female fertility

Rachel Liverman Crane is the Founder & CEO of the East Coast skincare facial concept Glow Bar. Yet, her dynamic life doesn't end with her professional achievements; she's also taken a bold step in her personal life by freezing her eggs — a journey made even more remarkable by overcoming medical anxiety, a common fear that affects many people facing medical procedures.

Medical anxiety is more than a fleeting concern; it's a genuine fear that can hinder individuals from pursuing necessary or elective medical treatments. In Rachel's case, it was a hurdle she had to conquer on her path to securing future family planning options.

Her journey reflects a blend of determination, pragmatism, and an unwavering belief in one's self, sending a strong message to others about the power of informed choices and the beauty of self-confidence. By bravely facing her fears, Rachel serves as an inspiration to others who may be on the fence about egg freezing. Whether it's expanding a skincare brand or planning for a future family, she navigates life with grace, wisdom, and a touch of humor, embodying the future's endless possibilities.

In a candid interview with us, Rachel shares this journey, opening up about her experience with egg freezing and how she overcame the anxiety that often accompanies medical decisions.

Deciding to freeze

At the age of 35, while single and deeply focused on growing her business, Rachel made the decision to freeze her eggs. Recognizing that she wouldn't be having children in the immediate future, she saw this as a way to retain her focus on her career without the looming pressure of biological timing. "I figured I would freeze my eggs so my focus could remain on my career and not have the pressure of having kids feel so strong."

The process resulted in a "lucky dozen" of 12 eggs, with nine being frozen. Her AMH was 1.81, and she candidly shares her experience, describing herself as an "open book."

Embracing the process even with medical anxiety

When asked what she was most nervous about, Rachel replied, “The shots, the blood draws every morning, the anesthesia, the IV, the recovery — I worried about it all!”

“But in the end”, she says, “it was so simple and my doctor and his team took such great care of me the entire way.”

Having seen friends go through it, she knew what to expect, although the physical discomfort and bloating after retrieval did surprise her. “The thing that surprised me the most was how bloated and uncomfortable that would feel after the retrieval process.”

What stands out, however, is the empowerment and strength she felt after going through this elective procedure, particularly given her medical anxiety. "I was really proud of myself for doing something that scared me for my future self!" 

Rachel, we’re proud of you too!

Facing the hard parts head-on

The journey wasn't without its challenges. The financial burden was a difficult aspect for her. As a startup founder, making such a significant investment had a real impact. Still, the sacrifice was worth it, even if it meant missing events like close friends' weddings abroad. "I don't have any regrets," she asserts.

Read more about paying for egg freezing:

• How to Pay for Egg Freezing
• How to Freeze Your Eggs for Free
• Does Insurance Cover Egg Freezing?

Choosing Dr. Joshua Stewart at Dr. Joshua Stewart at Cornell for the procedure, she feels the decision has had a profoundly positive effect on her professional life. It allowed her to prioritize her career, team, and business without sacrificing personal aspirations.

Looking back and looking ahead

Looking back, the only thing she might have done differently is to take supplements or seek acupuncture to support her eggs. Yet, she considers the freezing of her eggs as part of her journey, jokingly referring to them as her "insurance plan" and the possibility of thawing these "cuties" to make babies if and when needed.

Rachel says that her relationships and dating life remained unaffected. Freezing her eggs just became "another part of me," not altering her approach to dating or personal relationships.

Advice for others

Her advice for others considering this path is wise and considerate. She urges people to talk to others who have undergone the process, ask questions, advocate for themselves, and not to push themselves if it doesn't feel right.

"Don't feel pressure to do this if it doesn't feel right for you. It's a serious and expensive procedure, so make sure that this is something that you really care about and feel is right for you and where you are today.” We couldn’t agree more!

When you're freezing your eggs, it can feel like you're navigating a maze of unfamiliar terms and unfamiliar people. Who are all these people? What do they do? And when should you see them? 

Here, we'll break down the different members of your fertility team and what services they provide, to help you understand who you'll be working with on your egg freezing journey.

Your Primary Care Physician (PCP)

For some, the dialogue about fertility begins with a conversation with their Primary Care Physician (PCP). This medical generalist can provide an overview of the fertility landscape and may guide you towards specialized care if your situation calls for it.

Obstetrician-Gynecologist (OBGYN)

As a specialist in women's reproductive health, an Obstetrician-Gynecologist (OBGYN) can offer nuanced insight into fertility and hormonal health. Although not directly involved in the egg freezing process, their counsel is often a valuable stepping stone to more specialized care.

Reproductive Endocrinologist (REI)

An OBGYN with additional training in reproductive endocrinology, your REI is the main person overseeing your egg freezing journey. Specializing in the hormonal and medical intricacies of fertility, they oversee and perform the egg retrieval process. Many people start their egg freezing/donation journeys with an REI consultation. 

Nurse Coordinator

An RN serving as a lynchpin in patient care, the Nurse Coordinator organizes patient education, scheduling, and medication management. Their role varies by clinic but invariably serves to harmonize the efforts of the entire fertility team.

Embryologist

The Embryologist also works at the fertility clinic and is the scientist who helps fertilize and grow your embryos! They are in charge of making sure your eggs get safely frozen. 

Egg Freezing Agency, such as Cofertility

For those seeking an additional layer of service and support, Cofertility helps streamline your journey. We help you find a clinic, connect with others freezing their eggs at the same time, and fill the gaps not covered by a standard fertility clinic.

Financial Counselor

Navigating the costs of egg freezing can be daunting. A Financial Counselor specializes in demystifying this aspect, helping you explore insurance coverage and financing options.

Fertility Courier

Responsible for the logistical challenge of safely transporting your frozen eggs, the Fertility Courier is a specialized service provider you may never meet but will trust implicitly.

Cryostorage Facility

A cryostorage facility serves as the vault for your frozen tissue. Specializing in the preservation of biological material, these facilities are where your eggs will reside until you decide to use them. We have a partnership with TMRW where we have negotiated discounted rates for our members. 

Genetic counselor

Being a carrier doesn't mean you have the condition, but it can still be concerning when your genetic testing reveals you have a genetic predispositions to certain conditions. Your genetic counselor helps you understand the implications of your carrier status. They can explain the risks, potential impacts on future children, and provide guidance on family planning.

Third-party reproductive (TPR) care coordinator

A clinic employee who works in the field of assisted reproductive technology (ART) and reproductive medicine. Their primary role is to facilitate and coordinate various aspects of third-party reproduction, which involves using donated eggs, sperm, or embryos, as well as gestational surrogacy.

If you participate in our Split program, there are even more people you will work with along the way 

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

Member Advocate 

At Cofertility, the Member Advocate serves as your personalized concierge, easing communication among all the parties above and ensuring a smooth journey  from start to finish. A Member Advocate plays a crucial role in supporting you through the complex and highly regulated process of egg freezing and donation, helping you navigate the medical, emotional, and logistical aspects of preserving your fertility with compassion, evidence-based research and trustworthy guidance.

Fertility Psychologist 

Emotional support is invaluable. We have a Fertility Psychologist on our team to support the psychological and emotional aspects of your journey, offering screening and therapeutic support.

Third-party Reproduction Lawyer

When you match with a family, you will work with a Fertility Lawyer to ensure that all agreements, from donor agreements to future use contracts, are conducted within the bounds of the law. We can help you find a lawyer with expertise in this space, which is entirely free to you. 

It's important to note that not everyone needs the same team or the same services. Your path will be as unique as you are; tailored to meet your specific needs and circumstances. Never hesitate to ask questions or advocate for yourself; after all, this is your journey, and you deserve a team that not only supports but champions your reproductive goals. The most important person on your fertility team is you. 

At Cofertility, we have a preferred network of partners across the country that can help with every aspect of your egg donation journey, from the legal contracts to the embryo storage. While reading this list can feel overwhelming, if you work with us, know that we can handle most every interaction.

If you’re considering freezing your eggs, you’re probably open to trying just about anything to make your cycle as successful as possible. You’re doing all the things: taking supplements, eating a healthy diet, and being mindful of your lifestyle choices. When it comes to acupuncture, though, you may have heard mixed advice. Can acupuncture really help improve egg freezing outcomes? Let’s find out. 

What exactly is acupuncture, anyway?

Acupuncture is a medical treatment based on the disciplines of traditional Chinese medicine (TCM). It’s built on the theory that there are channels that flow through the body, kind of like the circulatory system. 

When someone goes in for an acupuncture treatment, the practitioner inserts teeny-tiny, stainless steel, disposable needles into the patient’s body at specific points along those channels (typically between eight and twelve points, but sometimes up to twenty). Different points are used depending on any symptoms you might be experiencing — back aches, anxiety, acid reflux...you name it! — and practitioners view the body as totally interconnected. It is considered to be generally painless.

What does acupuncture (supposedly) do?

The goal of acupuncture is to regulate each of your systems to get them to work optimally and in harmony with each other. For example, a 2002 Fertility and Sterility study published by the American Society for Reproductive Medicine (ASRM) indicated that receiving regular acupuncture treatments can regulate patients’ endocrine systems (where sex, mood, and sleep hormones are manufactured). 

Regulating your endocrine system via acupuncture can dial down your stress response, which may be heightened during an egg freezing cycle. But the question remains, will decreased stress translate to improvement in actual egg freezing cycle outcomes, in terms of quantity and quality of eggs?

Egg freezing and acupuncture: what the data says

Remember: beta endorphin levels regulate and balance a woman’s Follicle Stimulating Hormone (FSH) levels, which do impact the ability of her ovaries to grow and mature eggs. So when we see a 1998 Journal of Traditional Chinese Medicine study demonstrate dramatically increased beta endorphins among those who received acupuncture vs. those who hadn’t, that’s worth noting.  

But by and large, when it comes to acupuncture and egg freezing, there’s a lot of misinformation out there. The vast majority of available studies focus primarily on IVF success measures: embryo fertilization, positive pregnancy results, and live births. While embryo fertilization is the primary indicator of egg quality, (though many other factors also contribute to fertilization), only looking at acupuncture’s relationship with IVF outcomes can be problematic, because we are viewing a limited population who already may have fertility challenges. 

Some studies have explored the potential influence of acupuncture on the number of eggs retrieved during ovarian stimulation, the egg freezing phase during which a patient takes injectable hormone medications to stimulate her ovaries to mature more eggs for retrieval and freezing. This is helpful for us to explore, but it’s important to note if those studies are only looking at a population who needs to undergo IVF to conceive, as this is different from the population of those looking to electively freeze their eggs.

All of this being said, there is some data out there that’s worth investigating. 

Stress and fertility

In some cases, we may be able to triangulate studies about acupuncture’s impact upon stress and anxiety with studies about the impact of stress upon egg retrieval outcomes. But we need to acknowledge that these are assumptions and hypotheses, taking a transitive property into account rather than studying the direct impact of acupuncture upon egg retrieval outcomes. 

Even then, when only looking at the impact of stress upon fertility and egg retrieval outcomes (largely related to egg quantity), the data is mixed:

• A 2011 British Medical Journal study noted that “pretreatment emotional distress was NOT associated with treatment outcome” (in this case, it’s important to consider that “outcome” = successful pregnancy and live birth using eggs from that treatment cycle).
• A 2009 Psychological Reports article showed a significant correlation between depression and number of eggs retrieved, with fewer eggs retrieved associated with higher instances of depression.
• A 2001 Fertility and Sterility article stated that “baseline (acute and chronic) stress affected biologic endpoints (i.e., number of oocytes retrieved and fertilized).”
• A 2015 General and Comparative Endocrinology study concluded that increased cortisol levels may cause anovulation in stressed mice.
• A 2016 Journal of Biomedical Science study showed that increased cortisol and oxidative stress levels affect our granulosa cell functions, possibly by inducing apoptosis — which results in changes to our estradiol hormones and egg growth, development, and quality.

Some more direct evidence

While there is lots of (mixed) data out there about the relationship between stress and fertility, and some data about how acupuncture reduces stress, there are a handful of studies that actually look directly at the correlation between acupuncture treatments, number of eggs retrieved, and potential egg quality conclusions based on fertilization and live birth outcomes. It’s important to remember that quantity does not necessarily translate directly to quality. Meaning, there is a chance you could have many eggs and very few (or even zero) could result in a fertilized embryo or pregnancy. The general principle is, the more eggs you retrieve, the greater chances you’ll have of having enough high quality eggs for future use. 

One of the more applicable studies is a 2023 Frontiers in Endocrinology meta-analysis, which looked at seven clinical randomized controlled trials (RCTs) that ultimately included 516 women. Although the quality of those studies may have been questionable, this meta-analysis showed that the use of acupuncture increased the number of eggs retrieved and the antral follicle count, while improving the patients’ estradiol and FSH levels. However, there was no difference in fertilization rate or pregnancy rate. This analysis suggests that acupuncture does not improve the ultimate outcome most egg freezers care about: chances of a healthy baby down the line. 

On the flip side, a 2006 Fertility and Sterility study of 273 women in Denmark showed no statistical difference in the number of eggs retrieved between those who received acupuncture and those who did not. For what it’s worth, this study did, however, show a substantial improvement in pregnancy and live birth rates among those who received acupuncture on the day of their embryo transfer.  

What to expect at your acupuncture appointment

If you’ve decided to move forward with acupuncture, you’ll first need to find a local practitioner. At your first treatment, your acupuncturist will ask you tons of questions about your medical history, just like any Western doctor would. Then they’ll take your pulse and look at your tongue (seriously). 

Here’s what they’re looking for: patterns of disharmony, which may be missed by your regular doctor because they don’t show up as illnesses. Let’s say you have trouble sleeping and you feel anxious and your skin is dry and your hair is falling out. In Chinese medicine, that grouping of symptoms together indicates a “blood deficiency.” It wouldn’t be severe enough for your main doctor to call it anemia, but there may be enough symptoms to show some imbalance is going on in your body. With that information, your acupuncturist can determine where to insert the needles to best address your individual needs.

When it’s time for your treatment, you may be asked to undress and put on a gown or cover yourself with a sheet and lay down or face up on a table, like you’re getting ready for a facial. The practitioner will then reenter the room and begin “tapping” the needles into the points they’ve selected specifically for your needs.

The insertion of the needles doesn’t usually hurt — maybe just a pinch — but it shouldn’t stay painful because the needles are as fine as a strand of hair. If you’re not comfortable, just let your practitioner know and he/she will make an adjustment. Comfort is key. Once all the needles are in, the acupuncturist will leave the room (ideally turning on some music or relaxing white noise) and you’ll rest there on the table for about 30 minutes. You may fall asleep right away, or you may need a couple of sessions to get used to it.

To experience the full desired effects of acupuncture, some practitioners say it could take about 3 months of weekly treatments. Think of it this way: it takes about 100 days for red blood cells or sperm to mature, so according to acupuncturists, if you want acupuncture to make changes in your body’s functioning, you’ll want to give it the time it naturally needs. At the very least, you should leave your treatment feeling like you just got a really good night’s rest.

The TLDR on acupuncture and egg freezing

There’s so much more research to be done regarding the relationship between acupuncture and egg freezing outcomes. But, based on the scouring we’ve done through existing studies, there does not appear to be evidence that acupuncture could directly help your egg freezing experience. Acupuncture cannot influence structural issues, like fallopian tube blockages, for example. 

But while it may not help you retrieve more eggs or increase your chances of pregnancy down the line, it may be something you want to do purely for relaxation. You can think about it like a massage or day at the spa. 

With that in mind, the only nuisances may be appointment scheduling or dealing with insurance to see what’s covered. But, beyond that — the goal of acupuncture is to make your mind and body feel good. So, if you have the time and willingness to pay, we support that! In my case, I’m incredibly lucky; my insurance covers unlimited acupuncture visits throughout the year, including for pain or anxiety (note: I do not believe fertility is a billable reason for my acupuncture coverage). If you’re interested in pursuing acupuncture, it is definitely worth having a conversation with your acupuncture clinic and with your insurance provider. But if you can’t squeeze it in or justify the cost…please do not worry about it. You’ve got enough going on as it is.

Remember, when freezing your eggs with Freeze by Co, our team of medical experts (plus our free member community of others freezing their eggs, just like you!) will be with you every step of the way to answer questions like this and more. Our Split program even offers those ages 21-33 the chance to freeze their eggs for free! With 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 or not interested in donating half of the eggs retrieved, you can still participate in our Keep program up to age 40. With Keep, you can freeze your eggs and keep them all for yourself, on your timeline while having access to valuable community support. 

Regardless of which path you choose, our team is here to guide you through the process to keep your family-building options on the table.

Can you test your fertility from the comfort of your own home? The answer is a bit complicated. Isn’t it always when it comes to fertility? Yes, there are some tests that both men and women can take at home to get a better idea about some aspects of their fertility. But are they an acceptable substitute for an individualized appointment with a fertility specialist? 

Unfortunately, no—while these tests are often fairly accurate, that’s not really the issue here, says Dr. Jaime Knopman, a board-certified reproductive endocrinologist. It’s all the medical expertise you’re missing out on when you test your fertility at home. 

“The tests we run in our clinic are much more accurate because our job can’t be done completely by machine,” she explains. “It’s not just the tests, it’s the person interpreting them.”

But you still might not live close to a fertility clinic, have insurance that covers fertility appointments or testing, or even feel like you’re really at the point yet in your fertility journey where you need a formal eval from a specialist. We get that.

So whatever your reason for wanting to take an at-home fertility test, here’s what you need to know about what your options are, how they work, and what you can expect to learn.

How can I test my fertility at home: for women

When it comes to the ladies, there are two main varieties of tests you can do at home: you can check your ovarian reserve and you can do a broad panel screening for several different hormones that play a part in fertility health. Here’s the scoop.

Ovarian reserve tests measure the amount of follicle-stimulating hormone (FSH) in your blood with a pinprick. Typically, you collect a sample yourself and mail it back to the company so they can read and deliver your results. Very high levels of FSH can be a sign that you don’t have a lot of eggs, that they’re poor quality, or both, because your body is working overtime to produce enough FSH to release a healthy egg.

• Taking this test feels like a typical finger prick. It hurts for a sec and then you’re over it. You will have to squeeze out some blood into designated spots on a testing card, though, so if you’re blood-averse be prepared.
• The tests themselves can accurately check your FSH level, but there’s more than one way to figure out what your ovarian reserve looks like. Only measuring FSH will give you a piece of the puzzle...but could also cause you to unnecessarily panic about your fertility. Try not to do that! Remember, these tests are useful, but not foolproof.
• FSH levels alone may not be a great way to assess your fertility in the first place. A 2017 JAMA study found that biomarkers like FSH aren’t the best predictors of future fertility in women with reduced versus normal ovarian reserves.

Fertility health screenings capture your FSH level but also a bunch of other hormones that impact your fertility in one way or another. The exact hormones measured in an OTC fertility test differ between companies, but you can usually find out your FSH level and any or all of the following:

• thyroid-stimulating hormone, or TSH a marker of thyroid health)
• estradiol (helps with ovulation)
• anti-mullerian hormone, or AMH (an indicator of egg reserve)
• prolactin (makes breast milk after birth)
• luteinizing hormone, or LH (regulates your cycle, especially ovulation)
• testosterone (helps make follicles, but too much may mess up your fertility)

These tests all work like the ovarian reserve test: you prick your finger, collect some blood samples, send the samples back to the company, and then wait for your results to come in. Usually, you’ll get factual data (like, “your TSH is off”) but also an explanation of what that might mean for your fertility. 

Most companies allow you to see your results online and consult with an on-staff medical professional if you have questions or don’t understand your results. They’re pretty easy to order online, but many aren’t cheap—they’re usually about $150—and you’ll have to pay out of pocket.

How can I test my fertility: for men

The only kind of male fertility test that can be done at home is a sperm analysis. About half of all couples’ infertility problems can be caused by male infertility, so knowing if your swimmers are strong or not is a good place to start if you’ve been trying to conceive for a while. 

There are actually several different kinds of sperm analysis kits; sometimes you collect a sample and send it through the mail for testing, sometimes you put some sperm on a slide and insert it into a testing device, and sometimes you can even use your smartphone (yes, for real!). 

• Testing at home is private and confidential. You don’t have to worry about being unable to provide a sample at an unfamiliar clinic or doctor’s office. 
• The kits you send off to labs via mail can be more accurate, but at the same time, there’s a lot that can go wrong here—like failure to keep the sperm stored at just the right temp, which can cause damage to the sample. At-home tests, while giving quicker results with no middle-man, have a lot of potential for both user and technology errors.
• Male fertility is about more than just the amount of sperm: there’s motility, shape, concentration...the list goes on. If your at-home kit is only looking at the number of sperm, your results may not be that helpful. Try to choose a test that looks at more than one type of factor—this will give you the most bang for your buck. 

Don’t forget about ovulation!

While ovulation predictor kits only tell you if and when you’re ovulating, this can be very helpful if you’re actively TTC. 

These kits work by detecting the presence of LH in the urine, says David Diaz, MD, reproductive endocrinologist and fertility expert. When your LH rises above a certain level, the test strip you’ve peed on will let you know that an ovary is just about to release an egg. This is a good time to get it on, since there’s a good chance that egg could become fertilized. 

According to Dr. Diaz, these tests are about 85 percent accurate and available as digital and non-digital tests. If you have fairly regular menstrual cycles, an ovulation predictor kit can be a useful tool in identifying exactly when your fertile window is, but if your cycles are irregular (because of PCOS, pre-menopause, or even just your personal biology), it can be harder to rely on them unless you’re taking a test every day.

Next steps

Okay, you took an at-home test and got your results back...now what? Well, you might not like our answer, but here it is: you should probably still go see a fertility doctor. Yes, even if your results are “normal.” Why? 

Because, like we told you upfront, a test you do at home gives you important data — but not the expertise and counsel of a doctor who has met you in person and knows your medical history. You’ll have the info, just not necessarily the context...and the context is super important when it comes to your fertility. At-home tests simply can’t paint the same kind of comprehensive picture that doctor-interpreted lab tests can. 

But you’re here because you want to take an at-home fertility test...and TBH, we kinda don’t blame you! We’re curious, too! Just make sure you know what you’re buying, (Dr. Knopman says that you should make sure any OTC test you buy comes from a legit manufacturer with a fertility doctor on their medical review board), what the tests can tell you, and what you’re going to do with the results. 

“Even if you don’t want to do fertility treatments [right now], there is no harm in coming in to talk to us about it,” says Dr. Knopman. “You can make better decisions when you have that information than when you don’t…[and] the worst thing to do is sit at home and ruminate, trying to interpret your own results or diagnose yourself.”

What’s the takeaway here? After taking an at-home fertility test, you might want to plan to make an appointment with a fertility specialist. It can be a simple introductory or informational appointment, and even a virtual one. But hopefully, it will give you peace of mind and — most importantly — answers. 

Read more

• Female Fertility Hormones: Everything They Didn’t Teach You in Sex Ed
• A Step-by-Step Guide to Freezing Your Eggs

Ever scrolled through that health and wellness side of social media and stumbled upon something called AMH? Maybe your best friend casually mentioned getting her AMH tested, and you were too embarrassed to ask what the heck she was talking about. You're young, you feel great, and having babies isn't even on your radar right now. But here's the thing: understanding this thing called AMH could be a major game-changer for your future.

What is AMH?

AMH stands for Anti-Müllerian Hormone.  Think of it as a little signal your ovaries send out. This hormone level tells your doctor about how many eggs you have left – also known as your ovarian reserve. Basically, AMH is one clue into your fertility.  And, here's why you should care even if kids aren't on your mind yet.

Why does AMH matter in your 20s and 30s?

AMH can be a helpful biomarker for your health and fertility. Why?

1. Knowledge is power: Knowing your AMH levels gives you valuable insights into your reproductive timeline. It helps you make informed decisions about when you might want to start a family and whether fertility preservation options (like freezing your eggs) might be something to consider down the road.
2. Fertility isn't forever: You might think of your 20s as your prime fertility years, and while you're not wrong, it's not the full picture.  Your fertility peaks in your early 20s and starts a gradual decline in your mid-30s. For some people, this decline is faster, and AMH levels can give you a heads-up.
3. Unexpected roadblocks: AMH testing can help detect potential fertility issues early on, like Polycystic Ovarian Syndrome (PCOS) or premature ovarian insufficiency. Getting this info sooner rather than later can help you take steps to manage these conditions and protect your fertility.

What can AMH test results tell you?

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

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

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

So, you got your AMH tested. Now what? Here's a basic breakdown of what those numbers usually mean: 

• Normal AMH means you're right on track for your age – good news!  
• High AMH might suggest a good number of eggs remaining, and potentially even point towards conditions like PCOS where your egg count is unusually high. 
• Low AMH could mean you have fewer eggs remaining than typical for your age group.  It might signal a faster decline in fertility, but it doesn't mean you can't get pregnant at all.  

Remember, your AMH level is just one piece of the fertility puzzle. Other factors like your overall health, other hormone levels, family history, and lifestyle habits matter too!

What are normal AMH numbers?

What is considered a “normal” AMH level depends on your age, as well as the lab where you take the test. Since there is no international standard, it’s best to use the reference ranges included on the test results (your doctor can share those with you if you did a test through a clinic). 

In general, however, an AMH between 1.0 and 3.5 ng/mL suggests a “normal” range that is likely to have a good response to egg freezing.

Common reasons for high AMH

The most common reason for high AMH is that you are very fertile and likely to retrieve more eggs in an egg freezing cycle.  But, it does not necessarily mean that the eggs are of good quality. Egg quality is determined by factors such as your age, genetics, and environmental factors, and cannot be measured directly by AMH levels.

But a high AMH level may also indicate PCOS, which is a hormonal disorder that affects 8–13% of females of reproductive age. Those with PCOS typically have high levels of androgens (male hormones) and may have irregular periods, acne, and excess hair growth. Patients with an average AMH level ≥ 4.45 ng/ml have a 9.35 times higher likelihood of developing PCOS, but not all patients with a high AMH have PCOS.

In rare cases, abnormally high AMH could be a sign of an ovarian tumor. Certain types of ovarian tumors, such as granulosa cell tumors, can produce high levels of AMH. 

Read more in: What Does a High AMH Result Mean?

Common reasons AMH would be low

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

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

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

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

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

Read more in: What Does a Low AMH Result Mean?

Factors that can influence AMH levels

It's important to know that some things can temporarily or even permanently change your AMH:

Birth control

Certain types of birth control can suppress your natural AMH levels. One study looked at data from women on various types of birth control and found: 

• Combined oral contraceptive pill led to 23.7% lower AMH
• Progestin-only pill led to 14.8% lower AMH
• Vaginal ring led to 22.1% lower AMH
• IUD led to 6.7% lower AMH
• Implant led to 23.4% lower AMH
• Copper intrauterine device led to 1.6% lower AMH

The authors concluded that birth control use is associated with a lower mean AMH level when compared to those who are not on contraceptives, with variation depending on the type of birth control

Health conditions

Things like PCOS, endometriosis, vitamin D deficiency, or even a recent ovarian surgery can impact your AMH levels.

Chemotherapy 

Chemotherapy treatments for conditions like cancer can significantly lower AMH levels. Research indicates that pre-chemotherapy AMH levels may be helpful in predicting ovarian function and potential fertility after treatment. A prospective study of women treated with chemotherapy for early breast cancer showed that long-term ovarian function after treatment was predictable using serum AMH levels before treatment. 

Obesity

Studies suggest a connection between obesity and lower AMH levels, though the exact relationship is complex. Obesity is linked to hormonal imbalances and inflammation, which can disrupt ovarian function and potentially affect AMH production. However, it's important to note that not everyone with obesity experiences lowered AMH, and other factors could also be at play. More research is needed.

Smoking

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

What is a good AMH level for egg freezing?

Research has found that AMH is a good predictor of the response to ovarian stimulation and the number of eggs retrieved. Because of this, fertility doctors typically use your AMH levels (along with other biomarkers) to determine the drugs and dosages you will need to maximize your response to ovarian stimulation. 

Now, what about a correlation between AMH and actual babies born (live birth rate)? Well, while AMH does seem to have some association with live birth rates after IVF, its ability to actually predict a live birth is not that great. This is especially true for younger people. A 2021 study found that AMH is a good predictor of live birth in older (>39 years old), but not younger, people. They found that younger participants (≤38 years old) could get pregnant even with low AMH levels as long as they had frequent egg retrievals. 

Does AMH predict the number of eggs you will retrieve during egg freezing?

The overall success of an egg freezing cycle largely depends on the number and quality of eggs retrieved. Studies have shown that AMH levels can be used as a predictor of egg quantity, and can thus help to predict the potential success of egg freezing. Those with higher AMH levels tend to have better outcomes with egg freezing, as they are likely to have more eggs retrieved and a higher chance of success in future fertility treatments. 

But by no means does a high AMH level guarantee a lot of eggs during an egg retrieval procedure for fertility treatments. The number of eggs retrieved during an egg freezing cycle depends on several factors, including your age, ovarian response to stimulation medications, any other underlying medication conditions, and the skill of the fertility doctor performing the procedure.

When eggs are retrieved, only a portion of those eggs will be mature. A mature egg is one that’s ready and able to be fertilized. At most clinics, any non-mature eggs are discarded, though you can talk to your clinic about whether they’re open to freezing those too. 

Multiple studies have shown a strong correlation between AMH levels and mature eggs retrieved during egg freezing or IVF.

Let’s look at a few of the studies:

The study: Correlation between anti-Müllerian hormone, age, and number of oocytes 

Who: 1500 patients in Brazil between July 2012 and April 2019

The findings: “A positive correlation was found between serum AMH levels and total number of retrieved and mature oocytes from stimulated cycles”

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The study: Different anti‐Műllerian hormone (AMH) levels respond to distinct ovarian stimulation methods in assisted reproductive technology (ART) 

Who: 1,112 patients undergoing an egg retrieval as part of ART

The findings: “AMH showed a stronger correlation with egg number compared with age over a wide age range”

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The study: Relationship Between Anti-Müllerian Hormone and In Vitro Fertilization-Embryo Transfer in Clinical Pregnancy 

Who: 314 infertility patients with an average age of 31.0 ± 4.5 years

The findings: “the AMH level of women of all ages was positively correlated with the number of retrieved oocytes “

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The study: Antimullerian hormone (AMH) is a predictor of the number of eggs retrieved and D3 embryos in women with fluctuating and persistently elevated FSH levels 

Who: 58 women with fluctuating and persistently high serum day 3 (D3) FSH.

The findings: “These data demonstrate for the first time that serum AMH is a prognostic indicator independent of age and FSH of the number of eggs retrieved”

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The study: Random anti-Müllerian hormone (AMH) is a predictor of ovarian response in women with elevated baseline early follicular follicle-stimulating hormone levels 

Who: 73 women undergoing ART with elevated early follicular FSH levels

The findings: “Random AMH levels were strongly correlated with the number of oocytes retrieved during an ART cycle among women with elevated FSH”

Read more in AMH and Egg Retrieval Outcomes

What AMH do I need to donate my eggs?

Through Cofertility’s Split program, qualified freezers can freeze their eggs for free when donating half of the eggs retrieved to a family who can’t otherwise conceive. In the context of donating through our Split program, having an appropriate level of AMH is important. Fertility doctors typically consider an AMH level above 2.0 ng/ml as a good indicator for egg donation, and this is the benchmark used at Cofertility. Note that some clinics have a higher requirement.

This level suggests that you are likely to respond well to fertility treatments and produce a sufficient number of eggs for both donation and personal use. This allows us to proceed with the egg retrieval process in a manner that is both safe and effective.

However, if your AMH level is lower than this, it does not necessarily mean you cannot freeze your eggs. You can still qualify for our Keep program — where you keep 100% of eggs retrieved for your own future use — we offer exclusive discounts on expenses, such as frozen egg storage. Keep members also still gain free access to our Freeze by Co Community, a safe space for those engaging in the egg freezing process (or gearing up for it) to connect and lean on each other.

Everyone is unique, and AMH is just one factor of many that we consider during the evaluation process. You can learn more about qualifications for our Split program here. 

When should I test my fertility? 

So, when is the “right” age for testing your fertility, anyway? 

It depends.

And ultimately, it’s up to you! It’s your body, and your data, and there is no one-size-fits-all answer. We’re firm believers that knowledge is power and you deserve this information. Studies do show that our ovarian reserve declines with age — in other words, it’s a good idea to assess your fertility potential sooner rather than later. That way, if you do want to preventatively freeze your eggs, you can do so while your ovarian reserve is still higher. 

According to the American Society for Reproductive Medicine (ASRM), the optimal time to freeze your eggs is in your 20s and early 30s. This study also indicated that, as we get older, our chances of needing to do multiple egg freezing cycles increase in order to achieve a 70% live birth rate. We know we’re a bit of a broken record here, but: the younger you are, the healthier and more plentiful your eggs are.

Should I test my fertility at home or in a clinic?

At-home fertility tests have gained popularity in recent years due to their convenience and privacy. These tests typically involve collecting blood or urine samples and mailing them to a laboratory for analysis. On the other hand, in-clinic fertility tests are conducted at a medical facility, where specialized equipment and healthcare professionals are available.

The pros of at-home fertility tests include:

• Convenience and privacy: Samples can be collected in the comfort of your home.
• Cost-effective: At-home tests are often more affordable than in-clinic procedures.
• Early assessment: At-home tests allow you to gain insights into your fertility potential before actively trying to conceive. Plus, you won’t have to wait to get squeezed in for an appointment at the clinic!

The pros of testing your fertility at a clinic:

• A broader scope: At-home tests may not provide a comprehensive evaluation of fertility health, while testing your fertility at a clinic provides a more comprehensive picture of your fertility. An important note is, when testing your fertility at a clinic, you’ll also undergo a transvaginal ultrasound, where the technician or doctor will be able to get a view of what’s going on in those ovaries and the number of follicles available this cycle.
• Better accuracy: Some at-home tests may have varying levels of accuracy when compared to in-clinic tests.
• Facetime: At a clinic, you’ll have the ability to chat directly with a doctor, before and after your results.

If you do end up going with an at-home test, we have an exclusive discount with the LetsGetChecked Ovarian Reserve Test. It’s $139, and you can get 25% off with code COFERTILITY25. But there are many other options as well.

Although at-home fertility tests are a great way to get a peek behind the curtain of your fertility, they aren’t without limitations. For starters, according to recent studies, measuring AMH alone may not predict your time to pregnancy. As mentioned above, testing your fertility with a doctor at a clinic will likely provide a more comprehensive picture of your fertility outlook, especially as they consider your medical history, and conduct a physical exam and transvaginal ultrasound. Of course, you’ll also get professional interpretation of the results that you may not receive with an at-home fertility test. 

All of that being said, any fertility testing (whether at home or in a clinic) only measures your fertility at that given point in time. It should not be taken as a guarantee for future outcomes. It also can’t tell you anything about your egg quality, which cannot be truly observed until it comes time to actually fertilize those eggs. 

You are not a number

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

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

Read more:

• Which Matters More for Fertility: AMH or Age?
• What AMH Level Do I Need to Freeze My Eggs?
• What Does a High AMH Result Mean?
• What Does a Low AMH Result Mean?
• Birth Control and AMH Levels
• What Medications and Supplements Affect AMH Levels?
• What AMH Do I Need to Donate my Eggs?
• AMH and Egg Retrieval Outcomes

Follicle-stimulating hormone, or FSH, is a hormone that plays an important role in your reproductive health. As a woman, understanding your FSH levels can provide insights into your fertility potential and help you make informed decisions about family planning, including egg freezing. But what exactly is FSH, and what do your levels mean? Let's dive in and explore this essential hormone.

What is FSH and why should you care?

FSH, short for follicle-stimulating hormone, is a hormone produced by your pituitary gland, a small but mighty gland nestled in your brain. Its job is to stimulate your ovaries to grow follicles, the tiny sacs that house your eggs. As these follicles mature, they release estrogen, which triggers ovulation – the release of an egg that's ready for fertilization.

Your FSH levels aren't static; they naturally fluctuate throughout your menstrual cycle, peaking right before ovulation. However, consistently high FSH levels, especially at the beginning of your cycle, can be a red flag for diminished ovarian reserve.  This means your ovarian reserve may be decreasing, either in quantity or quality. While it doesn't mean you can't get pregnant, it does signal that your fertility might be declining.

Average FSH levels by age

FSH levels naturally creep up as you age. And results also depend on where you are in your menstrual cycle. For females, here are normal FSH test results by life stage:

• Before puberty: 0 to 4.0 mIU/mL (0 to 4.0 IU/L)
• During puberty: 0.3 to 10.0 mIU/mL (0.3 to 10.0 IU/L)
• Females who are still menstruating: 4.7 to 21.5 mIU/mL (4.5 to 21.5 IU/L)
• After menopause: 25.8 to 134.8 mIU/mL (25.8 to 134.8 IU/L)

What is a good FSH level for egg freezing?

Most clinics consider an FSH under 9 as a good number for egg freezing. Above that threshold, the response to egg freezing medication tends to decline.  

Here's a general idea of what's considered normal FSH for females on cycle day 3:

• <9: Normal FSH level, expect a good response to egg freezing medication
• 9-11: Fair FSH level, the response to medication is reduced 
• 11-20: Reduced ovarian reserve and lower changes of live birth rate
• 20+: Very poor chances of response to stimulation, egg donation is generally recommended

Remember, these are just guidelines, and results vary by lab. Your doctor will interpret your FSH levels in the context of your age, medical history, antral follicle count, and other hormone levels to assess your overall fertility picture.

What abnormal FSH results may mean

Abnormal FSH results can be a sign of various underlying conditions related to fertility and reproductive health. 

High FSH Levels (typically 10 mIU/mL+ in premenopausal people) can suggest:

• Diminished Ovarian Reserve (DOR): This means the number of eggs in your ovaries are declining. 
• Primary Ovarian Insufficiency (POI): Also known as Premature Ovarian Failure (POF), this condition occurs when the ovaries stop working normally before age 40.
• Menopause: Naturally occurring decline in ovarian function leading to the end of menstruation.
• Polycystic Ovary Syndrome (PCOS): FSH levels are often higher in people with PCOS, a metabolic and hormonal disorder caused by high androgen (male sex hormone) levels. It can also cause enlarged ovaries due to an increased number of follicles on the outer edges. 
• Turner Syndrome: A genetic condition that can impact ovarian function, leading to a higher FSH.

If you get an abnormal result, your doctor will talk to you about what it could mean and if they suggest any next steps.

Testing your FSH

Getting your FSH levels checked is simple – it's just a routine blood test, typically done on the third day of your cycle. Your doctor may order additional tests, such as an antral follicle count (AFC) ultrasound or an anti-Mullerian hormone (AMH) test, to get a more comprehensive picture of your ovarian reserve.

Or, if you want to take a test at-home, there are a few convenient options:

• Natalist Women’s Fertility Test ($149) measures 5 hormones: estradiol, LH, FSH, TSH, and total testosterone. Get 20% off with code Cofertility20.  
• Modern Fertility Hormone Test ($179) measures 7 hormones: AMH, TSH, FSH, estradiol, prolactin, fT4, and LH

What you need to know about FSH tests: the fine print

While FSH tests are a valuable tool for understanding your fertility, there are a few important caveats to keep in mind:

• FSH levels fluctuate: Don't panic over a single high result. FSH levels naturally change throughout your menstrual cycle and as you get older. 
• FSH is not a diagnostic tool: An FSH test alone can't diagnose a specific condition like menopause or polycystic ovary syndrome (PCOS). It's just one piece of the puzzle, and your doctor will consider other factors to make a diagnosis.
• FSH is just one indicator of fertility: While an abnormal result (high baseline FSH) tends to be very predictive of low egg quantity, a normal result does not necessarily mean that the egg quantity is good. Some people with normal levels can still experience age-related fertility decline or have low quality eggs.
• Invalid in some cases: If you're taking hormone therapies like birth control pills, FSH tests might not be accurate. Be sure to let your doctor know about any medications you're taking before the test.

The bottom line? FSH tests provide valuable information, but they're not the be-all and end-all of fertility assessment. Talk to your doctor about your results and what they mean for your individual situation.

The bottom line: knowledge is power

While FSH tests are a valuable tool for assessing ovarian reserve and determining if egg freezing could be a fit, it's important to remember that they're just one piece of the puzzle. A single FSH result doesn't define your fertility journey, and your doctor will consider various factors, including your age, medical history, AFC, and other hormone levels, to develop a comprehensive picture of your reproductive health.

If you're considering egg freezing or have concerns about your fertility, don't hesitate to consult with a fertility specialist. They can help you interpret your FSH results, discuss your options, and guide you towards the best path for achieving your family-building goals. Understanding your FSH levels is a crucial step towards taking control of your fertility and shaping your future.

Egg freezing, also known as oocyte cryopreservation, has become an increasingly popular fertility preservation option for women who want to delay motherhood or preserve their eggs now due to medical reasons. 

Many egg freezers opt to do more than one cycle to increase the number of eggs they can preserve (read more in How Many Eggs Do I Need to Freeze?). One question that often arises is, "How long do I need to wait between egg freezing cycles?" In this guide, we'll delve into the factors that influence the waiting period between cycles and provide you with the information you need to make an informed decision.

Understanding the egg freezing process

Before we discuss the recommended waiting period between egg freezing cycles, it's important to understand the process itself. Egg freezing involves stimulating the ovaries with fertility medications to produce multiple eggs, which are then retrieved and cryopreserved for future use. 

It’s considered a safe procedure, but there are some side effects. The most common being:

• Mild bruising and soreness at the injection site
• Bloating, nausea and, occasionally, vomiting
• Temporary allergic reactions, such as skin reddening and/or itching at the injection site
• Breast tenderness and increased vaginal discharge
• Mood swings and fatigue
• Ovarian hyperstimulation syndrome (OHSS)

Every woman has a different experience. I’ve had some patients who feel great after the retrieval and go right back to work. But I do recommend that my patients take a day or two off to recover and pamper themselves before resuming normal activities.  

Recommended waiting period between egg freezing cycles

While back-to-back egg freezing cycles is possible, it may or may not be the best path for you. 

After you complete your egg retrieval, you will get your period about two weeks later. At that time, you can work with your fertility doctor to assess how your body responded to the hormone injections from the previous cycle's treatment. Your fertility doctor will assess the ovaries to ensure they are healed and that there’s a new cohort of antral follicles. It’s important that you feel back to baseline before starting another cycle. 

In some cases, it is recommended to wait at least one full menstrual cycle before starting another egg freezing cycle. This means that if you complete your first cycle in January, you should wait until at least March to begin the next one, assuming you have a normal 28-day cycle. This waiting period allows your body to recover, your hormones to return to baseline levels, and your ovaries to be ready for another round of stimulation.

In other cases, your fertility doctor may advise a longer waiting period, especially if you experienced complications or had a particularly high response to the stimulation medications. You’ll want to get input from your doctor and also listen to your body's signals to determine the most appropriate time to start another cycle.

Other factors to consider:

1. Age: Age is a significant factor when it comes to fertility preservation. Women in their late 30s or early 40s may have a more limited time frame for egg freezing due to the natural decline in egg quantity and quality. In such cases, your fertility doctor may recommend a shorter waiting period between cycles to maximize the number of eggs retrieved while you still have good ovarian reserve.
2. Ovarian reserve: Your ovarian reserve, which refers to the number and quality of eggs remaining in your ovaries, can influence the waiting period between cycles. If you have a high ovarian reserve, you may be able to wait longer– even years– between cycles without compromising your chances of success. However, if your ovarian reserve is low, your doctor may suggest a shorter waiting period to retrieve as many eggs as possible while you still can.
3. Personal circumstances: Your personal circumstances, such as upcoming life events, work commitments, or financial considerations, may also play a role in determining the timing of your egg freezing cycles. 

Preparing for subsequent cycles

During the waiting period between egg freezing cycles, there are several steps you can take to optimize your fertility and prepare for the next round:

1. Maintain a healthy lifestyle: Adopting a healthy lifestyle can significantly impact your fertility. Eating a well-balanced diet, exercising regularly, managing stress, and getting enough sleep can all contribute to better egg quality and overall reproductive health.
2. Track your cycle: Keeping track of your menstrual cycle can help you and your fertility doctor determine the optimal timing for starting your next egg freezing cycle. Make note of the length of your cycles, any unusual symptoms, and the duration of your periods.
3. Supplement wisely: Certain supplements, such as CoQ10 and vitamin D, have been shown to support fertility. However, you must consult with your doctor before starting any new supplements to ensure they are safe and appropriate for you.
4. Communicate with your clinic: Maintain open lines of communication with your fertility clinic throughout the waiting period. Keep them informed of any changes in your health, menstrual cycle, or personal circumstances that may impact your egg freezing journey. They can provide valuable guidance and support every step of the way.

Summing it up

The decision of when to undergo another egg freezing cycle isn't a one-size-fits-all answer. The answer will be a combination of listening to your body and your doctor's expert advice. While it's often recommended to wait one full menstrual cycle between cycles to allow your body to recover and reset, it's not a hard and fast rule. 

Some women bounce back quickly after a cycle, while others need a little more time. Your fertility doctor can help you assess your individual response to the first cycle and tailor a plan that's just right for you. Plus, your personal circumstances, like work deadlines or financial considerations, also play a role. It's all about finding a balance that works for you.

The takeaway?  Trust your gut, listen to your body, and lean on your doctor's expertise.  They'll help you navigate the waiting game and find the perfect timing for your egg freezing journey.

Freeze your eggs with Cofertility

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

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

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

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

Egg freezing, also known as oocyte cryopreservation, is a process where a woman's eggs are retrieved, frozen, and stored for later use. This allows women to preserve their eggs at their current age, potentially increasing their chances of having a biological child in the future.

Egg freezing is becoming more and more common, with a 30% increase in egg-freezing cycles from 2021 to 2022 alone! 

I’m Dr. Meera Shah, a double-board certified OBGYN and Reproductive Endocrinologist (REI). I have helped countless women freeze their eggs as a fertility doctor and as a Medical Advisor to Cofertility. This article is a guide to everything you need to know to make a confident, informed decision about egg freezing.

Why people choose to freeze their eggs

There are many reasons why women opt for egg freezing. Here are some of the most common reasons we hear:

• Focusing on other priorities: Women focusing on career or personal goals can freeze their eggs until they're ready to start a family.
• Waiting for the right partner: As the average age of first marriage continues to rise, some women choose to freeze their eggs instead of rushing into a marriage.
• Medical reasons: Women facing medical conditions or treatments that could impact fertility, such as chemotherapy or radiation, can freeze their eggs before undergoing these treatments.
• Genetic predisposition: Women with a family history of early menopause may choose to freeze their eggs to ensure they have viable eggs for future use.
• Peace of mind: Some women simply want the peace of mind knowing they have a backup plan for their fertility.

At what age should you freeze your eggs?

There is no perfect age at which to freeze your eggs. However, 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. 

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.

Read more in What’s the Best Age to Freeze My Eggs?

Is it worth freezing eggs after age 35?

The findings from the study above 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. 

Your biological clock is not a cliff. Everyone’s fertility decreases down at a different rate. Having your fertility hormones checked can sometimes help you and your doctor get a general idea of your ovarian reserve and chance of a future pregnancy. This can better help you decide if egg freezing is right for you.

Egg freezing success rates by age

Success rates with egg freezing depend on a lot of factors: your health, your ovarian reserve, your response to egg freezing medication, and the quality of the clinic. That being said, generally, younger women have higher success rates due to better egg quantity and quality. 

A study of 1,241 women found that the average number of eggs retrieved on the first egg freezing round was:

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

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

Now, you might be thinking: isn’t 14 eggs a lot?  It’s true that eggs retrieved from women under the age of 36 will have a 95 percent survival rate after being thawed.  But, not all thawed eggs will become viable embryos and lead to a live birth. The probability of a live birth varies with the age of the woman trying to conceive and the number of mature eggs available. In short, the older the woman, the more eggs required to achieve a high probability of a live birth. 

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

The right number of eggs to freeze for your age

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

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

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

Should I do multiple egg retrievals?

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

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

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

The right number of eggs to freeze to have multiple children

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

As we shared above, a woman under age 35 will need to freeze about nine eggs to achieve a 70% chance of a successful pregnancy and live birth. If you’re under age 35 now and thinking you might want to use frozen eggs to conceive twice in your future, you will want to freeze closer to 18 eggs.

The number of eggs necessary will increase with your age at time of the retrieval, and the number of children you hope to have via those eggs. 

Can frozen eggs guarantee a successful pregnancy in the future?

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

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

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

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

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

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

Know this: most people do not regret their egg retrieval procedure. We looked at five studies on egg freezing. The rates of regret reported in these studies varied, likely due to the sample size, study design, and the follow-up period. However, taken together, these studies suggest that the vast majority of those who freeze their eggs have zero regrets.

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

The egg freezing process: step-by-step

The egg freezing process is about a two-week journey. You will work closely with a Reproductive Endocrinologist (fertility doctor) and the clinic team throughout the process. 

Here's a detailed breakdown of what you can expect from start to finish, and beyond:

1. Ovarian stimulation: You'll take hormone medications to stimulate your ovaries to produce multiple eggs, and have multiple monitoring appointments and blood tests to see how the eggs are maturing.
2. Egg retrieval: Your eggs will be retrieved through a minor surgical procedure using ultrasound guidance.
3. Vitrification: Your eggs will be rapidly frozen using a technique called vitrification, which helps preserve their quality.
4. Storage: Your frozen eggs will be stored in a secure facility until you're ready to use them.
5. Thawing and fertilization: When you're ready to conceive, your eggs will be thawed, fertilized with sperm (either your partner's or a donor's), and transferred to your uterus.

Will egg freezing hurt my future fertility?

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

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

Is egg freezing safe?

Like any other procedure, there are risks and side effects when freezing eggs, including risks of anesthesia, bleeding, pain, and infection. Thankfully, the majority of people who go through with it deal with side effects for a few days at most. When it comes to the ovaries themselves, they generally recover quickly. The overall data indicate that the potential risks of surgical complications from egg retrieval are generally very small. However, in people with a history of endometriosis, pelvic inflammatory disease, pelvic adhesions or previous pelvic surgery, the risks are slightly increased so make sure to speak to your doctor about your medical history if you fall into any of these categories.

Egg freezing vs embryo freezing 

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. 

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 frozen embryos might be the way to go with the goal of a future embryo transfer. 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. 

Read more in Should I Freeze Eggs or Embryos?

Cost of egg freezing

The question of how much does it cost to freeze your eggs will come down to a few factors. These include the number of cycles you undergo to retrieve eggs and how long you keep the eggs in storage. Overall, the typical egg freezing can cost anywhere from $10,000 to $20,000 for one cycle plus the cost of storage fees.

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

Or, if you want to freeze and store your eggs for your own future use without donating, Freeze by Co offers lower prices on things like consultations and storage, along with access to our community of freezers. ‍We partner with lenders, like Sunfish, to offer you fertility financial resources.

Learn more about egg sharing

Egg sharing programs exist worldwide to help make fertility care more accessible. Egg sharing is when a woman undergoes an egg retrieval, and some of the resulting eggs are donated to a family that can’t otherwise conceive.

In Cofertility’s Split program, women can freeze their eggs for free when they donate half of the retrieved eggs to a family who can’t otherwise conceive. 

Ask us anything

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

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

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

Amidst the chaos of career-building, social engagements, and personal growth, it's all too easy to overlook the most critical aspect of your life: your health. But by cultivating healthy habits in your 20s, you can lay the foundation for a lifetime of better health and wellness. 

It’s hard to keep track of these things, so we put together this article for you to easily check off the activities, tests, screenings, and more during this decade. So let's delve into the key areas that demand your attention and explore the steps you can take to take care of yourself.

General Health

First off, now is the time to find a primary care physician (PCP) if you don’t already have one. They will be your go-to for annual check-ups, preventive care, and any health concerns that arise.

Feeling under the weather? Call your PCP. Need your annual vaccines? Call your PCP. Need referral to a specialist? Call your PCP.  Your health care provider is there to guide you to optimal health. 

At home:

✔ Get 7-9 hours of sleep per night.

✔ Eat a colorful, nutrient-dense diet filled with fruits, vegetables, whole grains, lean proteins, and heart-healthy fats.

✔  Engage in regular exercise, aiming for at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity each week.

✔ Limit alcohol and avoid tobacco and drugs.

At the doctor:

✔ Schedule annual check-ups with a primary care provider. Make sure to track your heart rate and blood pressure for changes over time.

✔ Discuss any family history of chronic diseases or genetic conditions.

✔ Get recommended vaccinations, such as the annual flu shot and the HPV vaccine if you haven't already received it.

Reproductive and Sexual Health

Taking charge of your reproductive and sexual health is important for your overall well-being and future family planning.

At home:

✔ If you're sexually active, practice safe sex by using condoms and openly discussing STI testing with your partner(s).

✔ Track your menstrual cycle to better understand your body and identify any irregularities.

✔ Take an at-home ovarian reserve test to have a better understanding of your fertility health. 

✔ Educate yourself on egg freezing, and if it’s right for you.

At the doctor:

✔ Attend annual well-woman visits with an OBGYN, which include a pelvic exam and breast exam.

✔ Get a Pap smear every three years starting at age 21, or as recommended by your OBGYN, to check for cervical cancer.

✔ Discuss contraception options with your healthcare provider to find the best fit for your lifestyle and health needs.

✔ Get tested for sexually transmitted infections (STIs) if you're sexually active, or if you have any symptoms.

Skin Health

Your skin is your body's largest organ, and caring for it now can pay dividends in the future.

At home:

✔ Protect your skin from the sun's harmful rays by applying a broad-spectrum sunscreen with an SPF of at least 30 daily, even on overcast days. And stay far away from tanning beds!

✔ Develop a skincare routine that includes cleansing, moisturizing, and exfoliating to keep your skin healthy and radiant.

✔ Always remove makeup before you go to bed.

✔ Perform monthly self-examinations of your skin.

At the doctor:

✔ If you have a skin condition or have a high risk for skin cancer, establish care with a dermatologist.

✔ Promptly report any concerning changes in your skin to your dermatologist.

Breast Health

Regular breast care and awareness can lead to early detection of potential issues and peace of mind.

At home:

✔ Perform monthly breast self-exams to familiarize yourself with your breasts and detect any changes early on.

At the doctor:

✔ Your OBGYN visit should include a breast exam.

✔  Those with a personal or family history of breast cancer or who have an ancestry associated with BRCA1/2 gene mutations get a familial risk assessment. Those with a positive result on the risk assessment tool should receive genetic counseling and potentially genetic testing.

Mental Health

Your mental health is just as important as your physical health, and nurturing it in your 20s sets the stage for emotional resilience.

At home:

✔ Practice self-care activities that promote relaxation and help manage stress levels, such as reading, taking a bath, or pursuing a hobby.

✔  Maintain a strong support system of friends and family.

✔  Consider journaling or other forms of self-reflection to process your thoughts and emotions.

At the doctor:

✔  If you're experiencing persistent feelings of sadness, anxiety, or hopelessness, reach out to a mental health professional.

✔  Schedule a mental health check-up with your PCP or a therapist, especially if you have a family history of mental health conditions.

Oral Health

Maintaining good oral hygiene in your 20s can help prevent tooth decay, gum disease, and other dental problems down the road.

At home:

✔  Brush your teeth twice a day with an electric toothbrush and fluoride toothpaste for at least two minutes each time.

✔  Floss daily to remove plaque and food particles between your teeth.

✔  Limit sugary and acidic foods and drinks, as they can erode tooth enamel.

✔  Consider using an antiseptic mouthwash to further reduce bacteria and freshen your breath.

At the doctor:

✔  Schedule regular dental check-ups and cleanings every six months, or as recommended by your dentist.

✔  Don't ignore any persistent pain, sensitivity, or bleeding in your teeth or gums; these could be signs of a more serious issue that requires attention from your dentist.

Eye Health

Taking care of your eyes in your 20s can help prevent vision problems and maintain healthy eyesight for years to come.

At home:

✔ Protect your eyes from UV damage by wearing sunglasses with 100% UV protection when outdoors.

✔ Practice the 20-20-20 rule when working on digital devices: every 20 minutes, look at something 20 feet away for at least 20 seconds to reduce eye strain.

At the doctor:

✔ Schedule a comprehensive eye exam every 1-2 years, or as recommended by your eye doctor.

✔ If you wear contact lenses, follow your eye doctor's instructions for proper use and replacement.

✔ If you experience persistent eye pain, redness, or changes in vision, consult your eye doctor promptly.

The power of healthy habits in your 20s

Your 20s are a great time for establishing healthy habits that will serve you well throughout your life. By paying attention to these key areas of health - from general wellness to reproductive, skin, breast, mental, oral, and eye health - you're investing in your future self. 

Remember, health is not a destination but a journey, and it's never too early to start taking care of yourself. Regular check-ups, preventive care, and healthy lifestyle choices made now can lead to a healthier, happier you in the decades to come. So, embrace this time of growth and self-discovery, and make your health a top priority. Your future self will thank you for the care and attention you give to your health today.

As you embark on your egg freezing journey, you're likely to encounter a whirlwind of medical terms, tests, and metrics that can feel overwhelming at first. Among these is an especially important one: the Antral Follicle Count (AFC). This key indicator plays a significant role in understanding your chances of success with egg freezing by measuring the number of follicles in your ovaries.

But what exactly is AFC, and why does it matter so much? More importantly, is it a fixed number, or can it change over time? These are questions that many folks grapple with as they navigate egg freezing.

In this article, we'll dive into the world of AFC, demystifying this important metric and exploring its variability. We'll break down the science in a way that's accessible and relevant to your egg freezing journey, helping you understand what your AFC means for your fertility and how it might influence your treatment plan.

Whether you're just starting to consider egg freezing or you're already in the midst of the process, understanding AFC can empower you to make informed decisions about your reproductive future. It's not just about numbers on a chart; it's about gaining insight into your body's unique fertility landscape and working with your healthcare team to optimize your chances of success.

By the end of this article, you'll have a clearer understanding of what AFC is, how it's measured, why it matters, and yes - whether it can change. Armed with this knowledge, you'll be better equipped to navigate your egg freezing journey with confidence and clarity.

What is AFC and how is it measured?

Antral Follicle Count is a key indicator of your ovarian reserve - essentially, it's a snapshot of your egg supply. Whereas AMH measures your ovarian reserve through a hormone blood test, AFC is an actual look at your antral follicles, which are small fluid-filled sacs containing immature eggs. But what is an ovary follicle exactly? An ovary follicle is a structure within the ovary that contains a developing egg. To assess AFC, a fertility doctor performs a transvaginal ultrasound, typically early in your menstrual cycle, to count these follicles in your ovaries.

The number of visible follicles, your AFC, is a helpful predictor of how your ovaries might respond to fertility medications during the egg freezing process. A higher count generally suggests a better ovarian reserve and potentially more eggs that can be retrieved.

Fertility doctors use this information to tailor your treatment plan, determining which medications to use and in what doses. It's like creating a personalized roadmap for your egg freezing journey.

Does AFC change within a cycle?

While it's often recommended to perform the AFC early in your menstrual cycle, experts suggest that it can be assessed at various points. However, it's important to remember that there can be some fluctuation depending on when the ultrasound is done. In fact, studies have shown that AFC can vary by as much as 30-34% within a single cycle. This variability is worth keeping in mind as you interpret your results.

Can AFC change month to month?

Does antral follicle count change? Yes, your AFC isn't set in stone. Indeed, it can vary from one menstrual cycle to the next. This variability is one reason why fertility specialists often consider AFC alongside other markers, like Anti-Müllerian Hormone (AMH) levels, to get a more comprehensive picture of your ovarian reserve.

Remember, AFC correlates with the number of eggs retrieved during an IVF cycle, which is why it's such a valuable predictor for egg freezing outcomes.

A very low AFC (typically less than 5-7) is associated with a smaller number of eggs retrieved and potentially reduced pregnancy rates down the line. On the flip side, a high AFC (20 or more) could indicate a risk of ovarian hyperstimulation syndrome (OHSS) during fertility treatments.

Can I increase my AFC?

While AFC generally declines with age, there are factors that can influence it. For instance, if you're using hormonal contraceptives or certain other medications, your AFC might appear lower than it actually is. Once you stop these medications, you might see an increase in your AFC.

To increase your chances of a successful egg freezing cycle, optimize your fertility health as soon as possible. This step will look a little different from person to person since everyone has their own unique medical history and concerns. Generally speaking though, optimizing your health will include following a balanced diet and making other healthy lifestyle choices. In some cases, you may want to consider adding certain vitamins and supplements to your regimen too. Make sure to talk to your fertility specialist if you’re not sure!

You may also want to consider doing multiple egg retrieval cycles. If you have the resources and time to do multiple cycles, this can vastly improve the pool of eggs to choose from in the future. This is an especially helpful option for people who are older or have a low AFC. If your fertility provider thinks more cycles will improve your chances, they’ll discuss those recommendations with you.

What is a normal AFC by age?

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

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

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

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

What does this mean for you?

Understanding the variability of AFC can help you approach your egg freezing journey with realistic expectations. If your first AFC measurement isn't what you hoped for, remember that it can change. Your fertility doctor might recommend retesting in a subsequent cycle or adjusting your treatment plan based on your individual AFC trends.

Remember, AFC is just one piece of the puzzle. Your age, overall health, and other fertility markers all play crucial roles in determining your egg freezing outcomes. The goal is to create a personalized plan that gives you the best chance of success.

As you navigate this process, don't hesitate to ask your fertility doctor questions. Understanding your body and your options is empowering, and it can help you make informed decisions about your fertility preservation journey.

If you're considering egg freezing or donation and are just curious about its long-term effects, you may have heard a rumor: "Does egg donation cause early menopause?" It's a valid question, and in this article I will break it down for you with the latest scientific information and my professional insights as a board-certified OB/GYN.

I have guided countless patients considering egg freezing and donation processes, and I understand the importance of addressing these concerns head-on. After all, your reproductive health is a big deal, and you deserve clear, accurate information to help you make informed decisions.

In this article, I’ll explain the science behind egg freezing and donation, explore common misconceptions, and look at what the research really says about its impact on your future fertility. I'll also share some insights on what actually influences the timing of menopause and offer tips on how to take care of your reproductive health. Alright, let’s go!

The short answer

Let's start with the good news: No, neither egg freezing nor egg donation causes early menopause, also known as premature ovarian insufficiency (POI). But I know you're looking for more than just a simple "no." You want to understand why, how we know this, and what these processes actually do to your body. So let’s go even deeper.

Understanding your ovaries and egg supply (aka ovarian reserve)

Before we get into the specifics of egg freezing and donation, let's refresh our understanding of how ovaries work. You were born with all the eggs you'll ever have – about 1-2 million of them! By the time you hit puberty, that number has already decreased to about 300,000-500,000. Throughout your reproductive years, you'll typically release one egg per month during ovulation.

Your body is constantly losing eggs, whether you're trying to get pregnant, on birth control, or not thinking about fertility at all. It's a natural process called atresia. Each month, several eggs begin to mature, but usually only one reaches full maturity and is released during ovulation. The rest are reabsorbed by the body.

What happens during egg freezing and donation?

When you freeze your eggs or donate them, you're given hormones to stimulate your ovaries to mature multiple eggs in a single cycle – typically anywhere from 10 to 20 eggs. These are eggs that would have otherwise been lost to the natural process of atresia. We're not dipping into some secret egg reserve or using up eggs that your body was "saving" for later.

The main difference between egg freezing and donation is what happens to the eggs after they're retrieved. With egg freezing, they're stored for your future use. With donation, they're provided to someone else who needs them to build their family. And with an egg sharing program like we offer at Cofertility, you keep and store half of your eggs retrieved for up to 10 years for free when you donate the other half to a family who can’t conceive otherwise.

Why the misconception exists

So, if the science is clear, why does this myth persist? There are a few reasons:

• Misunderstanding of ovarian stimulation: The process of stimulating multiple eggs to mature at once can sound unnatural, leading some to worry it's "using up" eggs too quickly.
• Confusion with natural fertility decline: As we age, our fertility naturally declines. Both the quantity and quality of our eggs decreases. Some people might attribute this normal process to their past egg freezing or donation.
• Individual variations: Someone who froze or donated eggs might experience fertility issues later, but this isn't necessarily caused by the procedure. Remember, 1 in 6 people are affected by infertility, whether they froze their eggs or not.
• Lack of long-term studies: While we have good medium-term data, very long-term studies (30+ years) are still ongoing. This can lead to uncertainty for some people.

What egg freezing and donation actually do to your body

Okay, so if these procedures don't cause early menopause, what do they actually do to your body? Let's break it down. During the stimulation cycle, you'll experience short-term hormonal changes, with higher levels of some hormones circulating in your system. This can lead to symptoms like bloating, mood swings, and breast tenderness – similar to what you might experience during your menstrual cycle, just more pronounced. These effects are temporary and typically subside after the egg retrieval process.

I break down all of the side effects and risks of egg freezing here. 

The medications used in egg freezing and donation will temporarily override your natural menstrual cycle. This is a necessary part of the process to stimulate multiple eggs to develop. After the egg retrieval, it usually takes about 1-2 months for your cycle to return to its normal rhythm. During this time, you might experience some irregularity in your periods, but this is generally nothing to be concerned about.

There is a minor risk of complications, primarily ovarian hyperstimulation syndrome (OHSS), where the ovaries become swollen and painful. However, serious cases of OHSS are rare, especially with modern protocols and careful monitoring throughout the process. Your medical team will be vigilant in watching for any signs of OHSS and can adjust your treatment if necessary.

Perhaps most importantly, current evidence shows no significant long-term impact on your fertility or the timing of menopause from egg freezing or donation procedures. Your body continues its natural reproductive processes after these procedures, and your remaining eggs are unaffected. This means that your future fertility and the onset of menopause should follow their natural course, just as they would have without the egg freezing or donation process.

Factors that actually influence menopause timing

Now that we've cleared up the egg freezing and donation myth, let's talk about what really can influence when you'll hit menopause:

1. Genetics: The age your mother went through menopause is a good indicator of when you might do so.
2. Your period: The age when you had your first period can influence the timing of menopause, especially if you got your first period before age 11. So can an irregular menstrual cycle.
3. Number of pregnancies: Compared to those who had never been pregnant or who had been pregnant for less than six months, women who had one full-term pregnancy had an 8% lower risk of early menopause. Those who had two pregnancies had a 16% lower risk, and those who had three pregnancies had a 22% lower risk.
4. Lifestyle factors: The use of tobacco and alcohol, as well as your level of physical activity, can influence when menopause occurs.
5. Medical history: Procedures that remove your ovaries or uterus can affect menopause timing. So too can autoimmune diseases.
6. Diet: Your diet, particularly the consumption of polyunsaturated fats, may have an effect.

Notice that egg freezing and donation aren't on this list!

Taking care of your fertility

Whether you're considering egg freezing, donation, or neither, there are several important steps you can take to support your reproductive health. First and foremost, regular check-ups are key. Keeping up with your gynecological exams allows you to stay on top of your reproductive health and provides opportunities to discuss any concerns with your doctor. These regular visits can help catch potential issues early and ensure you're taking the best possible care of your reproductive system.

Adopting a healthy lifestyle is another key aspect of maintaining your fertility. This includes eating a balanced diet rich in nutrients that support reproductive health, exercising regularly to maintain a healthy weight and promote overall well-being, and avoiding harmful habits like smoking. These lifestyle choices not only benefit your reproductive health but also contribute to your overall health and longevity.

If you're concerned about your future fertility, considering options like egg freezing can be a proactive step. At Cofertility, we understand the importance of having options when it comes to your reproductive future. 

• Through our Split program, qualified freezers can freeze their eggs for free when donating half of the eggs retrieved to a family who can’t otherwise conceive.
• Through our Keep program — where you keep 100% of eggs retrieved for your own future use — we offer exclusive discounts on expenses, such as frozen egg storage. Keep members also still gain free access to our Freeze by Co Community, a safe space for those engaging in the egg freezing process (or gearing up for it) to connect and lean on each other.

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

Final thoughts

So, there you have it – the long and short of egg freezing, egg donation, and menopause. The bottom line is that current scientific evidence does not support the idea that these procedures cause early menopause. Your body is incredibly resilient, and these processes work within your natural reproductive system, not against it.

That being said, egg freezing and donation are still significant medical procedures. It's important to work with reputable clinics (like our partner clinics!) that prioritize your health and provide comprehensive information.

Understanding your body and your options is key to making informed decisions about your reproductive health. Whether you're considering egg freezing, thinking about donation, or just curious about how it all works, I hope this information has been helpful.

If you have more questions about egg freezing, donation, or reproductive health in general, don't hesitate to reach out. At Cofertility, we're here to support you every step of the way on your fertility journey.

Read more:

• What are the Side Effects and Risks of Egg Freezing?
• Does Donating Eggs Affect Your Fertility?
• What’s the Best Age to Freeze My Eggs?

If you just started researching egg freezing, you might feel like you’ve been introduced to a whole new language. Whether clinical in nature or just shortened slang, with egg freezing comes its own terminology. And even if you’ve already educated yourself on what’s involved with egg freezing, chances are, you’ll come across an acronym you’ve never heard of. 

Fear not. Below, you’ll find a comprehensive list of acronyms, abbreviations, and terms you should know when diving into an egg freezing cycle. Read this, and soon you’ll rattle off egg freezing lingo like a pro. 

Hormones and general fertility 

• AMH: One of the first hormones your reproductive endocrinologist will investigate, Anti-Müllerian Hormone is measured early in a woman’s cycle to determine her ovarian reserve. A higher AMH level correlates to a higher ovarian reserve, or in other words, more eggs.
• CD: "Cycle day"—or the day of one's menstrual cycle, with CD1 = the first day of a period. Understanding your cycle length is super important, as it may indicate your most fertile window of dates. It will also help you determine any irregularities to consider as you embark on an egg freezing cycle. 
• DPO: "Days past ovulation." In a typical menstrual cycle, women can expect their period at 14DPO.
• Dx: Diagnosis, the medical identification of a condition or issue affecting fertility, which may impact decisions regarding egg freezing and related treatments.
• E2: Estradiol, a female hormone that's produced by ovarian follicles and determines how well a woman is responding to controlled ovarian hyperstimulation with fertility drugs. If you're freezing your eggs, you’ll have several routine monitoring appointments that include ultrasounds and bloodwork that measures estradiol levels. The higher the estradiol, the more follicles that are likely developing and (fingers crossed) the more eggs that may be retrieved.
• FSH: Follicle stimulating hormone, a hormone released from the pituitary gland to stimulate the ovaries or testicles. When getting an initial fertility workup, you'll get tested for your existing FSH. If you're taking FSH as a drug as part of your egg freezing protocol, it's also known in the United States as Follistim, Gonal-F or Bravelle.
• hCG: Human Chorionic gonadotropin, a hormone produced by an implanting embryo. If this hormone is present in a woman's blood, it indicates a possible pregnancy. It can also be given to women undergoing an egg freezing cycle to trigger ovulation right before a retrieval procedure.
• LH: Luteinising Hormone, a hormone released by the pituitary gland to stimulate the gonads (ovaries and testicles). If you're freezing your eggs, you'll have levels of this hormone measured often via bloodwork in order to determine ovulation timing.
• LMP: "Last menstrual period," or the start date of a woman's last menstrual period.
• MII: Metaphase II, the stage of egg maturation where the egg is ready for (hypothetical) fertilization, with chromosome alignment necessary for successful embryo development.
• PCOS: "Polycystic ovarian syndrome," a condition where the ovaries develop many small cysts, which results in irregular periods and ovulation. It can contribute to future infertility, so if you know you have PCOS, regardless of whether you’re freezing your eggs or not, chat with a reproductive endocrinologist to ensure a safe and healthy plan.
• TSH: Thyroid stimulating hormone, a hormone produced by the pituitary gland meant to stimulate the release of thyroid hormone by the thyroid gland. Recent research has suggested that slightly low TSH may associate with fertility challenges.

Egg freezing 

• AFC: “Antral follicle count,” a count of the number of small follicles in a woman's ovaries, seen via ultrasound early on in her cycle. Used to measure ovarian reserve, you'll have a lot of these if you're freezing your eggs to monitor how you're responding to ovary-stimulating medication.
• ART: “Assisted reproductive technology,” including any procedure involving egg retrievals and manipulating eggs and sperm outside the body. It includes things like egg freezing, gamete intrafallopian transfer (GIFT), in vitro fertilization (IVF), and zygote intrafallopian transfer/tubal embryo transfer (ZIFT/TET). 
• BCP: Birth control pills. If you’re freezing your eggs, your doctor may prescribe these as part of a medicated cycle in order to regulate the timing
• COH: “Controlled ovarian hyperstimulation,” when several follicles mature simultaneously in response to fertility drug treatment. The key word here is controlled. Your follicle growth will be carefully monitored by your doctor, who will adjust your medication protocol accordingly to stimulate or halt further growth.
• ER: "Egg retrieval" — not "emergency room!" An ER will be performed as part of an egg freezing cycle, and may also be referred to as a VOR (“Vaginal Oocyte Retrieval”).
• IM: Intramuscular, a method of injecting medication directly into a muscle. This method is often used for hormone treatments during the egg freezing process.
• OC: “Oocyte Cryopreservation,” which is another term for egg freezing. 
• OHSS: “Ovarian hyperstimulation syndrome,” a condition where the ovaries become excessively swollen and painful due to the overproduction of eggs from fertility medications. This is very rare, but can happen.
• REI: "Reproductive endocrinologist," or a doctor who specializes in treating male and female fertility.
• SD1: “Stimulation Day 1,” or the first day of medication administered to stimulate the ovaries for egg production during the egg freezing process.
• SQ: Subcutaneous (also abbreviated as SC), a method of injecting medication into the fatty tissue just under the skin, commonly used for administering fertility hormones during an egg freezing cycle.
• TVUS: “Transvaginal Ultrasound,” an imaging technique used to visualize the ovaries and follicles internally, providing information about egg development and ovarian health. If you’re undergoing an egg freezing cycle, you’ll have a lot of these, but they are quick and painless. 

Egg donation

• DE: “Donor eggs,” or eggs provided by another woman to be fertilized with sperm and transferred to the uterus of an intended parent or gestational carrier.
• IP: “Intended parent,” which is a person who becomes the legal parent of a child born through third party reproduction.

If you’re feeling totally overwhelmed by all that’s involved with egg freezing, we’ve got you covered. Take our quiz to see how you may qualify for our more accessible egg freezing opportunities, including our Split program, through which you can freeze your eggs for free when you donate half to another family who can’t conceive. 

We’re wishing you the best of luck on your egg freezing journey! 

In today's world, the path to parenthood is anything but one-size-fits-all. People are getting married later, and about 20% of women in the U.S. now have their first child after age 35. Whether you're focused on your career, haven't found the right partner, or are facing health challenges, your timeline for starting a family probably looks different from your parents. 

If you're exploring options for future family planning, you may be wondering about embryo banking. Is it the right choice for you? Let's dive in and learn more.

How does embryo banking work?

In essence, embryo banking is the process of creating embryos through in vitro fertilization (IVF), then freezing and storing them for future use. It's like having a biological time capsule, waiting to be opened when you're ready for parenthood.

The journey begins with the same steps as IVF. First, you undergo ovarian stimulation to encourage the production of multiple mature eggs. Once ready, these eggs are retrieved through a 30-minute minimally invasive procedure. Then, in the lab, these eggs are fertilized with sperm (from a partner or donor), creating embryos. The embryos are carefully selected and frozen using a technique called vitrification, which allows them to be stored safely for many years to come.

Who is a candidate for embryo banking?

Embryo banking is for women who are absolutely sure they know who they want to be the biological father of their future children. It's a proactive choice for individuals and couples in a variety of situations:

• People undergoing IVF: If you’re undergoing IVF and want multiple children, some doctors will recommend embryo banking before doing an embryo transfer. 
• People delaying parenthood: Maybe you're not quite ready for kids, but you want to ensure you have the option later. Embryo banking can help you safeguard your chances of having a biological child.
• Individuals facing medical treatments: Cancer treatments, surgeries, or other medical conditions can impact fertility. Embryo banking offers a way to preserve your options before undergoing such treatments.
• Same-sex couples: Embryo banking, combined with egg or sperm donation, can help same-sex couples achieve their dream of having a genetically related child.
• Single individuals: If you're single but know you want to use a sperm donor, embryo banking can give you a head start on that goal.

How many embryos should you bank?

During the IVF process, not all fertilized eggs will develop into viable embryos suitable for transfer. This natural attrition rate can mean that you will likely start with a larger number of fertilized eggs but end up with fewer healthy embryos.

It’s generally recommended to aim for approximately two genetically tested embryos frozen per the number of children you'd like to have. So, if you're hoping for two children, aiming to bank around four genetically tested embryos would be a reasonable goal.

Of course, you’ll want to talk through this with your fertility doctor. They can take into account factors like your age, overall health, and any specific fertility concerns to provide personalized guidance on the ideal number of embryos to bank for your situation.

Is embryo banking right for you?

You’ll want to weigh the potential benefits of embryo banking against the considerations, and figure out if this is an investment you want to make. Here are some questions to ask yourself:

• What are my future family plans?
• Am I okay creating embryos I may never use?
• Can I afford the associated costs?
• Am I emotionally prepared for the process and potential outcomes?

Of course, egg freezing is an alternative option. You can learn more about that here. 

The bottom line

Embryo banking is one way to take control of your fertility journey. It's not just about preserving embryos, it's about increasing the chances and the possibility of building a family when the time is right for you. The path to parenthood is unique for everyone, and embryo banking might be the key to unlocking yours.

If you are interested in freezing your eggs or banking embryos, we can connect you with a fertility specialist for a consultation to discuss your specific situation. Our Freeze by Co platform 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.

As an OBGYN, my patients are often seeking information about their fertility now and in the future. I sometimes get questions specifically regarding their “biological clock” and if it’s “ticking”. Is this really a thing? Or just a scare tactic? 

This article aims to provide clear, factual information about the so-called biological clock and the option of egg freezing for women in their 20s. Understanding these concepts early can empower you to make informed decisions about your reproductive health and future family planning.

What does it mean when people say your “biological clock is ticking”?

The term "biological clock" in reproductive health refers to the finite timeline of female fertility. This concept is rooted in the biological fact that women are born with all the eggs they will ever have. Unlike men, who produce new sperm throughout their lives, women's ovaries contain a fixed number of eggs from birth. This number, which starts at about 1-2 million at birth, decreases to approximately 300,000 by puberty.

As we naturally age, both the quantity and quality of these eggs decrease. This decline begins in the late 20s and accelerates in the mid-30s. The biological clock concept encompasses three key aspects:

1. Egg quantity: The number of eggs remaining in the ovaries, also known as ovarian reserve, diminishes over time. This decline is gradual at first but speeds up significantly after age 35.

2. Egg quality: The genetic integrity of the eggs also declines with age. Older eggs are more likely to have chromosomal abnormalities, which can lead to increased risk of miscarriage or genetic disorders in offspring.

3. Hormonal changes: As the number of eggs decreases, the body undergoes hormonal shifts that can affect fertility. These changes can impact the regularity of menstrual cycles and ovulation.

While the “biological clock” affects all people with ovaries, the rate of decline can vary between individuals due to genetic and environmental factors. Understanding your own “biological clock” is helpful for making informed decisions about family planning and fertility preservation. 

At what age does the “biological clock” start ticking?

The biological clock doesn't suddenly start at a specific age; rather, it's a gradual process that begins earlier than many of us realize.

The number of eggs (oocytes) we have is at its peak before we’re even born! At about 20 weeks of gestation, female fetuses have approximately seven million eggs. By birth, this number has already decreased to about 1-2 million eggs.

However, when we talk about the biological clock in practical terms of fertility and family planning, we generally focus on the reproductive years. Here's a breakdown of the key stages:

1. Early 20s: Those in this age group typically have regular ovulatory cycles and the highest chance of natural conception.
2. Mid to Late 20s: Subtle changes begin to occur. While fertility is still high, there's a slight decrease in egg quality and quantity. However, these changes are not noticeable in terms of ability to conceive.
3. Early 30s: Around age 32, fertility begins to decline more rapidly. This is often considered the point at which the biological clock starts "ticking" more noticeably. The decline is due to both decreasing egg quality and quantity.
4. Mid to Late 30s: The decline in fertility accelerates. By age 37, the drop in egg quantity and quality becomes more pronounced, leading to a significant decrease in fertility.
5. 40 and Beyond: Fertility declines sharply, with a much lower chance of unassisted conception and a higher risk of chromosomal abnormalities in any resulting pregnancies.

Of course, these are general trends, and individual experiences can vary. I’m sure you’ve heard of someone who got pregnant unassisted in their 40s. While it’s more difficult, it certainly happens. And on the other hand, some people may experience a decline in fertility earlier, and struggle to conceive even in their late 20s and early 30s. Factors such as genetics, overall health, and lifestyle can all play a role in how quickly the biological clock progresses.

Moreover, the answer to when the biological clock starts ticking can differ depending on individual life plans and circumstances. For someone who wants to have children in their early 30s, the biological clock might not feel like it's ticking in their 20s. However, for someone who wants to delay childbearing until their late 30s or early 40s, the biological clock might feel like it starts ticking earlier.

From a medical perspective, we often advise patients to start thinking about their fertility and family planning goals in their mid to late 20s, even if they're not ready to have children yet. This allows time to assess fertility status, address any potential issues, and consider options like egg freezing if desired.

The impact of biological clock on fertility

The impact of the biological clock on fertility is significant, progressive, and inevitable. While individual experiences may vary, general trends in fertility rates correlate strongly with age.

Peak fertility is usually in the early to mid-20s. During this time, the chance of conceiving naturally in any given month is approximately 25-30% for a healthy couple. This high fertility rate is due to the abundance of high-quality eggs and optimal hormonal balance.

As someone enters their late 20s and early 30s, there's a slight decline in fertility. The monthly chance of conception during this period is about 20-25%. While this represents a small decrease, many people in this age group still conceive without difficulty.

A more noticeable decline occurs in the mid to late 30s. By this time, the monthly chance of conception drops to about 10-15%. This decrease is due to both a reduction in egg quantity and quality. Additionally, the risk of miscarriage and chromosomal abnormalities in the fetus begins to increase.

Once someone is 40 and beyond, the chances of natural conception decrease significantly, often to 5% or less per month. At this stage, not only is it more challenging to conceive, but the risks associated with pregnancy also increase.

Signs your biological clock is ticking

While there's no definitive test to determine the exact state of your so-called biological clock, several indicators can provide insight into your fertility status. You’ll want to be aware of these signs, especially if you're considering delaying parenthood:

• Age: Age is the most significant factor in fertility decline. As you approach your mid-30s, your ovarian reserve declines more quickly, even if you feel young and healthy in every other way.
• Changes in menstrual patterns: Your period can also be indicative of fertility issues. Irregular menstrual cycles may suggest irregular ovulation, which can make conception more challenging. If you notice significant changes in the length or regularity of your cycles, it may be worth discussing with your OBGYN.
• Certain medical conditions: Conditions such as endometriosis, polycystic ovary syndrome (PCOS), or thyroid disorders can affect your ability to conceive. If you've been diagnosed with any of these conditions, or suspect you might have them, it's important to discuss their potential impact on your fertility with a specialist.
• Ovarian reserve: Ovarian reserve testing can tell you more about the number (although not the quality) of eggs you have. These tests typically involve measuring hormones such as Anti-Müllerian Hormone (AMH) and Follicle-Stimulating Hormone (FSH) which play a pivotal role in follicle development and the maturation of eggs within the ovaries.  Learn more in At-home Fertility Testing: Everything You Need to Know
• Family history: If your mother or sisters experienced early menopause or had difficulty conceiving, you might be at higher risk for similar issues. While family history isn't determinative, it can be a valuable piece of information when assessing your fertility potential.
• Lifestyle factors: Smoking, excessive alcohol consumption, and being significantly over or underweight can all negatively impact your fertility. Maintaining a healthy lifestyle can help optimize your fertility and overall reproductive health.

These signs don't necessarily indicate infertility. Rather, they suggest that it might be time to start thinking seriously about your reproductive future and potentially seek guidance from a fertility specialist.

Can egg freezing pause the biological clock?

Egg freezing, or oocyte cryopreservation, is a medical procedure that offers a way to preserve fertility potential by freezing eggs at their current biological age. While it doesn't literally pause the biological clock—your body continues to age normally—it provides the option to use younger eggs later in life.

The process of egg freezing involves several steps:

1. Ovarian stimulation: This phase typically lasts 10-14 days. You'll receive hormone injections to stimulate your ovaries to produce multiple eggs in a single cycle, rather than the one egg typically released each month.

2. Egg retrieval: Once the eggs have matured, they're retrieved through a minor surgical procedure. This is usually done under light sedation and takes about 15-20 minutes.

3. Vitrification: Immediately after retrieval, the eggs are frozen using a flash-freezing process called vitrification. This technique rapidly cools the eggs to prevent ice crystal formation, which could damage the eggs.

4. Storage: The frozen eggs are stored in liquid nitrogen at a temperature of -196°C (-320.8°F) until they're needed. Eggs can be stored for many years without significant degradation.

When you're ready to use your frozen eggs, they'll be thawed, fertilized with sperm (using a process called ICSI - Intracytoplasmic Sperm Injection), and the resulting embryos will be transferred to your uterus.

While egg freezing can provide additional options for future family planning, it's not a guarantee of future pregnancy. The success of egg freezing depends on various factors, including the age at which you freeze your eggs and the number of eggs frozen.

Can egg freezing extend your biological clock?

Egg freezing doesn't extend the biological clock in a literal sense, as it doesn't add more eggs to your ovaries or alter the natural aging process of your reproductive system. However, it can extend the window of fertility opportunity by preserving younger, healthier eggs for future use.

The success rates with frozen eggs depend on several factors:

• Age at the time of freezing: Eggs frozen at a younger age (ideally before 35) have a higher likelihood of resulting in a successful pregnancy later.
• Number of eggs frozen: More eggs frozen increases the chances of a successful pregnancy, as not all eggs will survive the freeze-thaw process or fertilize successfully.
• Egg quality: This is largely determined by age but can also be influenced by overall health and genetic factors.
• Laboratory techniques and expertise: The success of egg freezing and subsequent fertilization depends significantly on the skill and experience of the laboratory team.

One study of 1,241 women found that the average number of eggs retrieved on the first egg freezing round was 21 eggs for women under 35, 17 eggs for women 35-37, and 14 eggs for women 38-40.

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The bottom line

I don’t love the term “biological clock,” but declining fertility is a reality of female reproductive biology, and understanding it allows for informed decision-making about family planning. Egg freezing is one option that can provide additional choices for future family planning, but it's not the right choice for everyone.

We encourage people in their 20s to be proactive about their reproductive health. This means staying informed about your fertility, maintaining regular check-ups with your healthcare provider, and leading a healthy lifestyle. If you have concerns about your fertility or are considering egg freezing, we recommend scheduling a consultation with a reproductive specialist.

Every person’s fertility journey is unique. What works for one person may not be the best choice for another. By staying informed and considering your options early, you can make the decisions that are right for you and your future.

As a Reproductive Endocrinology and Infertility (REI) specialist, I've had the privilege of guiding many women with diabetes through their fertility journeys. The intersection of diabetes care and reproductive health requires some unique considerations, but I'm continually inspired by the resilience and determination of my patients. Thanks to advancements in reproductive medicine, women with diabetes now have more options than ever for family planning.

In this article, I'll share how diabetes can impact fertility, the egg freezing process for women with diabetes, the potential for diabetic women to become egg donors, and important considerations for managing diabetes during fertility treatments.

Whether you're actively planning for a family, considering preserving your fertility for the future, or simply curious about your options, this guide aims to provide you with comprehensive, up-to-date information. 

Type 1 vs. Type 2 Diabetes

Diabetes mellitus comes in two main forms that affect blood sugar control in different ways. Type 1 diabetes is a rare condition where the immune system mistakenly attacks and kills the cells that make insulin in the pancreas. Only about 1% of people in developed countries have this form. Without these cells, the body can't produce insulin, which is vital for controlling blood sugar. Making matters worse, the body also releases too much of a hormone called glucagon, which further disrupts blood sugar balance.

Type 2 diabetes is much more common, showing up in about 8.5% of adults. Instead of losing insulin-producing cells, people with Type 2 diabetes have cells that don't respond properly to insulin– a problem called insulin resistance. It's like having a key (insulin) that doesn't quite fit the lock (cell receptors) anymore. 

While these conditions start differently, they can begin to look similar over time. People with Type 2 diabetes might eventually lose their insulin-producing cells, while those with Type 1 can develop resistance to insulin, especially if they gain weight from insulin shots or become less active. When someone with Type 1 diabetes develops significant insulin resistance, doctors call it "double diabetes"– it's like having aspects of both types at once. Both groups face similar long-term health risks, including increased chances of infertility.

Understanding the impact of diabetes on fertility

Diabetes can significantly affect a woman's reproductive health in various ways. The condition may disrupt hormone balance, leading to irregular menstrual cycles and potential ovulation issues. Women with diabetes, especially those struggling with blood sugar control, might face:

• Increased risk of vaginal yeast infections and urinary tract infections (UTIs)
• Difficulties conceiving
• Increased risk of complications during pregnancy
• Higher likelihood of polycystic ovary syndrome (PCOS)
• Premature ovarian aging

These challenges make it even more important for women with diabetes to consider their fertility options early. This is where egg freezing and donation can enter the picture.

Can I freeze my eggs if I have diabetes?

Egg freezing, or oocyte cryopreservation, is a medical procedure for women who want to increase their chances of conceiving down the line. For women with diabetes, this procedure can be particularly valuable. Generally someone with diabetes can safely freeze their eggs, but your doctor will evaluate your health and medical history on a case by case situation before giving you medical clearance.  

If cleared, egg freezing can offer the opportunity to preserve eggs before potential diabetes-related complications arise, providing flexibility in family planning and reducing stress about declining fertility due to age or diabetes-related health issues.

The process of egg freezing for women with diabetes is similar to that for non-diabetic women, but with some important considerations:

1. Strict blood sugar management is important before and during the egg freezing process.
2. Women may need to work closely with their endocrinologist to adjust their diabetes management plan.
3. Fertility medications used in the process may affect blood sugar levels, so insulin or other diabetes medication dosages might need tweaking.
4. More intensive monitoring may be required throughout the process.

While egg freezing can be a game-changer, it's not without risks. Women with diabetes may have an increased risk of ovarian hyperstimulation syndrome (OHSS). However, with proper medical supervision and careful management of blood sugar levels, most women with diabetes successfully undergo egg freezing.

Can I donate my eggs if I have diabetes?

Many women with diabetes wonder if they can become egg donors. The answer isn't straightforward, and it depends on several factors, including the type of diabetes, duration of the condition, overall health, blood sugar control, and preferences of the fertility doctor. 

All egg donors undergo a rigorous screening process, which includes:

• Comprehensive medical history review
• Physical examination
• Blood tests and genetic screening
• Detailed diabetes management assessment

Unfortunately, women who have Type I diabetes mellitus (T1DM) that was diagnosed in childhood (aka juvenile diabetes) are generally not eligible for egg donation. Most clinics also disqualify anyone with prediabetes or Type II diabetes. If you’d like us to review your specific case, please reach out. 

Managing diabetes during fertility treatments

Whether pursuing egg freezing or considering egg donation, managing diabetes during fertility treatments is important. Maintaining optimal blood sugar levels can improve the quality of eggs, reduce the risk of complications, and potentially improve the success rates of the procedures.

Beyond medical management, lifestyle factors play a significant role. A balanced Mediterranean diet, regular exercise, stress management techniques, and adequate sleep all contribute to overall health and can positively impact fertility treatments.

Success rates and outcomes

Regarding success rates, the data for women with diabetes undergoing egg freezing is limited. However, there are studies of women with diabetes undergoing infertility treatments, like IVF. While we can't assume those outcomes directly translate to egg freezing success rates, they do provide valuable insights.

One study found that women with Type II diabetes and infertility have decreased ovarian reserve and a lower chance of pregnancy during IVF.

Another study found the same thing: that women with Type II diabetes had a “significantly decreased” chance of live birth. However, this study also found that women with Type 1 diabetes had an equivalent chance of a live birth per embryo transfer as women without diabetes, as long as their blood sugar levels were well-managed.

Looking to the future

The field of egg freezing for patients with diabetes is continuously evolving. Ongoing research focuses on improving ovarian stimulation protocols, enhancing egg freezing techniques, and better understanding the long-term effects of diabetes on egg quantity and quality.

For women with diabetes considering egg freezing or donation, it's important to have open, honest discussions with your fertility doctor. 

While diabetes adds complexity to fertility and family planning, options like egg freezing are making it possible for more women with diabetes to pursue their dreams of parenthood. With careful management, expert medical care, and informed decision-making, women with diabetes can explore these fertility preservation options with confidence.