egg retrieval

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

The egg freezing process & your body

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

Screening (1-3 days)

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

Hormonal stimulation (10-14 days)

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

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

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

What to expect physically

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

Increased bloating & water retention

Temporary weight fluctuations due to hormonal stimulation can occur.

Fatigue & recovery

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

Temporary training adjustments

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

When can you resume training after an egg retrieval?

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

Performance & long-term impact

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

Balancing fertility & athletic goals

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

Benefits of egg freezing for women athletes

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

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

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

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

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

Why should women athletes freeze their eggs?

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

How to schedule an egg freezing cycle as an athlete

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

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

How to pay for egg freezing as an athlete

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

Many women interested in egg donation or egg freezing have IUDs for birth control, leading to questions about whether they need to have them removed before starting the process. The good news: research shows that having an IUD doesn't interfere with egg donation or egg freezing. Let's explore why IUDs are generally compatible with egg donation and what you should know if you're considering donating eggs.

Understanding IUDs and egg freezing and donation

IUDs (intrauterine devices) work differently from other forms of birth control. While some birth control methods prevent ovulation, IUDs primarily work by preventing fertilization and implantation. This means they don't affect your body's natural egg production or the ability to stimulate egg development during the donation process.

There are currently two types of IUDs available:

Hormonal IUDs:

• Mirena (releases 20 micrograms of levonorgestrel daily)
• Kyleena (releases 17.5 micrograms of levonorgestrel daily)
• Skyla (releases 14 micrograms of levonorgestrel daily)
• Liletta (releases 18.6 micrograms of levonorgestrel daily)

Non-hormonal IUD:

• Paragard (Copper IUD)

Both hormonal and non-hormonal IUDs are generally compatible with egg donation. However, some doctors may prefer patients to have it removed before a cycle as it may require higher dose of FSH. If you have specific questions about your type of IUD, discuss them with your fertility doctor and how it may relate to your medical history.

A look at the research

A large study from the University of California San Francisco looked at the outcomes of over 1,000 women undergoing egg freezing or donation. The research found no difference in the number or quality of eggs retrieved from women with or without hormonal IUDs. Even more encouraging, when these eggs were used in fertility treatments, the success rates were equivalent - showing that IUDs don't impact egg quality or future pregnancy potential.

The detailed findings showed remarkably similar outcomes:

• Total number of eggs retrieved
• Number of mature eggs
• Fertilization rates
• Pregnancy success rates
• Live birth rates

Because of this research, most doctors are comfortable allowing patients to proceed with egg freezing or donation while keeping an IUD in place. There's generally no need to remove it before starting the process unless you were planning to do so anyway.

Can you do an egg retrieval with an IUD in?

Yes, most doctors do allow you to keep your IUD in during the egg retrieval. When you donate eggs with an IUD:

• Your IUD can stay in place throughout the entire process
• The stimulation medications work normally
• The retrieval procedure isn't affected
• The IUD isn’t impacted
• Recovery remains the same

Read more in Egg Freezing and Birth Control: An Overview

Can I have my IUD removed during the egg retrieval?

If you've been planning to have your IUD removed anyway, you might consider asking your fertility doctor about removing it during the egg retrieval procedure. This can save you an extra appointment and make efficient use of the anesthesia you'll receive for the retrieval.

Can you check your egg count with an IUD?

Yes, you can get your ovarian reserve (egg count) tested while using an IUD. The two main fertility tests - AMH blood testing and antral follicle count via ultrasound - can both be performed with an IUD in place. 

However, one study looked at data from women on various types of birth control and found that hormonal IUD led to a small and temporary 6.7% lower AMH (there was not a significant difference with the copper IUD). 

If you are donating your eggs, most clinics require an AMH of at least 2. If your AMH comes back below that, you may be able to test again after removing the IUD. We have had donors who were able to bring up their AMH to a qualifying level just by removing their IUD.

Read more in Can Birth Control Affect Your AMH Levels?

How soon after getting an IUD can I donate eggs?

The good news is that there's typically no required waiting period between having an IUD placed and starting the egg donation process. Since IUDs begin working immediately after placement and don't interfere with your body's natural egg production, you can begin the donation process right away if you choose to do so. This is true for both hormonal IUDs (like Mirena, Kyleena, Skyla, and Liletta) and non-hormonal IUDs (like Paragard), as neither type affects egg quality or production. While some women may prefer to wait a few weeks to ensure they're comfortable with their IUD, this is a personal choice rather than a medical requirement. Your fertility doctor can help you determine the best timing based on your individual circumstances.

Birth control and the Split program

At Cofertility, we work with many egg donors who have IUDs. Our Split program allows women to freeze their eggs for free by sharing a portion with a family who could not otherwise conceive. The presence of an IUD doesn't affect eligibility for the program or impact the success rates.

Remember:

• No need to remove your IUD before donating unless directed otherwise by your doctor
• Research shows equivalent success rates
• Optional removal during retrieval if desired
• All forms of birth control should be discussed with your medical team

Next steps

If you're interested in egg donation or freezing and have an IUD:

1. Take this quiz to see if you qualify  
2. Learn more about the egg sharing process
3. Discuss any birth control concerns and medical history with your healthcare team

The choice to donate or freeze your eggs while having an IUD is safe and well-studied. Our team can help you understand your options and guide you through the process, whether you choose to keep or remove your IUD during the cycle.

Key take-aways

• Having an IUD does not disqualify you from donating eggs or affect your eligibility for egg donation programs.
• Both hormonal IUDs (Mirena, Kyleena, Skyla, Liletta) and non-hormonal IUDs (Paragard) are compatible with egg donation.
• You will likely not need to remove your IUD before starting the egg donation process - research shows IUDs don't interfere with donation.
• IUDs are not shown to have a negative impact on egg quality or the number of eggs you retrieve in a donation cycle.
• Your IUD stays safely in place during the egg retrieval procedure and isn't affected by the process.
• Hormone testing is okay with an IUD, though hormonal IUDs may slightly affect AMH levels (by about 6.7%).
• There are no known increased risks or complications for egg donors who have IUDs.
• You can start the donation process immediately after getting an IUD - there's no required waiting period.
• If desired, you may be able to have your IUD removed during the egg retrieval procedure while under anesthesia.
• After you complete your egg retrieval, you will get your menstrual cycle about two weeks later.

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

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

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

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

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

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

Birth control and egg freezing

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

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

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

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

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

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

Bipolar, depression, and anxiety medications

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

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

Spironolactone

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

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

Acne and skin care medications

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

Allergy medications

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

Non-steroidal anti-inflammatory drugs (NSAIDs)

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

Blood thinners

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

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

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

Steroids

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

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

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

Hormone replacement therapy

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

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

Summing it up

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

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

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

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

What is the egg freezing trigger shot?

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

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

What does the trigger shot do?

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

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

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

Is the trigger shot necessary?

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

Types of trigger shots

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

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

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

How is the trigger shot administered?

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

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

Is the trigger shot painful?

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

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

Common mistakes to avoid

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

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

Potential side effects

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

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

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

What to expect after the trigger shot

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

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

Tips for Success

To ensure the best possible outcome with your trigger shot:

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

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

Frequently Asked Questions

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

Final thoughts

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

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

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

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

Exactly what happens during the egg donation procedure, anyway? You’re excited about Cofertility’s Split Program, where those qualified get to freeze their  eggs for free when they donate half to a family that can’t conceive. Still, you're unsure about one thing — the egg retrieval procedure itself. You want to understand what goes into maturing more eggs, and how those eggs will be retrieved. It’s a big deal — we get it!

We outlined all the details about what to expect during the procedure—including the protocol leading up to your retrieval. The stimulation and retrieval process is the same as what takes place during egg freezing or IVF. Use this guide to get a glimpse into and help you navigate the process. 

How the egg donation process begins

At the start of your cycle, there are many tiny follicles with the potential to produce mature eggs. A follicle is a fluid-filled sac that continues to grow while the contained egg matures.

Usually, one follicle takes the lead. It grows faster than the rest, maturing before the others can. Once the egg inside fully develops, the follicle ruptures, releasing the egg during ovulation. This halts the other egg follicles in their tracks and never gives the immature eggs inside these follicles a chance to develop. These eggs are lost each month. 

If a woman is not pregnant, the cycle restarts with a new batch of potential follicles. But with the aid of certain medications, doctors can help ensure that many - not just one - follicles mature at the same time. 

The stimulation process

While the medications prescribed may be a little different for every cycle, most protocols to stimulate the ovaries during the egg donation are designed to do the following: 

1. Shut it down. Doctors will prescribe birth control or a progesterone-only pill to  shut your ovaries down for a couple of weeks before your cycle begins. This sets the stage for fertility drugs and makes it easier to control your ovaries' response to those meds. 
2. Stim it up. When it's time to start the cycle, your doctor will prescribe medication to stimulate your ovaries. These drugs are similar to hormones that your body already makes, but in higher amounts. One of these hormones produced by the body is the follicle-stimulating hormone (FSH), while the other is the luteinizing hormone (LH). Your doctor may prescribe medication similar to either of these, or a combination of the two. These medications are injectables, but you’ll receive proper training from your clinic before you have to give your first dose at home. You’ll need to take these injections once or twice a day for about two weeks. 
3. Ongoing check-ins. During the two weeks that you’re taking these medications, the doctor will continually monitor your progress. Blood work will help monitor your estrogen levels while a vaginal ultrasound will be used to view follicle growth. These monitoring visits will help your doctor decide if and how to adjust your medication doses. If you've never had a vaginal ultrasound, it may sound a little scary, but the probe is slightly bigger than the size of a tampon. It’s totally comfortable, but it shouldn’t hurt. 
4. Prevent Ovulation. Once your follicles reach a certain size, or your estrogen reaches a certain level, your doctor may start you on a medication to prevent premature ovulation. This medication is also done via injection and, if necessary, will be added to your daily routine. 
5. Go time. Once the doctor decides that your follicles are ready for retrieval, you'll take what's known as a “trigger shot.” This injection will help the growing eggs mature and prepare them for retrieval.
6. The egg retrieval. This is the only real “procedure” - the retrieval will be done outpatient (at the clinic, not the hospital) and will be done within 30 minutes. Your doctor will use a vaginal ultrasound with a needle attached. The needle will be guided into your ovary and used to aspirate the fluid in each follicle. With this fluid, will come eggs that can be used to create embryos. You will be under light anesthesia, so you won’t feel a thing and you will be provided medication to help you avoid any discomfort during or after the process. 
7. Recover. Right after the procedure, you may feel a bit foggy. The clinic will give you time to rest and your doctor will likely reiterate that you'll also need to take it easy for the next day or two. Physically, you can return to work or school the following day, but if you have the flexibility, you may want to take a day or two off to relax.

A highly-skilled clinical team will guide you through each of these steps in the egg donation process. Importantly, this team will help ensure that you don't develop  any issues, such as ovarian hyperstimulation syndrome. Ovarian hyperstimulation syndrome is when your body responds too actively to the fertility medication and produces too many eggs. If you have symptoms of OHSS, these usually will resolve after a couple of weeks, says the American Society for Reproductive Medicine (ASRM).

Navigating with ease

If you’re considering the Split program, remember that while you may be new to the process, your team is not. Your doctors and nurses (and Confertility’s community) will guide you every bit of the way and answer any questions you may have.

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.

More and more people are freezing their eggs; in fact, in 2021 we saw a 46% increase in egg freezing cycles in the United States. If you’re exploring egg freezing, you may have a lot of questions, including if you can stay on birth control or not. In this article, we will discuss how birth control works and answer common questions about egg freezing while on various types of birth control.

How birth control works

Birth control methods work in various ways to prevent pregnancy. Hormonal methods, such as the pill, patch, ring, and injection, regulate hormones in the body to prevent ovulation. Without ovulation, there is no egg available for fertilization.

Non-hormonal methods, such as condoms, diaphragms, and intrauterine devices (IUDs), physically prevent sperm from reaching the egg or alter the environment in the uterus to prevent implantation. IUDs can be either hormonal or non-hormonal, depending on the type.

If you are freezing your eggs, do not start or stop your current birth control regimen without talking to your fertility doctor. 

Can I freeze my eggs while on the pill?

You will need to stop taking the pill before the actual egg freezing cycle. That’s because hormonal birth control is intended to prevent ovulation, but during freezing you want to do exactly the opposite. Some doctors will have you stop during your egg freezing cycle, and some may have you stop for the month leading up to the retrieval. 

The irony is that in preparation for an egg freezing cycle, the birth control pill is commonly prescribed for two to three weeks to sync your cycle and reduce the chance of inducing a cyst from the ovulation follicle. It can also help synchronize the cohort of follicles for a more optimal response. So if you’re not on the pill, you may be prescribed birth control pills with the start of the menstrual cycle in which you plan to undergo the egg freezing cycle.

Can I freeze my eggs while on Depo-Provera?

Depo-Provera (medroxyprogesterone acetate) is an injection that contains a synthetic form of the hormone progesterone. Since this shot can interfere with hormonal medications, you You may have to wait up to three to six months after the last shot until your ovaries are in an optimal state to be stimulated.

While Depo-Provera can affect the timing of ovulation, it does not impact the number or quality of eggs that are retrieved during the egg freezing process.

Can I freeze my eggs with an IUD?

Yes! Unlike other forms of birth control, IUDs do not prevent ovulation and therefore will not get in the way of stimulating egg production during your freezing cycle. If you have an IUD, there’s no need to remove it before your cycle. Although if you’ve been meaning to take it out, ask the doctor if they can do it during your procedure. 

Studies show that egg and embryo freezing results are the same for patients with or without IUDs.

Can I freeze my eggs with Nexplanon (birth control implant)?

Nexplanon is a small rod that is inserted under the skin of the upper arm and contains a synthetic form of the hormone progesterone. It can remain in place and does not appear to impact the number or quality of eggs that are retrieved during the egg freezing process.

Can I freeze my eggs with the patch?

Like the pill, the patch contains synthetic hormones that regulate the body's natural hormone levels and prevent ovulation. In order to begin an egg freezing cycle, you will need to remove the patch. 

Can I freeze my eggs with NuvaRing?

The NuvaRing is a vaginal hormonal birth control ring. Because it’s using hormones to prevent ovulation, like the pill and the patch, you will need to remove the NuvaRing before your cycle. However, your fertility doctor will give you instructions and there’s no need to remove it until they tell you to. 

Why is my doctor prescribing birth control to freeze my eggs?!

While it may seem counterintuitive, many fertility doctors recommend or prescribe birth control at the beginning of the egg freezing process. There are several reasons why:

• To coordinate the timing of stimulation start. Hormonal birth control pills can be used to offset the menstrual cycle to help facilitate the best timing for your cycle with your clinic/lab.
• To reduce the likelihood of ovarian cysts. Birth control pills may help to suppress the growth of ovarian cysts, which can interfere with the egg retrieval process. 

So while it may seem counterintuitive, using birth control pills before egg freezing is pretty typical. 

Summing it up

Hormonal birth control methods work by regulating hormones in the body to prevent ovulation, while non-hormonal methods physically prevent sperm from reaching the egg or alter the environment in the uterus to prevent implantation. While it is possible to freeze your eggs while on various types of birth control, it depends on which one. 

• Definitely okay: condoms, diaphragms
• Generally okay: IUD, birth control implant
• Need to stop: the pill, the patch, NuvaRing
• Potential wait of three-six months: Depo-Provera

Of course, do not start or stop your current birth control regimen without talking to your fertility doctor first.  

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 program allows you to freeze your eggs for free when you give half of the eggs retrieved to a family who can't otherwise conceive.

Whether you’re about to go through the egg retrieval process for egg donation, egg freezing, or a full in vitro fertilization (IVF) cycle, you’re likely going to have some questions. While this procedure seems intimidating to a lot of folks, it’s actually not as scary as it seems. Understanding how the process works and what to look out for can help ease some of those pre-procedure jitters, so let’s break it all down. 

Before

Questions for your provider

Knowing what’s coming is half the battle when it comes to medical procedures.Here we’ve listed some great questions to ask your provider before your egg retrieval.

• Can you walk me through the timeline for the egg retrieval, from when I give myself the trigger shot (a medication sometimes used to help your ovaries release mature eggs) to the recovery room after the procedure?
• What anesthesia options are available?
• What is your best estimate of how many eggs you think you’ll be able to retrieve?
• What are the most common side effects you see after the procedure? What do you recommend I do to manage those symptoms if I have them?
• Is there anything you recommend I do leading up to the procedure to minimize my risk of ovarian hyperstimulation syndrome (OHSS)? 
• When and how will the clinic update me about the eggs after the procedure (e.g., phone, email, app, etc.)?
• How can I reach your clinic if I have questions or concerns?
• Who do I contact if I have a problem outside the clinic’s normal hours?

Depending on your particular situation, you may need to ask more questions, but this is a good place to start. 

Anesthesia/sedation options

For egg retrievals, an anesthesiologist will be on site to provide your sedation. Most clinics use monitored sedation that is propofol-based. This is not the same as general anesthesia, which is used for longer and more invasive procedures and requires a breathing tube. With monitored sedation, a medication is given through the veins (IV) to make sure you feel no pain or discomfort during the procedure. No breathing tube is used, so you’ll be able to breathe on your own. This is commonly called “twilight” sedation—think of it as a really great nap! 

Unfortunately for some folks, nausea can be a side effect of the anesthesia. If you’ve had anesthesia before and you know you’re prone to nausea, make sure to let the anesthesiologist know about it. There are a few other ways to help manage nausea due to anesthesia.

• Stay hydrated. Postop nausea is sometimes due to dehydration, usually because you haven’t had anything to eat or drink before your surgery. Dehydration leads to low blood pressure, which can make you even more queasy. As soon as you’re able to after your procedure, start rehydrating. Staying really hydrated up until the night before your procedure can also help. 

• Take anti-nausea medicines. Some over-the-counter (OTC) options like antacids, ginger root tablets, and others can be helpful for mild to moderate nausea. Ask your doctor before using any of these though! Some medications can’t be taken together. If the OTC options don’t help, you can also ask your doctor about prescription options.
• Avoid activities that require too much movement or concentration. Things that involve concentration or changes in your perception (like reading or riding in a car) will often make symptoms worse. Closing your eyes and keeping your room dimly lit can help calm your nervous system while the anesthesia wears off fully.

You can learn even more about all the anesthesia and sedation options here.

Prep

Most clinics will go through their specific requirements and recommendations at your preoperative visit. The most important thing to avoid is having anything to eat or drink the day of the procedure. 

A common question people ask is whether they need to shave before their egg retrieval. The answer is no—shaving (or not shaving) does not impact the procedure at all so come as you are! If you prep anything, it should be everything you need for when you come back home to recover. Here’s a checklist of things to have ready on the day of your procedure:

• Comfortable, loose clothes
• Heating pad(s)
• OTC medicines like Tylenol, stool softeners, and anti-nausea 
• Plenty of fluids and electrolytes (water, Gatorade/Powerade, coconut water, etc.) 
• Activities like audiobooks, movies, etc. that don’t require too much concentration
• Someone to take you home

During

Is egg retrieval painful?

This is the most common question we get and it’s totally understandable! Thankfully, with the anesthesia that’s given, you will be asleep so won’t feel or remember anything during the procedure. 

What exactly happens during an egg retrieval?

Alright, let’s get into how this procedure actually works. First, the doctor will use a transvaginal ultrasound to find your ovaries, which should by now have clusters of tiny follicles. Your doctor will then gently guide a long needle through an opening in the ultrasound probe and into the vaginal wall. This needle is attached to a catheter and the catheter is attached to test tubes labeled with your name and unique patient identification number. One by one, the eggs will be drawn out of the ovaries using light suction and collected in the test tubes. These test tubes are  then handed off to the embryologist, an expert in the science of oocyte cryopreservation (the technical term for egg freezing).

Once all the eggs that can be retrieved are collected, the doctor will remove the needle. They will examine your ovaries and your vaginal wall to make sure there isn’t too much bleeding. It’s normal for these sites to bleed a little–they did just have a needle inserted into them. Typically,  your doctor will be prepared to apply pressure or, rarely, to use a cauterizing (heated) agent to control any bleeding. 

That’s it! You’ll leave with no stitches or scars. Pretty cool, huh?

How long does an egg retrieval take?

The process described above may sound really complicated but in reality, it only takes about 15 minutes. That’s less time than most people spend scrolling TikTok while on the toilet. 

After

Waking up

Immediately after the egg retrieval, you’ll definitely be a little groggy as you recover from the anesthesia. You’ll usually be told to rest for 30–60 minutes in the recovery area, where someone will monitor you as you wake up from the anesthesia. Most anesthesia takes about 24 hours to be fully out of your system, but you’ll feel close to normal by the time you leave the office.

During your recovery time, your doctor will come in to let you know how many eggs were successfully retrieved. They will also let you know how many eggs were deemed mature by the embryologist. What does that mean? Well, let’s go way back to middle school biology. Mature eggs have reached the metaphase II (M2) stage and are therefore considered to have “meiotic competence”. Meiosis is the process of cutting the number of chromosomes and genetic material by half so that when it combines with sperm, the resulting embryo has the proper number of chromosomes and all the genetic material it’s supposed to have.

Immature eggs are not capable of fertilizing because they are not “meiotically competent”. However, sometimes it is possible to have eggs mature in the lab (in vitro maturation or IVM) and then fertilize them. While this isn’t popular now, we do ask our partner clinics to freeze immature eggs for when this technology is more widespread in the future. 

In our Split program, where you freeze for free when donating half, you keep half of the mature eggs PLUS 100% of any immature eggs if they are retrieved and vitrified.

Common side effects and how to manage them

After everything is said and done, the most common side effects people have are constipation, bloating, cramping, spotting, and pain. Rest, over the counter medicines like Tylenol and stool softeners, and staying hydrated are usually all that’s needed for these symptoms. Heating pads can also be really helpful for those who have cramping or pain. If you have any bleeding, make sure to use pads—not tampons—so you can monitor the amount.

The majority of people are back to their normal activities by the next day, but it’s recommended that you go home and relax for the rest of that day with another adult with you, just in case. You also should not drive for at least 24 hours after your procedure. 

Your doctor may prescribe an antibiotic or other medications depending on your case. You may be asked to avoid sexual intercourse for a period of time or avoid things like taking a bath. Make sure to follow any specific instructions your provider gives you for your recovery. 

Red flags

If you notice any of the symptoms below, report them to your healthcare provider asap:

• Temperature above 101 F
• Severe abdominal pain or swelling
• Severe nausea or vomiting that doesn’t go away
• Heavy vaginal bleeding (soaking through a pad in an hour; some light bleeding is normal)
• Difficulty urinating, or painful urination
• Fainting or dizziness

Good Luck!

If and when you decide to pursue egg freezing, Freeze by Co is here to help you every step of the way. As mentioned earlier, 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, so you get half the mature eggs and all the immature ones. 

Don’t want to donate? We got you! You can still participate in the Keep program, where 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. This is a valuable resource that lets you engage with other people freezing their eggs at the same time! 

The best way to feel comfortable and confident about your egg retrieval is to know what to expect. The process won’t be exactly the same for everyone but with the tips we shared above, you’ll be more than prepared when the big day comes. Whatever you choose, our team is here to support you and help you feel empowered as you determine which family-building options are right for you!

Intro 

If you're thinking about freezing your eggs and you've started to gather information about it, you're probably coming across a lot of information. This can definitely be overwhelming but there’s no need to panic! We're here to help you figure out if egg freezing is the right choice for you, no matter what age you are.

What is egg freezing?

Before we dive further into this topic, what is egg freezing? 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 naturally, the eggs are unfrozen 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.

Should I freeze my eggs?

There are many, many reasons why someone might choose to freeze their eggs but the decision is a deeply personal one that requires some careful consideration. When making that decision though, 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, not all the eggs that get frozen will actually be viable. It’s expected that some eggs will not survive the warming process. In addition, the chances of the eggs that do survive being successfully fertilized depends partially on how old you were when you froze them (more on this later). Beyond that, fertility and pregnancy risks change with age. If you freeze your eggs at 30 and use them when you're 40, you'll have to deal with the realities of pregnancy at 40.

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.

Pros of egg freezing

Ok, now that we’ve gone through the basics, let’s discuss the pros and cons.

Perhaps the biggest advantage of freezing your eggs is the fact that it lowers the risk of having children with genetic abnormalities associated with ovarian aneuploidy. Ovarian aneuploidy refers to when an egg has an abnormal number of chromosomes which leads to an abnormal pregnancy. Most people are born with 46 total chromosomes (23 pairs). The most common aneuploidy risk seen by far is Down syndrome. Babies with Down syndrome have an extra copy of one of these chromosomes, chromosome 21. The medical term for having an extra copy of a chromosome is “trisomy” so Down syndrome is also known as Trisomy 21. Freezing your eggs at a younger age decreases (but does not totally eliminate) the risk of an abnormal number of chromosomes.

Another 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 getting a 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. 

Egg freezing also gives you options in terms of having your own biological children. Of course, there is the obvious option of having the eggs fertilized and the embryos implanted into your uterus. But you also have the option of having those embryos implanted into a gestational carrier or into your partner if they have uterus. 

Finally, freezing your eggs does not affect your ability to get pregnant naturally. The egg freezing process and retrieval procedure simply rescue eggs that would have died with your next menstrual cycle. This means it 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.  

Cons of egg freezing

Now, let’s talk about the disadvantages of egg freezing. 

The most obvious downside is the cost. While some insurance plans may cover egg freezing, this isn’t the case most of the time. The out-of-pocket cost of egg freezing varies but it can be up to $20,000 depending on where you are and which clinic you use. This typically includes bloodwork, medications, ultrasounds, and the egg retrieval procedure. This does not include the annual storage fee (which can be up to $800 per year) and any follow-up procedures if you end up using those eggs. Learn how you can freeze for free with Freeze by Co. 

The next thing to consider is the hormone medications and egg retrieval process themselves. These medicines not only require injecting yourself (or having a partner or friend do it) but they can have some not-so-fun side effects. These can include fatigue, nausea, bloating, headaches, abdominal pain, breast tenderness, and irritability. A severe risk of hormone medications is ovarian hyperstimulation syndrome (OHSS). This condition can lead to blood clots, shortness of breath, abdominal pain, dehydration and vomiting. It may even require admission to the hospital to manage. Thankfully, OHSS is rare nowadays, affecting only up to 2% of patients.

The egg retrieval process is quick and the most common symptoms afterwards are pelvic or abdominal pain, constipation, bloating, and spotting. The main concern here is the time you need. One typical egg-freezing cycle can range from 10 to 14 days and during that time you'll be attending doctor appointments almost daily to make sure your eggs are maturing correctly.

If you’re taking any gender-affirming hormones like testosterone, you may need to take a break in order to freeze your eggs. One study showed that transgender men who used gender-affirming hormones and stopped a few months before fertility treatments ended up with the same number of eggs as cis women. But getting off hormones can be hard and could trigger gender dysphoria so the best option is to freeze eggs before transitioning if at all possible.

No one likes to be the bearer of bad news but this is an important one. Egg freezing may mean your eggs stay the same age forever but unfortunately, your body does not. As you age, the risks of pregnancy increase for both you and your potential child. These risks include gestational diabetes, preeclampsia, c-section delivery, preterm delivery of a baby with low birth weight and other risks related to the pregnancy being IVF. However, these risks vary widely depending on many other factors. 

One final caveat to remember is that egg freezing does not guarantee a live birth. It’s likely that not all eggs will survive the thawing process. Some will not fertilize. Others fertilize abnormally, and still others don’t implant successfully in the uterus. A large study at NYU in July 2022 showed a 39% live birth rate for people who used their frozen eggs. The two factors that affected the success rates the most were age at the time of egg freezing and the number of eggs thawed. Specifically, the live birth rate was over 50% for people who thawed at least 20 eggs or who were under 38 when they froze their eggs. Which brings us to our next question: what age is best for egg freezing? 

When should I freeze my eggs? 

Let me start by saying that there is no perfect age at which to freeze your eggs. However, the TL;DR is that the younger you can do it, the better. According to the American Society for Reproductive Medicine (ASRM), an optimal time to freeze your eggs is in your 20s and early 30s, while you have a higher ovarian reserve and eggs are healthier. So whether you’re 25 or 35, you can absolutely freeze your eggs!

A large 2020 study at a fertility clinic that specializes in this area looked at egg freezing cycles for over 1,200 people. It compared the average number of eggs people of different ages were able to freeze versus the “optimal” or goal number of eggs they should freeze. This goal number was based on how many eggs would give them a 70% live birth rate after doing 1 or 2 egg freezing cycles (this rate is calculated using some other numbers and it typically goes up as we age to make up for the lower number of healthy eggs). 

The study found that younger people, unsurprisingly, have an easier time freezing the goal number of eggs in one cycle. As people aged, they needed multiple egg freezing cycles to reach that goal number.

These findings bring up a common question–is it worth freezing eggs after age 35? Well, it depends. The ASRM does not recommend egg freezing for people older than 38, but this isn’t a strict cutoff. Everyone’s fertility goes down at a different rate. Having your fertility hormones checked can sometimes help you and your doctor get a general idea of what your ovarian reserve is. This can better help you decide if egg freezing is right for you.

Egg freezing can be a tricky process to navigate and you are not alone when it comes to questions and concerns around it. Freeze by Co is here to help you every step of the way. With our Split program, people between 21 to 34 years old have the chance to freeze their eggs for free! In a “Split” cycle, you would donate half of the eggs retrieved to a family that’s trying to conceive and freeze the remaining half for yourself. If you’re over 34, you can still participate in the Keep program up to age 40. You would be able to freeze your eggs and keep them all for yourself, on your timeline while having access to an additional valuable resource in our support community, The Nest. This community allows you to engage with other people freezing their eggs at the exact same time! 

Regardless of which path you choose, our team will be there to guide you through the process as we work to keep your family-building options on the table.

You might have heard at some point that freezing your eggs can help you preserve your fertility options for your long term future. But just how many eggs should you freeze? Is there an optimal number for egg freezing?

Let’s take a look at how many eggs you can expect to get during the retrieval process and how many eggs you should be freezing for fertility preservation. 

How many eggs do I have?

Before we talk about the number of eggs you should freeze during oocyte cryopreservation — more commonly known as freezing your eggs — we should probably talk about how many eggs are in your ovaries right now. 

Your fertility doctor may have mentioned the term ovarian reserve a few times. When they do that, they’re talking about the number of eggs in your body. But how many eggs are in that reserve?

There is no exact answer here. On average, women are born with anywhere from one to two million eggs. Some women are born with more. Some women are born with less. 

It may sound like a lot either way, but most of the eggs we’re born with don’t stick around. By the time most of us hit adolescence,we have about 300,000 eggs left. From there, the number of eggs in the body naturally decreases by about 1,000 every year, and the decline becomes more rapid after age 35.  

That’s where egg freezing comes into play. The doctors of the Association of Reproductive Medicine (ASRM) states that planned oocyte preservation is “ethically permissible” because it provides women with more autonomy over their reproductive choices. 

Doctors can get a sense of how large your ovarian reserve is before egg freezing by testing the level of the anti-Müllerian hormone (AMH) in your body. This test looks at both your ovarian reserve and how well your body may or may not respond to medications that will stimulate the ovaries. What it can’t determine, however, is the quality of those eggs. And ultimately, you need both quantity and quality.

How many eggs do I need to freeze?

OK, so you may have a lot of eggs in your ovarian reserve — or maybe not. But how many do you actually need to freeze?

This answer varies from person to person and depends on a few individual factors:

• How old are you right now?
• Do you plan to freeze all of your eggs or do you hope to also donate some to help intended parents grow their family? 
• If you think you may want to have children one day, how many do you have in mind?

This list presents a lot to think about, so let’s dive a little deeper to help you make informed decisions about the number of eggs you freeze. 

The right number of eggs to freeze for your age

Different folks have different reasons for freezing their eggs. Some may be thinking about prolonging their fertility into the future. Others may be freezing some eggs but also hoping to donate some eggs to help others grow a family — something that’s done via our Split program, where you freeze for free when donating half of the eggs to a family that can’t otherwise conceive. 

Either way, studies have found that the optimal number of eggs to freeze really comes down to your age. That’s because the number of eggs in the body isn’t the only thing to decrease as you get older — egg quality decreases too, and egg quality is the number one factor in determining whether an egg can eventually result in a live birth. 

Here are the number of eggs you’ll want to freeze based on your age in order to obtain an optimal live birth rate:

How many eggs are retrieved?

For  egg donors aged 25-29, the average number of eggs retrieved is 18, and that number drops to 16 for people age 30-35 — although it varies from person to person.

Your reproductive endocrinologist will be able to tell you the day of your retrieval how many eggs were retrieved. This number will include both mature and immature eggs, so it’s not necessarily the total number of eggs that can be frozen. 

Immature Eggs

• May be partially or completely damaged or have its quality compromised in some way
• Lower chance of fertilization

Mature Eggs

• Have good egg quality
• Are more likely to be fertilized
• Can be frozen

After your retrieval, all of your eggs will be sent to an incubator to check maturity. The lab technicians will look for eggs to achieve meiosis, a kind of cell division that occurs in egg cells. 

The eggs that achieve meiosis will be frozen, and you will be notified of the total number. 

Should I do multiple egg retrievals?

What happens if you don’t get as many eggs as you had hoped during your egg retrieval cycle? 

If you’ve undergone one round of egg freezing and the number of eggs your reproductive endocrinologist retrieved from your ovaries wasn’t as high as you’d hoped, you may want to talk to them about trying again. 

There is technically no limit to the number of egg freezing rounds a person can undergo, but it’s not recommended that egg donors undergo more than six cycles. If you’re hoping to split your eggs with intended parents (donating half of the eggs retrieved) as part of our Split Program, you may find that additional retrievals help you provide the optimal amount of eggs for a live birth for you and for the intentend parents too. 

Of course, you should talk to your doctor about any risks or benefits that come with additional rounds. 

The right number of eggs to freeze to have multiple children

If you’re planning to have a big family one day, you may want to look at the number of eggs it’s recommended you freeze to achieve one live birth and talk to your doctor about freezing more eggs. 

For example, the studies show that a woman under age 35 will need to freeze about nine eggs to achieve a 70% chance of a live birth. If you’re under age 35 now and thinking you might want to use frozen eggs to conceive twice in your future, you will want to freeze closer to 18 eggs to achieve that 70% chance each time. 

That number will increase with each number of children you foresee — provided your expectation is that each child will be conceived with the use of the eggs you are currently freezing. 

Bottom line

There is no “magic number” when it comes to freezing your eggs. Your age, your future plans, and more all come into play. 

We’re here to answer any questions you might have, and the Cofertility community is also here to lend support as you consider all the important factors to make the choice that is right for you.

While in theory, the idea of egg freezing would have many raising their hands to give this a try, practically speaking it may be more complicated. There are real-world factors to consider: Do I need to freeze my eggs? Will I actually need them down the line? Am I a good candidate? And if so, would it actually fit into my budget, and are the logistics really feasible?

No need to wonder. Here’s what you need to know to make egg freezing possible in reality and the sort of programs where you can bring this to fruition.

Affordable egg freezing programs

We at Cofertility are dedicated to the idea that egg freezing should be more accessible. To make it possible for more of those who are interested, we have designed two different programs that prioritize different aspects of egg freezing. Take our quiz to see if you qualify for these programs.

Paying for keeps

With our “Keep” program, it’s about maximizing the number of eggs that you freeze, geared to enabling many people to be able to answer the question, “Can I freeze my eggs?” with a big, “Yes.”

As a member in this program, you get access to discounted prices we’ve negotiated with clinics and pharmacies, as well as a community of women also freezing their eggs at the same time. With this Keep program we give more leeway on exactly who can participate. While we are aware that research shows that fertility starts to decrease considerably after age 35, you can still take part in the program as long as you are under age 40.

This is egg freezing with real world families in mind, with steps taken to make fees more affordable. The idea is to lighten the load and to make budgeting for egg freezing that much easier, while bringing a little more joy and positivity to the process

The Split cycle

With our Split program, it’s all about taking budgeting out of the equation altogether, while helping another family. 

As a Split program member, if you qualify, you don’t have to set money aside for these burdensome costs at all – they are free as part of the program, including up to ten-years of storage. In return, you give half of your retrieved eggs from a cycle to someone who would be otherwise unable to conceive. The family receiving the donated eggs pays for all the costs to freeze and store your eggs, for their use to build a family now, and your use in the future. 

But, because we are splitting the number of eggs here, every single one counts that much more. So, we need to be more stringent in determining who can become a Split member. 

Important X factors

One of the factors that we weigh heavily for the Split program is age. In order to participate, you cannot be over age 34. That’s because data shows that, on average, those over 35 may not respond to fertility medication as well and therefore may not produce as many eggs. Also, research shows that, unfortunately, egg quality declines with age. 

Given the amount of time it may take to do initial testing and to match you with an intended parent, we have aligned our policy with ASRM (American Society for Reproductive Medicine) guidance on this and limit membership here to those who have not yet turned 34. This way if there’s a hiccup along the way, you won’t have to miss out — there should still be sufficient time to participate in the program.

Another factor to consider is what’s known as your anti-Mullerian hormone (AMH) levels. These levels signal how responsive your ovaries are likely to be to medication given to stimulate them to produce multiple eggs. If this number is pretty high, it usually means that your ovaries will respond well to stimulation. 

If at the time of initial screening, your ovarian reserve appears low based on your ultrasound and bloodwork, you, unfortunately, will not be eligible for the Split program, although you can still become a Keep member and achieve your goals that way. The ASRM guidance underscores the importance of considering biomarkers that indicate a donor’s potential ovarian reserve as part of the selection process. Scientists have found the AMH serum range of 2.20 to 6.8 ng/ml to be the one that research predicts will show if someone has enough ovarian reserve. This indicates how you will likely respond during an egg freezing cycle. 

No matter your ovarian reserve, you can still freeze your eggs. You just may not qualify for our Split program. That’s because we want to ensure that enough eggs are produced in the cycle to make it worthwhile for everyone after the eggs are divided, without your feeling that you’ve come up short and won’t be happy unless you do another cycle.

If you’re among those who qualify though, as many in their fertility prime may be able, this can be a golden opportunity. Feel free to read more about qualifications for joining our Split program.

Logistics

There is, of course, also the question of where you’ll need to go to make all this happen. 

If you’re a Split member, your initial physical screening takes place after you are matched with an intended parent. This includes some blood work and a vaginal ultrasound, which helps determine if this program will work for you, and will likely take place somewhere between where you and the intended parent’s locale. If any travel is needed though, our team will help you to make this happen, doing the necessary organizing. But monitoring for the cycle itself can be done at a local clinic right in your own area.

Meanwhile, Keep members have the flexibility to do the testing as well as the cycle locally, where it’s most convenient. 

Can you freeze your eggs? 

So, is this something that could practically work for you? Both of our programs are designed to make this feasible for a wide-variety of women. We try to keep costs down for Keep members while offering added flexibility to pursue their egg freezing goals. Meanwhile, for Split members the financial barriers are removed altogether.

Hopefully, this helps you to see how, practically speaking, you too can raise your hand up high and answer the question, “Can you freeze your eggs?” with a giant, yes, to make egg freezing in reality.

Cofertility's Split program offers a unique opportunity: freeze your eggs for free when you donate half to a family who needs them. If you’re eligible for the program, your egg freezing procedure, medications, any travel, and ten years of storage will be completely free of charge. 

This guide explains how the program works, who qualifies, what the process involves, and important considerations around egg donation. Whether you're exploring egg freezing options or specifically interested in Split, you'll find clear answers to your questions about eligibility requirements, the matching process, medical screenings, and what happens after donation.

Where do my donated eggs go?

Many different families need donor eggs to have children. These include:

• Couples experiencing infertility
• LGBTQ+ couples
• Cancer survivors
• Women with age-related fertility decline
• Single intended parents

Cofertility welcomes all intended parents to our platform to find their match. The families who receive your donated eggs have often tried multiple approaches to building their family before turning to egg donation.

Who qualifies for the Split program?

While we aim to make Split widely available, we maintain guidelines to protect everyone involved.

To qualify for the program, you must:

• Have both ovaries
• Be between ages 21-33
• Have a BMI less than 29 (for medication safety and procedure effectiveness)
• Be physically and emotionally healthy with no genetic or reproductive disorders
• Be a non-smoker and abstain from recreational drugs and Depo Provera birth control

If you're currently pregnant or breastfeeding, you may still qualify but will need to wait until you've stopped breastfeeding and had at least one menstrual cycle. You'll also need to provide a complete medical history about yourself and your biological family members.

How does the process work?

The Split program involves several steps from application through egg retrieval:

Take the initial quiz

Start with our quick one-minute quiz to see if you might qualify for Split. This gives us basic information about your health and background.

Submit your program application

If your quiz responses indicate potential eligibility, you'll complete a full application. This determines your qualification and helps create your profile that intended parents will see.

Consultation with our team

After passing the initial screening, you'll speak with a Member Advocate who can answer your questions and make sure you understand the process before your profile goes live.

Sign the Split program agreement

We'll send you an agreement outlining the program details. This agreement remains non-binding until you begin your egg retrieval cycle, and it's written in clear language. Our team is available to explain anything you don't understand.

Complete initial testing

You'll take a free AMH (Anti-Mullerian Hormone) test to assess your ovarian reserve. Fertility doctors typically look for an AMH level above 2.0 ng/ml for egg donation, as this suggests you'll likely respond well to fertility treatments and produce enough eggs for both donation and personal use. You’ll also take a free genetic test to tell you whether you carry a gene for certain genetic disorders.

Match with intended parents (optional)

Your profile will be listed on our platform for intended parents to view. Once matched, you'll have a dedicated Member Advocate to guide you through every single step. You can choose to meet the intended parents before proceeding. 

Complete medical screening

After matching, you'll undergo physical screening based on FDA, ASRM, and industry guidelines. This includes bloodwork and a vaginal ultrasound to evaluate your ovarian reserve. Depending on your location, testing may happen at a clinic near you or require some travel (which we organize and pay for).

Start your egg freezing cycle

If approved, you'll begin the stimulation phase. You'll take injectable medications to encourage your ovaries to mature multiple eggs simultaneously. While this might sound intimidating, we provide detailed tutorials and support. A fertility doctor will monitor your progress throughout the 10-14 day stimulation period.

Egg retrieval

When your eggs reach peak maturity, you'll undergo the egg retrieval procedure. This outpatient procedure takes about 30 minutes under sedation. The doctor uses ultrasound guidance to remove the eggs vaginally.

Immediately after retrieval, half the eggs are frozen and stored for you (free for 10 years). You can access them anytime and have them shipped to your chosen fertility clinic. The other half go to the intended parents for fertilization. If an odd number of eggs is retrieved, the additional egg goes to the intended parents.

Next steps

Depending on your family planning goals and how many eggs are retrieved in your first cycle, you might decide to complete a second cycle. 

For women under 35, studies show an average of 18-21 eggs retrieved per cycle, closely correlated with AMH levels. Research indicates that freezing nine eggs gives women under 35 approximately a 70% chance at a live birth.

What will I know about potential genetic offspring and what will they know about me? 

When you join Cofertility, you'll choose between two contact options:

• Disclosed donation: You meet the family (virtually or by phone) before finalizing the match. The relationship afterwards develops according to both parties' preferences.
• Undisclosed donation: You match without meeting the family and communicate only through Cofertility, with no contact information exchanged. If both parties agree, we can facilitate a phone or video meeting in which you can speak without sharing names.

In the case a donor-conceived child experiences a serious medical condition, you may need to provide medical information to us, the fertility clinic, or the intended parents. Also, if new information comes up about your medical history, we’ll need you to let us know. The intended parents are required to do the same. This is in everyone’s best interest so everyone can be made aware of unknown medical conditions that occur.     

Based on psychological research, we encourage families to be open with children about their conception story. As donor-conceived children grow up, they may become curious about their genetics and wish to connect. This is something to carefully consider before joining the Split program.

What Split members say about their experience

We recently surveyed Split members about their experiences. Here’s what they said:

• Strong preference for egg sharing: 88% of respondents said they were more motivated to donate eggs through egg sharing than through traditional cash compensation. Many expressed feeling more comfortable helping a family while preserving their own fertility options.
• High satisfaction rates: 97.4% of members agreed or strongly agreed that regardless of their own family-building journey, they were glad to have participated in the Split program. This exceeds industry standards compared to similar programs in other countries.
• Evolving motivation: Many members noted that while they initially joined for the free egg freezing benefit, meeting the intended parents shifted their perspective. As one member shared: "I initially started this process mostly thinking about the free egg freezing benefits for myself, but after virtually meeting the IPs I am donating to, it made me so much more excited for that part of the process, and that I'm able to help such a great couple start a family of their own."
• Practical value: Members frequently mentioned appreciating the financial accessibility of fertility preservation. As one participant noted: "It really is problematic that your eggs are most viable when you have the least in your bank. This Cofertility split program has given me the chance to secure my eggs while they are still viable without worrying about cost, and the bonus is that I get to help a family in need as well."

Summing it up

Freezing your eggs—especially when donating half—is a huge decision. We hope this overview provides a solid foundation to help you determine whether the Split program aligns with your values and goals. Our team remains available to address any additional questions as you consider this option.

Read more:

• Should I Freeze Eggs or Embryos?
• Does Donating Eggs Affect Your Fertility?
• Will I Regret Donating My Eggs?

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

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

You could get a heads up about certain reproductive concerns

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

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

You’ll get a better picture of your reproductive schedule

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

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

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

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

Your doctor will find out how many follicles you have

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

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

There will be additional health screenings 

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

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

Getting proactive can save you money

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

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

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

Our goal at Cofertility is to match intended parents with Split members who can help them achieve their goal of parenthood.  Because of that, we want to make sure we’re upfront about what might disqualify someone from our Split program. 

Through this program, you can freeze your eggs for free if you donate half to a family who can’t otherwise conceive. But, importantly, several factors may limit your eligibility.  Some of these are official disqualifiers based on regulations by the Food and Drug Administration (FDA). Others are discretionary disqualifications based on recommendations by governing bodies like the American Society for Reproductive Medicine (ASRM). 

While it’s not possible to create an exhaustive list of every reason someone may not qualify for our Split program, this guide outlines some of the most common reasons for disqualification.

Age

To apply to be a part of the Split Program, you must be between the ages of 21-33. This is because you’ll need to complete your retrieval before you turn 35, so because the process can take some time, we don’t accept applicants who are 34 or older. 

The reason for this age limitation is because 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. Also, research shows that, unfortunately, egg quality declines with age. Various factors may affect your cycle timing (application paperwork, time to match with a family, and more) and you will need to cycle before you turn 35. We’d hate for someone to apply, get accepted, and then when the time comes for the cycle itself, potentially age out.

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. 

If you are under 21 and you’d like to participate, please reach out and we’ll get back in touch after you turn 21. 

Health-related factors 

As a preliminary step in the process, we’ll review several health-related factors. 

For starters, you’ll need to have two ovaries and you cannot have taken a Depo Provera shot, which can interfere with hormonal medications, within the past 6 months. 

Due to these hormonal medications you’ll need to take during egg freezing, you also cannot be currently pregnant or breastfeeding. However, if you plan to stop breastfeeding within the next six months, you can still go through with your Split application. You’d just need to hold off on your actual freezing cycle until then, and this situation would be communicated to potential match families. 

Additionally, you’ll need to have a BMI of 18-29. Those outside of this range are at increased risk of complications, negative outcomes, and negative side effects from hormonal medications or an egg retrieval. 

You will not qualify if you’ve had a sexually transmitted disease within the past 12 months (but can apply after 12 months of treatment). You also will be disqualified if you’ve been refused as a blood donor due to other infectious disease or medical conditions. Same goes if you’ve ever had a blood transfusion. 

Medical and family history

We will also review your and your family’s medical history. Unfortunately, this means that if you are adopted and cannot confirm your biological family’s medical history, you will not qualify. 

Though not an exhaustive list of every condition that may disqualify a member, when reviewing your personal and family medical history, we look for personal and/or family history of:

• Cancer
• Heart/blood disease
• Neurological diseases
• Mental health disorders
• Thyroid disorders
• Genetic disease
• Fertility issues
• Reproductive disease
• Autoimmune disease
• Respiratory disease
• Metabolic disease
• Gastrointestinal disease
• Kidney disease
• Birth defects

We review your personal and family medical history as a whole with our medical advisors. When reviewing, we consider the severity of the disease/conditions, number of relatives with the disease/condition, age of diagnosis, as well as that relative’s relation to you.

Psychological screening

There are also some psychological questions you’ll have to answer. We don’t expect you to be perfect. But note that certain psychological factors may be more likely to disqualify you than others. 

For example, a history of physical, sexual or substance abuse or having family members with psychiatric disorders that could be passed down may make it more difficult to be approved than, for example, having had some mild depression or anxiety. Per ASRM guidance, we will exclude those with a personal or first-degree (parents, siblings, offspring) family history of: 

• Bipolar disorder
• Schizophrenia
• Schizoaffective disorder
• Severe depression
• History of alcoholism or drug abuse

Genetic screening

As part of the process, you’ll also be required to do genetic testing via blood test or saliva sample. This helps ensure that embryos resulting from your eggs will lead to a viable pregnancy and that a child won't be born with severe disease. 

But even for serious diseases, not all disease-related genes are deal breakers. For example, if we find that you have a copy of a gene that can lead to cystic fibrosis, spinal muscular atrophy, or thalassemia, this may or may not disqualify you; it can depend on the clinic and genes of the intended parents. 

In line with ASRM guidance, in most conditions where carrying one copy of a particular gene won't impact the child themselves, you can still qualify for the Split program. 

Physical screening

In addition to genetic screening, you will have to undergo a physical screening to ensure you are physically healthy and producing a good number of eggs.  

Some disqualifications here are set in stone by the Food and Drug Administration (FDA). If evidence of any of these conditions arises, you will be considered ineligible for the program. These are considered to be non-negotiable.

• HIV
• Hepatitis B
• Hepatitis C
• Human transmissible spongiform encephalopathy
• Treponema pallidum

The following could also be deal breakers: 

• Issues with your ovaries, such as having only one ovary
• Hormone levels outside of recommended limits with concerns about your ability to produce sufficient eggs
• Any issues that would make the egg freezing and donation process risky for your health
• Evidence that you are at high risk of getting a sexually transmitted disease or could already have one. Doctors will look for discharge or ulcerative lesions for this purpose
• Indicators of possible drug use (needle tracks, for example) or exposure to needles in non-sterile conditions—including recent piercings or tattoos within the past 12 months

Anti-Mullerian hormone (ovarian reserve) levels

As you likely know, women have a set egg quantity present at birth. Your eggs mature in ovarian follicles, and each of these follicles produces the anti-Mullerian hormone (AMH). Over time, this hormone level drops; eventually, it drops so low that women naturally develop what's known as a diminished ovarian reserve (DOR).

Your AMH level can help predict how well medication may work to stimulate your ovaries to produce eggs. It also tells doctors what dosage of drugs may be needed to do so. The higher the AMH level, the more eggs generally produced. 

At Cofertility, if your AMH < 2, you are ineligible for our Split program. We only accept Split Members with these higher AMH levels as it helps mitigate the possibility of a second cycle to obtain enough eggs that could result in a live birth down the line (for yourself and for intended parents). Nevertheless, it’s important to note that, even with a high AMH level, there is always a chance that you need to do another cycle to improve the odds of a live birth. In the Split Program, you will receive AMH-reading bloodwork prior to being activated on our platform. 

If it turns out that your AMH levels are below the required minimum threshold, you would unfortunately be ineligible to move forward with egg donation. However, we can still help you freeze your eggs for your own future use through our Keep program.

State-specific qualifications

Some states do maintain their own requirements for women who are donating eggs. These requirements will extend to those in our Split program and would be determined by the location of the clinic at which you would be conducting the retrieval. 

Any state-specific egg donation qualifications will be evaluated at the time of your physical examination. 

Additional disqualifying factors

Lastly, there are a few additional factors that, unfortunately, would disqualify you from our Split program. These include if you:

• Have served jail time for more than two days within the previous 12 months
• Have undergone body piercing and/or tattooing within the past twelve months in which sterile procedures may not have been used
• Have the highest education level of GED
• Have Indigenous American ancestry and are associated with a tribe — this is due to the Indian Welfare Act 
• Currently use any nicotine products regularly, since the ASRM has confirmed an association between smoking and decreased fertility — if you engage in vaping, you will need to quit for 2-3 months before re-applying for Split, but if you only vape occasionally/socially, you will need to quit for one month prior to your retrieval date

If one or more of the above applies to you and you’d still like to participate in our Split program, reach out to us. We’d be happy to chat with you about your fertility options, including your ability to re-apply in the future. 

The net net

We know this sounds like a lot, but these disqualifiers are in place to respect the health and wellbeing of our Split members and intended parents. If you have any questions about Split—including the factors outlined here—don’t hesitate to connect with us. 

You have tons to offer, and whether you qualify for the Split program is in no way reflective of your value. The most important thing is that you feel one hundred percent comfortable in any decision you make. This is a big one, and we’re with you every step of the way.