more serious complications.

OHSS is typically classified into three categories:

1. Mild OHSS: Characterized by abdominal bloating and mild pain. This form is common and generally resolves on its own.
2. Moderate OHSS: Involves more noticeable abdominal pain, nausea, and sometimes vomiting. Ultrasound may show fluid in the abdominal cavity.
3. Severe OHSS: A rare but serious condition that can involve severe abdominal pain, rapid weight gain, severe nausea/vomiting, decreased urination, and shortness of breath. This form requires immediate medical attention.

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

Read more in What is OHSS and What Are My Risks?

Seven ways doctors try to minimize OHSS risk

Fertility doctors have several strategies to reduce your risk of OHSS if they believe you are at a high-risk. The body of evidence and research is constantly evolving, and new approaches are continually being studied and refined. What's considered the best practice today may be updated in the future as we learn more about ovarian stimulation and OHSS prevention.

While these strategies may reduce the risk of OHSS, they can't eliminate it entirely. Every patient responds differently to fertility treatments, and what works well for one person may not be as effective for another. This is why personalized care and close monitoring throughout your treatment cycle are so important.

Personalizing your treatment

Gone are the days of "one-size-fits-all" approaches to ovarian stimulation. Modern fertility clinics use personalized protocols based on each patient's individual characteristics. This process typically involves:

• Thorough pre-treatment assessment: Your doctor will consider your age, BMI, ovarian reserve tests (AMH and AFC), and any history of PCOS or previous OHSS.
• Tailored medication doses: Based on your risk profile, your doctor will choose an appropriate starting dose of gonadotropins (the hormones used to stimulate egg production). Women at higher risk of OHSS often start with lower doses.
• Dose adjustments: Throughout your stimulation, your doctor will monitor your response through blood tests and ultrasounds, adjusting medication doses as needed.

Picking the right protocol

During IVF, your fertility doctor will prescribe medications to stimulate your ovaries to produce multiple eggs. This process helps to control the egg development so they can retrieve a safe number of mature eggs at the best time. There are a few ways (stimulation protocols) to do this:

• "GnRH agonist protocol or "long protocol": This involves taking medications for several weeks to essentially rest your ovaries before stimulating them.
• GnRH antagonist protocol: This approach has a shorter duration of injections, and uses an “antagonist to prevent your body from releasing eggs too early.
• Flare protocol: Also known as the microdose flare or low dose Lupron protocol, uses a low dose of Lupron to trigger the pituitary gland to release follicle stimulating hormone (FSH).

Research has shown that the newer method (GnRH antagonist protocol) is safer and reduces the risk of ovarian hyperstimulation syndrome (OHSS).  A very large review and meta-analysis, including 73 RCTs with 12,212 participants, demonstrated a statistically significant reduction in all types of OHSS in cycles using GnRH antagonists, due to the Lupron trigger shot. 

Most clinics prefer the GnRH antagonist protocol because it's easier for patients and gives clinics more flexibility to adjust your treatment if needed. However, there may be cases where a doctor will choose the best protocol for you based on your individual situation. You can always ask your doctor which protocol they have chosen and why!

Lower starting doses plus oral medication

To reduce OHSS risk, your fertility doctor may start with lower doses of gonadotropins (the injectable hormones used to stimulate egg production), especially if you have risk factors for OHSS. This "low and slow" approach allows your body to respond more gradually, reducing the risk of over-stimulation.

Your doctor might also add oral fertility medications (pills) to your protocol, such as:

• Clomiphene citrate (Clomid): This medication helps stimulate egg production and can allow for lower doses of injectable hormones.
• Letrozole (Femara): Originally a breast cancer drug, letrozole is now commonly used in fertility treatments. It can help stimulate egg production while potentially reducing OHSS risk. It also lowers estradiol levels which can aid in reducing OHSS risk and lower side effects.

By combining lower doses of injectable hormones with these oral medications, doctors may be able to minimize the risk of overstimulation while still achieving good outcomes. This approach is especially beneficial for women with PCOS or other risk factors for OHSS.

Alternative trigger medications

The trigger shot, also known as the "ovulation trigger" or simply "the trigger," is a hormonal medication given near the end of your egg freezing cycle. Its primary purpose is to mimic the natural surge of luteinizing hormone (LH) that occurs in your body just before ovulation. This surge signals your ovaries to complete the final maturation of the eggs and prepare them for retrieval.

Traditionally, the trigger shot has been human chorionic gonadotropin (hCG), which mimics the natural LH surge. However, hCG has a long half-life and can increase the risk of OHSS. To mitigate this risk, doctors now have alternative options:

• GnRH agonist trigger (eg. Leuprolide, Lupron): For cycles using a GnRH antagonist protocol, a GnRH agonist can be used to trigger ovulation. This causes a short, self-limited LH surge. Research has found this can dramatically reduce OHSS risk.
• Dual trigger: Some doctors use a combination of a low dose of hCG along with a GnRH agonist. This approach aims to balance OHSS risk reduction with optimal egg maturation.
• Low-dose hCG: If a GnRH agonist trigger isn't possible, some doctors might use a lower dose of hCG. However, research has not found a consistent or statistically significant differences in the rate of OHSS when comparing hCG-only triggers of 4,000 IU compared with 6,000 IU or 10,000 IU.

Medications called dopamine agonists, particularly cabergoline, have been shown to reduce the risk of OHSS when given around the time of the trigger shot. These medications work by reducing VEGF activity, which is thought to play a key role in OHSS development.‍

Metformin for PCOS patients

For women with PCOS who are at higher risk of OHSS, some doctors prescribe metformin during the stimulation phase. While the evidence is mixed, some studies suggest it may help reduce OHSS risk in this population.

Monitoring: The key to OHSS prevention

Perhaps the most important aspect of OHSS prevention is careful monitoring throughout the stimulation process. This typically involves:

• Frequent ultrasounds: To track the number and size of developing follicles.
• Blood tests: To monitor estradiol and other hormone levels.
• Symptom tracking: Your doctor will ask about any symptoms you're experiencing.

This close monitoring allows your fertility team to adjust your treatment plan quickly if you show signs of over-responding to the medications.

What about other strategies?

You may hear about other OHSS prevention methods, such as taking aspirin, certain supplements, eating a high-protein diet, or drinking lots of electrolyte solutions. While some of these may have anecdotal support, current scientific evidence doesn't strongly back their use for OHSS prevention. 

Always consult with your doctor before taking any additional medications or supplements during your egg freezing cycle.

What to expect after egg retrieval

Even with all these preventive measures, it's normal to experience some mild OHSS symptoms after egg retrieval, such as bloating, mild abdominal pain, and feeling full quickly when eating. These symptoms usually resolve within a week.

However, it's crucial to contact your doctor if you experience:

• Severe abdominal pain
• Significant abdominal swelling
• Nausea or vomiting
• Decreased urination
• Shortness of breath
• Rapid weight gain (more than 2-3 pounds per day)

These could be signs of more severe OHSS and require prompt medical attention.

The bottom line

While OHSS remains a concern in ovarian stimulation cycles, modern protocols, and preventive strategies have dramatically reduced its occurrence and severity. By working closely with your fertility doctor, asking questions, carefully following their instructions, and promptly reporting any concerning symptoms, you can minimize your risk and focus on a successful egg freezing cycle.

Remember, everybody responds differently to fertility medications. What works best for one person may not be ideal for another. That's why individualized care and open communication with your medical team are so important throughout the egg freezing process.

If you have any questions or concerns about OHSS or any other aspect of egg freezing, don't hesitate to discuss them with your doctor. They're there to support you and ensure the safest possible experience as you take this important step toward preserving your fertility options.

If you're taking any prescription medications, you may be wondering how they might affect your egg freezing journey. It's a common concern, and an important one to address. Whether you're on birth control, managing a chronic condition, or taking medication for mental health, it's crucial to understand how these drugs might interact with the egg freezing process.

First and foremost, we want to emphasize a critical point: Do not stop taking any of your medications without explicit instructions from your fertility doctor. This is absolutely vital for your health and safety. Abruptly discontinuing certain medications can have serious consequences, and your overall well-being is the top priority throughout this process.

Your fertility doctor will work closely with you to create a personalized plan that takes into account all aspects of your health, including any medications you're currently taking. They have the expertise to determine which medications may need to be adjusted, which can be continued as usual, and which might need to be temporarily paused during your egg freezing cycle.

Remember, egg freezing is a medical procedure that involves carefully controlled hormonal stimulation. Your doctor's goal is to optimize your chances of success while ensuring your safety. This means carefully considering how your current medications might interact with the fertility drugs used in the egg freezing process.

In this article, we'll discuss some common medications that people often ask about when considering egg freezing. However, it's important to understand that this information is general and may not apply to your specific situation. Your individual health profile, the specific medications you're taking, and their dosages all play a role in determining the best approach for you.

Let's explore some of the medications that might need to be adjusted during the egg freezing process, always keeping in mind that any changes should only be made under the guidance of your healthcare team.

Birth control and egg freezing

Most fertility clinics will ask you to stop taking hormonal birth control pills, patches, or rings at least one month before starting your egg freezing cycle (IUDs can remain in place). This allows your natural menstrual cycle to resume and helps your doctor accurately assess your ovarian function. It’s counter-intuitive, but some clinics might prescribe you birth control pills to time your cycle as part of their treatment protocol. This will all be discussed with your fertility doctor before your cycle begins.

Read more in: Egg Freezing and Birth Control: An Overview

GLP-1 medications (e.g., Ozempic, Wegovy)

If you're taking GLP-1 medications for weight management or diabetes, discuss this with your fertility doctor as well as your PCP (or whomever wrote the prescription). 

Many doctors recommend pausing GLP-1 medications for a few weeks before procedures involving sedation or anesthesia, including an egg retrieval, to reduce potential risk

The reason is, that there have been some reports that the delay in stomach emptying due to the GLP-1 medication could be associated with an increased risk of regurgitation and aspiration of food into the airways and lungs. And, because you are unconscious during the egg retrieval, you can’t clear your lungs or eliminate the obstruction on your own. Unfortunately, there is currently a lack of scientific data on how GLP-1 medications affect patients having procedures like egg freezing, so most doctors like to play it safe. 

Bipolar, depression, and anxiety medications

Most women can continue their psychiatric medications during egg freezing. However, some medications may need dose adjustments. It's important to involve both your psychiatrist and fertility doctor in this decision to ensure your mental health is properly managed throughout the process.

Read more in: Do I Need to Stop Taking My Antidepressant to Freeze My Eggs?

Spironolactone

Spironolactone is often used for acne or hormonal issues. Recent research has shown that there was no significant difference in the number of mature eggs retrieved between patients who continued spironolactone, those who discontinued it prior to cycle initiation, and patients with no prior use of spironolactone.

This research suggests that patients may be able to continue taking spironolactone while undergoing egg freezing. As with all medications, transparency with your healthcare team is key. Be sure to inform your fertility doctor about your use of spironolactone, including dosage and duration of use, so they can provide the most appropriate guidance for your situation.

Acne and skin care medications

Your doctor may suggest stopping some acne medications, like Isotretinoin (Accutane®), well in advance of egg freezing due to unknown risks to the eggs. Topical acne treatments like Retinol or Tretinoin may be safe to continue, but always check with your doctor.

Allergy medications

Generally, allergy shots don't interfere with egg freezing. However, inform your fertility doctor about any allergy treatments you're receiving to ensure they don't conflict with your fertility medications.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs like ibuprofen and naproxen may need to be avoided during your egg freezing cycle as they can interfere with ovulation. Your doctor may recommend alternative pain relief options, like acetaminophen (Tylenol), if needed.

Blood thinners

If you're taking blood thinners such as warfarin (Coumadin), heparin, or newer anticoagulants like apixaban (Eliquis) or rivaroxaban, it's important to discuss this with your fertility doctor. Blood thinners can potentially affect the egg retrieval procedure, which involves passing a needle through the vaginal wall into the ovaries.

Your doctor will need to carefully balance the risks of stopping or adjusting your blood thinner regimen against the risks associated with the egg retrieval procedure. In some cases, they might recommend adjusting the timing of your medication around the retrieval procedure.

Do not stop or adjust your blood thinner medication without explicit instructions from your healthcare team. Your fertility doctor may consult with your prescribing physician to create a safe plan for managing your anticoagulation therapy during the egg freezing process.

Steroids

Steroids, such as prednisone or dexamethasone, are used to treat a variety of conditions, from autoimmune disorders to asthma. If you're taking steroids, it's important to inform your fertility doctor. In many cases, patients can continue their steroid medication during the egg freezing process. 

However, the impact of steroids on fertility treatments can depend on the specific medication, dosage, and reason for use. Your fertility doctor will consider these factors when determining whether any adjustments are necessary for your egg freezing cycle.

As with all medications, never adjust or stop your steroid regimen without guidance from your healthcare providers. Abrupt discontinuation of steroids can have serious health consequences. Your fertility doctor will work with your prescribing physician to ensure your condition is properly managed throughout the egg freezing process.

Hormone replacement therapy

If you're a transgender man undergoing hormone replacement therapy as part of your gender-affirming care, it's crucial to have an in-depth discussion with your fertility doctor about your options for egg freezing. If you have already started hormone therapy, such as testosterone (T) therapy, your doctor will likely recommend discontinuing testosterone before you proceed with the egg freezing process. 

Read more in Egg Freezing for Transgender Men: What You Need to Know

Summing it up

Preparing for egg freezing involves a careful review of your current medications and potential adjustments. Always be transparent with your fertility doctor about all substances you're taking, and follow their guidance closely. Remember, the goal is to create the optimal conditions for retrieving and freezing high-quality eggs, giving you the best chances for future fertility success.

Every person's medical history is unique, so what applies to one individual may not apply to another. Your fertility doctor will work with you to create a personalized plan that takes into account your specific health needs and medications. 

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If you're considering egg freezing or have already started the process, you've likely heard rumors about the "trigger shot." This important step in the egg freezing journey can, like much of the process, seem mysterious and perhaps a bit daunting. But don't worry – we're here to demystify the trigger shot and provide you with all the information you need to feel confident and prepared.

In this guide, we'll explore what the trigger shot is, why it's necessary, how it works, and what you can expect when it's time for you to take this important step in your egg freezing cycle. We'll also address common concerns, potential side effects, and tips for ensuring the best possible outcome.

What is the egg freezing trigger shot?

The trigger shot, also known as the "ovulation trigger" or simply "the trigger," is a hormonal medication given near the end of your egg freezing cycle. Its primary purpose is to mimic the natural surge of luteinizing hormone (LH) that occurs in your body just before ovulation. This surge signals your ovaries to complete the final maturation of the eggs and prepare them for retrieval.

In a normal menstrual cycle, this LH surge would lead to ovulation – the release of a mature egg from the ovary. However, in an egg freezing cycle, the trigger shot allows your doctor to precisely time the egg retrieval procedure, ensuring that your eggs are at the optimal stage of maturity for freezing.

What does the trigger shot do?

The trigger shot serves two important functions in the egg freezing process:

1. Final egg maturation: It prompts the final stage of egg maturation, ensuring that the eggs are ready for retrieval and freezing.
2. Timing control: It allows your fertility doctor to precisely schedule the egg retrieval procedure, typically 34-36 hours after the trigger shot is administered.

These two functions of the trigger shot work together to optimize the egg freezing process, helping to ensure the best possible outcome for preserving your fertility.

Is the trigger shot necessary?

In short, yes. The trigger shot is an important part of the egg freezing process. Without it, it would be extremely difficult to time the egg retrieval accurately, and the eggs might not be at the optimal stage of maturity for freezing. The trigger shot ensures that you get the best possible outcome from your egg freezing cycle.

Types of trigger shots

There are two main types of medications used for the trigger shot:

1. hCG (Human Chorionic Gonadotropin): Brands include Ovidrel, Pregnyl, and Novarel. This medication directly mimics the LH surge, and requires some mixing before administration.
2. GnRH Agonist: Brands include Lupron (also known as leuprolide acetate). This alternative trigger medication works by causing your body to release its own surge of LH.

Your doctor will decide which type of trigger shot is best for you based on your individual circumstances and how you've responded to the stimulation medications.

How is the trigger shot administered?

The trigger shot is typically given as a subcutaneous injection (into the fatty tissue just under the skin) or intramuscular injection (into the muscle). Your fertility clinic and/oor pharmacy will provide detailed instructions on how to administer the shot, which is usually done at home.

The timing of the trigger shot is very important. Your doctor will give you very specific instructions about when to take the shot, often down to the exact hour. It's essential to follow these instructions precisely to ensure the best outcome.

Is the trigger shot painful?

Most women report that the trigger shot is not particularly painful. The needle used for subcutaneous injections is very small, and while you might feel a slight pinch, any discomfort is usually brief. There are tactics you can use to make the injection less painful, like icing the area beforehand.

Read more in I'm Afraid of Needles; Can I Still Freeze My Eggs?

Common mistakes to avoid

While the trigger shot is straightforward, there are a few common mistakes to be aware of:

1. Timing errors: Administering the shot at the wrong time can significantly impact the success of your egg retrieval. Set alarms and double-check your instructions.
2. Incorrect dosage: Make sure you understand exactly how much medication to inject.
3. Wrong injection site: Follow your clinic's instructions carefully regarding where to administer the shot.
4. Forgetting to mix medications: Some trigger shots require mixing before injection. Make sure you understand the preparation process.
5. Not asking for help: If you're unsure about anything, don't hesitate to contact your clinic for clarification.

Potential side effects

Like all medications, the trigger shot can have side effects, although many women experience few or no side effects since it’s just one shot. Possible side effects may include:

• Injection site reactions: Redness, swelling, or mild pain at the injection site.
• Breast tenderness: Your breasts might feel swollen or sensitive.
• Feeling restless or irritable: Hormonal fluctuations can sometimes affect mood. .
• Headache: Some women report feeling headaches.
• Ovarian Hyperstimulation Syndrome (OHSS): In rare cases, the trigger shot can contribute to OHSS, a condition where the ovaries become swollen and painful. Your doctor will monitor you closely for signs of OHSS.

Most side effects, if they occur, are mild and resolve on their own. However, always inform your doctor of any side effects you experience. Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

What to expect after the trigger shot

After administering the trigger shot, you'll likely be asked to abstain from sexual activity to prevent unintended pregnancy. You may notice some increased discomfort or bloating as your eggs complete their final maturation.

Your doctor will schedule your egg retrieval procedure for approximately 34-36 hours after the trigger shot. It's important to arrive on time for this appointment, as the timing is precise!

Tips for Success

To ensure the best possible outcome with your trigger shot:

• Follow instructions carefully: Pay close attention to your clinic's instructions regarding timing, dosage, and administration.
• Create a comfortable environment: Set up a clean, well-lit area for administering the shot.
• Stay calm: If you're nervous, try deep breathing exercises or ask a friend or partner for support.
• Be prepared: Gather all necessary supplies before starting.
• Track everything: Keep a log of when you administered the shot and any side effects you experience.
• Stay in touch with your clinic: Don't hesitate to reach out if you have any questions or concerns.

At this point in your egg freezing cycle, you are nearly finished! Celebrate how far you’ve come and start making plans to treat yourself after the cycle is over.

Frequently Asked Questions

• Can I exercise after the trigger shot? It's generally recommended to avoid strenuous exercise after the trigger shot. Light activities like walking are usually fine, but consult with your doctor for personalized advice.
• What if I miss the timing of the trigger shot? If you realize you've missed the scheduled time for your trigger shot, contact your clinic immediately. They will advise you on the best course of action.
• Can I travel after the trigger shot? It's best to avoid travel between the trigger shot and egg retrieval. The timing of the retrieval is crucial, and travel could potentially interfere.
• Will the trigger shot affect a pregnancy test? Yes, the hCG trigger shot can cause a false positive on a pregnancy test for up to 14 days after administration. If you need to take a pregnancy test during this time, inform your doctor about the trigger shot.
• What happens if the trigger shot doesn't work? While rare, if the trigger shot doesn't work effectively, your doctor might cancel the egg retrieval and adjust your protocol for a future cycle.

Final thoughts

The trigger shot is a huge step in your egg freezing journey. While it might seem intimidating at first, understanding its purpose and what to expect can help alleviate any anxiety. Remember, this shot is bringing you one step closer to increasing your fertility options for the future.

As with all aspects of egg freezing, the key to success with the trigger shot is clear communication with your clinic’s team. Don't hesitate to ask questions or voice concerns. Your clinic is there to support you every step of the way.

By following your fertility doctor's instructions carefully and staying informed, you're setting yourself up for the best possible outcome. The trigger shot is more than just another injection – it's the final step before your egg retrieval, bringing you to the culmination of your egg freezing cycle!

As you prepare for your trigger shot, take a moment to appreciate the journey you're on. Egg freezing is a proactive step towards taking control of your reproductive future, and each step of the process, including the trigger shot, is a part of that empowering decision.

Key Highlights:

• Demand for egg freezing is soaring, with nearly 40% year-over-year increase in cycles from 2022 to 2023. This reflects changing priorities and greater acceptance of the procedure.
• Motivations for egg freezing evolve with age. Initially, the focus is on career and education. Later, finding a partner becomes more important. Egg freezing offers flexibility amidst these changing life goals.
• Egg freezing aligns with the broader trend of “later” parenthood, reflecting shifts in how women navigate career, relationships, and reproductive choices.

Once a niche and experimental procedure, egg freezing was limited to investigational protocols until 2013 when the American Society for Reproductive Medicine (ASRM) stated that egg freezing was no longer ‘‘experimental’’ which opened the floodgates for routine use. 

Since then, egg freezing has been proven a safe and growing option for those seeking to navigate an increasingly complex reproductive landscape. Its rising popularity reflects a shift in the cultural zeitgeist, where people are marrying and having children later in life– if at all.  

This steady growth trajectory of egg freezing cycles is evident in the 39.2% year-over-year increase in cycles reported by SART in 2023, the most recent year we have data. Over 40,000 people froze their eggs in 2023, compared to around 29,000 the previous year. This report aims to dive deeper into this trend, examining the motivations driving this demand, technological advancements, and the evolving societal implications of delayed parenthood.

Demand for egg freezing is soaring, but it’s still the early days 

The values on this graph do not represent absolute search volume. Instead they are normalized, then indexed on a scale from 1-100. Search interest looks at the percentage of searches for a topic, as a proportion of all searches during that time in the United States. Learn more about Google Trends.

Looking at a five-year Google Trends chart for how often the term "egg freezing" has been searched as a proportion of all searches in the United States reveals a sustained increase in interest over time. Beginning at a relative interest level of approximately 30, the trend exhibits consistent growth, doubling twice over the last five years. 

This upward trajectory indicates a shift in awareness and curiosity, suggesting egg freezing is moving from a specialized topic to one of broader interest and consideration. These changing search patterns may reflect enhanced awareness of the procedure, alongside evolving societal attitudes towards reproductive autonomy and delayed parenthood.

While the interest continues to grow, the actual number of egg freezing procedures is still in its infancy. Let’s consider the number of egg freezing cycles within the broader context of reproductive choices:

• There were 39,269 egg freezing cycles reported to SART in 2023
• There were over 432,641 IVF cycles reported to SART in 2023
• There are over 500,000 vasectomies (a male sterilization procedure) in the U.S. annually, with a 13% increase post-2022
• There were an estimated 1,037,000 abortions in the U.S. in 2023
• There were 3,591,328 births births in the U.S. in 2023

These figures underscore the significant gap between the increasing awareness and curiosity surrounding egg freezing, and its current utilization rate. This suggests that, while the trend is undoubtedly upward, there's substantial room for growth as financial barriers are addressed, medical technology advances and societal acceptance further solidifies egg freezing as a mainstream fertility preservation option.

Shifting priorities: what matters most to potential egg freezers

To better understand the motivations of those considering egg freezing, we surveyed over 75,000 women of reproductive age who came to our website to learn more about egg freezing. Our findings revealed distinct trends in what they considered their top priorities, trends that closely mirrored the broader societal shift toward later marriage and parenthood.

Before 28: career focus dominates  

For respondents under 28, the number one priority was establishing themselves professionally— pursuing a fulfilling career or investing in further education. These goals likely reflect a desire for financial stability and personal achievement before considering family formation.

Age 29: peak desire to travel

The urge to see the world and experience diverse cultures reached its peak for women at age 29, potentially reflecting both the excitement of discovery and a sense of freedom before focusing more intently on building a family.

Age 35+: marriage takes center stage  

By the age of 35, the desire to find a life partner eclipsed all other priorities for a significant 40% of respondents. This coincides with the increasingly common decision to get married later than previous generations, all while navigating personal and professional goals.

Timing of kids: ideal vs. reality

Interestingly, our survey showed a discrepancy between desired and anticipated age for having children. At age 20, more than half of respondents expressed a desire to have kids before 30.  However, by the age of 30, this shifted, with 63% now aiming to have children before 35. This suggests a potential disconnect between early aspirations and the realities of navigating competing priorities, potentially leading some women to consider egg freezing.

The importance of connection increases with age  

Spending meaningful time with friends and family steadily increased in importance with age. This underscores the enduring value of close relationships, offering support and a sense of belonging throughout life's transitions.

Geography influences subtle shifts  

While priorities remained broadly consistent across geographies, subtle variations emerged based on where women lived. In larger cities, the emphasis on career advancement and education was even more pronounced. Meanwhile, those living in smaller communities saw a stronger relative focus on close-knit relationships and spending time with loved ones.

City-folks showed more uncertainty around having kids 

City size significantly influenced family planning perspectives. The bigger the city, the less likely respondents were to already have children, and the more likely they were to express uncertainty about wanting kids altogether. Conversely, those in rural areas were more likely to already have children. Interestingly, regardless of location, a consistent 7% of respondents were certain they did not want children.

Trends driving the increase in egg freezing demand

Several converging trends are propelling the rise in egg freezing demand. 

Despite remaining gender bias and gender pay gaps in the workplace, women are making significant strides in their careers. Women aged 25-34 are 28% more likely to have a college degree than men the same age and outnumber men in graduate school. Three-quarters of women ages 25–54 hold down a job today, compared with slightly more than two-thirds a decade ago. This broader focus on personal and professional goals is a primary factor of growth in egg freezing services, with many women prioritizing their careers, further education, or financial stability before starting a family. Egg freezing allows them to proactively address the biological realities of declining fertility while pursuing other life ambitions. 

Additionally, shifting societal norms around marriage and parenthood offer more flexibility. In 1980, the average age of a first-time bride was 22. Today, it’s over 28. For women with a college or graduate degree, 41% and 54%, respectively, have their first child over the age 30. The traditional timeline is no longer the only path, increasing the relevance of egg freezing for those desiring the option for biological children “later” in life. Technological advancements, especially the highly efficient vitrification method, have significantly improved thaw rates, making egg freezing even more viable.

Greater visibility through media coverage and open discussions plays a significant role in driving demand. Celebrities like Priyanka Chopra Jonas, Rebel Wilson, Kristen Stewart, and Paris Hilton have spoken openly about freezing their eggs. The stigma around the procedure is lifting, leading to broader awareness, acceptance, and excitement. Additionally, expanding financial accessibility, such as employer-sponsored benefits, opens up the possibility of egg freezing to a wider demographic.

Finally, a changing social climate, including events like the overturning of Roe v. Wade, may influence women's choices. For some, the desire for greater control over their reproductive future might make egg freezing appealing as a proactive measure, ensuring future options in the face of potential uncertainty.

The future of fertility preservation

The growth trajectory of egg freezing, alongside the evolving priorities and motivations of those considering it, plays into the dynamic landscape of reproductive choice. From the increasing openness towards delaying family formation to the challenges of aligning personal timelines within a complex world, egg freezing has become interwoven with broader social and technological trends.

However, significant questions remain. Will financial accessibility or insurance coverage expand, making egg freezing a more viable option for a wider demographic? How will emerging medical technologies transform success rates and further advance the potential of fertility preservation? And, most importantly, how will shifting cultural perceptions continue shaping the conversation around motherhood, career, and individual paths in life?

As egg freezing moves further into the mainstream, the coming years will undoubtedly reveal evolving dynamics and new layers of complexity within the rapidly changing field of reproductive health.

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A note on SART data:

The Society for Assisted Reproductive Technology (SART), the association of America’s fertility clinics dedicated to the practice of assisted reproductive technologies (ART), tracks data amongst its 360 member clinics. The data generally takes 16 months from the end of the year to be published online. So, the most recent year for which we have data is 2023. 

The number of member clinics has decreased over time (in 2021, there were 453 member clinics). This could be due to clinic consolidation and/or fewer clinics opting to report data to SART. Not all fertility clinics are members of SART, so we know the numbers reported likely represent a conservative estimate of the true number of procedures performed nationally.

A note on Cofertility survey data:

Data shared is from a survey of 76,314 survey respondents ages 20-45 from August 2022 to April 2024. While a large sample size, it is not necessarily representative of all women of reproductive age in the United States, as the survey was conducted of women who came to the Cofertility website (cofertility.com/freeze) already looking for egg freezing information.
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Learn More About Egg Freezing:

• What are the Side Effects and Risks of Egg Freezing?
• A Breakdown of Egg Freezing Success Rates by Age
• Which Matters More for Fertility: AMH or Age?
• Should I Freeze Eggs or Embryos?
• Questions to Ask Your Doctor at an Egg Freezing Consultation
• Can I Freeze My Eggs If...

Maybe you’ve just begun to explore egg freezing or donation and heard about Body Mass Index (BMI) as a clinical measure of eligibility for the procedures. Or perhaps you’ve already applied to donate your eggs and were told you did not qualify on the basis of BMI. Wherever you’re at on your egg freezing or donation journey, it’s possible that your BMI may come into question. You may be wondering what one has to do with the other, and if this criteria is even legit. 

BMI is a tool that categorizes intervals of body fat based on a person’s height and weight, with the associated categories being “underweight,” “normal weight,” and “obese.” Labels we really don’t love…but are used by the medical industry nonetheless. In the case of fertility clinics, BMI is often used as a requirement for egg freezing and donation. Most clinics have set a BMI threshold, meaning women considered overweight or underweight are often disqualified from receiving fertility services without any investigation into the rest of their medical profile. Because Cofertility is a matching platform and partners with fertility clinics, their guidance is what informs our policy. 

Let’s dive into BMI as a health metric, why some clinics rely on it for fertility treatment eligibility (the TLDR: correlating anesthesia risks), and why its roots can be problematic. 

A quick primer on BMI 

The formula for calculating BMI is weight in kilograms divided by height in meters squared.

It has been widely used by medical professionals as a quick way to assess a person's overall health and risk of various health conditions, such as heart disease, diabetes, and certain cancers. Despite its imperfections as a metric (and the flaws of relying on any one measure to look at the big picture), historically, BMI has been used by the medical community to more easily identifying certain comorbidities.

Why fertility clinics take BMI into account

For better or for worse, fertility clinics — like other medical establishments — often look to BMI as one requirement when evaluating someone’s eligibility for egg freezing or donation. Here’s a bit more about the why.

What is the recommended BMI range for freezing or donating eggs?

First, let’s clarify what BMI requirements for egg freezing or donation even entail. They can vary by fertility clinic, but most criteria are based on CDC and WHO classifications of “normal weight.” At Freeze by Co, your BMI must be between 18-29 in order to qualify as a Split member — where you can freeze your eggs for free if you donate half of the eggs retrieved to another family who can’t conceive. If you feel like your BMI does not reflect your health, because you’re an athlete or otherwise, please send us a note. We also review lots of other health profile criteria as part of your application and understand that BMI is not always indicative of a person’s overall health.

If you’re a Keep member — where you can still freeze your eggs more affordably and keep 100% of them for your own future use — you may also be subject to similar BMI requirements as set out by clinic partners. It is worth noting that clinics’ BMI parameters for egg freezing may be more flexible than those for donation.

Does weight and BMI affect the retrieval cycle itself? 

It can. Probably the biggest reason fertility clinics are reluctant to conduct egg retrievals  on those outside the “normal” BMI range is that your BMI may affect your overall risk profile for the stimulation and procedure. Throughout the time that you are taking hormone stimulating meds, your doctor will monitor your ovaries through an ultrasound to measure follicle growth. Women with higher BMIs may have more abdominal tissue; thus, it can be harder for your doctor to visualize the ovaries and ensure that everything is progressing as expected. 

Further, the American Society of Anesthesiologists notes that a high BMI increases the risk of surgical and anesthetic complications. While some clinics are finding ways to safely perform the procedure under local anesthesia (eliminating many risk factors), fertility clinics don’t all necessarily have the same equipment you’d find at a hospital, and many are simply not comfortable with this risk for safety reasons. 

Women with very low BMIs may also be at risk of complications and side effects from ovarian stimulation, too. For example, some studies indicate that individuals with low BMI are at higher risk of developing Ovarian Hyperstimulation Syndrome (OHSS). 

According to Cofertility Medical Advisor, Dr. Meera Shah,"Research does suggest that obesity is associated with impaired fertility and decreased live birth outcomes with assisted reproductive technologies. Some studies have demonstrated a correlation with increased BMI and lower oocyte yield, mature eggs, and blastocyst development. Obesity may also increase procedural risks including anesthesia related complications and procedural complexity. From a clinical perspective, it is important to balance these risks with a woman's autonomy to preserve her fertility. It is important that this patient population seek extensive counseling regarding such risks and are referred to centers equipped with the resources to provide safe and compassionate care.”

Does weight and BMI affect egg retrieval outcomes? 

Maybe. A systematic review of 13 studies found that women with higher BMIs are less responsive to hormone stimulating medications. While these studies pertained to ovulation-inducing medications (like clomid) vs. medications specifically involved in egg freezing, it still indicated a potential need for higher total doses of follicle stimulating hormones for those with higher BMIs. 

Another large cohort study has shown that, relative to women of normal weight, overweight women (BMIs > 25) have fewer eggs retrieved per cycle. While we do have some data about the hormonal implications of very low BMIs — ASRM reports that very low BMIs can cause irregular menstrual cycles and may cause ovulation to stop altogether, impacting a woman’s fertility overall — evidence of the effects of low BMI on actual retrieval outcomes is more varied. We’ll continue to keep tabs on that data as it becomes available, but this heterogeneity may be due to smaller sample size of underweight groups or the influence of biological differences such as ethnicity (more on that below).

On the flipside, there is a single study on BMI and egg freezing (373 elective egg freezing cycles), which found that egg yield actually increased by 2% per increase of BMI measured. This study also illuminated the fact that the existing research on women with known infertility issues cannot be easily extrapolated to egg donors and freezers, because they are unique populations.

Does weight and BMI affect egg quality?

It can. Although there is not absolute consensus, some studies have shown that obese women can experience poorer egg quality. Because women are born with a limited number of eggs, the environment in which those eggs develop is critical. A study published in the Journal of Assisted Reproduction and Genetics stated that obesity impairs egg maturation. It can also induce elevations in insulin, glucose, or fatty free acids, all of which appear to impact the development of the egg. 

Another study done at Washington University in St. Louis looked at the effects of obesity on the egg quality of infertile women. They found:

• Oocyte quality: six studies found an adverse effect, one found no effect
• Fertilization: three studies found decreased rates, eight found no difference
• Embryo quality: two found decreased quality, two found no difference

As we review this study, though, we’ll need to remember that findings on infertile populations can’t necessarily be applied to egg freezers. Plus, fertilization and embryo quality have unrelated confounding factors like semen quality.

Why do you need a certain BMI in order to freeze or donate eggs? 

Most doctors set BMI parameters in response to data on outcomes and the complication risks shared above. In most cases, BMI limits are in place to protect your bodies and reduce the risk of complications. 

Also, when it comes to egg donation, specifically, since families needing egg donors have generally already been down a difficult, and expensive road, their doctors want to reduce any potential risks and increase chances of a successful retrieval. Given what you are putting your body through in order to stimulate and retrieve the eggs, this can be beneficial to all parties involved in the process. 

Why BMI can be a problematic metric

Clearly, there is a lot of contradictory research when it comes to BMI’s impact on fertility outcomes — our heads are spinning, too! Despite this, BMI is still widely used by fertility clinics to determine a woman’s eligibility for both freezing and donation. 

In recent years, more and more researchers and medical professionals have argued that BMI is a flawed method of body measurement. And while we need to comply with and respect the BMI parameters put in place by our clinic partners, we also have a few issues with BMI as a metric.

Looking at the full picture

As the Cleveland Clinic points out, BMI does not distinguish between excess fat, muscle, or bone mass. This means it is inaccurate in certain populations such as athletes (who have a lot of muscle mass) or those who are very tall or very short. Similarly, BMI does not provide any indication of the distribution of fat in the body. And we know that the location of body fat in someone’s body is an important variable in assessing their full health picture.

Because the freezing and donation processes follow similar steps up until the point of retrieval, the fertility clinic you ultimately work with will likely ask you about your BMI as part of the Split and Keep programs. We want you to be prepared, and while there is a push for clinics to evaluate BMI as part of the full picture, for our Split program in particular we do need to ask about BMI on our initial intake questionnaire. Reason being: we would hate for someone to spend valuable time and energy on the program’s full application, only to be told by a fertility clinic that they would not qualify for egg donation based on this metric. 

Reliance on BMI can further perpetuate racial inequities

Relying solely on BMI to assess health also has the potential to lead to increased racial bias. Although the BMI calculation was primarily based on White body types and not necessarily an appropriate measure for people of other ethnicities, Black and Latina women are more likely to face infertility than white women, and may benefit the most from fertility preservation.

Yet, because of BMI cutoffs, these populations face more obstacles when it comes to receiving fertility care. The prevalence of obesity is higher for women of color due to myriad social determinants of health and differences in body composition. Therefore, women of color are disproportionately impacted by BMI requirements. Obesity prevalence in the U.S. in 2020:

• 39.6% of white women
• 45.7% of Hispanic women
• 57.9% of Black women

This doesn’t mean that the potential egg freezing risks associated with BMI described above should be disregarded, but we should acknowledge that this data does have the potential to perpetuate racial inequities. The AMA itself even states that it has “issues with using BMI as a measurement due to its historical harm, its use for racist exclusion, and because BMI is based primarily on data collected from previous generations of non-Hispanic white populations.”

The need to preserve reproductive autonomy

If a clinic denies someone access to egg freezing services based on her weight alone, this essentially denies her the opportunity to preserve her fertility and her reproductive autonomy. Egg freezing may be even more important for people with high BMI, who are statistically more likely to struggle with infertility down the road. This can have devastating consequences for women who may want to delay pregnancy for personal or medical reasons, such as cancer treatment.

Insufficient data about BMI and egg donation

Ultimately, there is just insufficient data to make a conclusive assessment of the relationship between BMI and egg retrieval outcomes. And, when it comes to egg donation in particular, there are zero studies on the effects of BMI upon donation outcomes, since women with BMIs over 29 have largely been denied the opportunity to donate. 

So, how should we look at BMI?

The bottom line is that BMI evaluated in isolation does not provide an accurate picture of one’s overall health. And although we ask about our applicants’ BMI due to clinical compliance, we believe in improving accessibility to egg freezing for all. 

Despite being bound by clinical parameters for egg donation that we must screen for, we believe that BMI as a single measure should not disqualify someone from egg freezing or donation. Our hope is that fertility clinics instead consider patient health more holistically — in addition to taking BMI into account as one metric.

What industry governance *does* say

An ASRM committee opinion on obesity and reproduction, ASRM directly states, “Obesity should not be the sole criteria for denying a patient or couple access to infertility treatment.” Further, neither the Food and Drug Administration (FDA) nor the American Society for Reproductive Medicine (ASRM) provide specific guidance around the use of BMI. In fact, ASRM has recently voted to adopt the new AMA policy urging that “the use of BMI be in conjunction with other valid measures of risk.” 

Our hope is that fertility clinics consider these messages in assessing a patient’s overall profile. This could look like counseling and support for women who may be struggling with weight-related issues, or the exploration of alternative methods for assessing fertility, such as ovarian reserve testing. 

Moving forward, we hope that more fertility clinics focus on providing evidence-based care that is tailored to each individual’s unique needs and circumstances. One thing we can all agree on: the outcomes of holistic healthcare will always eclipse those grounded in the use of a single number. 

What are your options?

If you’ve been told you can’t move forward with egg freezing or donation due to your BMI, we know how disheartening this must feel. But this does not have to be the end of the road for you.  

If your BMI is above the appropriate range, available data suggests that as little as 5%-10% weight loss can improve fertility outcomes. Notably though, in order for weight loss to be most effective, it must be gradual and sustained. If your BMI is below the appropriate range, ASRM recommends working with your doctor to understand the cause of the situation and develop a plan to correct it. 

At Cofertility, our mission is to make egg freezing accessible, but we never want to compromise the health and safety of our members. If you’re interested in our Split or Keep programs but have concerns about your BMI impacting your eligibility, we recommend that you reach out to your doctor to discuss further. 

In addition, please don’t hesitate to reach out to us with any questions about our program qualifications. Even if you have to put your application on pause, we may still be able to help you get ahead of other requirements. And no matter what, we’ll be here for you as soon as you’re ready to move forward.

Today, more than ever, women are choosing to delay parenthood for various reasons, including focusing on career advancement, establishing financial stability, and finding the right partner. To help with this, many are turning to egg freezing, also known as oocyte cryopreservation. Egg freezing has grown in popularity, with a 46% increase in egg freezing cycles from 2020 to 2021 alone! 

If you’re considering egg freezing, you may be wondering: Is egg freezing tax deductible? Let's delve into this topic to provide some much-needed clarity.

The basics of egg freezing

Egg freezing, also known as oocyte cryopreservation, is a procedure where your eggs are extracted, frozen, and stored for later use. Because younger eggs are, on average, healthier, the egg freezing can increase your chances of conceiving a biological child in the future, even as your fertility naturally declines over time.

Despite the positive possibilities it offers, egg freezing is not an inexpensive procedure. The overall cost depends on the clinic you’re going to, where you are located, the medications you are prescribed (it differs based on your age and body), and where/how long you store the eggs. In the US in 2023, on average, the process can cost anywhere from $10,000 to $20,000 per cycle, not including annual storage fees. Thus, it's only natural for individuals to explore avenues for financial relief, such as tax deductions.

Understanding medical expense deductions

According to the Internal Revenue Service (IRS) in the United States, certain medical expenses are eligible for tax deductions. The IRS's guidelines state that one can deduct medical expenses that exceed 7.5% of one's adjusted gross income for the year. So, if you have a significant amount of qualifying medical expenses in a year, you could potentially benefit from this tax deduction.

Egg freezing and tax deductions

Is egg freezing considered a deductible medical expense? The answer is complex and largely depends on your individual circumstances. As a baseline, the IRS has traditionally considered fertility preservation treatments, like egg freezing, to be tax-deductible only when they are deemed medically necessary. This typically refers to situations where a medical condition or treatment (such as chemotherapy for cancer) could cause infertility.

When it comes to egg freezing for elective, non-medically necessary reasons (such as delaying childbearing for personal reasons), the situation becomes more nuanced. And unfortunately, as of writing this article, the IRS has not issued definitive guidance on whether egg freezing for non-medical reasons qualifies as a tax-deductible medical expense.

Given this ambiguity, if you're considering egg freezing for elective reasons, it's highly recommended to consult with a tax professional. They can provide advice tailored to your specific situation and keep you informed of any changes or updates in tax law.

Employer benefits and HSAs

Another important aspect to consider is employer-provided benefits. Some progressive employers are starting to cover egg freezing as a part of their employee benefits package, in which case the question of tax deduction might be moot.

If you have a Health Savings Account (HSA) or a Flexible Spending Account (FSA), you might be able to use these pre-tax dollars to pay for egg freezing. However, the rules surrounding these accounts are complex and constantly evolving, so you’ll want to check with your plan administrator or a tax professional to ensure that this is a viable option for you.

Freeze your eggs for less – or even for free – 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:

1. Our Split program offers women a chance to freeze their eggs for free when donating half of the eggs retrieved to a family who cannot otherwise conceive. 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.
2. Our self-pay Keep program allows women to freeze their eggs and keep them all for their future use. Through Keep, we offer our members partnerships and discounts to lighten the financial load of egg freezing, as well as access to our member community. An important note: even if you do have insurance or benefits coverage through work, you’re still able to participate in the Keep program. We’ll work with you to make sure all of your care is handled in a way that you remain eligible for the associated benefits. 

The benefits 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.

Summing it up

Egg freezing is an empowering choice for those who want to preserve their eggs for future use. However, its high cost can be a barrier. While certain tax deductions may apply for medically necessary procedures, the applicability of tax deductions for elective egg freezing is less clear. You’ll want to seek personalized advice from a tax professional to understand your options fully. 

In the quest to make egg freezing more accessible, every avenue of financial relief counts. As the conversation surrounding egg freezing continues to evolve, so too may the tax implications. It’s an ever-changing landscape that we’ll be keeping a close eye on moving forward.