egg freezing

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 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 a 30% year-over-year increase in cycles. 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.
• While booming interest suggests a massive growth trajectory, the number of egg freezing cycles remains relatively small compared to other reproductive procedures.
• 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 30% year-over-year increase in cycles reported by SART in 2022, the most recent year we have data. Over 29,000 people froze their eggs in 2022, compared to a little over 22,000 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 nearly 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 29,083 egg freezing cycles reported to SART in 2022
• There were 389,993 IVF cycles reported to SART in 2022
• There are over 500,000 vasectomies (a male sterilization procedure) in the U.S. annually
• There were over 900,000 abortions in the U.S. in 2019
• There were 3,661,220 births in the U.S. in 2022

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 368 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 2022. 

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...

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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. 

Freezing your eggs can be a major expense. With most clinics and egg freezing companies, the cost of freezing your eggs can run between $10,000 - 20,000, including upfront consultation costs and the retrieval process. Once the retrieval is complete, you can expect to pay an additional storage fee, which ranges depending on the clinic or facility. 

We believe the best time to freeze your eggs is when you can least afford it. While we provide more affordable — even free! — egg freezing options, if you do not qualify for our Split program, where you can freeze your eggs for free when you give half to another family who can’t conceive, we’ve still lightened the financial load of egg freezing with partnerships and discounts as part of our Keep program. That said, we always recommend taking a closer look at the fine print of your health insurance policy to see what you’re entitled to.

As of June 2022, there are 20 states in the US that have laws on the books requiring health insurance companies provide some type of coverage for infertility. However, for those looking to be proactive about their fertility and freeze their eggs without an infertility diagnosis, coverage is even more sparse.

In a 2020 study tracking the coverage of employer sponsored fertility benefits, Mercer discovered that just 42 percent of employers with 20,000 or more employees provide coverage for IVF. Unfortunately, those numbers drop significantly for those looking to help offset the cost of proactive egg freezing, with just 19 percent of employers in that same size employee pool providing coverage. 

If you don’t live in a state with mandated fertility coverage (or work for one of the 19 percent of large companies that include egg freezing as part of their benefit package) there are a few things you need to know about how your health insurance policy stacks up when it comes to freezing your eggs. 

Your health insurance may cover some costs

According to the journal Dovepress, the process of freezing your eggs is called vitrification. There are several steps involved in completing the vitrification process. While your insurer may cover parts of this process (like some basic blood work) other parts may require you pay out of pocket (like the cost to store your eggs after they’ve been frozen). 

• Consultations: You will likely have a sit down meeting with your doctor to discuss your fertility plans. If your insurance covers fertility procedures like having your eggs frozen, your insurer may cover these types of visits in full. If they're not covered you may need to foot the bill for a portion of the visit like a co-pay.       
• Blood tests and lab work: You’re going to have to have to undergo a few different types of tests throughout the process of freezing your eggs to monitor important things like the quantity and quality of your eggs (ovarian reserve testing), as well as an  ultrasound of your ovaries (to check their function), and screens that will confirm your overall health (which include a variety of tests including routine lab work like a Complete Blood Count). 
• Medications: Typically your doctor will prescribe synthetic hormones to help manage your ovulation. There are a few different different types of medication used, depending on what stage of the process you're in, including drugs that can help your ovaries produce multiple eggs ahead of the retrieval and ones that will prevent premature ovulation so that you and your medical team can get the timing of your retrieval just right.      
• Retrieval: Once it's time for your egg retrieval, you'll do this on-site as an outpatient procedure where you go home the same day. You'll be under anesthesia for this procedure, requiring the expertise of a few different medical professionals.   
• Storage fees: After your eggs have been successfully retrieved they will need to go into storage. Depending on the type of facility you used for your retrieval, this may be handled by them or taken care of by a third party.

Questions to ask your insurer

To get the best picture of what your insurance covers when you freeze your eggs you should call your benefit hotline to ask a few key coverage questions like: 

• Are all of my medical consultations covered, especially if I meet with a few different facilities before choosing one?
• Do I have to have a diagnosis or preexisting condition to have any portion of freezing my eggs covered?
• How does the coverage for freezing my eggs factor into my lifetime limit for fertility treatment? 
• Does my coverage change depending on whether the retrieval was successful? 
• Will you cover any of the ongoing costs of freezing my eggs (like storage) and is there a time limit on how long that coverage lasts?
• What are my coverage options if I decide to use my eggs later on?

Making freezing your eggs more affordable

Through our Split program, members are able to freeze their eggs for free when they give half to another family in need of donated eggs. This could include LGBTQ+ parents, couples with infertility, or those with other fertility-impacting medical conditions. 

If you’d rather keep all of the eggs from your retrieval, our Keep program still offers a more affordable way of freezing your eggs when your insurance won’t cover the total cost. Depending on where you live, some of the benefits of Keep may include lower medication costs, egg storage fees, and discounted consultations discounts. 

Summing it up

Through most avenues, egg freezing can be pretty cost prohibitive. We’re excited to change this, while supporting reproductive choice for all women and helping intended parents seeking egg donation to help complete their families.  

Anti-Mullerian hormone (AMH) is a hormone produced by the follicles in the ovaries (the fluid filled sacs that contain eggs). It requires a simple blood draw and is most often used as a marker of ovarian reserve. Ovarian reserve is the term for the number of healthy eggs left in your ovaries. Since people with ovaries are born with a fixed number of eggs, this number naturally declines over time. 

A low AMH level is usually related to natural aging, but it can also have other causes. In this article, we’ll explore what a low AMH result means and answer some common questions that can come up.

AMH and its role in fertility

So what exactly can AMH tell you about your fertility? As mentioned, your AMH level is positively correlated with the number of follicles you have in your ovaries. Simply put, the more follicles you have, the higher your AMH level typically is. As a result, AMH levels have been shown to be a good predictor of ovarian reserve and someone’s expected response to fertility treatments. 

In fact, several studies have shown that there is a strong correlation between what your AMH level is and the number of mature eggs retrieved during an egg freezing or in vitro fertilization (IVF) cycle. To learn more about those studies, check out AMH and Egg Retrieval Outcomes. 

What your AMH level can’t tell you is the exact number of eggs you have left in your ovaries or what your chances of pregnancy are. There are a number of other factors like your age, overall health, and genetics that also affect the number and quality of eggs and your overall fertility. So while AMH can be a useful tool in assessing your fertility, it shouldn’t be the only factor when making decisions about fertility treatments.

What is a low AMH result?

As with most things in medicine, there’s no absolute answer here. What is considered a low, normal, or high AMH level depends on your age and the lab where you take the test. Since there is no international standard, it’s best to use the reference ranges that come with your test results.

In general, an AMH between 1.0 and 3.5 ng/mL is considered to be in the “normal” range, which means you’re likely to have a good response to fertility treatments. Anything below 1.0 ng/mL is considered low and a sign of a declining ovarian reserve.

What does a low AMH mean?

Having a low AMH level can be a sign that your ovaries are making less of the preantral follicles. The lower the number of follicles, the lower your ovarian reserve is. 

So what does this mean in terms of fertility?

First, having a lower AMH does not automatically mean you aren’t ovulating regularly or that you won’t be able to get pregnant naturally or with assisted reproductive technologies. However, research has found that what AMH is good at predicting is the response to ovarian stimulation and the number of eggs retrieved, regardless of a person’s age. So, someone with a higher AMH is generally expected to be able to get more eggs in one cycle than someone with a lower AMH. Because of this, fertility doctors typically use AMH levels (along with other information) to figure out the drugs and dosages you’ll need to maximize your response to ovarian stimulation medications. 

If you’re trying to conceive naturally, you’ll be glad to hear that multiple studies have shown that AMH does not correlate with how likely you are to actually get pregnant. In fact, one study looked at levels of AMH, FSH, and another ovarian hormone, inhibin B and tracked people for a year. They found that there was no correlation between someone’s ovarian reserve and their ability to conceive and that a low ovarian reserve was not associated with lower fertility. As a result, they did not recommend the use of FSH or AMH levels to “assess natural fertility.”

Reasons AMH would be low

There are a few reasons that could explain a low AMH. Let’s explore them.

Natural decline with aging

By far, the most common reason for a low AMH is age. People with ovaries are born with all the eggs that they’re going to have in their lifetime. These eggs are then slowly used up over time as you ovulate during each menstrual cycle until menopause is reached. As a result, ovarian reserve naturally decreases over time, meaning the AMH level also decreases. 

Hormonal birth control

Research suggests that hormonal birth control may affect AMH levels but it depends on the type of birth control. Specifically, birth control use is associated with a lower average AMH level than for people who are not on birth control, with the exact effect depending on the type of birth control. 

The amount of time you’re on birth control may also be a factor. Multiple studies have shown that AMH doesn't change if you use combined oral contraceptive pills for less than six months. However, you may have a lower AMH if you’ve been a long-term user of the pill (or other hormonal methods). Thankfully, this is temporary – AMH levels typically rebound after a person stops using birth control.

You can learn more about birth control and AMH here.

Tobacco use

Studies have shown that tobacco use, usually cigarette smoking, decreases AMH levels. This effect appears to be reversible though–it was only seen in people who were active smokers, not people who had previously smoked. 

Less common causes 

There are several other, less common causes for a low AMH level. These include:

• Genetic disorders that affect the X chromosome.
• Medical treatments like radiation or chemotherapy.
• Having surgery on your ovaries.
• Losing one or both of your ovaries.
• Autoimmune conditions.

Can I still donate my eggs with a low AMH?

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

What to do if you have a low AMH result

Finding out you have a low AMH can be disheartening, especially if you had future fertility plans that you’re worried may be affected. While there’s unfortunately not much that can be done to reverse a low AMH, there is still hope for starting a family someday even with a low AMH. With the exception of birth control or cigarette smoking, most studies have shown that lifestyle changes like diet or supplements have an insignificant effect on AMH levels but despite this, I promise it’s not all gloom and doom. 

Let’s go through a few things you can do as you move forward with this new information. 

Lean on your village

The first thing to do is take a deeeeeep breath… There are a lot of nuances involved here which can make it hard not to get lost in the weeds. Fertility is impacted by so many different things that you can drive yourself crazy trying to manage all of them. 

Having friends, family, and mental health specialists available to support you when you need it is going to be crucial. Navigating fertility is hard no matter what, so having people around you who you can lean on on bad days and celebrate with on good days will help immensely. 

Consult a fertility specialist

Speaking of your village, it should definitely include a fertility specialist. Consulting with a fertility doctor can help you better understand your reproductive health and provide guidance on any concerns or questions you may have. They’ll be able to review your specific options and work with you on a plan that helps you reach your family-building goals. This treatment plan will depend on a lot of things including how soon you want to have a child, how many children you want to have, your finances, and your desire to have a child who is genetically related to you. 

So does this mean I have to freeze my eggs ASAP?

This is typically the first question people ask and the answer is not necessarily. As mentioned before, there are many other factors involved in assessing your fertility and modern technology has allowed for advances that make family building a possibility for virtually everyone. Your fertility specialist will be able to discuss all the options for starting a family based on your unique family-building goals. This could certainly include freezing your eggs for later use but it could also mean trying to conceive unassisted, undergoing IVF with your own eggs or with donor eggs, using a gestational carrier, or even options beyond these. Again, this is something that will require you to examine your personal goals and work with your provider to figure out the best way to reach them. 

You are not a number

Repeat after me: you are more than one number! Your AMH level provides valuable insights into your ovarian reserve, but it’s just one piece of the puzzle when it comes to your fertility. AMH is always used as part of a full fertility evaluation, which often includes information about your medical history and age, a partner semen analysis, an ultrasound of the pelvis, an x-ray of the uterus and fallopian tubes, and/or additional lab work.

If that sounds like a lot, it is. This process can be overwhelming but focusing on the things that you can control can help you feel more grounded during your fertility journey, whatever that may look like.

How Cofertility can help

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

In our Keep program, you can freeze and store your eggs for your own future use, with lower prices on things like storage and medication. as well as our team’s support and access to our community.In addition, you’ll have access to our team’s support and access to our community where you can engage with other people freezing their eggs at the same time! 

Your journey is uniquely yours and our team is here to help you through it in whatever way you need.

If you're considering or embarking on the path of egg freezing, you may have come across the term "Antral Follicle Count" (AFC) during your research. AFC is a crucial tool in assessing ovarian reserve and predicting the success of fertility treatments, including egg freezing. In this article, we delve into the world of AFC, exploring its significance, measurement techniques, and its role in optimizing your egg freezing journey.

In this comprehensive guide, we will walk you through the intricacies of AFC. We'll discuss what an antral follicle is, how AFC is measured, and what a normal AFC looks like based on age. Additionally, we'll explore the relationship between AFC and the egg freezing process, shedding light on how this information can guide and optimize your fertility journey.

What is an antral follicle?

Antral follicles are small fluid-filled sacs found within the ovaries that contain immature eggs. These follicles serve as the building blocks of our fertility. Each month, a group of antral follicles starts developing in response to hormonal signals. Among this group, one follicle becomes dominant and eventually releases a mature egg during ovulation.

How do you measure AFC?

There’s only one way to measure the antral follicle count: through a transvaginal ultrasound, which allows for a close examination of the ovaries. During this procedure, a specialized ultrasound probe is inserted into the vagina to visualize the ovaries and count the number of antral follicles present in both ovaries (the definition of antral follicles varies across fertility clinics. Some clinics count follicles that measure 2–10 mm in diameter, while others focus on follicles ranging from 3–8 mm). 

The AFC measurement is typically taken during the early follicular phase of the menstrual cycle when the antral follicles are at their most visible and measurable state. But it can be done anytime of the cycle.

What can an antral follicle count test tell you?

The antral follicle test holds a wealth of valuable information that can shed light on your reproductive health. So, what exactly can an antral follicle test tell you?

Ovarian reserve assessment 

The number of antral follicles detected during the test directly correlates with your ovarian reserve. This information can help your fertility doctor understand the quantity of follicles remaining in your ovaries in relation to your age. As we age, the number of antral follicles typically decreases, reflecting a decline in ovarian reserve. Understanding this relationship can help in making decisions about family planning and fertility preservation options. Learn more about ovarian reserve here.

How your body would respond to egg freezing

Antral follicles are a key determinant of how your ovaries will respond to ovarian stimulation during fertility treatments such as egg freezing. In fact, AFC correlates directly with the number of eggs retrieved at egg collection. By assessing your AFC, your healthcare team can tailor the stimulation protocol to optimize your chances of success.

Best timing for egg freezing 

The antral follicle count can also assist in determining the ideal timing for initiating fertility treatments. By assessing the AFC, your fertility doctor can guide you on the optimal time to start treatments, maximizing your chances of a successful outcome.

Premature ovarian failure (POF)

POF, also known as premature menopause, refers to the loss of ovarian function before the age of 40. Antral follicle testing can help in the diagnosis of POF by revealing a significantly reduced antral follicle count. A diminished AFC can indicate a decline in ovarian reserve, which is a characteristic feature of POF. This information is crucial in understanding the reproductive potential and considering appropriate fertility treatment options for individuals with POF.

Polycystic ovary syndrome (PCOS) 

PCOS is a common hormonal disorder that affects women of reproductive age. It is characterized by hormonal imbalances, irregular menstrual cycles, and the presence of multiple small follicles on the ovaries. Antral follicle testing plays a vital role in assessing PCOS by revealing an increased number of small antral follicles during the scan. This high AFC, along with other diagnostic criteria, helps in confirming the presence of PCOS and guiding appropriate management strategies.

The antral follicle test is a powerful tool in assessing your fertility health, but it is just one piece of the puzzle. It should be considered alongside other diagnostic measures and discussions with your fertility doctor to form a comprehensive understanding of your fertility health.

What is a normal AFC by age?

The normal range of antral follicle count can vary depending on your age. In general, younger women tend to have a higher number of antral follicles, indicating a larger ovarian reserve. As a woman ages, the number of antral follicles naturally declines, reflecting the diminishing ovarian reserve.

While the specific numbers can vary, a typical AFC for a woman in her 20s and early 30s may range between 10-20 follicles, in her late 30s around 8-15 follicles, and by her 40s, it could further decline to under 10 follicles. It's important to remember that these numbers are approximate and can vary based on individual factors such as genetics and overall reproductive health.

One study of infertile women looked at exactly how antral follicle count declines with age, finding the median AFC to be:

• 14 at age 25
• 12 at age 30
• 10 at age 35
• 8 at age 40
• 6 at age 45

AFC and egg freezing

When it comes to assessing ovarian reserve and predicting the number of eggs that can be retrieved during egg freezing, the antral follicle count (AFC) is a very helpful biomarker. It may even be the most important of ovarian reserve measures. A meta-analysis of 11 studies found that the AFC scan was as accurate as using multiple markers to predict ovarian response to stimulation. AFC outshined its counterparts like anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) as the predictor of ovarian response to egg freezing stimulation. 

So, when it comes to determining the potential success of your egg freezing journey, keep an eye on AFC. It can guide you through the uncertainties and help your healthcare team tailor the stimulation protocol to maximize your chances of a fruitful outcome. 

What does low AFC mean?

A low AFC can indicate a lower ovarian reserve and may have implications for fertility. When the AFC is low, it suggests that there are fewer follicles available in the ovaries, which can impact the number of eggs that can be retrieved during fertility treatments such as egg freezing.

But having a low AFC does not necessarily mean that pregnancy is impossible, but it may suggest that the response to ovarian stimulation during fertility treatments could be lower than average. With fewer follicles available, there may be a reduced number of mature eggs that can be retrieved for fertilization. This can affect the overall success rates of fertility treatments, as the quantity and quality of eggs play a crucial role in achieving a successful pregnancy now or down the line.

Remember that AFC is just one piece of the fertility puzzle, and other factors such as age, hormone levels, and overall reproductive health matter. 

What does high AFC mean?

A high AFC typically indicates a greater ovarian reserve and can be a positive indicator of fertility health. When the AFC is high, it suggests that there are a larger number of antral follicles present in the ovaries, which can potentially result in a higher number of eggs available for retrieval during egg freezing.

Having a high AFC is generally associated with a better response to ovarian stimulation during fertility treatments. With more follicles available, there is a greater likelihood of obtaining a larger number of mature eggs for fertilization. This can potentially increase the chances of success in achieving a pregnancy now or down the line.

A high AFC alone does not guarantee pregnancy or fertility success. Other factors such as the quality of the eggs, age, overall health, underlying reproductive conditions – as well as the health of the sperm – can also influence fertility outcomes. 

AFC is just one piece of the puzzle

The antral follicle count is a valuable tool in the realm of fertility assessment. By providing information about your ovarian reserve, it assists in predicting the response to ovarian stimulation and guides decisions regarding fertility preservation options like egg freezing. 

The AFC measurement, combined with other diagnostic tests and a thorough evaluation of an overall reproductive health, helps paint a comprehensive picture of your fertility health. Armed with this knowledge, you can make informed choices about your reproductive journey and take proactive steps towards preserving your fertility and achieving your family planning goals.

You are not a number

With all the nuances involved here, it’s important not to get lost in the weeds. Fertility is impacted by so many factors that you can drive yourself crazy trying to manage all of them. Remember, you are more than any number. This process can be overwhelming, but focusing on the things that you can control can help you feel more grounded during your fertility journey, whatever it may look like.

Cofertility is here to help you every step of the way on that journey.

Our Split program allows qualified people between 21 to 34 years old (with an AMH of 2+) to have the chance to freeze their eggs for free when donating half of the eggs retrieved to a family that can’t otherwise conceive.

Or, if you’re over 34, you can still participate in the Keep program up to age 40. In the Keep program, you’re able to freeze your eggs and keep them all for yourself, on your timeline. In addition, you’ll have access to our online support community, the Nest. This valuable resource lets you engage with other people freezing their eggs at the same time!

Whatever your journey looks like, our team is here to guide you through it and keep your family-building options open.

Sources:

• Antral Follicle. Science Direct. URL
• Verhagen TE, Hendriks DJ, Bancsi LF, et al. The accuracy of multivariate models predicting ovarian reserve and pregnancy after in vitro fertilization: a meta-analysis. Hum Reprod Update 2008;14:95–100. URL
• CAROLE GILLING-SMITH, STEPHEN FRANKS, CHAPTER 28 - Ovarian Function in Assisted Reproduction, The Ovary (Second Edition), Academic Press, 2004, Pages 473-488, ISBN 9780124445628, https://doi.org/10.1016/B978-012444562-8/50029-X. URL‍
• Almog B, Shehata F, Shalom-Paz E, Tan SL, Tulandi T. Age-related normogram for antral follicle count: McGill reference guide. Fertil Steril. 2011;95(2):663-666. doi:10.1016/j.fertnstert.2010.08.047 URL

Anti-Müllerian hormone (AMH) has gained significant attention in the field of reproductive medicine as a valuable marker of ovarian reserve. It provides insight into egg quantity and can be useful in assessing fertility health and predicting the chances of egg freezing success. 

However, there are certain medications that can potentially influence AMH levels, raising questions about the accuracy and interpretation of AMH testing while on them. In this article, we will explore the relationship between medications and AMH levels, shedding light on the impact of specific drugs and discussing their implications for women's reproductive health.

What is AMH?

AMH is a hormone produced by the cells within ovarian follicles. Its primary role is to promote the growth and development of follicles. AMH levels are generally stable during the menstrual cycle, making it a reliable marker for assessing ovarian reserve. It is measured through a simple blood test and has become an important tool in fertility evaluations and treatment planning.

What causes AMH to change?

AMH levels naturally decline as we age. The highest levels of AMH are typically found in women during their early reproductive years, and the levels gradually decrease as we approach menopause… making age the most common reason for AMH to change.

But there are other reasons AMH may change over time. The most common reason is simply age. Since AMH is considered a reliable marker of ovarian reserve, which refers to the quantity of eggs remaining in the ovaries, this hormone naturally decreases as we get older.

Certain medical conditions, such as ovarian tumors, can also affect AMH levels. Additionally, treatments like chemotherapy or radiation therapy that target the ovaries can significantly reduce AMH levels.

While the direct impact of lifestyle factors on AMH levels is not yet fully understood, some studies suggest that factors such as smoking, obesity, and extreme exercise may be associated with lower AMH levels. However, more research is needed to establish definitive conclusions.

Lastly, certain medications can impact AMH levels. For example, oral contraceptives and drugs like clomiphene citrate used in fertility treatments can temporarily decrease AMH levels. On the other hand, supplements like DHEA (dehydroepiandrosterone) and vitamin D have been associated with increased AMH levels. We’ll go more into detail about these below.

Remember that individual variations exist, and AMH levels should be interpreted in conjunction with other fertility assessments to gain a comprehensive understanding of your reproductive health. If you have concerns about your AMH levels or fertility, it's best to consult with a fertility doctor for personalized guidance and recommendations.

What medications can affect AMH levels?

Several medications have been found to influence AMH levels, potentially complicating its interpretation as a marker of ovarian reserve. Here are some examples:

Oral birth control 

Oral contraceptives are commonly used for birth control and to regulate menstrual cycles. Studies have suggested that oral contraceptive use may lead to decreased AMH levels in the short term.

One study compared the AMH levels of 228 hormonal contraception users and 504 non-users. They found that users of birth control had 29.8% lower AMH concentrations. Because of this, the authors concluded that AMH may not be an accurate predictor for women using hormonal contraception.

You may want to consider the timing of the AMH test when using hormonal contraceptives. Estrogen can suppress the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are necessary for the development and maturation of follicles. 

As AMH levels are influenced by FSH and LH, you could wait for a few weeks after discontinuing birth control before measuring AMH levels for a more accurate assessment of ovarian reserve. Or, you could take the test knowing the results may be lower due to birth control. It’s best to discuss this with your doctor.  

Metformin

Metformin is a medication commonly used in the treatment of polycystic ovary syndrome (PCOS), a complex endocrine disorder associated with metabolic and reproductive disturbances, and for managing insulin resistance. Research has shown that metformin use may be associated with decreased AMH levels.

Clomiphene Citrate

Clomiphene citrate (brand name Clomid©), is a medication used to stimulate ovulation in women who are trying to conceive. Similar to metformin, clomiphene citrate has been associated with decreased AMH levels. When undergoing fertility treatments involving clomiphene citrate, you’ll want to take this potential impact into account when interpreting AMH results.

What supplements can affect AMH levels?

Dehydroepiandrosterone (DHEA)

DHEA is a natural hormone that can be converted into other hormones in the body, including testosterone and estrogen. Some studies have suggested that supplementation with DHEA may lead to increased AMH levels. These findings suggest that certain nutritional interventions may have a positive effect on ovarian reserve.

Vitamin D

Vitamin D is essential for overall health and has been linked to various biological processes in the body, including reproductive health. Some research indicates that vitamin D supplementation may lead to increased AMH levels. However, more studies are needed to fully understand the relationship between vitamin D and AMH levels.

Is there anything I can take to increase AMH levels?

While there are medications and supplements that have been associated with changes in AMH levels, the impact of these medications is typically temporary or specific to certain conditions. 

Currently, there is no definitive medication or treatment specifically designed to increase AMH levels. However, there are lifestyle factors that may positively influence overall reproductive health, such as maintaining a healthy weight, adopting a balanced diet, managing stress levels, and avoiding smoking and excessive alcohol consumption. These lifestyle choices can contribute to optimal ovarian function and potentially support healthy AMH levels.

Summing it up

AMH testing has revolutionized our ability to assess ovarian reserve and guide fertility treatment decisions. However, it's crucial to consider the potential influence of certain medications on AMH levels. Understanding how specific drugs and supplements may affect AMH results can help you interpret the findings accurately and make informed decisions about fertility treatments. 

Remember that these effects are usually temporary or specific to certain conditions. It's always best to consult with your fertility doctor who can provide personalized guidance based on your specific situation. 

Better yet, focusing on maintaining a healthy lifestyle, managing stress levels, and adopting a balanced diet can contribute to overall reproductive health and support optimal ovarian function. By staying informed and working closely with your healthcare team, you can navigate the complexities of AMH testing and make informed decisions about your fertility journey.

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Cofertility is a human-first fertility ecosystem rewriting the egg freezing and egg donation experience. With our Freeze by Co platform, women can freeze their eggs for free when they donate half of the retrieved eggs to a family who can’t otherwise conceive. We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive.

In the world of reproductive health and fertility, there is a growing interest in understanding the quantity of eggs a woman has, also known as ovarian reserve. The concept of measuring ovarian reserve has gained popularity as more people seek to assess their fertility potential and make informed decisions about family planning. 

But can you truly measure how many eggs you have? Let's delve into the world of ovarian reserve testing and explore the possibilities and limitations.

How many eggs do females have?

Females are born with approximately one to two million oocytes, and it only goes down from here since no new eggs are made. But here's where it gets interesting.

Once we reach puberty, a process triggered by a complex interplay of hormones, only about 300,000 of these oocytes will remain. These precious few will have the opportunity to mature and potentially be released as eggs during our reproductive years. Our bodies typically release just one egg per menstrual cycle, and this process occurs approximately 400 times throughout our lifetime.

These remaining oocytes are not merely passive bystanders. Each one resides within a protective structure called a follicle, where it lies dormant and suspended in the middle of a cell division. Remarkably, the lifespan of an egg is one of the longest among the body's cells. However, this extended duration can also increase the chances of damage and genetic abnormalities as we age.

At menopause, which is defined as one year after your last menstrual period, the pool of remaining oocytes steadily declines until none remain. This natural process signifies the end of our reproductive years.

Understanding the intricacies of egg development and the limited supply available underscores the importance of considering fertility and family planning at an earlier age. Each egg is a precious resource, and its quality and viability can impact the chances of achieving a successful pregnancy. Exploring fertility preservation options, such as egg freezing, can provide women with greater control over their reproductive future.

While the numbers presented here provide a general understanding, it's crucial to remember that everyone’s ovarian reserve is unique. Factors like genetics, lifestyle, and overall health can influence the rate of egg loss and fertility potential. 

Egg count and age

As stated above, females are born with one to two million eggs. By puberty, only about 300,000 of these oocytes will remain. After starting the menstrual cycle, we lose about 1,000 immature eggs every month… meaning by age 37 there are around 25,000 eggs remaining. And by menopause, no more eggs remain.

Here is a rough chart of what this could look like for an individual. Keep in mind that everyone starts with a different number of eggs, and everyone’s rate of decline varies. This chart is just to give you an idea of what this egg count could look like: 

Measuring egg reserve (aka ovarian reserve)

Ovarian reserve refers to the number of eggs remaining in a woman's ovaries at a given time. It is one indicator of a woman's reproductive health, and can help guide fertility treatment decisions. The idea of quantifying ovarian reserve has gained significance as women strive to gain insights into their fertility and make proactive choices about their reproductive journey. And at the same time, at-home tests make it easier to measure your ovarian reserve.

Keep in mind that the number of eggs you have does not necessarily equate to your ability to conceive. Other factors, such as egg quality, the presence of any reproductive disorders, and the overall health of the reproductive system, play significant roles in fertility. Not to mention the health of the sperm! Some people have lower ovarian reserve but still achieve successful pregnancies, while others with a seemingly healthy ovarian reserve may face challenges in conceiving.

How to measure ovarian reserve

One of the most commonly used methods to measure ovarian reserve is through a blood test that evaluates specific hormone levels. These hormones include anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol. AMH, in particular, has emerged as a reliable marker of ovarian reserve, as it reflects the number of small follicles in the ovaries that contain immature eggs. Low levels of AMH may indicate a diminished ovarian reserve, while higher levels may suggest a larger pool of eggs.

While ovarian reserve testing provides valuable insights, it is not a crystal ball that can predict fertility outcomes with absolute certainty. Ovarian reserve is just one piece of the fertility puzzle, and other factors such as egg quality, uterine health, and sperm quality also play crucial roles in the conception process. Additionally, fertility is influenced by various external factors, including age, lifestyle, and underlying health conditions.

Fertility testing can provide a snapshot of ovarian reserve at a specific moment in time. Ovarian reserve naturally declines with age, and the number of eggs available for fertilization decreases over time. Therefore, it's crucial to interpret the results in the context of your age and overall health.

Egg reserve testing methods

Another consideration when evaluating ovarian reserve is the variation in testing methods and reference ranges used by different laboratories. Each laboratory may have its own set of standards and measurements, which can lead to variations in results. You may want to consult with a fertility doctor who is knowledgeable in reproductive medicine to interpret the test results accurately and provide personalized guidance (if you work with Cofertility, we can help you set this up).

So, can you measure exactly how many eggs you have?

While ovarian reserve testing can provide valuable information, determining the exact number of eggs a woman has remaining in the ovaries is not possible. 

Why? First of all, the number of eggs in the ovaries is not static but rather dynamic and constantly changing. We are born with a finite number of eggs, and this number gradually declines over time through a process called follicular atresia. This natural process of egg loss occurs throughout our reproductive years, and the rate of decline varies from person to person.

Second, the accuracy of measuring the exact number of eggs is hindered by the limitations of current medical technology. While imaging techniques like ultrasound can visualize the presence of ovarian follicles, they cannot precisely determine the number of eggs within each follicle. Additionally, even if the number of follicles can be counted, it does not equate to the exact number of eggs, as not all follicles contain a viable egg.

Ovarian reserve is just one piece of the puzzle

While ovarian reserve testing can provide valuable information, it is just one tool in the broader landscape of fertility assessment. A fertility doctor can consider your medical history, conduct a physical examination, measure your antral follicle count, and may recommend additional tests or imaging studies to provide a comprehensive assessment of your reproductive potential.

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Cofertility is a human-first fertility ecosystem rewriting the egg freezing experience. With our Freeze by Co platform, women can freeze their eggs for free when they donate half of the retrieved eggs to a family who can’t otherwise conceive. We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive.

If you are considering starting a family or have concerns about your fertility, understanding the concept of ovarian reserve is essential. Ovarian reserve refers to the quantity of eggs (oocytes) available for fertilization. It serves as a key indicator of your reproductive potential and can play a crucial role in fertility treatment decisions. 

In this guide, we will delve into the topic of ovarian reserve, exploring its significance, how it is assessed, factors that affect it, available options for optimizing fertility, and emotional considerations related to fertility journey.

First off, what does your ovarian reserve mean?

Simply put, your ovarian reserve is your fertility potential, which is influenced by a variety of factors, including age, genetics, and certain medical conditions.

As we age, our fertility naturally declines. This is totally normal, and due to fewer eggs in the ovaries, a decrease in egg quality, and an increase in chromosomal abnormalities of the remaining eggs. These collective factors contribute to lower pregnancy rates and higher miscarriage rates as we approach age 40.

While the decline in fertility happens to ALL of us, the specific age when we can no longer conceive varies from individual to individual. And in some cases, it may be earlier than we expected.

To assess your fertility potential, including your ovarian reserve, several tests are available that can give us clues to our reproductive capabilities. These tests can also help fertility doctors, like myself, evaluate the likelihood of successful pregnancy, and guide you in making informed decisions regarding family planning and fertility treatments.

How do I know my ovarian reserve?

If you want to know your ovarian reserve, it’s best to set up time for a fertility assessment with a fertility doctor (reach out – we can help with this!). 

There are two ways a doctor can help assess your ovarian reserve, including:

Blood hormone tests

Hormone tests, including follicle-stimulating hormone (FSH), estradiol, luteinizing hormone (LH), anti-Müllerian hormone (AMH), and estradiol, provide valuable information about ovarian function and egg supply. While AMH can be taken any time, FSH and LH are typically performed on specific days of the menstrual cycle to obtain accurate results.

Antral follicle count

Transvaginal ultrasound is used to visualize the ovaries and count the number of antral follicles present. Antral follicles are small, fluid-filled sacs that contain immature eggs. The count of antral follicles serves as an indirect indicator of ovarian reserve.

By combining the results of hormone tests and ultrasound assessments, we can estimate your ovarian reserve and provide insights into fertility potential.

What is a normal ovarian reserve?

Determining what constitutes a “normal” ovarian reserve involves comparing your results to established reference ranges for your age. Age-specific reference ranges serve as benchmarks to evaluate your ovarian reserve relative to peers of the same age group. Keep in mind that ovarian reserve will gradually decline for everyone – it’s the timing and pace of change that differs. 

For example, in younger women, a higher number of antral follicles (small fluid-filled sacs containing immature eggs) and lower levels of certain hormones like FSH may be considered within the normal range. However, as a woman ages, it is expected that the number of antral follicles will decrease and hormone levels, such as FSH, may increase.

While age is a significant factor, other individual factors should also be taken into account when interpreting ovarian reserve results. Factors such as medical history, previous fertility experiences, underlying medical conditions, and fertility goals play a role in assessing the overall fertility potential. These additional factors can influence the interpretation of ovarian reserve results and help guide fertility treatment decisions tailored to the specific needs of the individual.

What causes decreased ovarian reserve?

Decreased ovarian reserve can result from various factors, including:

• Age: As we age, the quantity and quality of eggs naturally decline. The aging process gradually reduces the quality of eggs and ovarian reserve, making it more challenging to conceive.
• Smoking: Cigarette smoking has been linked to a higher rate of diminished ovarian reserve. Chemicals in tobacco smoke can accelerate the depletion of eggs and negatively impact ovarian function.
• Cancer treatment: Some cancer treatments, such as chemotherapy and radiation therapy, can have damaging effects on the ovaries. These treatments may cause a decrease in ovarian reserve and compromise fertility.
• Pelvic Surgery: Surgical procedures involving the ovaries or other pelvic organs can inadvertently damage or remove ovarian tissue. This can lead to a decrease in ovarian reserve and potentially affect fertility.
• Autoimmune diseases: Certain autoimmune conditions, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis, can impact ovarian function and diminish ovarian reserve.
• Genetic conditions: Certain genetic disorders, such Fragile X syndrome, and other chromosomal abnormalities, can be associated with decreased ovarian reserve. These conditions may affect the development and function of the ovaries.

While these factors are known to contribute to diminished ovarian reserve, individual experiences vary. You may have none of the above conditions, and still face premature ovarian failure (POF). Or you may have one of the above factors, and have no problems at all getting pregnant. Sometimes, it just comes down to luck.

What does it mean if I have a high ovarian reserve?

A high ovarian reserve refers to a situation where there is an abundant number of eggs in the ovaries. While ovarian reserve naturally declines with age, certain factors can contribute to a higher ovarian reserve in some people.

One factor associated with a high ovarian reserve is younger age. Those in their 20s and early 30s generally have a higher number of eggs compared to those in their 40s, resulting in a larger ovarian reserve. Additionally, genetic factors can influence ovarian reserve, and some may have a naturally higher number of follicles and eggs in their ovaries.

Another factor that can contribute to a higher ovarian reserve is polycystic ovary syndrome (PCOS). PCOS is a hormonal disorder that can lead to the development of multiple small follicles on the ovaries. Those diagnosed with PCOS often have a higher number of immature follicles in their ovaries, which can translate into a higher ovarian reserve.

While a high ovarian reserve can be advantageous for fertility, it does not guarantee successful conception or a higher chance of pregnancy. Other factors, such as egg quality and hormonal balance, also play significant roles in achieving pregnancy.

At-home ovarian reserve tests

There are at-home options for ovarian reserve testing. However, keep in mind that most fertility doctors will want to re-do these tests. So taking a test at home, may mean paying for a test twice.

Here are some options:

• Natalist Women’s Fertility Test ($149) measures 5 hormones: estradiol, LH, FSH, TSH, and total testosterone. You can save 20% with code COFERTILITY20
• LetsGetChecked Ovarian Reserve Test ($139) measures 1 hormone, AMH. You can save 25% with code COFERTILITY25

Ovarian reserve and egg freezing

Ovarian reserve plays a significant role in the process of egg freezing, also known as oocyte cryopreservation. Egg freezing involves the retrieval and freezing of your eggs for future use, preserving your fertility potential at a younger age. 

Assessing ovarian reserve before undergoing egg freezing is crucial for determining the quantity of eggs available for freezing. Those with a higher ovarian reserve generally have a greater number of eggs suitable for freezing, increasing their chances of successful future pregnancy. 

On the other hand, those with diminished ovarian reserve may have fewer eggs available for freezing, necessitating careful consideration of the potential outcomes and options. Understanding your ovarian reserve provides valuable information to help guide the egg freezing process and optimize the chances of achieving successful future pregnancies when the frozen eggs are thawed and used in assisted reproductive techniques.

Freeze your eggs with Cofertility

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

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

The benefits for of working with Cofertility include:

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

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

The concept of family planning has evolved tremendously since our grandparents were in their reproductive years. Women are starting families later than ever. The latest U.S. Census Bureau figures show that, for the first time, the average age of women giving birth is now 30 in the U.S., the highest on record.

Couple this with tremendous progress in reproductive technologies, including egg freezing, and more women are opting to explore their career aspirations and personal growth before starting a family. 

But what if you’re not sure if you want kids? In this article, we will explore the ins and outs of egg freezing, helping you navigate the decision-making process and understand if it is the right choice for you.

You are not alone

To delve into this topic, we asked over 16,000 women without kids aged 21-40 their perspectives on family planning. Our survey revealed fascinating insights into the desires and uncertainties regarding family planning. Among the respondents, 69% expressed a desire to have children in the future, while 25% remained uncertain and 6% firmly stated they did not want children. Women ages 21-25 were most likely to be unsure, whereas women ages 31-34 were most likely to answer yes. 

What exactly is egg freezing anyhow

Okay so what is egg freezing exactly? Egg freezing, known as oocyte cryopreservation in the medical world, is a technique used to preserve someone’s fertility.  Eggs are collected from the ovaries and frozen so they can be used in the future. If the person is unable to get pregnant unassisted in the future, the eggs are thawed and used in an assisted reproductive technology (ART) procedure, like in-vitro fertilization (IVF). Whether you know you want to have kids or you aren’t sure and want to give yourself more time to figure it out, think of egg freezing as a way to keep your options open for the future.

To freeze or not to freeze, that is the question

When trying to decide if you should freeze your eggs, it’s important to know that egg freezing is not an “insurance policy” for your fertility. While egg freezing can take some of the stress of having a baby right now off your shoulders, it is not a guarantee that you’ll have a baby in the future. 

Why not? Well, for one, not all the eggs that get frozen will actually be viable. It’s expected that some eggs will not survive the warming process when it comes time to use the eggs. In addition, the chances of the eggs that do survive being successfully fertilized depends on a variety of factors, including how old you were when you froze them (more on this later). 

This is not to sway your decision one way or another. Ultimately, only you and your doctor can decide if egg freezing is the right decision for you. But it's important to go in knowing that it’s not meant to be a done deal. As egg freezing has gotten more popular, many companies will gloss over this fact. We don't think that's right and want to be straight with you from the outset.

Freezing your eggs when you’re unsure if you want kids

Perhaps the biggest benefit of egg freezing is that it puts the decision-making power entirely in your hands. Whether you’re freezing your eggs because you want to focus on your career or you’re about to undergo medical treatment that may affect your fertility later on, or you’re waiting to find the right partner, freezing your eggs allows you to preserve some of your fertility independently. 

While you might not be sure about having kids today, if you do decide you want kids down the road, especially if you’re in your mid- to late-thirties, having eggs on ice will increase the chances that you’re able to do so.

If I freeze my eggs, will it harm my fertility?

Freezing your eggs does not affect your ability to get pregnant otherwise. The egg freezing process and retrieval procedure simply rescue eggs that would have died with your next menstrual cycle. This means egg freezing does not affect your ovarian reserve (the number of eggs in your ovaries). Once you’ve completed the full process, your body will continue to ovulate and release an egg each month like normal.  

What happens to the eggs if I don’t use them?

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

• Keep them in storage. Most storage facilities offer long-term storage options, allowing you to keep your eggs frozen for many years if necessary. This may be a good option if you're not yet ready to use the eggs but want to keep them as a backup plan. If you freeze your eggs with Cofertility, our storage partner offers our members exclusive long-term storage rates up to 80% less than what you’d see with individual clinics. 
• Donate the eggs to someone else who may need them. Egg donation is a process of donating eggs to another person or couple who needs them, such as LGBTQ+ families or those suffering from infertility. This can be a wonderful gift for those who may not be able to have a child otherwise.
• Discard them.  If you decide that you no longer need your frozen eggs and don't want to continue storing them or donate them, simply request that they are disposed of by the clinic or storage facility.
• Donate to science. Many research studies rely on donated eggs to investigate new techniques and treatments for infertility. Ask your clinic if this is an option.

Know this: most people do not regret freezing their eggs

We looked at five studies on egg freezing. The rates of regret reported in these studies varied, likely due to the sample size, study design, and the follow-up period. However, taken together, these studies suggest that the vast majority of those who freeze their eggs have zero regrets.

There also appear to be factors that reduce the chances of regret, including feeling fully informed beforehand, and getting adequate support during the egg freezing process. In other words, if you take the time to think things through and feel supported throughout the journey, you’re less likely to regret making this decision for yourself.

Freeze your eggs with Cofertility

Whether you know you want kids or you’re still figuring it out, we’d love the opportunity to support you on your egg freezing journey. 

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

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

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

The benefits for of working with Cofertility include:

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

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

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Commonly asked questions

How do you decide if you want to freeze your eggs?

The decision to freeze one's eggs is deeply personal and multifaceted. Factors to consider include personal goals, relationship status, career aspirations, financial stability, and overall health. Seeking guidance from a fertility clinic, discussing your concerns and aspirations, can help you make an informed decision aligned with your values and future plans.

Is egg freezing right for me?

While egg freezing is an empowering option, it’s not for everyone. Factors such as age, ovarian reserve, and overall health play a role in determining the success of the procedure. A consultation with a fertility clinic will assess your individual circumstances and help determine if egg freezing is the right choice for you. (If you work with Cofertility, we can connect you with a fertility clinic for a consult).

What are my egg freezing options?

There are several egg freezing options available, including Cofertility's Split program. This innovative initiative offers the opportunity to freeze your eggs for free when you donate half of them to a family that could not otherwise conceive. This program not only provides a free egg freezing option, but also offers the chance to make a positive impact on others' lives.

What age should you freeze eggs before?

Age is a crucial factor when considering egg freezing. Generally, the quality and quantity of eggs decline with age, making earlier freezing more advantageous. Fertility experts recommend considering egg freezing before the age of 35 to optimize the chances of success. Read more in What’s the Best Age to Freeze My Eggs?

Can I freeze my eggs and have kids later?

Yes, egg freezing can offer a viable path to future motherhood. When you decide to use your frozen eggs, they can be thawed, fertilized with sperm through in vitro fertilization (IVF), and transferred to your uterus for pregnancy. While the success of pregnancy depends on various factors, including the quality of the eggs, freezing them increases the likelihood of having biological children later in life.