egg retrieval

You may have heard that freezing your eggs in your 20s can help increase your chances of pregnancy down the line, but is there actually any truth to the claim? According to the American College of Obstetrics and Gynecologists (ACOG), there really is, given a woman’s peak fertility years span from the end of her teens to the end of her 20s. 

Read on to learn what you need to know about egg freezing success rates by age.

The best time to think about egg freezing is probably…now 

During these prime fertility years, we’re often focused on other things. In our 20s, we’re finishing school, launching our careers, traveling, having fun…starting a family may not even be a blip on your radar. Unfortunately, that also means that by the time you’re ready to get proactive about your fertility (or starting a family), your prime reproductive years may have already passed. 

This is why we believe that proactively thinking about your fertility is always a good idea for anyone looking to stay in control of their reproductive options. And one major barrier, until now, has been the accessibility and affordability of egg freezing. At Cofertility, we aim to change that, by partnering with local fertility clinics to create opportunities to freeze your eggs more affordably. 

Take our quiz to see what egg freezing options you may qualify for, including our Split program, where you can even freeze your eggs for free(!) if you give half to a family that can’t otherwise conceive and you qualify.

What are the egg freezing success rates by age?

We measure the “success” of an egg retrieval and later vitrification (the process of freezing and storing your eggs) in a couple of ways. Some of the major important milestones in a successful retrieval are: 

• The ability to collect high quality and healthy eggs 
• The ability to collect a large, but safe, number of eggs during a single cycle (between 10-20 is ideal)
• Whether collection takes place at an age where the eggs have a very good chance of surviving both the freezing and the warming process down the line 

Success rates for women in their 20s

Your 20s are by and large the best time to freeze your eggs, with 25 to 27 being the optimal age, according to a 2010 report from the CDC. The report found that eggs frozen during a woman’s 20s will have a 50 percent chance of resulting in a live birth per cycle, regardless of the age of the person carrying the pregnancy once the eggs are used. Women in this age range have fully finished developing (as opposed to someone in their late teens or early 20s who may still be growing and maturing) and are likely to have the healthiest and most robust eggs. 

Not only does it make it easier for eggs collected at this age to go on to become successful pregnancies, but it also makes it the most cost effective period, because you’re likely to get more eggs with fewer rounds of freezing than if your eggs were collected at a later age. 

Success rates for women in their 30s

Success rates in your 30s will depend on if you’re closer to 30 or 40, as well as your AMH levels. One study of 1,241 women found that the average number of eggs retrieved on the first egg freezing round was:

• 21 eggs for women under 35
• 17 eggs for women 35-37
• 14 eggs for women 38-40

Because women in their 30s tend to produce less eggs, at this age you may end up having to either settle for fewer eggs for freezing or undergo multiple rounds to collect enough eggs to have on hand for later implantation. As you can imagine, those costs can creep higher and higher the more rounds you endure. 

Now, you might be thinking: isn’t 14 eggs a lot?  It’s true that eggs retrieved from women under the age of 36 will have a 95 percent survival rate after being thawed.  

But more importantly, not all thawed eggs will become viable embryos and lead to a live birth. As this chart underscores, the probability of a live birth varies with the age of the woman trying to conceive and the number of mature eggs available. In short, the older the woman, the more eggs required to achieve a high probability of a live birth. 

A study in the Journal of Assisted Reproduction and Genetics further supports this point. For example, a woman under 35 will need 9 eggs to achieve a 70% chance of having at least one live birth. If you’re trying to conceive in your mid to late 30s, you may need double as many eggs to achieve that same 70% success rate. 

Success rates for women in their 40s

Because success rates drop significantly as you near the end of your 30s, it’s actually not recommended that women have their eggs frozen past the age of 38, according to the American Society for Reproductive Medicine (ASRM). 

But don’t let that news worry you. If you haven’t had your own eggs retrieved by this point, and are struggling to conceive, you still have some other options (including the use of donated eggs). 

Ask us anything

If you’d like help figuring out when to freeze your eggs, you can contact Cofertility for more information. While every woman’s fertility path differs, we can connect you with reputable clinics who can offer basic guidance about when the time is right for you to freeze your eggs during a consultation or dig into specifics by going through a preliminary exam in a provider’s office.

We understand that the timing may not be right for you to start a family right now, but that doesn’t mean it’s too early to start thinking about what choices will be available to you when that time comes. As you can see, a lot goes into preparing to freeze your eggs.  The earlier you consider your fertility, the more options you’ll have. 

Whether you decide to freeze or not, we’re here for you to answer any questions or talk through any concerns. 

Egg donor agencies are all about matching families with qualified egg donor candidates. And at Cofertility, we want to make sure we’re upfront about what might disqualify someone from egg donation. 

Through our Split program, if you qualify, you can freeze your eggs for free if you donate half of the eggs to a family who can’t otherwise conceive. But some factors may limit eligibility (for Split and egg donation in general). Some of these are official disqualifiers based on regulations by the FDA. Others are discretionary disqualifications based on recommendations by governing bodies like the American Society for Reproductive Medicine (ASRM).  Read on to get the full picture.

Age

Unfortunately, most doctors and agencies will turn a donor away if she’s over age 33. At Cofertility, we take a similar approach for our Split program. 

The reason for this age limitation is because data shows that, on average, those over 33 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. 

If you are 34-39, you are still eligible to participate in our Keep program, where you can freeze your eggs and keep 100% of them for yourself. Also, if you are over 33 and donating for a family member or friend, a doctor may approve you for egg donation on a case-by-case basis. 

Please note, per ASRM guidelines, we also do not accept Split members who are under 21. If you’re younger than this 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 will review several health-related factors before you can be approved for egg donation. 

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

Agencies 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, agencies look for personal and/or family history of:

• Cancer
• Heart/blood disease
• Neurological diseases 
• Mental health 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

Following this, there will be some psychological questions you’ll have to answer. We don’t expect you to be perfect. But some 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, agencies - including our own - will, however, 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

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 are set in stone by the Food and Drug Administration (FDA). They, understandably, want to ensure that egg donor tissue doesn't spread contagious diseases. If evidence of any of these conditions arises, you will be considered ineligible for the Split 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 only having 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, and eventually, 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 you appear to have low ovarian reserve at the time of screening, you will be ineligible for our Split program. We only accept Split Members with a higher AMH level 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 is important to note that, even with high AMH levels, there is always a chance of having to do another cycle to improve the odds of a live birth. In the Split Program, once you are matched with intended parents, you’ll undergo your physical screening, which will include AMH-reading bloodwork. 

If you’d rather get a sense of your AMH ahead of matching, talk to us about helping you set up an initial egg freezing consultation at a local fertility clinic. While it’s not required until this later phase of the screening process, it can help you better understand your fertility outlook. We may offer discounted consult options in your area, and this could give you upfront peace of mind about your choice to pursue Split, Keep, or neither.  

Genetic screening

As part of the evaluation process, you will 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 your tests reveal that you have a copy of a gene that can lead to cystic fibrosis, spinal muscular atrophy, or thalassemia, this may disqualify you depending on the clinic. Even if two copies of the gene are needed in order for the condition to occur, clinics and agencies handle this differently.

In line with ASRM guidance, in most cases where carrying one copy of a particular gene won't impact the child themselves, you can still donate. 

Agencies often screen for Fragile X syndrome. However, since this is an X-linked condition, just one copy of the gene can cause health issues. While most agencies will disqualify you if the X-linked health issues are severe, they may allow you to participate if you carry genes for milder conditions, such as red-green color blindness. Note that agencies will still inform potential parents that you carry this gene. 

State-specific qualifications

Some states do maintain their own specific 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

In addition to the above, there are several factors that, unfortunately, would disqualify you from our Split program (and in many cases, per ASRM and/or FDA guidance, egg donation in general). These include if you:

• Are not a U.S. citizen
• Have served jail time for more than two days
• 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 

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.

You’ve likely heard about the process called egg freezing (sometimes called “fertility preservation”), where they stimulate the follicles in the ovaries and retrieve unfertilized eggs to preserve them for future use. 

But what exactly does that process look like? And why would someone want to go through it? Read on—we’ll explain everything you need to know about egg freezing. 

The process for freezing eggs

While it may sound like a very intense process—and for some women, the side effects of the  medications used to stimulate the eggs can certainly feel that way—freezing your eggs is actually a safe and minimally invasive procedure. 

1. Take our quiz to find affordable egg freezing options near you, including our Split program (where you can freeze your eggs for free if you give half to another family who can’t conceive) and our Keep program (where you can freeze your eggs more affordably and keep them all for your own future use). If you’d like to participate in Split, you can move forward with that application right away. If you’d like to join our Keep program, we’ll email you your options once you take the quiz.  
2. With Keep, the egg freezing process begins with a consult with your fertility doctor. They will do some initial testing to determine the current health of the eggs your ovaries are producing, both in number and in quality. You’ll undergo bloodwork and  an ultrasound to get a sense of this.
3. Next, you’ll likely undergo some general health screenings to make sure you’re not carrying any viruses that could complicate the process (like HIV or certain forms of hepatitis).
4. Once your health check is through, you’ll likely begin a series of medications, including ones that will stimulate your ovaries and/or prevent early ovulation. You’ll give yourself shots daily. If you freeze with Cofertility, we’ll provide you with step by step videos to ease the transition.
5. Around this time, you can also join the Cofertility Member Portal, where you can connect with (and lean on) other women freezing their eggs at the exact same time! 
6. Your doctor will monitor you during this time to confirm that the medications are working and that your estrogen levels are increasing while keeping your progesterone levels low. You may also undergo a vaginal ultrasound to monitor the condition of the follicles where your eggs will eventually mature.
7. After 10 to 14 days you’ll start a medication to help speed up egg maturity ahead of your egg retrieval. 
8. The retrieval process happens under light sedation and involves using a vaginal ultrasound and a needle with a suction device to retrieve the eggs—this sounds more intense  than it is.his procedure is normally done right in the clinic and takes about 10 minutes.
9. Once the eggs are retrieved, they’re flash frozen and stored in subzero temperatures, normally with a substance like liquid nitrogen to prevent the development of ice crystals. 
10. You can go home after the procedure and rest up!

How your body responds to the process

Everyone’s body will react differently to each step of the egg freezing process. While some women will experience bloating or hormonal responses from the medications that stimulate egg maturation, others may feel much less. You might experience some mild cramping or bloating following the retrieval process as your ovaries continue to remain enlarged from the medications used. 

Additionally, you’ll have an increased risk of pregnancy in the week following your retrieval. Because of this, many doctors suggest avoiding unprotected sex during this time period.

The goals for women who freeze their eggs can differ

Not everyone has the same intentions when they start the process of freezing their eggs. Some women may hope to prolong their reproductive years until they’re ready to have children, while others may be hoping to use their frozen eggs as donor eggs to help someone else who is trying to start a family. 

One thing all of these women have in common is that they’re hoping to improve their chances of those eggs eventually resulting in a healthy baby. To some extent, the more eggs there are, the better the chances of those resulting in a life birth. But we also know that egg quality is important. The number one factor impacting egg quantity and quality? Age. 

A study in the Journal of Assisted Reproduction and Genetics confirmed that the probability of at least one live birth varies with the number of mature eggs available and the age of the woman trying to conceive. For example, a woman under 35 who is trying to conceive will need 9 mature eggs to achieve a 70% chance of having at least one live birth. If you’re trying to conceive in your mid to late 30s, you may need double as many eggs to achieve that same 70% success rate. 

Because women in their 30s tend to produce less eggs, women who are freezing their eggs at this age may end up having to either settle for fewer eggs or undergo multiple rounds to collect enough eggs to have on hand for later implantation. As you can imagine, those costs can creep higher and higher the more rounds you endure, driving up the price tag and the risk of failure. 

Some things to consider about freezing your eggs

There are obviously many factors that go into the freezing process;  but, there are a few points to consider outside of the physical. You’ll also need to account for the cost—you not only need to pay for all of the testing and procedure plus monthly storage fees until you’re ready to fertilize your eggs. To this end, you will likely need to budget an extra $550-$1,000 a year to pay a company to store and monitor your eggs after they’ve been retrieved and frozen.

These procedures can quickly add up to a few thousand dollars—likely anywhere between $8,000 to $20,000. That price can be too high for some, which is why we’ve developed our Split program. With Split, you can freeze your eggs for free, if you qualify and donate half of your retrieved eggs to an intended parent who matches with your profile.

Getting a jump start on your fertility is a wise choice

Deciding to freeze your eggs is a proactive choice and a good idea if you’re not sure exactly when you’ll be ready to start a family (if you even want to). It’s also perfect for anyone who wants to retrieve healthy eggs before undergoing chemotherapy or a surgical procedure that could alter your fertility chances. 

The average age women have become parents has increased over time—with many spending their earlier adult years focused on getting an advanced degree, furthering their careers, or even finding the right partner—however, our biological clocks have remained the same.  

Take a look at your options

At Cofertility, we offer a variety of options for freezing your eggs, including our Split program where we’ll help you through the process of stimulating and retrieving your eggs at no cost as long as you donate half the eggs retrieved from each cycle (if you qualify). If donation is not for you, we also have a Keep Program in which you freeze and keep 100% of the eggs for yourself. Contact us today to learn more - no commitment required, but we’d love to talk through can help you take charge of your future reproductive health.

The egg freezing process can feel like a black box. How do you find a clinic to freeze your eggs? How long will the whole process take? And what is this all going to cost? 

With thousands of women freezing their eggs every year, there are plenty of options out there for you. Here’s a look at how to make sense of the egg freezing process and how to make sure this is the right path for you.  

Breaking down the egg freezing process

Choosing a clinic

The first step in the egg freezing process is choosing a clinic. If you decide to move forward with egg freezing, you will need to visit the clinic for monitoring every few days, so it’s best to choose a facility that’s within driving distance. With Cofertility’s Keep program — where you can freeze your eggs more affordably and keep them all for future use — we’ll help you find a clinic based on your location, their pricing structure, and their success rates. 

Our Split program, on the other hand, allows you to freeze your eggs for free if you give half to a family who can’t otherwise conceive and you qualify.

Consultation 

Once you’ve settled on a clinic, it’s time to meet with a reproductive endocrinologist (REI, or fertility specialist) to talk about the egg freezing process. You’ll get a chance to find out more about how egg freezing works at your chosen facility, discuss any risks of the procedure, and talk through any family-building goals. If kids are still a TBD, no problem!

Note that some clinics will only work with women under 40 when it comes to egg freezing. Research indicates egg quality begins to decrease in a woman’s early 30s and declines more rapidly past age 35. Because of this, you must be under 40 to participate in our Keep program.

Age is only one factor, however. During your egg freezing consultation, the REI will ask questions about your menstruation history, any past pregnancies, and your overall health. 

Evaluation and bloodwork

After (or during) your consultation with an REI, the next part of the egg freezing process is bloodwork and other testing to determine if you are a good candidate for egg freezing. 

This testing may include:

• Ovarian reserve testing: Your doctor will order bloodwork to evaluate your egg supply. These blood tests may screen for anti-mullerian hormones (AMH), follicle-stimulating hormones (FSH) and estradiol. Importantly, these labs can predict how your body will respond to the injectable fertility medications used in an egg freezing cycle. You’ll also do a (painless) transvaginal ultrasound, which will show how many egg-containing follicles your ovaries contain as a baseline.
• Disease testing: Bloodwork will help your doctor assess whether you have any infectious diseases such as HIV, syphilis, hepatitis, gonorrhea or chlamydia.

Connecting with your community

If you’re freezing your eggs through Cofertility’s programs, you’ll be able to utilize our Member portal to connect with other women freezing their eggs at the exact same time. Support one another, ask each other questions, and gain confidence as you begin your fertility journey. 

Medications

Most women’s bodies release just one egg a month during the menstrual cycle. In order to freeze more than one egg, injectable medications will be taken over a period of a couple weeks. These meds will stimulate your ovaries to produce more eggs in a single cycle.

Most women can give themselves the injections, which are needed 1-2 times per day for about two weeks. The medications do carry some side effects, including bloating, headaches and moodiness. About 0.5 - 5% of women develop a condition called ovarian hyperstimulation syndrome (OHSS), in which fluid accumulates around the ovaries and causes discomfort and bloating. While the condition can occasionally be severe, it is  typically temporary with symptoms subsiding about a week after your egg retrieval. 

Medications commonly prescribed in the egg freezing process include:

• Follitropin alfa or beta (Follistim, Gonal-f)— Used to stimulate the ovaries
• Menotropins (Menopur) — Used to stimulate the ovaries
• Ganirelix or Cetrorelix (Cetrotide) — Used to prevent premature ovulation
• Leuprolide acetate (Lupron) — Used to prevent premature ovulation or as a trigger shot to help eggs mature
• Human chorionic gonadotropin (Pregnyl, Ovidrel) — Used as a trigger shot to help the eggs mature

If you choose to freeze your eggs through Cofertility’s Keep program, you’ll be able to take advantage of partnerships and discounts on medication costs to help lighten the load. 

More blood tests and monitoring

Once you’ve started hormone injections, your REI will keep a close eye on you to make sure things are moving along smoothly. You’ll visit the clinic every few days to undergo bloodwork and ultrasound so the doctors can determine how your ovaries are responding to the medication and if it’s time to retrieve your eggs. 

This process usually lasts around two weeks until the fertility specialist determines egg development has reached a point where it’s time for all your eggs to be retrieved. 

During this time, it’s recommended that you abstain from sex or use barrier methods of contraception as the medications can make your body more fertile, increasing your chances of getting pregnant. You’ll also want to decrease exercise during the stimulation phase to prevent ovarian torsion, or twisting. 

Egg retrieval 

Also called aspiration, the egg retrieval process is done right at your fertility clinic where your REI will use a mild sedative or anesthesia. With the help of a guiding ultrasound, your doctor will use a special needle that’s inserted into the ovarian follicles to remove multiple eggs.  

Although you may feel some cramping and general discomfort after the procedure, the egg retrieval is not usually painful. You should plan to have someone with you that day to drive you home from the doctor’s office, but many women are able to return to work within a day or two after the procedure.

Because your ovaries are enlarged, you may continue to feel cramping and a feeling of fullness for a couple weeks. You will also be advised to avoid unprotected sex in the weeks directly after the egg freezing process as your chances of getting pregnant may be higher during this time. 

Cryopreservation

Once the eggs are removed from the ovary, you’ve reached the final step of the egg freezing process. The eggs undergo a process called vitrification.  

Eggs are then frozen to subzero temperatures and can be stored for years to come, ready to be thawed if you decide you want to use them for in vitro fertilization (IVF). With Cofertility’s Keep program, we offer our Members discounts and promotions on various parts of the egg freezing process to help make it more affordable.

A second egg freezing process

Depending on how many eggs were able to be retrieved, your doctor may recommend a second round of medication and another retrieval. 

The number of eggs you should freeze will depend largely on your age — researchers at Brigham & Women’s Hospital in Massachusetts have created a calculator that estimates the likelihood of live birth for elective egg freezing in women. Although it’s not exact, it does supply some probabilities to help you make a decision on whether you should do a second cycle of egg freezing. 

For example, they estimate if a 30-year-old woman has frozen 15 eggs, she has an 83% chance of giving birth to one child from those eggs. She has a 50% chance of giving birth twice and a 22% chance of having a third child with the use of her frozen eggs. 

Costs of the egg freezing process

Another factor to consider when deciding if you want to proceed with the egg freezing process — or undergo a second cycle — is cost. Around the country, the process of freezing your eggs can cost anywhere from $10,000 to $20,000 or even more, and there are yearly costs for storage of eggs after the retrieval process. 

At Cofertility, we’ve made it our mission to make egg freezing more accessible. With discounts, partnerships and promotions, we’re hoping to remove lack of affordability as a barrier to fertility preservation. To get a sense of pricing (and savings!) for our Keep program with clinics in your area, take our quiz to tell us more about yourself. 

Unfortunately, most insurance companies do not pay for many egg freezing costs unless it has been deemed medically necessary for a woman. Cofertility’s offerings, similarly, are self-pay. 

Bottom Line

There’s a lot going on during the egg freezing process and a whole lot to consider. The homework you’re doing now will make all the difference as you move along through the process and can ask all the right questions!

According to the American College of Obstetrics and Gynecologists (ACOG), a woman’s peak fertility years are from their late teens to their late 20s. While these may be the easiest biological years for starting a family, between travel, work, school, life…at that point in your life, family planning might not be your top priority. 

Fortunately, thanks to modern medicine, you have some options. Egg freezing allows you to preserve your healthy eggs at any point in time, without committing to starting a family. Let's talk about what you need to know about freezing your eggs. 

Here’s what you need to know about the process

While there are some big hurdles to clear—like the expenses of going through the process and how (and where) you’ll store your eggs—freezing your eggs is a way to take more control of your future fertility health. 

That being said, it’s important that you think of freezing your eggs not as a guarantee, but rather, a proactive step you can take towards fulfilling potential long-term family planning goals. It is not an insurance policy, but it can help give you more options in the future. 

Research has found that freezing nine eggs while under age 35 leads to a 70% chance of a live birth (studies found that the average number of eggs retrieved for the same women is 18-21). And the more eggs you freeze, the better those odds get. There are always chances that your retrieval could fail, or that implantation down the line may not take. Still, egg freezing in your 20s does offer higher chances of success than having them retrieved at a later age.

Getting ready for retrieval 

Before you can freeze your eggs, you’ll want to ensure your body is producing as many eggs as possible. This means taking hormones that can help stimulate the follicles on your ovaries to produce a larger than normal quantity of eggs.

According to the Mayo Clinic, this may include taking multiple medications or injectables like: 

• Ollitropin alfa or beta (Follistim AQ, Gonal-f) 
• Menotropins (Menopur)
• Leuprolide acetate (Lupron Depot) 
• Cetrorelix (Cetrotide)
• hCG

Your doctor will monitor your progress with blood tests across the 10-14 day period. He or she will tweak any ovarian-stimulating medications you’re given to make sure your estrogen and progesterone levels are where they need to be for a successful retrieval. 

During these visits, you’ll likely also have vaginal ultrasounds. The doctor will use this to check on the development of the follicles where your eggs mature. It might sound overwhelming, but vaginal ultrasounds are usually painless. 

Then, when the time is right—typically 10 to 14 days after you’ve started your medications—you’ll check back in with your doctor and receive a final  injection of something called a human chorionic gonadotropin. This is the final kick to help your eggs mature and prepare them for retrieval. 

Retrieving your eggs

Retrieval is typically done while you’re under a light sedation at a fertility clinic. Your doctor will retrieve your eggs via vaginal ultrasound with suction to remove eggs from follicles. You’ll likely wake up feeling well rested while your medical team has done all of the heavy lifting for you!

While you won’t feel any pain during the procedure, a little soreness afterwards isn’t uncommon.  

Freezing and monitoring

After your procedure your eggs undergo a process called vitrification (AKA: freezing). This process relies on subzero temperatures to cool the eggs for storage. They’re normally stored along with a substance (like liquid nitrogen) that  keeps ice crystals from forming within the frozen eggs. They’re then placed in cold storage for 24/7 temperature monitoring.  

Storage timelines

You may be surprised to learn that your frozen eggs have no expiration date. In fact, in 2021 a child was born from an embryo frozen 25 years prior! Once your eggs have been successfully frozen they cease all biological activity, including aging and deterioration. 

While some countries may have limits on the length of time your eggs can remain frozen, this has not taken hold in the United States. This comes as good news for women who are hoping to freeze their eggs earlier in life and may need more years of frozen storage. 

Our Split program includes 10 years of free storage at a reputable long-term facility, where you'll have access to them whenever you choose to use them. Our Keep program also allows you to store your eggs for 10+ years, though note that the payment will be out of pocket each year. 

How much does it cost?

A lot of women worry about the price tag for freezing their eggs. One piece of good news is that as technology (and availability) of these solutions advances, costs are starting to come down.

Still, you can be looking at a bill for a few thousand dollars for the procedure alone—anywhere between $6,000 to $11,000—plus an annual bill between $300-$1,200 for storage, and up to $5,000 for medications. 

With Cofertility, however, we’ve worked with clinic partners to get you discounts on freezing (think: 75% off initial consults at certain clinics), storage (up to 80% off compared to reputable clinic freezing), and medications (about a 20% savings). 

For those who qualify, our Split program also offers the opportunity to freeze your eggs for free if you donate half of them to a family who can’t otherwise conceive. Yep, zero dollars. 

Split allows you to take control of your reproductive future (while offsetting the costs), and enables you to give someone else the greatest gift of all: a shot at parenthood. But at the end of the day, our mission is to empower women with reproductive choice. If you decide that freezing isn’t for you, we respect that. And most of all, we applaud you for taking this step towards exploring your options and learning more about your own fertility. 

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

What is endometriosis?

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

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

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

Signs of endometriosis

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

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

How endometriosis can affect fertility

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

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

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

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

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

What your doctor might recommend

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

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

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

Bottom line

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

If you think you probably want kids someday—just maybe not, like, today—you might be considering freezing your eggs. Women who choose to do it can find it really empowering, but it can also be a huge personal and financial investment. We’ve gathered the basic info you’ll need to decide whether egg freezing is right for you. 

What’s the process like?

The whole point of egg freezing is to trick your ovaries into sending a whole crop of eggs out into the world in one go. This starts with nearly two weeks of intense, at-home prep work on your part. Here’s how it all plays out:‍

Shots/Sonograms/More Shots

Starting on day 2-3 of your period, you’ll give yourself daily injections of follicle stimulating hormones (FSH) and luteinizing hormones (LH). In a natural cycle, your brain makes smaller doses of these hormones on its own to signal to the ovaries that it’s time to make a single egg ready for ovulation. With this treatment, the brain’s natural process is overridden by the injections in order to encourage the ovaries to release as many eggs as possible.

But not so fast, ovaries! You’ll also be given a third drug in combination with these that will keep your eggs from releasing before the doctor is ready to catch them. Depending on which one you’re prescribed, you’ll start taking this at the same time as the stimulants, or about halfway through the stimulant cycle. Don’t worry, you’ll receive specific instructions on all of these and before you know it, you’ll be an expert at giving yourself a shot. Look at you go!

You’ll take these daily injections for 10-12 days, during which time you’ll also be carefully monitored by the clinic with trans-vaginal ultrasounds that examine your follicles (the ovarian sacs that release the eggs), and blood tests to track your hormone levels. Your medications will be adjusted based on the info from these tests.

When follicles are nice and plump, you do a trigger shot and then go into the center for your egg retrieval. This actually triggers ovulation and it’s what’s needed for the DNA to become mature, but your eggs will be retrieved right before they’re released from the follicles.

Retrieval

An egg retrieval is a minor surgical procedure. Most centers use twilight anesthesia, so you’ll be under sedation through an IV, but breathing on your own. The doctor performing the egg retrieval will insert a trans-vaginal sonogram. Now, here’s the kinda weird part: on the tip of that sonogram wand is a small needle, which pierces the vaginal wall, and then enters the ovary on the other side (the doctor is watching all of this happen on the sonogram screen). The needle drains the fluid (containing the microscopic egg) from each of the mature follicles. The entire thing takes about 20 minutes, and you can go home soon after. 

In the lab, each egg is isolated from the fluid by an embryologist, then stripped of its surrounding cells, and checked under a microscope for maturity. Mature eggs are frozen, post-mature eggs are discarded, and immature eggs may be observed overnight, to see if they are ready to be frozen the next day. 

Recovery

Depending on how many eggs are retrieved, getting over the procedure might be no big deal, or you could have post-retrieval symptoms. Some women experience bloating, cramping, nausea, and potentially some weight gain for a few days after the procedure. Time to stock up on coconut water and get cozy with some Netflix. 

How many eggs will I get?

“People always ask, ‘why can’t you just give every woman enough drugs so that everyone makes 20 eggs?’ But that’s not how it works. Our ovaries have a set number of follicles every menstrual cycle,” explains Dr. Talebian. And of course, each woman is different, so the expectation for egg retrieval has to be set on an individual basis. 

“You can have a 30-year-old who has 30 follicles and produces 30 eggs; and you can have a 30-year-old with 4 follicles and produces 4 eggs.” Once you begin the process, your doctor will monitor your follicle count as well as a blood test of your anti-Müllarian hormone (AMH), which are both good predictors of how many eggs you can expect. It’s super personal and varies case-by-case.

Once your eggs are frozen, the next important number to seek when interviewing a clinic is their thaw rate. This number indicates the percentage of frozen eggs actually survive the warming process in order to be used for IVF. Beyond that, there isn’t really enough data to provide success rates for pregnancy using a woman’s own frozen eggs (versus frozen embryos, for example.

“Anyone who says they can give success rates based on egg freezing is probably not giving an accurate answer,” says Dr. Talebian. “We can give you success rates for healthy donor eggs, but most women who come in to freeze eggs at ages 30-35 have not come back to use those eggs. So there isn’t enough data to give a success rate.”

At what age should I freeze my eggs? 

As we’ve said before, everyone is different, but Dr. Talebian provided some basic guidelines.

• If you have no fertility risk factors: between ages 30-34
• If you have some fertility red flags: consider testing at an earlier age, if, for example, if you have a history of endometriosis, family history of early menopause, or any history of radiation or chemotherapy exposure

“Unfortunately, there’s no magic blood test or ultrasound or MRI that says ‘oh you could wait until you’re 38, or you need to do it at 28,’” says Dr. Talebian. What the centers do have are the stats for the average women at each age and then your personal history and the follicle counts they can take when you come in for your first appointment. Based on all this information, you can have a straightforward convo with the doctor about your likelihood of success, so you can make the best call for your future. 

Read more: A Breakdown of Egg Freezing Success Rates by Age

How much will it cost?

It can totally vary, depending on where you live and from center to center. We can help with this. In our Freeze by Co program, we get special pricing from clinics and on medications. Plus, you get access to an amazing community of women freezing at the same time.

We also offer free egg freezing through our Split program, where you freeze your eggs for free when you donate half to a family that can’t otherwise conceive.

Want to learn more? Take our quiz to see if you’re eligible. 

As women, we are born with all the eggs we’ll ever have, so it’s crucial to consider the health of our eggs as we age — and that includes accounting for the impact diet can have upon egg quality. The number of eggs we have decreases and the percentage of our eggs that contain genetic abnormalities actually increases the older we get. We’re just the messenger here! 

To put this into perspective, women are born with around one to two million oocytes (or egg cells) and by the time we are around 37, this number drops to roughly 25,000. In addition, women in their 20’s will have mostly “normal” egg quality, while women in their 30’s will have mostly “abnormal” egg quality. Each of these factors plays a large role in why fertility may be harder to achieve as we celebrate each birthday. 

Before we dive into how to improve egg quality with diet, let us first explain that currently, there is no “test” for egg quality. The only way to know if an egg is chromosomally normal is to try and fertilize it, and if successful, perform genetic testing. 

Is there an egg freezing diet? 

Yes! What we’re putting into our body (both for better or for worse) can greatly influence the health and quality of our eggs. And during the cycle of an egg’s journey, there is a window of time (90 days) in which certain factors — like diet — can influence the health of that egg. So, it can take roughly three months to improve the quality of your eggs. I recommend optimizing your egg health for at least 90 days before egg freezing. 

When it comes to boosting egg quality, here is where we’d recommend starting:

Omega-3 fatty acids

Omega-3’s are a rockstar when it comes to women’s health and reproductive functions, and egg quality is no exception. Studies have demonstrated a diet rich in omega-3 fatty acids may help improve egg quality. 

However, not all sources are created equal! The omega-3 fatty acids you find in plant-based foods like chia seeds and walnuts, while definitely healthy, are nowhere even close to being as beneficial to egg quality as animal-based sources like fatty fish (think salmon, trout, mackerel, sardines, and tuna). This is because animal-based sources contain EPA and DHA (the kind of omega-3’s that are actually helpful for this purpose), while plant-based sources contain ALA which then needs to be converted into DHA and EPA. Unfortunately, the conversion rate is less than 10%. 

Vitamin D

Studies have shown women undergoing IVF who had higher levels of the sunshine hormone (aka Vitamin D) produced better quality eggs and were more likely to conceive. Not only that, but Vitamin D deficiency has been linked to other hormonal imbalances and anovulatory infertility. Basically, Vitamin D packs a powerful punch if you’re seeking to improve your egg quality. 

The easiest way to get Vitamin D is to head outside for some sunshine for 15-20 minutes per day, but you can also work it into your diet with foods like eggs (specifically the yolk), salmon, herring, sardines, and tuna. 

CoQ10

Coenzyme Q10 levels gradually decline as we age, so this coenzyme is especially important to consider when it comes to egg quality. Studies have demonstrated suboptimal CoQ10 status may drive age-associated declines in egg quality, so load on up. Some of the best sources of CoQ10 are organ meats, however, so if you’re not so keen on a diet loaded with liver, a supplement is a great way to go!

Inositol 

Inositol is thought to increase insulin sensitivity of the ovary, which may help improve egg quality. Working a combination of myo-inositol and D-chiro inositol into your diet is preferable and while beans, oats, oranges, and cantaloupe are good sources, taking a supplement  in the body's normal ratio of 40:1 is preferable here. Recent studies have shown that taking a combination of these two forms, in this ratio, is more beneficial than taking myo-inositol or D-chiro inositol alone. 

Zinc

Zinc is a key regulator when it comes to egg quality and development! Research shows a zinc deficiency may negatively affect the early stages of egg development, reducing the ability of egg cells to divide and become fertilized. Good sources of zinc to work into your diet include oysters, beef, chickpeas, lentils, hemp seeds, pumpkin seeds, and pine nuts.

Antioxidants

Research shows antioxidants such as vitamins A and E may help with the mitochondrial function of our eggs by helping with DNA replication — which is what you want when you’re aiming for healthy, fertilized embryos. Other studies of antioxidants such as catechins, N-acetylcysteine, and proanthocyanidins have also demonstrated a benefit to mitochondrial function in several organ systems. 

The best way to improve egg quality by getting a wide variety of antioxidants into the body is by simply eating the rainbow! This means stacking your plate with as many bright, colorful fruits and veggies as humanly possible. 

Blood sugar balance

Blood sugar balance is super important for egg quality, even if insulin resistance is not an issue. This is because high levels of insulin may be associated with impaired egg quality. More recent data shows that a high starch diet, which was associated with a higher plasma insulin to glucagon ratio, had adverse effects on egg quality. To work towards better glucose control, focus on proteins, healthy fats, and fiber and limit meals and snacks that are full of naked carbohydrates. 

The net-net on egg freezing and diet

In sum, what you put into your body (or what you don’t!) can have profound effects on the health and quality of your eggs. We recommend starting to work on egg health for at least three months before any fertility procedure. Use this list to help guide your diet and supplement intake so you can be on the path to improved egg quality!

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

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

Your body on PCOS

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

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

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

How PCOS could impact your fertility

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

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

So can I freeze my eggs if I have PCOS?

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

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

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

What your doctor might recommend for managing PCOS

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

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

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

Summing it up

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

Egg freezing (oocyte cryopreservation) has become an increasingly common option for those looking for more control over family planning. While the procedure is considered safe, like any medical procedure from getting Botox to an appendectomy, it's important to understand all potential risks, including rare complications like ovarian torsion. At Cofertility, we believe in providing complete transparency about the egg freezing process, including both the benefits and potential risks, so you can make informed decisions about your reproductive health.

Ovarian torsion occurs when an ovary twists around its supporting ligaments, potentially cutting off its blood supply. This is considered a gynecological emergency requiring immediate medical attention. In the context of egg freezing, the risk of torsion is linked to the temporary enlargement of the ovaries that happens during the stimulation phase of the process.

This article explores what ovarian torsion is, why egg freezing may increase the risk, how common it actually is, and most importantly, what you and your medical team can do to minimize this risk. We'll also look at symptoms to watch for and what happens if torsion does occur.

What is ovarian torsion?

Ovarian torsion happens when an ovary rotates around the ligaments that support it, twisting off the blood vessels in its stalk. This can rapidly decrease or block blood flow to the ovary (and often the fallopian tube), causing ischemia (loss of oxygen) in the ovarian tissue.

If not promptly treated, the lack of circulation can lead to necrosis (death) of the ovary, which necessitates medical attention. (This used to require surgical removal, but more recent data support that even a necrotic ovary can be untwisted and left alone and will often re-perfuse.) Ovarian torsion is therefore considered a medical emergency requiring urgent surgical intervention to untwist (detorse) the ovary and restore blood flow. When treated in time, the ovary can often be saved, and future fertility is usually not compromised.

Symptoms of ovarian torsion

The hallmark symptom of ovarian torsion is sudden, severe abdominal or pelvic pain, typically on one side (the side of the affected ovary). The pain often has an acute onset and can be intense and sharp; some patients also report crampy or intermittent pain if the ovary twists and untwists intermittently.

Additional symptoms may include:

• Nausea and vomiting 
• Fever 
• Abnormal bleeding

These symptoms can mimic other conditions like appendicitis or kidney stones, so prompt evaluation (often with transvaginal ultrasound Doppler imaging) is critical to diagnose torsion.

Common causes and risk factors

Ovarian torsion is typically triggered by an imbalance in the ovary's weight or support that makes it prone to flipping over. The most common precipitating factor is the presence of an ovarian mass or cyst, especially one larger than ~5 cm in diameter. A heavy cyst or benign tumor on the ovary can make the ovary top-heavy and more likely to twist on its ligament. In fact, studies indicate that in up to 85% of torsion cases, an ovarian cyst or other mass is present.

General risk factors for ovarian torsion include:

• Reproductive age: About 70–75% of cases occur in females of reproductive age (often in their 20s-30s)
• Ovarian cysts or tumors: Especially those larger than 5 cm
• Fertility treatments: Including egg freezing and IVF
• Polycystic Ovary Syndrome (PCOS): Due to multiple ovarian follicles and enlarged ovaries
• Pregnancy: Approximately 20–25% of ovarian torsion cases occur in pregnancy
• Long ovarian ligaments: Some individuals are born with longer-than-normal utero-ovarian ligaments
• Prior tubal ligation: A history of tubal ligation has been noted as a risk factor
• Previous ovarian torsion: Having had an ovarian torsion in the past increases the risk of recurrence

Overall, ovarian torsion is uncommon in the general population, but it is one of the more frequent gynecologic emergencies. Estimates suggest it accounts for roughly 3% of gynecologic emergency surgeries, making it the fifth most common gynecological surgical emergency.

Why does egg freezing increase torsion risk?

In egg freezing (as in IVF), patients undergo controlled ovarian hyperstimulation – a process of using hormonal medications to make the ovaries produce multiple mature eggs in one cycle. Normally, a woman releases one egg per month and the ovary remains small (about the size of a walnut). In an egg freezing cycle, however, many follicles (egg sacs) develop simultaneously, each filling with fluid as the eggs mature.

By the time of the egg retrieval, the ovaries can become significantly enlarged due to numerous enlarged follicles. This temporary ovarian enlargement and increased weight makes the ovary more mobile and prone to twisting. In short, ovarian stimulation causes the ovaries to be heavier and less stable, which increases the risk of ovarian torsion.

During stimulation, the ovarian ligaments also may loosen slightly under hormonal influence, and the abdomen has more space as the ovaries move away from their normal position. Fertility doctors note that twisting or vigorous movement of the body can precipitate torsion when the ovaries are enlarged. For example, sudden motions, exercise, or intercourse can cause an already heavy ovary to swing and rotate around its tether.

Ovarian torsion can happen at different points in the egg freezing process:

• Most commonly, torsion occurs shortly after the egg retrieval procedure, when the ovaries are at their largest and beginning to shift back in position
• It can also occur during the stimulation phase or around the time of the trigger injection, though this is less common
• There have even been a few reported cases of torsion before the egg retrieval (after the trigger shot but prior to retrieval)

In any case, the risk period for torsion spans from the start of the cycle through the couple of weeks following the egg retrieval, until the ovaries shrink back to normal size.

To summarize, egg freezing increases torsion risk because it creates the perfect storm of risk factors for torsion: multiple ovarian cysts (follicles), significantly enlarged ovaries, and often a high estrogen environment that can loosen ligaments. While this risk is low, both patients and providers remain vigilant for torsion during egg freezing cycles due to the ovaries' temporarily vulnerable state.

How common is ovarian torsion during egg freezing?

Thankfully, ovarian torsion is rare during egg freezing or IVF cycles, but it does occur infrequently. 

Studies of IVF (which is analogous to egg freezing in terms of stimulation) have reported ovarian torsion rates ranging from about 0.02% to 0.2% of cycles. This is roughly between 1 in 4,000 and 1 in 500 cycles.

Overall, acute complications like ovarian torsion, bleeding, or infection occur in under 0.5% of egg freezing cycles. 

So to put it in perspective, ovarian torsion is far less common than other egg freezing side effects like bloating or mild ovarian hyperstimulation. It is a rare event – on the order of a fraction of a percent of cycles – but one that fertility clinics watch out for closely. 

What you can do to reduce torsion risk during egg freezing

While your medical team plays an important role in minimizing torsion risk through careful protocol (medication and dosing) selection and monitoring, there are several steps you can take to protect yourself during the egg freezing process:

Modify your activity level appropriately

During the stimulation phase and especially around and after the egg retrieval, avoid strenuous exercise and heavy lifting. This isn't the time for activities that involve:

• Bouncing movements
• Twisting your midsection
• Rapid changes in direction
• High-impact aerobics or running
• Heavy weightlifting

Instead, stick to gentle activities like walking or light stretching. Many fertility doctors recommend avoiding exercise entirely during the week of egg retrieval and a few days after, when your ovaries are at their largest size and torsion risk peaks. Remember that this limitation is temporary—your normal fitness routine can resume once your ovaries return to their usual size.

Take recovery seriously

After your egg retrieval procedure:

• Rest for at least the remainder of that day
• Have someone drive you home and stay with you for the first 24 hours if possible
• Stay hydrated 
• Avoid strenuous activity for several days following the procedure
• Ease back into your routine gradually, avoiding intense workouts or heavy household chores for about a week
• Listen to your body and don't push yourself if you're experiencing discomfort

Abstain from sexual intercourse

Your doctor will likely advise you to avoid sexual intercourse during the stimulation cycle and for a short period after retrieval. This recommendation serves two purposes:

1. Prevents jostling of the enlarged ovaries that could trigger torsion
2. Avoids unintended pregnancy during a time when you're extremely fertile

Know the warning signs

Familiarize yourself with symptoms that require immediate medical attention:

• Sudden, severe abdominal or pelvic pain (especially on one side)
• Pain that doesn't improve or worsens
• Nausea and vomiting
• Fever
• Significant bloating or abdominal swelling
• Dizziness or feeling faint
• Heavy bleeding

If you experience any of these symptoms, contact your clinic immediately or go to the emergency room. Don't hesitate or downplay severe pain—prompt intervention can save your ovary if torsion has occurred.

Summing it up

The risk of ovarian torsion during egg freezing is very low but not zero. A combination of precautions (limiting physical strain, watching symptoms) and medical management (careful stimulation and monitoring) helps keep this complication rare.

For the vast majority of individuals undergoing egg freezing, torsion never occurs. For those unlucky few who do experience it, prompt surgical care usually results in a good outcome with preservation of the ovary.

By understanding the causes, risk factors, and preventive measures, patients can feel confident that everything possible is being done to make egg freezing both a successful and safe process. We wish you all the best on your journey!

It’s no secret that egg freezing is a significant journey that demands time, money, and energy. Having gone through IVF twice — which involves the same egg retrieval process — I know first-hand the importance of being as prepared as possible leading up to your retrieval. From personal experience and extensive research, I’ve created a detailed three-month roadmap to help you optimize your preparation for egg freezing. I wish I had access to this kind of guide when I was starting my fertility treatments! 

In order to help you prioritize, this list is organized by “must-do’s” vs. “nice-to-haves”. While we can’t significantly affect our egg quality, at the very least, these simple tips could hopefully help enhance your egg quality and quantity in some capacity. And at most, they’ll also provide some peace of mind so you feel calm, ready, and empowered to take on this incredible thing you’re doing for your fertility future. 

Month 1: laying the foundation

If you’re still a few months out from your retrieval, you have the luxury of time to make real lifestyle shifts that might benefit your outcome. Let’s make the most of it! 

Must-dos

Nutrition adjustments 

Focus on a balanced diet rich in antioxidants, which can help protect eggs from oxidative stress. Integrating more fruits, vegetables, whole grains, and healthy fats can improve overall reproductive health. Key nutrients to focus on include:

• Folate: Recent studies indicate the importance of folate intake when it comes to cycle regulation, ovarian function, and pregnancy preparation. Folate can be found in leafy greens, citrus fruits, and legumes. Note: folate is a naturally occurring nutrient, while folic acid is a synthetic version of folate added to fortified foods and supplements.
• Omega-3 fatty acids (DHA): Found in fish oil and flaxseeds, these nutrients support cellular health, and improve ovarian function, and some data suggests that improved omega-3 intake can enhance egg quality, though these studies are primarily limited to women undergoing treatment for infertility. 
• Hydration: Drinking enough water is important for everyone, but if you’re about to undergo an egg freezing cycle, consider upping your daily water intake to 2-3 liters per day in order to remain properly hydrated.

For a deeper dive into dietary tips prior to egg freezing, check out our guide here. 

Medication changes

In addition to adding new supplements into your routine, you should connect with your doctor about what supplements or medications to adjust leading up to your cycle. Your doctor may have you change a dosage or pause a certain medication altogether. For more on which medications you might need to adjust during an egg freezing cycle, click here.

Nice-to-haves

Upgrade your supplement regimen 

While you should not begin a supplement regimen without discussing it with your doctor first, here are a few supplements worth talking to your doctor about as you prepare for egg freezing:  

• CoQ10: Several studies indicate that CoQ10 supplementation can be associated with increased egg volume, improved fertilization rates, and improved embryo development rates. Click here for an extra 20% off your CoQ10 order with code COFERTILITY20. 
• Myo-inositol: This substance can improve insulin resistance and ovarian function, with studies supporting its role in enhancing egg quality. Click here for an extra 20% off your Myo-inositol order with code COFERTILITY20. 
• Vitamins B6, B12, E, and K2: All often found in prenatal vitamins like the one we linked, these are essential for cellular function and embryo development down the line. Click here for an extra 15% off your prenatal order with code COFERTILITY. 

For a full list of recommended supplements for gearing up for egg freezing, click here. 

Moderate exercise

Studies on the relationship between exercise and fertility are limited, but the endorphins you’ll feel as a result of regular movement won’t hurt. Be careful to avoid excessive, high-intensity workouts as you get closer to your retrieval as this can negatively affect your reproductive cycle. And, during the ovarian stimulation phase right before your retrieval, you’ll need to hold off on high-intensity workouts altogether to prevent ovarian torsion. 

Self-care essentials

Start stocking up on items like a good ice pack or heating pad for injections, comfy clothes for bloating, and cozy socks (those stirrups can get chilly!). 

Month 2: enhancing egg quality

As you get closer to your egg freezing cycle, continue managing the adjustments you’ve begun to make to your lifestyle. You’ll also start communicating more regularly with your clinic — beginning medications if prescribed, or starting to visit the office more for assessments and monitoring. 

Must-dos

Increased monitoring

While you won’t ramp up frequent office visits until closer to your cycle, expect to visit your fertility clinic a bit more frequently than before. You’ll usually need to do some bloodwork and/or ultrasound before finalizing a medication plan and timing. This may include starting birth control to bring your cycle back to baseline before kicking things off. 

Stress management

While stress might feel unavoidable, high stress levels can disrupt hormonal balance. Aim to integrate stress management activities or strategies into your daily routine in some capacity. This might include things like yoga or meditation, or even learning some quick deep breathing techniques to better navigate stressful moments throughout your day. 

Nice-to-haves

Acupuncture

If you’ve never tried acupuncture, now is a good time to start. Some studies suggest acupuncture can improve blood flow to the ovaries and enhance fertility outcomes, but honestly, the jury is still out. Our POV? There’s no downside, so if you can make it work and enjoy it, it could be worth a try. You can read more here for a deeper dive into acupuncture for egg freezing, and some insights based on my personal experience.  

Sleep quality

Studies suggest aiming for about 8 hours of quality sleep per night to help regulate hormone cycles, though it’s unclear if this directly affects egg quality or quantity. 

Reduce endocrine disruptor exposure

You may have heard about “endocrine disruptors,” which are chemicals that can interfere with your endocrine (hormonal) system and the reproductive and other biological processes it regulates. Unfortunately, endocrine disruptors are not fully regulated in the United States, and can be found in certain beauty products, plastics, and more. Consider switching to cleaner products and glass containers as you gear up for your egg freezing cycle. 

Month 3: final preparations

The final month is about adhering to prescribed medical treatments, minimizing exposure to harmful substances, and ensuring you are as relaxed and supported as possible as you approach your retrieval.

Must-dos

Adjust and organize your medications 

Spend some time leading up to your retrieval getting your medications organized, including syringes, alcohol pads, gauze, and the medication themselves. You could even use a special box or cute caddy. As your doctor provides final adjustments to your medication protocol, you’ll also want to write our your daily medication plan in a way that’s easy to follow. I personally had luck with a printed-out calendar view, with AM and PM medications listed out and color coded. This gave me a small sense of control over this time, which can feel a bit chaotic! 

Avoid harmful substances

While the link between caffeine and fertility is not clear, it’s probably a good idea to keep the jitters to a minimum as you gear up for your retrieval. Alcohol intake should also be reduced, and smoking should be ceased entirely as it can be detrimental to reproductive health. 

Nice-to-haves

Secure your support system 

Communicate your upcoming egg freezing journey on a need-to-know basis. That includes sharing with managers and/or coworkers any necessary scheduling shifts, but it also means connecting with trusted family members, friends, or even online communities (like ours!) about what’s about to happen. 

Freezing your eggs is a big deal, and besides needing someone to escort you home after the retrieval, you’ll want some shoulders to lean on — even virtually. 

Set your medication alarms

In addition to writing out your medication plan, setting alarms on your phone for medication times can help keep you sane during your egg freezing cycle. If you’ve got lots going on, setting alarms can be crucial as you’ll need to take medications at specific times throughout the day. 

How Cofertility can support your journey

At Cofertility, we understand that egg freezing is a significant emotional and financial decision. That's why we offer more affordable and even free egg freezing options for women who choose to donate half of their eggs retrieved to another family struggling with conception. 

Ready to begin your egg freezing journey? Take our quiz to discover how we can best support you, and learn about your eligibility for free egg freezing.

Embarking on your egg freezing journey can be an incredibly transformative period in your life. With the right preparation, informed choices, and supportive care, you can approach this phase with confidence and optimism. We're here to ensure that every step you take is grounded in knowledge and surrounded by support.

Environmental toxins called endocrine disrupting chemicals (EDCs) are everywhere in our modern world - from pesticides to plastics, and from cosmetics to cleaning supplies. Recent research suggests these chemicals may impact fertility and egg freezing outcomes. While we can't completely avoid EDCs, understanding their potential effects can help you make informed choices when freezing your eggs.

This article explores what EDCs are, how they might affect fertility, and practical steps you can take to minimize exposure during your egg freezing journey. We'll look at the latest research and provide actionable recommendations for reducing your exposure to these chemicals.

What are endocrine disrupting chemicals?

EDCs are substances that can interfere with your body's hormonal systems. According to a 2020 study in Endocrine Connections, these chemicals can affect hormone production, secretion, transport, and function. Even low-level exposure to these compounds can disrupt hormonal balance.

Common sources include:

• Pesticide residues on fruits and vegetables
• Plastics (especially those containing BPA)
• Personal care products
• Household cleaning supplies
• Some food packaging materials
• Non-stick cookware
• Receipt paper
• Furniture with flame retardants

How EDCs may impact fertility

Research suggests EDCs could affect fertility in several ways:

Impact on egg quality:

Certain pesticides and industrial chemicals may affect egg maturation and development. Some EDCs have been linked to oxidative stress in eggs, which could potentially impact their quality. The 2020 paper specifically found that exposure to certain pesticides was associated with poor egg maturation and competency.

Hormonal and cycle effects:

These chemicals can disrupt normal hormone function, potentially affecting ovulation and reproductive health. The 2020 study found that some EDCs may interfere with FSH and other hormones crucial for reproduction. This interference can affect regular menstrual cycles and ovulation.

Long-term reproductive health:

Research suggests that prolonged exposure to certain EDCs might be associated with conditions like premature ovarian insufficiency, polycystic ovarian syndrome, and endometriosis - all of which can impact fertility.

Impact on male fertility:

EDCs can also significantly affect male reproductive health. Research has linked EDC exposure to decreased sperm quality, including lower sperm count, reduced motility, and abnormal morphology. These chemicals may also disrupt testosterone production, leading to hormonal imbalances that impact overall reproductive function. Chronic exposure to EDCs has been associated with testicular dysfunction and reduced fertility outcomes in men.

The research on EDCs and fertility treatment

A study published in Endocrine Connections revealed concerning findings about how EDCs affect fertility treatments. Women living in agricultural areas with higher pesticide exposure showed significantly lower pregnancy rates during IVF compared to those in areas with less exposure. 

The research also found that certain EDCs were linked to fewer eggs retrieved during fertility treatments, potentially impacting the success of egg freezing cycles. Beyond egg retrieval, these chemicals appeared to affect later stages of fertility treatment too, with some EDCs showing negative effects on embryo development and implantation rates. These impacts were especially notable in women who had long-term exposure to these substances, suggesting that chronic exposure to EDCs may increase reproductive risks.

Practical steps during egg freezing

While more research is needed, there are several evidence-based steps you can take to minimize EDC exposure while preparing for egg freezing:

Food choices:

• Choose organic produce when possible, especially for items on the "Dirty Dozen" list
• Avoid canned foods (many cans are lind with BPA)
• Store food in glass containers rather than plastic
• Use stainless steel or glass water bottles
• Avoid heating food in plastic containers

Personal care products:

• Switch to clean self-care products free from phthalates and parabens
• Check ingredients in skincare products
• Use natural deodorants
• Choose fragrance-free options when possible
• Consider switching to organic tampons and pads

Home environment:

• Vacuum regularly to remove dust that may contain flame retardants
• Filter your drinking water if necessary
• Use natural pest control methods

As you consider these changes, remember that EDCs affect everyone differently. Your personal response depends on multiple factors, including how long you've been exposed and what combination of chemicals you encounter in your daily life. Some people are naturally more sensitive to these substances than others, and the timing of exposure matters - particularly during hormone-sensitive periods like the months before egg freezing. Your overall health, including diet, stress levels, and existing health conditions, also influences how your body processes these environmental toxins. Understanding this variability can help you make informed decisions about which exposure-reduction strategies make the most sense for your situation.

While EDCs are a concern, it's important not to become overly anxious about them. Focus on making reasonable changes within your control.

Can supplements help protect against EDCs?

If you're concerned about endocrine-disrupting chemical exposure, you might be wondering if supplements can help. While research in this area is still emerging, there are a few supplements that show promise:

Vitamin C 

A small 2016 pilot study found that taking 1,000mg of vitamin C daily for two months reduced levels of certain EDCs (specifically PCBs and OCPs) in participants' blood. However, it's important to note this was a small study with just 15 participants and no control group. While promising, we need larger, controlled studies to confirm these findings.

Iodine 

Several studies have linked iodine supplementation to reduced EDC-related effects on thyroid function. One 2015 study followed pregnant women taking 150 micrograms of iodine daily but found mixed results - while iodine supported thyroid function, it didn't completely counteract EDC exposure effects on early language development.

Folic acid 

While observational studies suggest folic acid might help protect against EDC-related developmental effects, there haven't yet been controlled trials to prove this connection. However, since folic acid is already recommended during pregnancy for other well-documented benefits, taking it may offer additional protective effects against EDCs.

Remember that supplements can't eliminate EDC exposure - at best they only help reduce some effects. The most effective approach is still minimizing exposure through diet and lifestyle changes. If you're considering taking supplements, always discuss this with your healthcare provider first, as they can help determine what's appropriate for your specific situation.

The bigger picture

While reducing EDC exposure is important for overall health, it's just one piece of the fertility puzzle. If you want to increase the chances of egg freezing success, you’ll want to focus on overall health optimization, including:

• Maintaining a balanced, antioxidant-rich diet 
• Stopping smoking and harmful drugs
• Regular exercise appropriate for fertility
• Reduce stress as much as possible
• Get adequate sleep
• Stay hydrated

Work with your fertility doctor to create a plan that takes into account your personal circumstances and helps optimize your egg freezing outcomes. They can provide guidance on specific steps that make sense for your situation, while helping you maintain perspective on what factors are most important for success.

Freeze your eggs with Cofertility

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

Through our Split program, qualified freezers can freeze their eggs for free when donating half of the eggs retrieved to a family who can’t otherwise conceive.

Through our Keep program — where you keep 100% of eggs retrieved for your own future use — we offer exclusive discounts on expenses, such as frozen egg storage. Keep members also still gain free access to our Freeze by Co Community, a safe space for those engaging in the egg freezing process (or gearing up for it) to connect and lean on each other.

By making egg freezing easier and more accessible, our programs further strengthen the American Society of Reproductive Medicine (ASRM)’s Committee Opinion that egg freezing can help promote social justice and strengthen gender equality.

Choosing where to freeze your eggs is one of the most important decisions in the egg freezing process. While cost is often a major factor, there are other important elements to consider when selecting a clinic. From success rates to lab quality to the patient experience, this article will help you learn how to evaluate different clinics to find the right fit for your needs. Let’s dive in!

Getting started with research 

Before you start screening for specific metrics, it's helpful to create a list of clinics within your geographical area. Most egg freezers prefer a clinic within an hour's drive since you'll need to visit frequently during the stimulation phase. Start by:

• Doing a quick search on Google maps
• Asking your OBGYN for recommendations
• Exploring your insurance provider's network
• Researching clinics through SART (Society for Assisted Reproductive Technology)
• Reading reviews on FertilityIQ and other patient forums
• Joining local fertility support groups or online communities
• Getting recommendations from friends who have frozen their eggs

If you choose to freeze your eggs with Cofertility, we’ll provide you with a list of our partner clinics and, depending on your program, pricing information if necessary.

Once you have a preliminary list, here's what we recommend evaluating:

Success rates matter - but look closely

‍

Success rates are important, but comparing clinic data is not always apples-to-apples. And, the data is not always up-to-date. When reviewing clinic statistics, consider:

• Laboratory competency: Ask about the clinic's egg survival rate after thawing. With modern vitrification techniques, survival rates should be 95% or higher. A lower rate might indicate issues with the lab's freezing protocols.
• Age-specific success rates: Look for success rates specific to your age group. Some clinics may have great overall numbers but less experience with patients in your demographic.
• Reporting transparency: Do clinics accept all patients, or do they cherry-pick patients that will have the best outcomes? Remember that success rates can vary based on patient population and case complexity. A clinic that takes on more challenging cases might have lower overall success rates but could still be excellent.
• Timing of data: Published success rates often reflect data from 2-3 years ago. Look to see if the doctors who achieved those results are still practicing there and whether the clinic has changed locations, protocols, or lab directors since the data was collected. Success rates can change significantly with staff turnover or protocol updates.

Clinic size 

The size of a fertility clinic can significantly impact your treatment experience. Smaller clinics typically offer more personalized attention and consistency in your care team. You'll likely see the same doctor and nurses throughout your journey, and scheduling tends to be more flexible to accommodate individual needs. However, smaller clinics may have limited resources or access to the latest technology, and they might face challenges with coverage during staff vacations or emergencies.

Larger clinics, on the other hand, often have more extensive resources and access to cutting-edge technology. They frequently offer multiple locations and broader scheduling options, which can be particularly convenient for monitoring appointments. Their larger support staff means more availability for patient questions and concerns. However, the experience might feel less personal, and you may see different doctors at each visit. Larger clinics also tend to have more standardized protocols, which can mean less individualization in your treatment plan.

Neither size is inherently better - the choice depends on your personal preferences and priorities. Some patients prefer the intimate setting and personalized attention of a smaller clinic, while others value the resources and convenience that larger clinics can offer. Consider asking for more information about a clinic’s scheduling practices to better understand how soon you can start treatment, how often appointments are available, and how long wait times might be during peak periods.

Clinic culture, perks, and approach

Every clinic has its own philosophy and approach. Consider:

• Patient volume: Some clinics take a high-volume approach while others focus on fewer patients with more personalized care. Neither is inherently better, but one style might suit you better.
• Treatment philosophy: Ask about their approach to medication protocols - do they customize for each patient or use standard protocols? Do they use their intuition or do they use software and AI to determine the best protocol?
• Communication policies: Understand how the clinic handles patient communications. Who will you contact with questions? What is the expected response times? What about after-hours support?
• Patient portal: Is there a patient portal or does communication happen via email, phone, or text?
• Perks: Some clinics offer additional resources like support groups, mental health support, nutrition counseling, and even acupuncture services.

The medical team

The quality of your medical team significantly impacts your experience. Consider:

• Experience and credentials: Look for board-certified reproductive endocrinologists with specific experience in egg freezing. Ask how many cycles they perform annually. As with most medical procedures, more volume correlates with better outcomes.‍
• Communication style: Does the doctor take time to answer questions? Are they accessible between appointments? You should feel comfortable asking questions and confident in their responses.‍
• Support staff: Your primary contact may often be with nurses and coordinators. Ask about their experience and availability.‍
• Team approach: Understanding how the clinic handles patient care is important. Will you always see your doctor, or do they rotate? How are weekend appointments handled?

Monitoring and flexibility

The egg freezing process requires frequent monitoring appointments, making a clinic's scheduling flexibility core to your experience. During the stimulation phase, you'll need early morning monitoring appointments every few days, so consider how the clinic's hours align with your schedule. Many clinics offer early morning monitoring before work hours, but availability varies significantly between facilities. Weekend monitoring options are especially important since your body doesn't follow a Monday-to-Friday schedule during treatment.

Some larger clinics offer multiple locations for monitoring appointments, which can provide valuable flexibility if you live or work in different areas. Wait times for appointments can vary dramatically between clinics - while some run efficiently with minimal waiting, others may have significant delays that could impact your work schedule. Additionally, some clinics now offer remote monitoring options for certain appointments, which could save you travel time during your cycle.

When evaluating a clinic's flexibility, ask specific questions about their monitoring process: How early do they open? What happens if you're running late? How do they handle weekend and holiday monitoring? Understanding these logistics upfront can help you gauge whether a clinic's scheduling approach will work with your lifestyle.

Laboratory quality and technology

The laboratory is the heart of any fertility clinic. Key factors to evaluate include:

• CLIA certification and CAP accreditation
• Whether the clinic has an in-house lab or outsources its services
• The experience level of embryologists
• Updates to equipment and protocols
• Clean room air filtration systems
• Backup power systems
• Security measures for stored eggs

Ask about the clinic's experience specifically with egg freezing, not just general IVF. Some clinics may have extensive experience with embryo freezing but less with egg freezing, which requires different expertise.

Insurance and financing 

Egg freezing can be a significant financial investment so, if you are self-funding your journey, it’s important to explore all your payment options. Consider the following:

• Verify if the clinic accepts your insurance plan and which parts of the process are covered (e.g., initial consultation, medication, or storage fees)
• Check whether your employer offers fertility benefits that can be used at the clinic
• Inquire about the clinic’s financing options or available payment assistance programs 

Support for LGBTQ+ 

If you’re a member of the LGBTQ+ community, finding a clinic that understands and supports your unique journey is essential. Here’s what to look for:

• Ensure the clinic has a proven track record of supporting LGBTQ+ individuals
• Ask whether they offer additional resources, like LGBTQ+-focused support groups
• Look for signs that the clinic fosters a welcoming, affirming space where diversity and inclusion are prioritized.

The bottom line

While cost is an important factor, choosing an egg freezing clinic should involve evaluating multiple aspects of care and service. Focus on finding a clinic that combines strong success rates, high laboratory standards, and a care approach that matches your needs. Take time to visit your top choices, meet with the medical team, and trust your instincts about where you feel most comfortable.

At Cofertility, we partner with leading fertility clinics nationwide that meet rigorous quality standards. Whether you're interested in our Keep or Split program (where you freeze your eggs for free when donating half), we can help connect you with top clinics in your area that align with your priorities and preferences.

If you’re considering freezing your eggs, you might have lots of other priorities going on — including your career. According to the Society for Assisted Reproductive Technology (SART), egg freezing is a dramatically growing trend, with a 30% year-over-year increase in cycles. 

Still, you might be wondering: Can you work while freezing your eggs? Do you need to take time off? This guide provides actionable strategies to help you manage egg freezing and work, from scheduling appointments to requesting time off for egg freezing.

How will freezing my eggs impact my work schedule?

Balancing egg freezing and work requires some planning, as the process involves hormone injections, frequent monitoring appointments, and the final egg retrieval procedure. Here’s how each stage might impact your work schedule:

Hormone injections

Hormone injections are administered daily for 10 to 14 days, typically in the evening. If you work a standard daytime schedule, you can still go into the office and handle your injections after work. For those who work evening or night shifts, you may need to adjust your hours, work remotely, or take short-term time off for egg freezing. 

If needed, you can even give yourself injections in your office bathroom, as long as you use an alcohol pad to keep the injection area sterile and safely dispose of your needles. Your medication should come with a small sharps container; if you need an extra one for this reason, ask your clinic. 

Fertility medication delivery

If you live in a large city, such as New York or Los Angeles, specialty pharmacies often carry fertility medications for same-day pick-up. In other areas, medications are typically shipped overnight to your home. Since these medications are time-sensitive (and some require refrigeration), you may need to be home to accept the delivery. If you can, schedule delivery on a day you work remotely, take a few hours off, or coordinate the delivery with a trusted friend ro neighbor.

Monitoring appointments

During the 10-14 day stimulation phase, you’ll have a few monitoring appointments to track how your follicles are growing. These appointments usually include ultrasounds and bloodwork and are scheduled directly with the clinic throughout the cycle. Fortunately, most clinics offer early-morning appointments, allowing more flexibility. You’ll need to plan your schedule to accommodate these visits.

Egg retrieval procedure

The egg retrieval procedure itself is minimally invasive and you won’t need to be at the clinic for more than a few hours, but we highly recommend taking the day off work so you can rest after the procedure. Most people feel well enough to resume work the next day, but it’s wise to block off  time around your projected retrieval date in case you want or need extra time to recover. 

Can you work while freezing your eggs?

The short answer is yes. Most women continue working full time during their egg-freezing cycle. However, it requires flexibility and proactive communication with your team. Here are some tips to help you navigate egg freezing and work seamlessly:

1. Talk to your employer: If you feel comfortable, let your manager or HR team know that you are undergoing a medical procedure that requires temporary flexibility. Be clear about your needs, such as the ability to work remotely or adjust your hours. If you don’t want to disclose specifics, you can simply say you are undergoing a “medical treatment” without mentioning egg freezing.
2. Block off key dates: Once your cycle begins, you’ll have an estimated timeline for your appointments and egg retrieval. Block off your calendar for early-morning monitoring visits and plan to take the day off for the egg retrieval. Since the exact timing of your retrieval depends on how your body responds to the hormone injections, be prepared to adjust your schedule with short notice. It’s a good idea to communicate this need for flexibility to your manager, as well as your peers or direct reports, in advance.
3. Work ahead: I know this is easier said than done, but if possible, complete high-priority tasks in advance to reduce stress during your cycle.
4. Be strategic about remote work: If your company allows remote work, use it to your advantage during the two-week egg freezing cycle. Working from home can help you stay more comfortable and manage any potential side effects from your hormone medications, like fatigue, bloating, or emotional changes.
5. Understand benefits and FMLA: You’ll want to understand your company’s benefits to see what type of resources and/or support you’re entitled to (if any) for an egg freezing cycle. Plus, if you work for a company with 50 or more employees, you may qualify for unpaid, job-protected leave under the Family and Medical Leave Act (FMLA). While FMLA doesn’t explicitly cover egg freezing, it may apply if the procedure is deemed medically necessary. Check your workplace policies and consult HR to understand your rights.
6. Leverage team support: If your workload feels overwhelming, it might be beneficial to fill in a trusted colleague or two, so you can coordinate coverage if needed. Or, at the very least, have a shoulder to lean on. 

Self-Care Strategies During Egg Freezing and Work

If balancing work, life, and an egg freezing cycle feels stressful, try these self-care strategies to stay healthy and reduce anxiety:

Manage side effects

For some people, hormone injections can cause bloating, mood swings, and fatigue. Stay hydrated, eat nutritious meals, and get plenty of rest to help manage these symptoms. I highly recommend avoiding tight clothes. Keep comfortable clothes and snacks on hand, especially if you’re working from the office.

Prioritize work-life balance

Set boundaries during your egg-freezing cycle. Limit after-hours work commitments, and allow yourself time to rest and recover after appointments and your egg retrieval.

Stress management

Incorporate stress-reducing activities such as yoga, meditation, or gentle exercise into your routine. Even a short walk during your lunch break can help clear your mind.

Lean on your support system

Share your experience with trusted friends, family members, or online support groups. Connecting with others who have undergone egg freezing can provide reassurance and practical advice. At Cofertility, we provide all members with access to our private online community, filled with tips, guidance, and a built-in support system. 

How Cofertility can help

If you’re considering freezing your eggs, we can help simplify the process. In addition to providing the opportunity to freeze your eggs for free when you donate half the eggs retrieved to another family that can’t otherwise conceive, Cofertility offers resources to connect our members with trusted clinics, provides educational materials, and fosters a supportive community. Whether you need guidance on scheduling, medication delivery, or balancing egg freezing and work, we’re here to be a helpful partner on your journey.

Summing it up

With proper planning and support, freezing eggs while working full-time is entirely achievable. By understanding how the process impacts your schedule, communicating your needs with your employer, and prioritizing self-care, you can successfully balance both. Whether you need time off for the egg retrieval or flexible hours for monitoring appointments, being proactive will ensure a smoother experience. 

With resources like Cofertility and support from loved ones, you can take control of your reproductive future while thriving in your professional life. To see if you qualify for our Split program that provides free egg freezing, take our one-minute quiz here. 

Egg freezing starts with something called "ovarian stimulation" - which may sound technical, but it's actually pretty straightforward.

When you decide to freeze your eggs, your doctor will start you on a medication protocol to stimulate your ovaries. While your body naturally releases one egg per month, for egg freezing to be effective, we want to collect multiple mature eggs in a single cycle. That's what ovarian stimulation is: a process that uses injectable medications to help your ovaries produce several eggs at once, giving you a better chance of preserving good quality eggs for your future.

These medications mimic the natural hormones in your body - just at higher levels - encouraging your ovaries to mature multiple eggs instead of just one. The process typically takes 8-12 days, during which you'll have monitoring appointments to check your progress. Understanding what happens during ovarian stimulation and what you might experience physically can help you prepare for the process ahead. 

In this article, we'll break down the medications used, what to expect at each stage, and how to make the experience more manageable.

What is the purpose of ovarian stimulation?

The main goal of ovarian stimulation is to help you freeze multiple mature eggs at once, improving your chances of having a baby in the future. Think of it like this: when you naturally try to conceive, you're working with one egg per month. If that egg isn't viable or doesn't fertilize, you try again next month. But when you're freezing eggs, you want to maximize your chances by collecting several mature eggs in a single cycle. Getting multiple eggs at once is particularly important because not every frozen egg will successfully thaw, fertilize, or develop into a healthy embryo later. By stimulating your ovaries to mature multiple eggs at once, you increase your options for your future family planning.

What happens in your body during ovarian stimulation

Ovarian stimulation follows a fairly predictable timeline, though each person's experience varies slightly. Here's what you can typically expect during the process:

• Day 1-5: Your ovaries begin responding to the medications, growing multiple follicles simultaneously. Each follicle contains an egg. You'll start regular monitoring appointments to track your progress.
• Day 5-10: Follicles continue growing, and hormone levels rise. Your monitoring appointments become more frequent as your doctor fine-tunes medication doses based on your response.
• Days 10-14: As your eggs reach maturity, your doctor will schedule your trigger shot and egg retrieval. Timing becomes very precise at this stage.

Throughout stimulation, you'll have regular appointments to track your progress:

• Blood tests measure your hormone levels, helping your doctor adjust medication doses for optimal results.
• Ultrasounds show how many follicles are growing and their size. These transvaginal ultrasounds are quick and help your doctor determine when you're ready for egg retrieval.

What you might notice

Physical changes during ovarian stimulation can vary person to person, but commonly include:

• Bloating, especially as follicles grow
• Tenderness in your lower abdomen
• Fatigue
• Breast tenderness
• Mood changes from hormonal fluctuations

Most women maintain their normal activities during stimulation, though you might want to scale back intense exercise as your ovaries enlarge.

Read more in What are the Side Effects and Risks of Egg Freezing?

What to do during ovarian stimulation

Success with ovarian stimulation often comes down to organization and support:

Create a medication schedule:

• Set alarms for injection times
• Keep medications properly stored
• Track your appointments
• Note any symptoms or questions for your doctor

Build your support system:

• Consider having someone help with injections
• Join egg freezing support groups (like Cofertility!)
• Keep your care team informed of any concerns
• Plan for rest when needed

Before beginning stimulation:

• Learn proper injection techniques from your fertility care team
• Organize your medication and supply storage
• Plan your monitoring appointment schedule
• Arrange any needed support
• Clear up any questions about your protocol

As stimulation progresses, your doctor will monitor your follicles' growth and hormone levels to determine the ideal time for egg retrieval. This precise timing helps ensure the highest number of mature, viable eggs for freezing.

Is ovarian stimulation painful?

While ovarian stimulation isn't typically painful, you may experience some discomfort during the process. The daily hormone injections use very thin needles - most women describe them as feeling like a quick pinch. Some report mild soreness at injection sites, similar to how your arm might feel after a flu shot. 

As mentioned above, during stimulation, you might feel increasingly bloated or experience tenderness in your lower abdomen as your ovaries grow larger. This is normal and expected. The monitoring appointments include transvaginal ultrasounds, which might be uncomfortable but shouldn't be painful. If you do experience significant pain during stimulation, it's important to let your doctor know right away

Read more in Does Egg Freezing Hurt?

What is overstimulation?

Ovarian hyperstimulation syndrome (OHSS) is a rare but potential complication where your ovaries respond too strongly to the fertility medications. Think of it as your ovaries becoming overachievers - they produce too many follicles, leading to excessive hormone levels. 

Mild OHSS can cause increased bloating, mild nausea, and abdominal discomfort. More severe cases might involve significant bloating, shortness of breath, or severe abdominal pain. The good news is that OHSS is largely preventable with modern protocols and careful monitoring. Your doctor will track your response to medications through regular blood tests and ultrasounds, adjusting your protocol if needed to minimize this risk. If you're concerned about OHSS, talk with your doctor about your personal risk factors and the precautions they take to prevent it.

The bottom line

Understanding ovarian stimulation is an important step in your egg freezing process! While the daily medications and monitoring appointments might seem overwhelming at first, remember that thousands of women have successfully completed this process before you. Your body is capable of amazing things, and with modern science and proper support, the stimulation phase is usually very manageable.

At Cofertility, we believe knowledge is power. That's why our Member Advocates will be with you every step of the way, ready to answer questions and provide support. Whether you're just starting to research egg freezing or ready to begin your medications, we're here to help you navigate this process with confidence.

Have questions about egg freezing or want to learn more about your options? Reach out to us. We'll help you understand what to expect and how to prepare for this important step in your fertility journey.