egg freezing

This article was medically reviewed by Dr. Samuel Pang

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More than half of transgender men (those who were assigned female at birth and identify as a male) say they want children one day. But those who are considering or have undergone hormone replacement therapy (HRT) or gender affirming surgery may wonder about their future ability to have biological children. In this article, we’ll review how egg freezing works, and if it’s possible for transgender men.

Egg freezing for transgender men

Egg freezing, also known as oocyte cryopreservation, is a process that involves extracting and freezing eggs for potential use in future. Before extracting the eggs from your ovaries, they are matured using hormonal stimulation for about two weeks. This leads to increased estrogen hormone levels, which may be difficult for some transgender men as it can exacerbate gender dysphoria. 

The extracted eggs can then be cryopreserved and stored for many years, and when you’re ready to become a parent, the cryopreserved eggs can be thawed, inseminated with sperm in a laboratory.  This is known as in vitro fertilization (IVF). If the eggs fertilize successfully and develop into embryos, the embryos may potentially be transferred into the uterus attempt to achieve pregnancy. This may be your uterus, the uterus of your partner, or a gestational carrier (surrogate). 

It is important to note that not all cryopreserved eggs will survive the freeze/thaw process and only those which survive can be inseminated with sperm.  Furthermore, not every egg that is inseminated will fertilize successfully and not every egg which fertilizes will develop into an embryo which is suitable for transfer into the uterus.  And not every embryo that is transferred into the uterus will result in a successful pregnancy or live birth of a healthy baby.  In other words, freezing 10 eggs does not mean that you can have 10 babies.  Freezing your eggs provides you with the opportunity to have biological children, but does not guarantee that you will definitely be able to have biological children from the frozen eggs.

When is the best time to freeze my eggs, before or after transitioning?

It is generally recommended to freeze your eggs before you start hormone therapy or undergo any gender-affirming surgeries, as these treatments can affect your egg production and quality.

In fact, the World Professional Association for Transgender Health (WPATH) and Endocrine Society both recommend that all transgender patients be counseled on options for fertility preservation (egg freezing) prior to transition. The American Society of Reproductive Medicine (ASRM) also put out a statement that providers should offer fertility preservation counseling to individuals before gender transition.

Can I freeze my eggs if I’ve started transitioning?

It may still be possible to freeze your eggs after transitioning, but it largely depends on the medical procedures you have had done. We’ll discuss those in more detail below. 

Can I freeze my eggs if I have started hormone therapy?

If you have already started hormone therapy, such as testosterone (T) therapy, it may still be possible to freeze your eggs. However, your doctor will likely recommend discontinuing testosterone before you proceed with the egg freezing process.  

Stopping hormone therapy, even temporarily, is easier said than done. Transgender men who stop testosterone to freeze their eggs have reported both physical and mental difficulties. These challenges can include fatigue, alterations in voice and body odor, and the return of menstruation, potentially leading to feelings of increased femininity and heightened gender dysphoria.  This is one of the reasons why it is preferable to freeze your eggs before you start  testosterone therapy.

While it has traditionally been recommended that transgender men go off testosterone to freeze their eggs, this may be changing. In 2022, UCSF reported that two transgender men were able to have their eggs retrieved without stopping testosterone. The researchers suggested more studies to confirm the findings, because it is unknown what impact the on-going use of testosterone may have had on these eggs, and whether these eggs will ultimately result in viable embryos or healthy children.  We may not have answers to these questions for many years.

How does testosterone (T) therapy impact fertility?

Testosterone (T) therapy affects fertility by leading to an anovulatory state and amenorrhea, meaning you no longer ovulate or have menstrual periods. But this is usually reversible when you stop testosterone (T) therapy. 

While more research is needed, one study from Boston IVF found that transgender men who froze their eggs have just as good outcomes as cisgender patients. More than half of the transgender male patients in the study had been on testosterone (T) therapy before egg freezing, and all of them stopped taking testosterone for an average of four months before starting their treatment cycle.

Another study out of Israel found the same thing: there was no difference in the number of eggs retrieved between transgender men and cisgender women. The authors concluded, “Transgender men have an excellent response to ovulation stimulation even after long-term exposure to testosterone.” 

One study from Boston IVF found that transgender men who froze their eggs have just as good outcomes as cisgender patients.

Can I freeze my eggs if I’ve had gender affirming surgery?

It depends on what was involved in the surgery. If the ovaries were removed (an oophorectomy or total hysterectomy), you will not be able to freeze your eggs. This is because egg freezing requires the ovaries to produce mature eggs, which are then retrieved and frozen for potential use in future. If the ovaries have been removed, then egg freezing is no longer an option.

However, if you have not had your ovaries removed, egg freezing may still be an option.

Can transgender men get pregnant?

Say you freeze your eggs now and are wondering if you can still get pregnant down the line. Transgender men who have a uterus may be able to become pregnant and carry a pregnancy to term. This is because testosterone therapy does not usually have an irreversible impact on the uterus. However, you would need to discontinue testosterone therapy in order to be pregnant, as you cannot take testosterone during pregnancy.  In addition, transgender men would face the same issues as cisgender women in becoming pregnant and carrying a healthy pregnancy, like age and overall health. 

Even if you cannot or do not want to become pregnant, it is still possible to have a genetic tie to your future child by freezing your eggs. Those eggs can potentially be fertilized and cultured into embryos in an IVF laboratory, following which they can then be transferred either to the uterus of a partner or a gestational surrogate to carry the pregnancy. 

What is ovarian tissue cryopreservation?

Ovarian tissue cryopreservation is an experimental technique involving the removal and freezing of a small piece of ovarian tissue from the ovary. The frozen tissue can later be thawed and transplanted back into the body, allowing the ovaries to produce eggs and potentially enabling the patient to conceive a biological child. This strategy has mostly been used to preserve fertility potential in cisgender women who need to undergo treatment for cancer which would negatively impact the eggs in the ovaries.

While ovarian tissue cryopreservation is still considered an experimental technique, it has shown promising results in several studies and has already resulted in at least 60 live births worldwide.

We can help you freeze your eggs

If you’re interested in freezing your eggs, it is important to find a doctor who can provide sensitive and affirming care for your journey. Our Freeze by Co platform makes egg freezing more accessible, and we can help connect you with our partner fertility clinics that have experience working with transgender men. Learn more.

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In recent years, egg freezing has become an increasingly popular option for those who wish to preserve their fertility. In fact, in 2021 alone, egg freezing cycles surged by a staggering 46%, marking a stunning upward trend that has quadrupled since 2017.

While the process of egg freezing has improved dramatically over the years, there is still some concern about whether those who choose this option will regret their decision later on, especially given the high price tag. There have been several studies and surveys that shed some light on if people show regret after freezing their eggs. In this article, we will explore the findings of these studies and ultimately help you answer the question: Will I regret freezing my eggs?

First off, what is regret?

Regret is a negative emotion that arises from the perception that a different choice or action might have resulted in a better outcome. In the context of choosing to do egg freezing, regret could stem from a variety of factors.

One possible cause of regret could be related to the decision-making process itself. Those who feel pressured to freeze their eggs by societal or familial expectations, rather than making an informed choice based on their own personal values and priorities, may be more likely to experience regret. Similarly, those who do not fully understand the risks, benefits, and limitations of the procedure, or who have unrealistic expectations about its success rates or the ease of future pregnancy, may be more likely to regret their decision.

Another possible cause of regret could be related to the actual experience of undergoing the egg freezing process. Patients who experience physical discomfort, emotional stress, or financial strain as a result of the procedure may be more likely to feel regret. Similarly, those who feel that they were not adequately supported or informed throughout the process, or who experienced complications or unexpected outcomes, may be more likely to regret their decision.

While some people do regret egg freezing, the vast majority have no regrets (more on that below). In my conversations with hundreds of women in their 30s and 40s, I have heard more regret from those who did not freeze their eggs than those who did.

Let’s take a look at six studies on the topic

We looked at six studies around the world that retrospectively surveyed egg freezers about their experience. Here are the summaries: 

1. To freeze or not to freeze: decision regret and satisfaction following elective oocyte cryopreservation

The study: A 2018 retrospective survey of 201 patients who froze their eggs at UCSF between 2012 and 2016. The researchers surveyed them at various intervals after their egg freezing procedure to assess their satisfaction with the decision and whether they experienced any regrets.

Key findings: Overall, the study found that the vast majority of egg freezers (81%) reported no regret at all.  And 89% affirmed they will be happy they froze eggs, even if they never use them.

2. What do reproductive-age women who undergo oocyte cryopreservation think about the process as a means to preserve fertility?

The study: A retrospective survey of 183 patients who froze their eggs between 2005-2011 at New York University Fertility Center. The researchers sought to better understand the beliefs, priorities, and attitudes toward egg freezing and to track the reproductive paths of women who chose to undergo oocyte cryopreservation treatment.

Key findings: Most (79%) of the women reported that they wished they had undergone egg freezing at an earlier age. Half of the patients (53%) believed that the experience was empowering, 36% found it empowering as well as anxiety producing, and only 6% believed that it was purely anxiety producing.

3. Perceptions, outcomes, and regret following social egg freezing in the UK; a cross-sectional survey

‍The study: A retrospective survey of 85 patients who froze their eggs between 2008-2018 at a UK fertility clinic. The aim of this study was to investigate the motivations of women who have undergone social egg freezing, identify their perceptions following treatment, and assess potential feelings of regret.

Key findings: 91% had no regrets over their decision to undergo social egg freezing.

4. Decision regret and associated factors following oocyte cryopreservation in patients with diminished ovarian reserve and/or age-related fertility decline

The study: A cross-sectional survey study of 162 patients with diminished ovarian reserve (DOR) and/or age-related fertility decline who froze their eggs between 2014 and 2019 in two clinics in Istanbul, Turkey.

Key findings: Egg freezing does not seem to cause high decisional regret. In the study, 31% had no decision regret, 52.5% had mild regret, and 16% had moderate to severe decision regret.

5. Assessing the quality of decision-making for planned oocyte cryopreservation

The study: A retrospective survey study of 98 patients who froze their eggs between 2012 and 2018 at a Canadian academic IVF center. Researchers aimed to examine the quality of egg freezing decision-making in the domains of decision change, decision difficulty, decision regret, and informed choice.

The findings: The vast majority (88%) of egg freezers said it was a good decision. 61% said they would have made 'exactly the same' decision without any change, and 35% would have made a 'similar' decision, but with option-related changes and process-related changes. Some stated their only regret was not doing it sooner.  

6. Exploring women’s attitudes, knowledge, and intentions to use oocyte freezing for non-medical reasons: A systematic review

The study: This 2020 systematic review by researchers in the UK analyzed 35 studies (including a few of the studies above) explored women's experiences of elective egg freezing. 

Key findings: The review found that those who froze their eggs tended to report high levels of satisfaction with the decision, and only a small portion felt regret after freezing their eggs. Those who said they received more adequate information and emotional support during egg freezing were less likely to report regret.  

Most people do not regret freezing their eggs

As you can see, the rates of regret reported in these studies vary, and may have depended on factors such as 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 do not have regret. And there appear to be factors that reduce the chances of regret, including feeling fully informed beforehand, and getting adequate support during the egg freezing process. 

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Those who regret egg freezing had a few things in common

It's worth noting that the patients who experienced regret tended to have certain characteristics in common. For example, they were more likely to be over 37 years of age, single, and have no children. Additionally, those who froze their eggs for non-medical reasons (such as to delay childbearing for career or personal reasons) were more likely to experience regret than those who did so for medical reasons (such as prior to cancer treatment).

However, it's important to note that the vast majority of patients in these studies did not experience any regret after freezing their eggs. Furthermore, many of the patients who did experience regret reported that it was temporary and ultimately resolved over time. In fact, the UCSF study found that 89% of the women who reported regret at the one-year follow-up no longer felt that way at the three-year follow-up.

Reducing the chances of regret 

It's worth noting that these studies are several years old, and the process of egg freezing has improved significantly in recent years, making it an even more viable option. Advances in technology, like vitrification, have made it possible to freeze eggs more effectively and with a higher success rate. 

When deciding whether to freeze your eggs, it's important to consider your own unique circumstances and goals. Do as much homework as possible (our blog is a great resource!) so you feel prepared and empowered. Studies also have shown that having a support system decreases the chances of regret. If you freeze your eggs with Cofertility, we’ll make sure you have all the support you need.

Freeze your eggs with Cofertility

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.

Regardless which program you join, we offer:

• Our Freeze by Co community: a safe space to connect with others freezing their eggs at the same time. 
• Education: Our library of resources provides proactive education around fertility, hormones, egg freezing, and egg donation that women can’t find anywhere else. We believe knowledge is power, especially when it comes to our bodies and our options.
• Empowerment: By making egg freezing easier and more accessible, our programs further strengthen the American Society of Reproductive Medicine (ASRM)’s Committee Opinion that egg freezing can help promote social justice and strengthen equality of men and women.

Summing it up

The decision to freeze one's eggs is a deeply personal one that comes with a range of emotions, risks, benefits, and limitations. While the possibility of regret is possible, it's helpful to remember that the majority of those who undergo egg freezing do not experience this regret. 

If we can be helpful on your journey, don’t hesitate to reach out!

OHSS, or Ovarian Hyperstimulation Syndrome, is a rare but potentially serious complication of egg freezing and egg donation. OHSS occurs when the ovaries become swollen and painful as a result of the hormonal medications used to stimulate egg production during fertility treatment. If you are considering egg freezing or donation, you may be wondering if you are at risk for OHSS. In this article, we will discuss everything you need to know.

What is OHSS?

OHSS is a condition that can occur as a result of fertility treatment, particularly after egg freezing. During this treatment, patients receive hormonal medications to stimulate the ovaries to produce multiple eggs for retrieval. In some cases, the ovaries may become overstimulated and produce too many eggs, causing them to become swollen and painful.

OHSS is a rare complication of egg freezing, but it can be serious if left untreated. In some cases, OHSS can lead to hospitalization and require medical intervention. Severe OHSS can cause complications such as blood clots, kidney failure, and fluid buildup in the lungs.

Ultrasound image of severe OHSS (Source)

How common is OHSS?

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). 

The incidence of OHSS has decreased over the years due to a better understanding of the risk factors and evidence-backed data on how to prevent OHSS. 

How do you know if you are at risk for OHSS?

The risk of developing OHSS depends on several factors, including: 

• Previous history of OHSS in past cycles
• High number of follicles during treatment puts you at an increased risk of developing OHSS
• Medications: The dosage and duration of hormonal medications can impact the chances of developing OHSS
• Age: Patients under the age of 30 are at a higher risk of developing OHSS 
• Low body weight puts you at a higher risk of developing OHSS
• Polycystic ovary syndrome (PCOS) increases your risk of developing OHSS due to the increased sensitivity to fertility medications
• Elevated hormone levels, including elevated serum estradiol (E2) concentrations and increased anti-Mullerian hormone (AMH) levels are risk factors for OHSS

Ask your doctor if they think you might be at higher-than-average risk for OHSS. If you are at high risk of OHSS, they may choose a specific protocol which utilizes the leuprolide trigger instead of hCG, which can prevent OHSS. Another medicine called cabergoline also can help reduce the fluid accumulation, or they may give you extra IV fluids at the time of egg retrieval. Most clinics will do extra monitoring of patients at risk of OHSS to decrease the risk of complications.

How many follicles put you at risk of OHSS?

Follicles are small sacs in the ovaries that contain eggs. During fertility treatment, patients are given medications to stimulate the ovaries to produce multiple follicles, which can increase the chances of achieving pregnancy down the line. However, when too many follicles develop, the risk of OHSS increases.

Ultrasound scans and blood tests are used to monitor the number and size of follicles, as well as hormone levels. There is no set number of follicles that puts you at risk of developing OHSS, as the risk varies depending on other factors such as age, body weight, and response to medications. However, as a general guideline, having more than 20 follicles on an ultrasound scan is considered a high risk for OHSS. If you are deemed to be at high risk of developing OHSS, your doctor may adjust your medication dosages or cancel the cycle to prevent OHSS from developing.

There is no set number of follicles that puts you at risk of developing OHSS. However, as a general guideline, having more than 20 follicles on an ultrasound scan is considered a high risk for OHSS.

Symptoms of OHSS after egg retrieval

Most people who undergo egg freezing do not develop OHSS. For those who do, the severity of the symptoms can vary from mild to severe and may include:

• Abdominal pain or discomfort: Patients with OHSS may experience abdominal pain or discomfort, which can range from mild to severe. This pain may feel like bloating, cramping, or a fullness in the abdomen.
• Bloating and fluid retention: OHSS can cause fluid to accumulate in the abdomen, leading to bloating and a feeling of fullness. Patients with OHSS may also experience swelling in the hands and feet due to fluid retention.
• Nausea and vomiting: Some patients with OHSS may experience nausea and vomiting, which can be caused by the swelling of the ovaries and the accumulation of fluid in the abdomen.
• Difficulty breathing: In severe cases of OHSS, the accumulation of fluid in the abdomen can cause pressure on the diaphragm, making it difficult to breathe.
• Rapid weight gain: People with OHSS may experience rapid weight gain due to the accumulation of fluid in the abdomen and other parts of the body.
• Decreased urine output: OHSS can cause a decrease in urine output, which can be a sign of dehydration and electrolyte imbalances.
• Fatigue: Patients with OHSS may experience fatigue, which can be caused by the body's response to the hormonal medications and the strain on the body's systems.

If you are undergoing egg freezing and experience any of these symptoms, it is important to contact your clinic immediately. Early recognition and management of OHSS can help to prevent the condition from worsening and ensure the best possible outcome.

How long after the egg retrieval are you at risk for OHSS?

The risk of OHSS typically peaks around five to ten days after egg retrieval. During this time, the hormones that were used to stimulate your ovaries to produce multiple eggs are still in your system, and your ovaries may continue to produce hormones even after the eggs have been retrieved. This can lead to excessive fluid accumulation and swelling in the body.

If you have undergone egg retrieval, it is important to be aware of the signs and symptoms listed above and report any concerns to your clinic right away.

Can you prevent OHSS after an egg retrieval?

Fertility doctors can identify your risk factors and take action to reduce your chances of getting OHSS in the first place. But there are also steps you can take to help prevent OHSS after egg retrieval. Here are some tips:

• Stay hydrated: Drinking plenty of fluids, especially electrolyte-rich fluids like coconut water or gatorade, can help flush out excess hormones and prevent dehydration, which can contribute to the development of OHSS. Aim for at least eight to ten glasses per day, or as directed by your doctor.
• Eat a high protein diet: A healthy, high protein diet is an important component of preparing for egg freezing.
• Rest and avoid strenuous activity: After the egg retrieval, it is important to take it easy and avoid activities that could increase your risk of developing OHSS. This includes exercise, lifting heavy objects, and sexual activity. Your doctor will likely recommend that you rest for at least 24 to 48 hours after the procedure.
• Monitor your symptoms: Be aware of the signs and symptoms of OHSS, such as those listed above. If you experience any of these symptoms, contact your clinic right away.
• Take prescribed medications as directed: Your doctor may prescribe medications, such as pain relievers or hormone supplements, to help prevent OHSS after egg retrieval. It is important to take these medications as directed and not to skip any doses.
• Attend follow-up appointments: Your doctor may schedule follow-up appointments to monitor your progress and check for signs of OHSS. Attend these appointments as scheduled and report any symptoms or concerns you may have.

While OHSS can be a serious complication, taking these steps can help reduce your risk and ensure the best possible outcome after egg retrieval. Be sure to discuss any concerns or questions you may have with your doctor, as they can provide personalized recommendations based on your individual needs and medical history.

How is OHSS treated?

Mild cases of OHSS can usually be treated with rest, increased fluid intake, and pain medication. More severe cases may require hospitalization and treatment with intravenous fluids, electrolyte replacement, and other supportive measures.

If you develop mild to moderate OHSS, your clinic may recommend close monitoring to ensure that your symptoms do not worsen. This may involve regular check-ins, blood tests, and ultrasounds to track your progress and check for signs of complications.

One of the most important treatments for OHSS is rest and hydration. This can help relieve symptoms such as bloating, abdominal pain, and nausea, and prevent complications such as dehydration and blood clots. Your doctor may recommend bed rest and increased fluid intake, and may also prescribe medications to manage your symptoms.

Your doctor may also prescribe medications such as pain relievers, anti-nausea medications, and diuretics (medications that help remove excess fluid from the body) to manage your symptoms and prevent complications. In some cases, medications such as cabergoline or GnRH agonists may be used to reduce the production of hormones that contribute to OHSS.

If you do develop severe OHSS, you may need to be hospitalized for close monitoring and treatment. In the hospital, you may receive intravenous fluids and medications, and may undergo procedures such as paracentesis (the removal of excess fluid from the abdomen) to relieve symptoms and prevent complications.

Does OHSS affect egg quality?

OHSS is caused by an overstimulation of the ovaries with fertility medications, which can lead to a higher number of eggs being produced than normal. However, the quality of those eggs is usually not affected by the presence of OHSS. In fact, one small study of 42 patients who developed severe OHSS during IVF found that while the fertilization rate was lower, the quality of embryos and the pregnancy rate were the same. 

The quality of the eggs retrieved during egg freezing is more dependent on your age and other factors, such as hormonal imbalances or underlying medical conditions. 

Does OHSS mean more eggs?

OHSS may mean more eggs, but only because having more eggs means a higher chance of OHSS. One of the main causes of OHSS is the use of medications called gonadotropins, which stimulate the ovaries to produce multiple eggs. Patients who produce a large number of eggs, usually more than 20, are at a higher risk of developing OHSS. 

In some cases, OHSS may indicate that a patient has produced a larger number of eggs than average. However, this is not always the case. Mild to moderate cases of OHSS can occur even when fewer than 10 eggs are retrieved.

Keep in mind that the number of eggs retrieved is not always an indicator of success. Other factors, such as the quality of the eggs, your age, and your overall health can all have an impact on the success of the treatment.

The goal of egg freezing is to produce a sufficient number of high-quality eggs for fertilization down the line, while minimizing the risk of complications such as OHSS. If you are undergoing egg freezing and have concerns about the number of eggs or the risk of developing OHSS, it is important to discuss your options with your doctor. They can provide guidance on the best course of action based on your individual circumstances and can help you make informed decisions about your fertility journey.

Summing it up

Egg freezing is becoming an increasingly popular option for those who want to preserve their fertility for future use. This process involves harvesting and freezing your eggs, which can then be thawed and used down the line when you are ready to start a family. However, like any medical procedure, egg freezing is not without its risks. One potential complication that can occur during the process of egg retrieval is OHSS.

While OHSS is a potential risk of egg freezing, the good news is that it is a relatively rare complication. Plus, the risk of OHSS can be reduced by carefully monitoring your response to the fertility medications and adjusting the dosage as needed. If you are worried about OHSS, we recommend talking to your doctor to discuss what can be done to reduce the risk.

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References:

1. Aboulghar M. Prediction of ovarian hyperstimulation syndrome (OHSS). Estradiol level has an important role in the prediction of OHSS. Hum Reprod. 2003 Jun;18(6):1140-1. doi: 10.1093/humrep/deg208. PMID: 12773437.
2. Fiedler K, Ezcurra D. Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment. Reprod Biol Endocrinol. 2012 Apr 24;10:32. doi: 10.1186/1477-7827-10-32. PMID: 22531097; PMCID: PMC3403873.
3. Kol S, Itskovitz-Eldor J. Severe OHSS: yes, there is a strategy to prevent it! Hum Reprod. 2000 Nov;15(11):2266-7. doi: 10.1093/humrep/15.11.2266. PMID: 11056117.
4. Namavar Jahromi B MD, Parsanezhad ME MD, Shomali Z MD, Bakhshai P MD, Alborzi M MD, Moin Vaziri N MD PhD, Anvar Z PhD. Ovarian Hyperstimulation Syndrome: A Narrative Review of Its Pathophysiology, Risk Factors, Prevention, Classification, and Management. Iran J Med Sci. 2018 May;43(3):248-260. PMID: 29892142; PMCID: PMC5993897.
5. Nelson SM. Prevention and management of ovarian hyperstimulation syndrome. Thromb Res. 2017 Mar;151 Suppl 1:S61-S64. doi: 10.1016/S0049-3848(17)30070-1. PMID: 28262238.
6. Sansone P, Aurilio C, Pace MC, Esposito R, Passavanti MB, Pota V, Pace L, Pezzullo MG, Bulletti C, Palagiano A. Intensive care treatment of ovarian hyperstimulation syndrome (OHSS). Ann N Y Acad Sci. 2011 Mar;1221:109-18. doi: 10.1111/j.1749-6632.2011.05983.x. PMID: 21401638.
7. Soave I, Marci R. Ovarian stimulation in patients in risk of OHSS. Minerva Ginecol. 2014 Apr;66(2):165-78. PMID: 24848075.
8. Sun B, Ma Y, Li L, Hu L, Wang F, Zhang Y, Dai S, Sun Y. Factors Associated with Ovarian Hyperstimulation Syndrome (OHSS) Severity in Women With Polycystic Ovary Syndrome Undergoing IVF/ICSI. Front Endocrinol (Lausanne). 2021 Jan 19;11:615957. doi: 10.3389/fendo.2020.615957. PMID: 33542709; PMCID: PMC7851086.

Vaping has become a popular alternative to traditional smoking in recent years. But while it’s been marketed as a healthier option, the long-term effects of vaping are still not fully understood. One area of concern is the impact of vaping on fertility, especially for those who are considering freezing their eggs for future use. In this article, we’ll dive into the research on if vaping is okay for egg freezing and donation.

Impact of vaping on fertility

Several studies have found that vaping can have negative effects on reproductive health, including decreased fertility and increased risk of miscarriage. According to the American Society of Reproductive Medicine (ASRM), infertility rates in male and female smokers are twice as high as infertility rates among nonsmokers, with infertility rates rising with the number of cigarettes smoked daily. The main ingredients in e-cigarette liquids, such as nicotine and propylene glycol, have been shown to have toxic effects on the ovaries and the eggs they contain.

Nicotine has been shown to reduce the quality and quantity of eggs in the ovaries. It can also lead to decreased blood flow to the ovaries, which can negatively impact the development of the follicles, the structures in the ovaries that contain the eggs. Despite needing more medication during the egg freezing process, smokers often have fewer eggs available for retrieval during an egg freezing cycle, as well as 30% lower pregnancy rates compared with nonsmokers.

Propylene glycol, another common ingredient in e-cigarette liquids, has been shown to have a toxic effect on the ovaries and eggs. The same study has linked propylene glycol to oxidative stress, which can lead to damage to the eggs and decreased fertility. In addition, propylene glycol has been shown to cause DNA damage, which can affect the quality of the eggs.

How vaping may affect egg freezing outcomes

Egg freezing is a process where a woman's eggs are retrieved, frozen, and stored for later use once she is ready to fertilize them and start or grow her family. The more eggs that are retrieved, the better the chances of a live birth down the line. 

While the effects of vaping on fertility are still largely unknown, many fertility clinics advise their patients to quit vaping in an effort to improve egg freezing outcomes related to quality and quantity based on the above research on smoking. Lower quality eggs with a higher DNA damage rate could impact the success of a future pregnancy using these frozen eggs, as these eggs may be less likely to fertilize into embryos (or result in a successful implantation). In addition, fewer eggs retrieved from those who vaped may result in fewer options for future use, which can increase the likelihood of needing additional egg freezing cycles.

Our programs offer the opportunity to freeze your eggs in a way that’s more empowering, positive, and affordable — even free. Take our quiz today to see if you qualify for Split, our free egg freezing program. 

Can I donate my eggs if I vape? 

If you are considering applying for our Split program, where you can freeze your eggs for free when you donate half of the eggs retrieved to another family, please note that you will not be considered eligible if you currently use any nicotine products, including vaping. If you engage in vaping regularly, you will need to quit for two to three months before re-applying for the program. If you only vape occasionally/socially, you will need to quit for one month prior to your retrieval date.

Summing it up

In conclusion, while data is somewhat limited, it appears that the effects of vaping on fertility can have an impact on women who are considering egg freezing. The ingredients in e-cigarette liquids, such as nicotine and propylene glycol, have been shown to have negative effects on reproductive health, including decreased fertilization rates and increased risk of miscarriage. In addition, it is possible that vaping can lead to a lower number of eggs retrieved during an egg freezing cycle and a higher rate of DNA damage in the retrieved eggs. 

Our recommendation? Safe is better than sorry — in the interest of the best cycle outcome, it’s probably a good idea to hold off on the e-cigarettes leading up to and during your egg retrieval. 

If you’re considering egg freezing, consult with a fertility specialist or take our quiz to learn more about how you can preserve your fertility.

Has anyone ever told you that freezing your eggs will affect your ability to conceive naturally in the future? If you’ve heard this before, it’s understandable that it would make you think twice about pursuing egg freezing or donation. While this is a common question, it’s actually a misconception. Read on to learn more about why this is a myth and what egg freezing actually does for your fertility. 

The truth about egg freezing (or donation) and fertility

Let's get right to it—does freezing or donating eggs impact your ability to get pregnant on your own in the future? The short answer is no, egg freezing won’t lower your egg reserve and it won’t affect your chances of getting pregnant naturally when you’re ready to do so. To understand why this is, let’s talk about the ovulation process. 

What happens when you ovulate?

At the start of each menstrual cycle, when someone is on their period, their pituitary gland (in the brain) will release follicle stimulating hormone (FSH). FSH triggers fluid-filled sacs in both ovaries to grow. These sacs are called follicles and they each contain an egg. The follicles grow until a second signal from the brain forces only one follicle (the “dominant” follicle) to continue to mature and eventually release its egg. That egg being released is what we call ovulation. 

Now that that single egg has been ovulated, what happens to all the other eggs in those other follicles? Well, since those follicles weren’t chosen as the dominant follicle, they stop growing and the eggs inside of them die. This is known as atresia. So, it’s basically survival of the fittest in each ovary every month — yikes!

So what does all that have to do with egg freezing?

Let’s briefly review what the egg retrieval process is for egg freezing, donation, and in vitro fertilization (IVF). The hormone medications used during all three processes prompts your ovaries to allow all of the eggs in a single cycle to mature (instead of the usual one) so you can freeze them for if and when you might need them later on. 

Once the follicles have reached an appropriate size, the eggs are collected during a quick procedure in the office. This retrieval process happens under light sedation and involves using a vaginal ultrasound and a long needle with a suction device to retrieve the eggs. I promise this sounds much more intense than it actually is! An embryologist (an expert in the science of egg freezing) looks at each egg and grades their maturity before freezing them. If you’re doing IVF, they’ll go through fertilization instead of being frozen.  

Can I get pregnant unassisted after egg freezing?

What you may have noticed from what was just explained is that egg freezing actually rescues all the other eggs that your body would otherwise allow to die during a normal menstrual cycle. So the process of egg freezing doesn’t take anything away from your egg reserve, it actually helps you save some extra eggs! And since during each cycle, your body goes through the ovulation process again with a new set of competing eggs, your chances of getting pregnant unassisted in the future also aren’t affected by egg freezing. 

What egg freezing does do is give you additional options for if and when you’re ready to start growing your family.

Egg freezing actually rescues all the other eggs that your body would otherwise allow to die during a normal menstrual cycle. So egg freezing doesn’t take anything away from your egg reserve, it actually helps you save some extra eggs!

Can egg freezing damage my ovaries?

Like any other procedure, there are risks and side effects when freezing eggs, including risks of anesthesia, bleeding, pain, and infection. Thankfully, the majority of people who go through with it deal with side effects for a few days at most. When it comes to the ovaries themselves, they generally recover quickly. While there isn’t a lot of data specific to egg donors (as opposed to people freezing their eggs for themselves), the overall data indicate that the potential risks of surgical complications from egg retrieval are generally very small. However, in people with a history of endometriosis, pelvic inflammatory disease, pelvic adhesions or previous pelvic surgery, the risks are slightly increased so make sure to speak to your doctor about your medical history if you fall into any of these categories.

In terms of complications down the road, there are really two main ways by which egg retrieval might conceivably affect future fertility. The first way is by bleeding and infection from the procedure leading to adhesions (scar tissue) and the need for further surgeries. The second way is through trauma to the ovaries causing the creation of antibodies that may make fertilization of an egg more difficult.

Fortunately, there is no data that supports either possibility. According to one large study of over 7,000 IVF cycles, the rates of both infection and need for surgery to treat a pelvic abscess was 0.03% (about 1 in 3,000 IVF cycles). As for the scar tissue and antibodies, researchers have not found a higher rate of adhesions among people who have had an egg retrieval compared to those who haven’t nor have they found evidence that antibodies interfere with sperm’s ability to fertilize an egg. 

It’s up to you!

If you decide to go through with egg freezing, Freeze by Co is here to help. Our Split program allows those who qualify to freeze their eggs for free! In a Split cycle, you donate half of the eggs retrieved to a family that can’t otherwise conceive and freeze the remaining half for yourself. 

If you don’t want to donate, you can still participate in the Keep program, where you’ll be 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. This valuable resource lets you engage with other people freezing their eggs at the same time! 

Whatever you choose, our team is here to support you as you determine which family-building options are right for you!

Donating eggs can be a generous and life-changing decision for both the donor and the intended parent. If you have been interested in donating your eggs, you may be wondering if there’s an age cut-off. The short answer is, yes, there are age restrictions when it comes to donating eggs. In this article, we will discuss how old you have to be to donate your eggs and what factors may affect your eligibility.

What is the minimum age for egg donation?

American Society for Reproductive Medicine (ASRM) suggests that egg donors be at least 21 years of age at the time of donation. Most clinics and agencies follow this suggestion to ensure the donor is mature enough to understand the procedure and follow through on the commitment. 

To be part of our Split Program, where you freeze your eggs for free when donating half to a family that can’t otherwise conceive, you must be at least 21 years old. And while we do not accept Split members who are under 21, please reach out and we’ll get back in touch after you turn 21. 

What is the maximum age for egg donation?

While there is no legal maximum age to become an egg donor, ASRM recommends that donors be under the age of 34 and most clinics follow this guideline. 

At Cofertility, we require our Split program members to be 33 or under, as it can take some time to match with intended parents and complete your cycle. If you are 34-39, you are still eligible to participate in our Keep program. With this program, you can freeze your eggs and keep 100% of them for yourself. 

Why are their age requirements for egg donation? 

Because donor egg IVF is already so expensive and time consuming, families and clinics want to do everything they can to increase chances of success.

One factor that can predict success is age. Women in their 20s typically have a higher quantity and quality of eggs, making them ideal candidates for egg donation. Data shows that, on average, those over 35 tend not to respond to fertility medication as well and therefore may not produce as many eggs. Research also shows that, unfortunately, egg quality declines with age. 

Are there exceptions?

There are cases where a clinician may accept a known donor outside the recommended age range. For example, if someone wanted their 35-year-old sister to donate and she had recently undergone a successful egg retrieval, the doctor may approve her donation. 

Conclusion

Egg donation is a serious commitment and involves a significant time and energy commitment from the donor. The process typically involves several weeks of hormone injections, frequent doctor's appointments, and a minor surgical procedure to retrieve the eggs. 

While 21-34 is the recommended age for egg donation, keep in mind there are additional eligibility criteria. It is important for potential donors to carefully consider the risks and benefits and to ensure that they meet all of the eligibility criteria before making a decision.

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Egg freezing, formally known as oocyte cryopreservation, is a medical procedure that allows you to preserve your fertility by retrieving, freezing, and storing your eggs for future use. 

Egg freezing is an exciting and empowering option for those who want to take control of their fertility and pursue their life goals on their own timeline. But where should you start? In this article, we’ll share some factors to consider when selecting an egg freezing clinic that will give you the confidence and support you need throughout the process.

Reputation

When it comes to choosing an egg freezing clinic, reputation is key. It’s not just about the clinic, it’s also about the doctor you will work with. There are a few ways to find out the reputation of a clinic and specific doctor. You can research online, read reviews, and ask for recommendations from your doctor or friends who have undergone the procedure.

If you work with Cofertility to freeze your eggs, we have a list of vetted fertility clinic partners we will share to help you make a confident choice.

Experience and outcomes

Now that you’ve narrowed down the list, you can use the Society for Assisted Reproductive Technology (SART) website to look up data on specific fertility clinics. SART data provides detailed information on the number of cycles performed, age of patients, and success rates for various fertility treatments, including egg freezing. By reviewing the SART data, you can gain insight into a clinic's expertise and quality of care for egg freezing. Here’s how:

1. Go to SART's website at www.sart.org.
2. Click on "Clinic Data" in the top menu and select "National Summary Report."
3. Choose the year for which you want to view the data.
4. Use the search bar to find the clinic you are interested in.
5. Click on the clinic's name to view their data.
6. Look for the section titled "Egg Freezing Cycles" to see the clinic's success rates for egg freezing.
7. Review the clinic's success rates for egg freezing and compare them to the national average.

Keep in mind that success rates alone may not give a complete picture of a clinic's quality. SART may also not be helpful when looking up newer clinics, as the data takes about two years to post. If you’re working with a newer clinic, you can look up the doctor’s previous clinic to learn more about their past track record.

Accreditation and certification

To ensure that you receive the highest quality care, look for clinics that are accredited and certified by respected organizations. These certifications demonstrate that the clinic has met rigorous standards for safety, quality, and performance. Specifically, look for:

• The Joint Commission (JCAHO) is an independent, non-profit organization that accredits and certifies healthcare organizations in the United States. A fertility clinic that is accredited by the Joint Commission has met rigorous standards for quality and safety.
• College of American Pathologists (CAP) is a professional organization that accredits laboratories and pathology services. A fertility clinic that is accredited by the CAP has demonstrated proficiency in laboratory techniques and quality control.
• Society for Assisted Reproductive Technology (SART) reporting, as described in the section above. 

At Cofertility, we only partner with clinics that report outcomes to SART and have a CAP certified lab.

Technology and facilities

Egg freezing technology has come a long way in recent years, so it's important to choose a clinic that uses the latest equipment and facilities. By finding a clinic with state-of-the-art technology, you can be more confident that your eggs will be frozen and stored in the best possible conditions. Plus, a modern and comfortable clinic environment will help you feel relaxed and at ease during the process.

Here are some questions you can ask the clinic to get a better idea of their capabilities:

• What type of equipment do you use for egg freezing?
• How long have you been using this equipment, and how often do you update it?
• What is the success rate of your egg freezing procedure?
• Do you use vitrification or slow freezing? (You want a clinic that uses vitrification)
• What measures do you take to ensure the quality and safety of the eggs during the freezing process?
• Can you provide details about your laboratory and facilities for egg freezing, including any recent upgrades or renovations?
• Do you participate in research or clinical trials related to egg freezing?

By asking these questions, you can get a better sense of the clinic's commitment to using the latest technology and techniques for egg freezing, as well as their focus on quality and safety. A reputable and modern clinic will be happy to answer your questions and provide you with information to help you make an informed decision about your egg freezing journey.

The team

The staff at an egg freezing clinic can make all the difference in your experience. Look for clinics that have a team of knowledgeable, caring professionals who will guide you through every step of the process. The best clinics offer ongoing support and counseling to ensure that you feel confident and empowered throughout your egg freezing journey. During a consult, you’ll get to meet with the doctor and see if you click before moving forward.

Plus, if you work with us, you’ll get access to our team to help you every step of the way. 

Cost 

And last, but definitely not least, cost is an important consideration when choosing an egg freezing clinic. There’s no way around it, egg freezing is expensive. The typical egg freezing cycle can cost anywhere from $10,000 to $20,000 plus the cost of storage. A few clinics list their pricing on the website, but for most clinics, you will need to ask. Keep in mind that the price from the clinic does not usually include medications or long-term storage.  

Read more in How to Pay for Egg Freezing.

Cofertility can help

Freeze by Co offers women a chance to freeze their eggs for free when they donate half of the retrieved eggs to a family that can’t otherwise conceive. The cost of the entire process, including 10 years of cryopreservation, is fully covered. 

Or, if you want to freeze and store your eggs for your own future use without donating, Freeze by Co offers lower prices on things like consultations and storage, along with access to our community of women going through the process at the same time. ‍

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

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

Educate yourself first

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

Talk about what this means for your future

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

Freezing eggs vs. embryos

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

Prepare for their questions

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

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

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

Revisit the conversation often

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

Summing it up

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