female fertility

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

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

Issues facing egg freezing and reproductive healthcare access

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

Understanding state-level impacts on egg freezing 

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

High costs and insurance gaps

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

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

Impact on LGBTQ+ individuals and family planning

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

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

Egg freezing access amid political changes

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

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

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

What to watch for this election season

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

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

How Cofertility can support you 

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

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

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

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

Key Highlights:

• Demand for egg freezing is soaring, with a 30% year-over-year increase in cycles. This reflects changing priorities and greater acceptance of the procedure.
• Motivations for egg freezing evolve with age. Initially, the focus is on career and education. Later, finding a partner becomes more important. Egg freezing offers flexibility amidst these changing life goals.
• While booming interest suggests a massive growth trajectory, the number of egg freezing cycles remains relatively small compared to other reproductive procedures.
• Egg freezing aligns with the broader trend of “later” parenthood, reflecting shifts in how women navigate career, relationships, and reproductive choices.

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

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

This steady growth trajectory of egg freezing cycles is evident in the 30% year-over-year increase in cycles reported by SART in 2022, the most recent year we have data. Over 29,000 people froze their eggs in 2022, compared to a little over 22,000 the previous year. This report aims to dive deeper into this trend, examining the motivations driving this demand, technological advancements, and the evolving societal implications of delayed parenthood.

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

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

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

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

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

• There were 29,083 egg freezing cycles reported to SART in 2022
• There were 389,993 IVF cycles reported to SART in 2022
• There are over 500,000 vasectomies (a male sterilization procedure) in the U.S. annually
• There were over 900,000 abortions in the U.S. in 2019
• There were 3,661,220 births in the U.S. in 2022

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

Shifting priorities: what matters most to potential egg freezers

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

Before 28: career focus dominates  

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

Age 29: peak desire to travel

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

Age 35+: marriage takes center stage  

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

Timing of kids: ideal vs. reality

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

The importance of connection increases with age  

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

Geography influences subtle shifts  

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

City-folks showed more uncertainty around having kids 

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

Trends driving the increase in egg freezing demand

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

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

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

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

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

The future of fertility preservation

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

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

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

‍

A note on SART data:

The Society for Assisted Reproductive Technology (SART), the association of America’s fertility clinics dedicated to the practice of assisted reproductive technologies (ART), tracks data amongst its 368 member clinics. The data generally takes 16 months from the end of the year to be published online. So, the most recent year for which we have data is 2022. 

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

A note on Cofertility survey data:

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

‍

Learn More About Egg Freezing:

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

‍

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

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

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

A quick primer on BMI 

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

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

Why fertility clinics take BMI into account

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

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

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

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

Does weight and BMI affect the retrieval cycle itself? 

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

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

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

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

Does weight and BMI affect egg retrieval outcomes? 

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

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

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

Does weight and BMI affect egg quality?

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

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

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

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

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

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

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

Why BMI can be a problematic metric

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

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

Looking at the full picture

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

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

Reliance on BMI can further perpetuate racial inequities

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

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

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

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

The need to preserve reproductive autonomy

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

Insufficient data about BMI and egg donation

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

So, how should we look at BMI?

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

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

What industry governance *does* say

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

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

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

What are your options?

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

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

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

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

With more and more women choosing to delay having children, it’s likely you’ve seen people sharing their egg freezing journeys on social media. Curious if you should be thinking about it too? You’re not alone. Let’s talk about some of the most common reasons people freeze their eggs, so you can decide if this is the right path for you.

First of all, what is egg freezing?

First things first, let’s talk about what freezing your eggs actually means. To keep it simple, egg freezing, or oocyte preservation, is a way to collect some of your eggs and preserve them for future use later. The process involves taking hormone medication to stimulate your ovaries, then undergoing a 30-minute medical procedure to retrieve the eggs.

If your brain is already spinning with questions, I hear you. When I chat with women interested in our program, these are some of the most common questions that I get:

Will freezing my eggs affect my ability to conceive in the future?

Long story short - nope! This is a very common misconception, but freezing your eggs doesn’t actually take away from your ovarian reserve. This is because the hormone medications involved in the egg retrieval process are essentially just telling your ovaries to allow all of the eggs released in a single cycle to mature, instead of just one. So rather than taking away from your ovarian reserve, egg freezing actually allows you to save some of the “extra” eggs that would have died off during your cycle! Pretty cool, right?

Read more: 

Does Donating or Freezing Your Eggs Affect Your Future Fertility?

Is egg freezing safe?

While no medical procedure is totally risk-free, egg freezing is considered a highly safe procedure, and overall risk is minimal. One of the most-talked-about risks is something called Ovarian Hyperstimulation Syndrome (OHSS), which is a condition where the ovaries can become swollen and painful in response to the hormone medications used during stimulation. However, research shows that the percentage of egg retrievals complicated by OHSS is now only 0.34% (down from 1.2% in 2014). 

Read more: 

What is OHSS and What Are My Risks?

How much does egg freezing cost?

I’m not going to lie — egg freezing isn’t cheap, and it’s typically not covered by health insurance. The average cycle can cost anywhere from $9K - $15K, and that doesn’t even include the yearly storage fees. 

At Cofertility, we know that the best time to freeze your eggs is often when you can least afford it, and we’re on a mission to give women egg freezing options that are accessible, empowering, and just plain better.

With our Split program, eligible women can freeze and store their eggs for up to 10 years entirely for free when they give half of the eggs retrieved to a family that can’t otherwise conceive.

Our Keep program allows women to freeze and keep all of the eggs retrieved for their own future use, with support and discounts to lighten the financial load.

Why do people freeze their eggs?

So we’ve covered the “what”, now it’s time for the “why”. Like I mentioned earlier, egg freezing is a way to keep your reproductive options open for later by preserving younger, healthier eggs for future use. I spend hours of my week chatting one-on-one with our members and when I ask them why they’re interested in freezing their eggs, almost everyone says the same things:

“I’m going back to school and focusing on my career right now.”

“I want to travel more first.”

“I haven’t found my ‘person’ yet, and don’t want to feel rushed to settle down just based on my biology.”

“I’m not even sure if I want to have kids or not, so I want to keep my options open.”

Seeing a pattern here? Nearly everyone who works with us knows that even if right now is the best time biologically to have children, it’s just not something they’re ready for yet. While you’ll never find us referring to freezing your eggs as an “insurance policy,” it does allow optionality for owning your future fertility by being proactive and giving yourself choices later in life.

How to decide if egg freezing is right for you

Now that you’re equipped with a basic understanding of what egg freezing is and some of the reasons why one may choose to freeze your eggs, you’re probably wondering if you should be thinking about it, too. 

Unfortunately that’s not something we can answer for you, but we are firm believers that everyone deserves options for their reproductive health that work for them.

However, as you’re thinking this through, here are some questions you can ask yourself to help guide your decision:

“When do I want to start having children?”

If your answer is any time after age 30, you may want to consider freezing eggs in your 20s so you have younger, healthier eggs to use if you need them.

‍“What personal goals do I want to accomplish before building my family?”

Though I’m a firm believer that moms can do it all, sometimes there are things you may want to get done before children are in the picture, and that’s okay too. So if you have big dreams to travel the world, finish your degree, save money, or work your way up the corporate ladder, and want to do that before having kids, freezing your eggs can help you do that more confidently.

“When do I see myself settling down with a partner?”

Don’t get me wrong, being a single mom by choice is totally an option too, but if you see yourself wanting to raise children with a partner by your side, freezing your eggs gives you more freedom to find your person on your own timeline, without feeling rushed by the pressure of family-building. 

“Am I even sure that I want to have children?”

I know: loaded question. But the truth is, a lot of us are in our “prime” baby-making years and don’t even know if we want to have children at all yet. Thankfully, we live in a time where egg freezing is a possibility, which means no one has to feel rushed to make that decision before they feel 100% confident that they’re doing what feels right for them.

The bottom line

To keep it simple — yes, more and more people are freezing their eggs (there was a 46% increase in egg freezing cycles in 2021!), and it’s probably something you should think about, too. While the decision to freeze your eggs is a highly personal one, being educated on the process and hearing about other people’s experiences can help ensure you’re making the most informed decision possible. If you decide you’re ready to take the next step in your egg freezing journey  — we’re here to help make sure it’s a process you can feel good about — every step of the way.

More people than ever are thinking about preserving their fertility for the future. But what’s the difference between freezing eggs and freezing embryos? More importantly, which is the better option for you?

While both procedures have given people more choice around when they have children and how they conceive them, they’re not the same and there’s plenty to think about when trying to choose one over the other.

What’s the difference?

There’s one major difference between freezing eggs and freezing embryos. When you freeze your eggs, they stay unfertilized. We all know that to make a baby, you need an egg and a sperm because each of them provides half of the material needed. On its own, an egg can’t function (and neither can a sperm).

An embryo, on the other hand, is an egg that has already been fertilized by a sperm. Once they combine, the egg and sperm become a single cell. Over the next three to four days, the embryo divides several times, going from one to two to four to eight cells, and so on until it reaches the blastocyst stage and is ready to be frozen. Once an embryo has developed, there’s no going back– that is, there’s no way to turn that embryo back into a separate egg and sperm. 

Things to consider

So how does this information help you figure out whether to freeze eggs or embryos? Well, there are two big factors to consider: your circumstances and the research.

If you don’t know who you want to have children with, then freezing your eggs may be the best approach. This option gives you the freedom to hold off on thinking about having a baby until you’ve met someone or are ready to choose a sperm donor. 

On the other hand, if you are currently with a partner who you know you’d like to have children with but now isn’t the right time, then freezing embryos might be the way to go. The caveat here is to be 100% certain—stars like Sofia Vergara and more recently, Anna Kendrick, have run into trouble after freezing embryos with partners they didn’t end up with. 

Now, let’s look at the research.

Is freezing embryos really better?

The short answer here is not necessarily. The long answer is that each case is unique so whether freezing embryos or eggs is the better option for you will depend on your specific situation and what your labs, imaging, and other health information suggest. 

With that in mind, let’s break down the pros and cons of each method.  

Pros and cons of freezing eggs vs embryos

Freezing/thawing process

Historically, embryos have been “tougher” than eggs and therefore, easier to freeze and thaw. Freezing eggs was much more of a gamble since they’re large cells with a lot of water inside. That water can turn into ice crystals during freezing which, in turn, can damage the chromosomes in the eggs and make them unusable.

But it’s not all gloom and doom for egg freezers! Researchers have continued to study the technology and the statistics have changed as newer and better freezing technologies have emerged. Nowadays, an excellent lab can expect 97% of the eggs that they freeze to survive compared to 95% for embryos. 

But, let’s be clear, these numbers don’t mean that your chances of a successful live birth are 3% higher with frozen eggs, it just means that they are a little more likely to make it to the next phase of IVF. The higher the quality of your frozen eggs (i.e. if you freeze your eggs relatively young and maintain a healthy lifestyle), the more likely they will have thaw rates that are just as good (if not higher) than that of embryos.

Quality

A major weakness of egg freezing is that there is no way to test the quality of eggs on their own–they still have to make it through the thawing process, fertilization, and develop into a healthy embryo that can be implanted into the uterus (not all of them make it this far).

This can lead to a situation where someone uses their eggs years after freezing them and those eggs don’t perform as well as they thought they would. By then, this person is older so their egg quality has declined even more. Not having that quality information upfront can make it hard to judge how many eggs need to be frozen to lead to an actual baby.

In contrast, embryos have to get past several important hurdles that give fertility specialists a much better sense of their quality and the chances of a baby later. That’s because turning eggs into embryos requires that they be successfully fertilized and that those embryos survive up to a point where they can be frozen (usually the blastocyst stage, around day 5 of development). 

In addition, embryos are graded at each point in their development based on an embryologist’s opinion of whether they are high quality or not (embryologists are experts who study the development of embryos). 

Finally, you have the option to run a genetic screening test on embryos, which can help more accurately predict whether they’re likely to become healthy babies. Research has shown that preimplantation genetic screening can result in lower miscarriage rates and higher live birth rates per embryo transfer. There is no such test for frozen eggs. 

Chances of a healthy baby down the line

Recent studies comparing the likelihood of actual babies being born, known as the live birth rate (LBR), have shown that it’s now pretty even whether you’re freezing eggs or embryos. Before this, the LBR with frozen eggs was quoted at about 50% the LBR of frozen embryos. 

A study published in May 2022 provides even more evidence to support this. The study, done at NYU, is the largest U.S. report of elective fertility preservation outcomes to date and is based on 15 years of real-life frozen egg thaw outcomes for people who had delayed having children and had natural, age-related fertility decline.

On average, study participants were 38 years old at the time they froze their first set of eggs. The study found that regardless of age, those who thawed at least 20 mature eggs had a 58% LBR. This was unexpected given that so many of the participants were past the optimal age to freeze eggs (35 years old or younger). People under 38 years old who thawed 20 or more mature eggs had a 70% LBR per patient. The length of frozen egg storage did not change the success rate.

Additionally, the study found that 39% of people between 27 and 44 years old (most were between 35 and 40 when they froze their eggs) had at least one child from their frozen eggs, which is comparable with age-matched in vitro fertilization (IVF) outcomes. Researchers also found that many of the participants studied had more than one child through egg freezing. 

When compared to data collected by the Centers for Disease Control and Prevention (CDC) from the nation’s nearly 500 fertility clinics on people trying to conceive at age 40 using fresh eggs or embryos, only 30% who underwent IVF became pregnant and the LBR was less than 20%.

The final conclusion? For those starting families later, egg freezing and thawing at a later date provides a higher pregnancy success rate than using fresh embryos during assisted reproductive technology.

‍

*One important point the researchers make about their study is that it was limited by the number of patients. More studies need to be done in the future that include people from a variety of geographic locations and center types. 

Cost

Last, but certainly not least, is the financial side of this. Is embryo freezing more expensive than egg freezing?

Honestly, yes. The upfront cost of egg freezing is definitely less than that of embryo freezing (which requires in vitro fertilization before freezing). While egg freezing costs upward of  $10,000 on average, creating and freezing embryos can add a few more thousand dollars to that bill. If you’re freezing embryos using a sperm donor, the sperm can add a further $300 to $4,000, depending on several factors. In both cases, you will also need to pay an annual fee to store your eggs or embryos until you use them. This can cost anywhere from $500-$1000 per year, depending on the clinic you use. 

Depending on the type of medical coverage you have, your insurance may cover some of these costs, so make sure you reach out and see what support you can receive from them. Many clinics also offer financial plans and other forms of support so always ask!

TL;DR: Freezing eggs comes with a lower upfront price tag which makes it an easier and more accessible choice than embryo freezing, allowing more people to preserve their future options. 

Additional Resources

Both the Centers for Disease Control & Prevention (CDC) and experts at Harvard Brigham and Women’s Hospital have developed calculators for assessing a person’s chances of success with artificial reproductive technology (ART). The CDC IVF Success Estimator helps estimate the chances of a live birth with IVF while the BWH Egg Freezing Counseling Tool helps to estimate the chances of at least 1 live birth based on your age and number of frozen eggs.  

What do I ask my provider?

Use your health care provider as a support and resource. They should be able to answer any of your questions. Not sure what to ask? Here are a few questions to help you get started: 

• How many eggs or embryos do you recommend I freeze, at my current age, to have the highest percentage chance of a live birth later on?
• How many treatment cycles will I need to do to get to this number? It’s totally normal to need more than 1 cycle, but it’s nice to know what to expect ahead of time. 
• What is this lab’s rate of successful freezing and thawing of eggs vs embryos (“oocyte cryosurvival rate” is the medical term)? Are they closer to minimal or maximum competency?
• How much would each cycle cost? 
• Are there any financial support options, plans, or advice? 
• What are the health risks? What about common side effects? 
• Is there an upper age limit for using my eggs or embryos in the future? 
• How long can I store them and how much will it cost per year?

Do You!

At the end of the day, there’s no universal rule around the best approach to preserving fertility. Family planning is going to look different for every person so you need to do what’s right for you. When you’re ready, talking to a fertility specialist can help you make up your mind. 

In the meantime, Freeze by Co is here to help you every step of the way on that journey. Our Split program allows those who qualify to freeze their eggs for free! In a “Split” cycle, you donate half of the eggs retrieved to a family that’s trying to conceive and freeze the remaining half for yourself. Or, if you don’t want to donate, you can still participate in the Keep program, where you’re able to freeze your eggs and keep them all for yourself, on your timeline. In addition, you’ll have access to our online support community. This valuable resource lets you engage with other people freezing their eggs at the same time! 

Whatever you end up choosing for yourself, our team is here to guide you through it and keep your options open.

Intro 

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

What is egg freezing?

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

Should I freeze my eggs?

There are many, many reasons why someone might choose to freeze their eggs but the decision is a deeply personal one that requires some careful consideration. When making that decision though, it’s important to know that egg freezing is not an “insurance policy” for your fertility. While egg freezing can take some of the stress of having a baby right now off your shoulders, it is not a guarantee that you’ll have a baby in the future. 

Why not? Well, not all the eggs that get frozen will actually be viable. It’s expected that some eggs will not survive the warming process. In addition, the chances of the eggs that do survive being successfully fertilized depends partially on how old you were when you froze them (more on this later). Beyond that, fertility and pregnancy risks change with age. If you freeze your eggs at 30 and use them when you're 40, you'll have to deal with the realities of pregnancy at 40.

This is not to sway your decision one way or another. Ultimately, only you and your doctor can decide if egg freezing is the right decision for you. But it's important to go in knowing that it’s not meant to be a done deal.

Pros of egg freezing

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

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

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

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

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

Cons of egg freezing

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

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

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

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

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

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

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

When should I freeze my eggs? 

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

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

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

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

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

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

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

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

You could get a heads up about certain reproductive concerns

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

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

You’ll get a better picture of your reproductive schedule

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

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

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

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

Your doctor will find out how many follicles you have

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

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

There will be additional health screenings 

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

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

Getting proactive can save you money

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

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

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

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

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

Affordable egg freezing programs

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

Paying for keeps

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

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

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

The Split cycle

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

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

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

Important X factors

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

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

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

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

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

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

Logistics

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

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

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

Can you freeze your eggs? 

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

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

If you’re a female physician in the United States, you may have heard that you’re at a higher risk of infertility than your female friends who took a different career path. It certainly sounds like the kind of “fact’ that gets posted on social media one day and suddenly becomes gospel, whether it’s true or not. 

Unfortunately, we can’t just write this one off as a social media hoax. Researchers have run the numbers, and it turns out almost 25% of female doctors who are trying to conceive are faced with fertility challenges. This is about double the rate of the general public.

“It turns out almost 25% of female doctors who are trying to conceive are faced with fertility challenges. This is about double the rate of the general public. “

So what’s going on? Should you be freezing your eggs now just in case? Is there anything else you can do? Read on for the research into this fertility concern and what American doctors are doing about it. 

Female doctors and fertility

General fertility rates have been trending downward in the US in recent decades with the CDC reporting record low birth rates in 2018 and only minimal increases since. In 2021, the American birth rate was 1,663 births per 1,000 women — not enough to maintain stable population figures in the US. 

And while some of that could be due to personal choice, scientists have found increasing rates of reproductive problems are cropping up in women and men. Miscarriage rates are up about one % every year and so are the rates of gestational surrogacy — an option growing in popularity for intended parents seeking the help of an additional party for conception. 

But the plight of female doctors stands out among all these figures: 

• 1 in 4 — The approximate number of female physicians who were diagnosed with infertility after trying to have a baby, according to a survey published in the Journal of Women’s Health in 2016 
• 11 % — The percentage of American women in the general population have had the same diagnosis. 
• 42 % —The amount of female surgeons who have experienced a pregnancy loss, according to a survey published in JAMA Surgery in July 2021 which reported that 42 % had experienced a pregnancy loss. 

What’s going on?

What makes female doctors so different from the rest of the population? In part, their education. 

There’s no real way to put this nicely: Age matters when it comes to fertility. Extensive medical research on fertility shows that getting older has a major effect on our reproduction system and our ability to conceive.

But many female doctors — surgeons included — delay pregnancy until after the completion of their residency. How long that will take depends on the doctor’s specialty, but this can be another three to eight years after medical school. For surgeons, a residency is a minimum of five years. 

That puts many female doctors into their 30s before they even begin trying to have their first child. In fact, in the 2016 survey, doctors reported they were 31.6 year old on average at completion of medical school and residency and 30.4 years on average at first pregnancy. By comparison, the average age of an American woman giving birth for the first time in the US is 26 years old, according to data compiled for the New York Times in 2018. 

Almost a third — 28% — of the female doctors surveyed in 2016 who experienced fertility challenges said they would have begun trying to conceive earlier if they could have seen what lay ahead. Close to the same number — 29% — said they experienced diminished ovarian reserve, a condition in which their fertility challenge was linked to having fewer eggs in the body. This condition is largely associated with age. 

But delaying reproduction is only part of the puzzle.

Even after adjusting for age, female physicians have higher rates of infertility. Perhaps this is due to female doctors facing high rates of stress at work that put a strain on the body and can affect reproduction as a whole. Those who opt to start a family before residency is complete may face irregular work schedules and long, grueling shifts that can put intense strain on anyone’s body, but prove especially hard for someone who is pregnant.

Together, all of these factors can have a significant impact on the fertility of a female doctor. 

How can female doctors preserve their fertility?

The numbers may seem a little daunting, especially if you’re in medical school or the midst of your residency. So what can women do about it? 

An infertility task force now exists as part of the American Medical Women’s Association to find answers to this problem plaguing women in medicine, and individual doctors around the country have been working to advocate for improved fertility education and fertility insurance coverage for their peers. 

One of the chief criticisms of the current system comes from Dr. Areila Marshall, one of the founders of the AMWA task force, who wrote about the issue in the journal Academic Medicine in 2020 calling for better awareness of egg, embryo, and sperm cryopreservation. 

Marshall echoed a wish expressed by a number of the physicians who took part in the original 2016 survey: 7% of those doctors said they wished they had known to use cryopreservation to extend their fertility. 

For female doctors who don’t know when — or even if — they want to conceive, egg freezing can be a viable option. 

Freezing is not a guarantee that you will have a baby down the line. It simply means that eggs will be there, waiting, if you decide at some point in the future that you wish to explore conception. 

At Freeze by Co, we are committed to giving women the opportunity to have more control over their reproductive choices. Here women have a variety of paths they can choose from when it comes to egg freezing – whether they’re looking to freeze eggs now or have already frozen some of their eggs.  

Members of our Split program even freeze for free when they give half  of their eggs to intended parents who cannot otherwise conceive.

Bottom line

Women should not have to choose between a dream of pursuing a career in medicine and making reproductive decisions on their own timeline. Egg freezing gives women the power to make more choices about her own body.

Many folks who have made the big (and exciting) decision to freeze their eggs want to improve their egg quality before freezing. But is egg quality really something you can control? What kinds of lifestyle changes should you make before freezing your eggs? Read on for a look at what the research says about egg quality — and what you can do to improve it before the egg freezing process begins. 

What is egg quality?

As you’ve been exploring the egg freezing process, you may have heard your fertility doctor mention that freezing during your 20s can be beneficial because your egg quality will likely be higher. 

It’s annoying, but true: as women age, our egg quality typically goes down further and further. The American College of Obstetricians and Gynecologists (ACOG) estimates a woman’s chances of getting pregnant begin to decrease at age 32 and continue to gradually go down until about age 37 when the decrease becomes more rapid. ACOG links this decrease in what they call fecundity — another word for fertility — to egg quality. 

This is one of the many reasons Freeze by Co partners with local fertility clinics to create opportunities for women in their 20s to freeze eggs more affordably. We want you to have more control over your reproductive choices, even if you’re not looking to get pregnant during this peak egg quality period.

But what does “egg quality” (also called oocyte competence) actually mean? Are doctors being a tad judgmental about a woman’s age? Not at all. 

When fertility specialists use this term, they’re referring to whether your eggs are considered genetically normal or abnormal, and it’s tied pretty closely to the chances that an egg could ever result in pregnancy.  

Euploid vs. aneuploid embryos 

While sperm health is undeniably important, it all starts with the egg. The quality of embryos made from your eggs comes down to two different types:

• Euploid embryos 

• These embryos are genetically “normal.” 
• They contain the right number of chromosomes at 46. 

• Aneuploid embryos

• These embryos are genetically “abnormal.” 
• They contain either fewer or more chromosomes than normal. 
• Embryos created with a low quality egg may inherit either too many or too few chromosomes. 
• Most aneuploid embryos will either fail to implant or result in miscarriage as they are usually not compatible with life. 

There’s also a significantly higher risk that an aneuploid embryo will not implant in the uterus after an in vitro fertilization (IVF) transfer — one study found as much as 96 percent of abnormal embryos transferred into the uterus did not implant. On the other hand, that same study found when euploid embryos were transferred, the pregnancy rate was 82 percent. 

Do I need to improve my egg quality before freezing? 

So if euploid embryos start with healthy eggs, you’re probably wondering: do I need to improve my egg quality before freezing? 

Some factors that affect egg quality such as your personal genetics and the passing of time can’t be controlled. But there are ample steps you can take to influence the health and quality of your eggs. 

Here are some simple changes that research shows may improve egg quality. We recommend you consider making these changes at least three months prior to egg freezing: 

1. Quit smoking 

If you’re using cigarettes, now is a good time to stop. Studies have found that smoking can have a detrimental effect on fertility. Puffing on cigarettes can increase the risk of infertility by as much as 60 percent with negative effects on the menstrual cycle, uterus, and ovaries. It’s the effect on the ovaries that is particularly troubling when it comes to egg quality with smoking damaging the DNA of the eggs themselves. 

2. Avoid marijuana

Although there aren’t a lot of studies on the effect of marijuana on fertility, those that exist indicate THC — the psychoactive ingredient in marijuana — can result in an impaired ability to produce viable embryos. According to a study published in the Journal of the Endocrine Society in 2020, the exposure of oocytes to THC was linked to a “significant decrease in the expression of genes called connexins.” These connexins are an important marker of egg quality. For our Split members, we require them to stop using marijuana products at least one month prior to retrieval.

3. Improve your diet

There is never a bad time to eat a healthy diet, and if you’re planning to freeze your eggs in the near future there are extra reasons to make smart choices at meal time. Eating a diet rich in leafy greens, whole grains, and lean proteins can all help those egg cells. 

Here are some rock star foods you might want to consider adding to your diet when you’ve got an eye on improving egg quality (plus the benefits they bring):

• Fish such as salmon, mackerel, and trout — Omega 3 fatty acids
• Egg yolks — Vitamin D
• Beans, oats, oranges, and cantaloupe — Inositol
• Fruits and veggies of any kind — Antioxidants
• Oysters, beef, chickpeas, lentils, hemp seeds, pumpkin seeds, and pine nuts — Zinc

Before embarking on any major diet changes, check with a registered dietician. They can help you craft a plan that’s just right for your body. 

4. Talk to your doctor about supplements

If you’re not already taking vitamins, you may want to chat with your reproductive endocrinologist about whether you should add Vitamin A, Vitamin B, folate and zinc — or maybe one of the four — to your daily routine. Studies have linked all three of these micronutrients to egg quality over the years, affecting the synthesis of DNA and other factors in oocyte development. 

Your doctor may want to check your vitamin D level with some bloodwork or go over your current vitamin regimen before deciding if adding on additional supplements is necessary. Make sure to bring any dietary changes you’re making into the conversation too — there can be too much of a good thing when it comes to some vitamins!

5. Talk to your doctor about your weight 

Being told you need to hop on the scale when you’re at the reproductive endocrinologist’s office can be frustrating, especially if you’ve struggled to lose or gain weight in the past, or if you have a condition such as polycystic ovarian syndrome (PCOS) that affects your weight. 

Still, the weight conversation is one worth having with your fertility specialist if you’re worried about your egg quality. Both being over and underweight has been linked to egg quality by researchers time and again. 

Obesity in particular has been found to affect the hormones that guide an egg as it matures. On the other hand, being underweight can stop the body from ovulating entirely. 

The “right” weight for your body is one you and your doctor can discuss. If changes are in order, they can help craft a plan for healthy changes — or recommend a dietician who can. For our Split program, there are BMI requirements, which you can read more about here.

The bottom line

The quality of your eggs may not be completely in your control, but you do have solid options when it comes to improving your egg quality before freezing. What you put into your body makes a difference, and making changes now can make a real difference down the line. 

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 probably never saw yourself using the words cervical mucus, much less pulling down your pants and checking to see if you’ve got any. But here you are. You’re trying to conceive, and your best friend told you that you’ve absolutely got to start checking it out if you want to figure out the best time for baby-making sex.

It might sound like an old wives tale that refuses to die, but it turns out tracking cervical mucus really can help some women get a better handle on their cycle. Here’s why you might want to start paying attention.

What's cervical mucus, anyway?

If it sounds like the stuff that comes out of your nose when you’ve got a bad cold, you’re halfway right…only this isn’t snot, and needless to say it’s not coming out of your nose.

Your cervix is located at the lower part of your uterus, says David Diaz, MD, reproductive endocrinologist and fertility expert at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif.

Dr. Diaz describes the cervix as a sort of bridge between the vagina and the uterus, and as an entry portal for sperm when a heterosexual couple has sex during the female partner’s most fertile time of the month—when she’s ovulating.  

Now comes the mucus part.

The cervical canal, which Dr. Diaz describes as, “a tunnel passing through the cervix,” is lined with glands that excrete a clear, slippery mucus during ovulation. The mucus actually helps sperm make its journey toward the egg for fertilization. Aren’t our bodies amazing?

Because the mucus is only set up for aiding sperm during ovulation, its consistency changes throughout your cycle. So just like the arrival (and blessed departure) of your period can tell you that you’re absolutely not ovulating, the arrival of the right kind of mucus can tell you when you are. Which leads us to…

Checking your mucus

Some folks ovulate like clockwork, and they don’t need no stinking mucus to tell them they’re fertile. But if you’re not one of those lucky ladies, you may not need to run to the doctor to find out if you’re ovulating. You can try to do a check on your own to see if your glands are pumping out that slippery liquid.

Dr. Diaz suggests inserting two fingers into the vagina and feeling for something wet and slippery. Pull them out, and take a look at your fingertips:

• Totally dry to just slightly damp: This is typical of the days right after your period ends, when fertility is at its lowest for most women.

• Mucus that’s slightly thick and sticky and either yellowish or whitish: Although you’re still not ovulating, this indicates your body is either preparing for ovulation or has just finished.

• Mucus that’s almost totally clear and stretchy: If the mucus has the consistency of egg whites and can stretch a few inches between your fingers, your ovulation window has arrived! It’s time for frequent sex, Dr. Diaz says.

Do you really have to?

So all this is well and good, but do you really need to stick your fingers into your vagina and feel around for mucus to help you get pregnant?

Well, that’s up to you, but consider this: When scientists at the University of North Carolina, Chapel Hill and the University of Utah in Salt Lake City monitored more than 300 women on their fertility journey for a 2014 study, the women who opted to check their cervical mucus regularly were found to have a statistically significant increased chance of conceiving over women who didn’t bother to check. And theirs was far from the first study to find a solid link between tracking cervical mucus and conception! The science on cervical mucus is pretty well-regarded by the experts.

So, if you’re having trouble nailing that ovulation window but don’t yet want to take the plunge into ovulation test kits, this could be just the thing you need.

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.

Maybe you’re ready to start trying to conceive, or perhaps you’re just done with taking hormonal birth control. Regardless of the reason, this can be a super big change leaving you wondering what the heck happens next, especially if you've been on it for a while. Will your skin break out like crazy? Will your cycle get wonky? Rest assured, we're here to answer all your questions about going off birth control.

How birth control works

The type of birth control you're quitting will dictate the type of things to expect when going off it. To understand the potential effects, it helps to understand exactly how the different methods work.

A hormonal method, like the pill, Depo shot, hormone patch, uses hormones to trick the body into not ovulating.

A copper or hormonal IUD makes changes to the cervical mucus and the uterine lining that prevent pregnancy.

A barrier method—think condom or diaphragm—blocks the sperm from meeting the egg and really doesn't affect the human body before or after its use.

Why someone might go off of birth control

There are a few different reasons you may go off birth control:

• Ready for pregnancy. If you're ready to start trying to have a baby, you obviously have no need for that IUD or NuvaRing any more.
• Health risks. We are all for birth control when it’s needed. It’s a beautiful thing! But people taking hormonal birth control are at a slightly higher risk for blood clots, migraine, high blood pressure, and cardiovascular disease. It’s important to keep in mind that in the absence of underlying risk factors (ie. older age, high BMI), most of these complications are exceedingly rare. For example, the risk of having a blood clot on birth control for a healthy, young, non-smoker is significantly lower than the risk of a blood clot during pregnancy. 
• Abstinence. Hey, if you're not having sex, then you really don't need birth control. You probably want to have a plan in case you start back up though.

Whatever the reason, talk it over with your doctor if you're taking prescription birth control. You could get pregnant as soon as you go off it, says Lilli Dash Zimmerman, MD, Fertility Specialist at Columbia University Fertility Center. So you should truly be prepared for that possibility. Some patients go off hormonal methods a few months before they want to try, and that's fine, but you'll want to use a barrier method, like a condom, until it's go time, she says.

Birth control side effects, nasties and other things to expect

It's common for people to experience acne, heavier periods, or irregular periods when they stop hormonal birth control, but those aren't exactly side effects from ditching the pill or patch. Rather, they're much more likely to be things that you experienced before you started birth control, that the medication was actually suppressing, says Zimmerman.

Remember: If you're on a hormonal birth control method, you're not actually getting a period, since you're not ovulating. Instead, any bleeding you get every month is not a true period—it's a withdrawal bleed that happens when you take a week of placebo pills.

"I see a lot of patients that say, 'Oh, well, I've been regular for the past 20 years on birth control pills. Then I came off and only for the past year, I've been having irregular periods,'" says Zimmerman. "Well, their birth control may have been hiding issues with anovulation or irregular cycles because they've been on birth control pills for so long."

Do I have to get off hormonal birth control for egg freezing?

Yes, you will need to stop taking the pill or remove the patch before freezing your eggs. That’s because hormonal birth control is intended to prevent ovulation, but during freezing you want to do exactly the opposite. If you’re on the pill or use the patch, some doctors will have you stop during your egg freezing cycle, and some may have you stop for the month leading up to the retrieval. 

If you have an IUD, you can keep it in. Although if you’ve been meaning to take it out, ask the doctor if they can do it during your procedure. 

Do I have to get off hormonal birth control to become an egg donor?

At Cofertility, our donors freeze their eggs for free when they give half to a family who can't otherwise conceive. This means the egg donation procedure is the same as the egg freezing procedure. As stated above, you will need to get off the pill but an IUD is fine.

Trying to conceive after going off birth control 

Now, we bet you're wondering just how quickly you can become pregnant after going off birth control and the answer is it depends on the type of birth control you've been using.

If it was a barrier method, you can start baby making right away, since the only thing preventing sperm from meeting egg was that physical barrier you've removed.

With a hormonal method, it depends—and it can be tough to predict. Some people's bodies need time to adjust to life without the birth control hormones and so they don't ovulate for about the first one to three months. When it comes to the Depo-provera injection, it is given once every three months, so the hormones stay in the body for about three months. Therefore, it is very unlikely to become pregnant until at least three months after your last injection.

As for the progesterone containing and non-hormonal copper IUD, these methods are immediately reversible. 

The best thing you can do, once you're off birth control, is to track your period to ensure you are ovulating regularly. There are several different apps that allow you to log Aunt Flo's visits. You'll probably want to invest in an ovulation predictor kit, too. This is a pee-on-a-stick test that helps you pinpoint when you're ovulating, which is the time each month you can get pregnant.

Be prepared

For some people, the conception process happens fast. "We see a lot of pregnancies within that first month of coming off birth control," Zimmerman says.

But we know first-hand that others may be in it for the long haul. If your periods are irregular, you don't get them, or you just...have a bad feeling, go with your gut and chat with an OB/GYN or a reproductive endocrinologist. We're rooting for you!

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.