female infertility

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

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

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

A quick primer on BMI 

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

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

Why fertility clinics take BMI into account

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

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

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

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

Does weight and BMI affect the retrieval cycle itself? 

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

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

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

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

Does weight and BMI affect egg retrieval outcomes? 

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

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

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

Does weight and BMI affect egg quality?

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

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

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

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

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

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

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

Why BMI can be a problematic metric

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

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

Looking at the full picture

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

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

Reliance on BMI can further perpetuate racial inequities

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

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

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

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

The need to preserve reproductive autonomy

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

Insufficient data about BMI and egg donation

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

So, how should we look at BMI?

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

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

What industry governance *does* say

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

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

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

What are your options?

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

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

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

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

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

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

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

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

Female doctors and fertility

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

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

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

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

What’s going on?

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

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

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

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

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

But delaying reproduction is only part of the puzzle.

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

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

How can female doctors preserve their fertility?

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

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

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

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

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

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

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

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

Bottom line

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

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

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

Age

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

The reason for this age limitation is because data shows that, on average, those over 33 tend not to respond to fertility medication as well and therefore may not produce as many eggs. Also, research shows that, unfortunately, egg quality declines with age. 

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

Please note, per ASRM guidelines, we also do not accept Split members who are under 21. If you’re younger than this and you’d like to participate, please reach out and we’ll get back in touch after you turn 21. 

Health-related factors 

As a preliminary step in the process, we will review several health-related factors before you can be approved for egg donation. 

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

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

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

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

Medical and family history

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

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

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

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

Psychological screening

Following this, there will be some psychological questions you’ll have to answer. We don’t expect you to be perfect. But some psychological factors may be more likely to disqualify you than others. 

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

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

Physical screening

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

Some disqualifications are set in stone by the Food and Drug Administration (FDA). They, understandably, want to ensure that egg donor tissue doesn't spread contagious diseases. If evidence of any of these conditions arises, you will be considered ineligible for the Split program. These are considered to be non-negotiable: 

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

The following could also be deal breakers: 

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

Anti-Mullerian hormone (ovarian reserve) levels

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

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

At Cofertility, if you appear to have low ovarian reserve at the time of screening, you will be ineligible for our Split program. We only accept Split Members with a higher AMH level as it helps mitigate the possibility of a second cycle to obtain enough eggs that could result in a live birth down the line (for yourself and for intended parents). Nevertheless, it is important to note that, even with high AMH levels, there is always a chance of having to do another cycle to improve the odds of a live birth. In the Split Program, once you are matched with intended parents, you’ll undergo your physical screening, which will include AMH-reading bloodwork. 

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

Genetic screening

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

But even for serious diseases, not all disease-related genes are deal breakers. For example, if your tests reveal that you have a copy of a gene that can lead to cystic fibrosis, spinal muscular atrophy, or thalassemia, this may disqualify you depending on the clinic. Even if two copies of the gene are needed in order for the condition to occur, clinics and agencies handle this differently.

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

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

State-specific qualifications

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

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

Additional disqualifying factors

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

• Are not a U.S. citizen
• Have served jail time for more than two days
• Have undergone body piercing and/or tattooing within the past twelve months in which sterile procedures may not have been used
• Have the highest education level of GED
• Have Indigenous American ancestry and are associated with a tribe—this is due to the Indian Welfare Act 

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

The net net

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

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

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

What is endometriosis?

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

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

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

Signs of endometriosis

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

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

How endometriosis can affect fertility

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

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

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

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

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

What your doctor might recommend

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

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

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

Bottom line

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

If your doctor told you that you have uterine fibroids—or even if you just think you might have them—you’re probably wondering if they’re going to mess with your chances of getting pregnant down the line, or if they’ll impact your ability to freeze your eggs. 

The good news is that fibroids are pretty common. The better news is that in most cases, they’re no problem at all. Here’s the 411 on fibroids and egg freezing.

What causes fibroids?

Fibroids are technically tumors, but they aren’t cancerous and shouldn’t increase your risk of uterine cancer, according to the Office on Women’s Health. Yay, right? Slightly less yay: there’s no clear answer about why these growths appear, but doctors do think there’s a genetic component. 

“Fibroids develop when one cell starts to divide and grow,” explains Dr. Anthony Propst, reproductive endocrinologist at Texas Fertility Center. According to Dr. Propst, they can be as small as a marble or as big as a volleyball. (Yup, you read that right. A volleyball—yikes.)

Dr. Propst says that 50% (!!!) of reproductive-age women have one or more fibroids, and that they’re more common among African American women. A 2013 study in the Journal of Women’s Health showed that African American women were more likely to experience severe fibroid symptoms (like heavy periods) and more likely to report that fibroids affect their physical activities.

What symptoms will I have?

Infertility is one symptom of fibroids, says Dr. Propst, but if you haven’t been trying to conceive yet then you may be totally in the dark about these little suckers. If that’s the case, here are some other symptoms to look out for:

• Heavy bleeding during menstruation
• Prolonged and/or painful periods
• Pelvic pain or pressure 
• Lower back pain
• Painful sex

UCLA Health reports that about one-third of fibroids are large enough to be detected by your OB/GYN during a physical, so don’t blow off those annual exams, ladies. 

How do I know if I have fibroids?

An ultrasound is the best way to tell if you have uterine fibroids. It will also reveal their location and size. Depending on your doctor, this may be an abdominal ultrasound or a transvaginal one. If you haven’t had one of those yet, we know it might sound intimidating, but trust us, it’ll be super helpful in getting a really good look around. 

So, can and should I freeze my eggs if I have fibroids?

Yes, you can freeze your eggs if you have fibroids. In fact, some people opt to freeze their eggs before certain fibroid treatments. 

However, some fibroids can make it difficult to access the ovaries during the egg retrieval. If you are interested in freezing with Freeze by Co, we will set you up with a fertility doctor for a consultation where they can give you more personalized advice.

Will fibroids affect my fertility?

Fibroids can affect fertility now or in the future. Approximately 5% – 10% of infertile women have fibroids, but most women with fibroids will not be infertile. According to Dr. Mark Trolice, infertility specialist at Fertility CARE: The IVF Center in Florida, it’s not the size of fibroids but the location that determines their overall effect on fertility.

“Unless the uterine cavity is affected by fibroids, we leave them alone,” he says. “But if there’s a distortion of the cavity—like if the fibroid is growing there, or is pushing into the cavity—then surgery is recommended,” since that might affect fertility.

Dr. Propst adds that fibroids growing within the muscle of the uterus (also called intramural fibroids) can impact your pregnancy chances, because fibroids within the womb can prevent implantation of an embryo. 

Can fibroids affect egg quality?

Fibroids can affect whether sperm and egg meet (by blocking the pathway) and if the embryo has room to implant in the uterus. Fibroids can also affect the growth and positioning of the baby if you do get pregnant. But there’s not much known about if fibroids can impact egg quality, and it’s likely that there’s no correlation. 

Do I need to do something about my fibroids?

Once more, for the people in the back: it depends on where they’re located. 

“With those intramural fibroids, the bigger they get, the more likely they are to affect fertility,” says Dr. Propst, who recommends surgery in those cases. So if your fibroid is large and located in the uterine muscle, you’re gonna have to problem-solve.

According to the Mayo Clinic, surgery for fibroids could include: 

• A noninvasive ultrasound procedure (done inside an MRI scanner)
• A minimally invasive procedure, like a laparoscopy or myomectomy (you’ll go home the same day)
• A traditional abdominal surgery (you’ll have to stay overnight...but get to eat lots of Jell-O)
• A hysterectomy (not good, but don’t panic...this is a worst-case scenario)

Whether or not to undergo fibroid surgery is a decision you’ll have to make with your doctor, but there are pluses and minuses, so make sure you’re well-informed. 

You may not be thrilled about surgery (especially if your fibroids aren’t causing symptoms), but Dr. Trolice says that there are risks of pregnancy complications with fibroids, especially larger ones, and a 2014 study published in the American Journal of Obstetrics and Gynecology backs this up: it suggests that the size, number, location, and type of fibroid can contribute to higher rates of preterm birth, cesarean delivery, and postpartum blood loss and hemorrhage.

What’s the bottom line with fibroids and fertility? Location, location, location. You might never know you have them, and even if you do, you might never need to do anything about them—unless they’re in a spot where they could interfere with a future pregnancy, in which case you’ll have a few mostly-not-terrible surgery options to choose from. 

So can you freeze your eggs if you have fibroids? Yes, you can still pursue egg freezing. And we’re here to help you freeze your eggs more affordably or, if you qualify, freeze for free when you give half to a family who can’t otherwise conceive. Plus, our inclusive online spaces allow you to connect with others going through the process. Learn more!

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

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

Educate yourself first

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

Talk about what this means for your future

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

Freezing eggs vs. embryos

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

Prepare for their questions

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

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

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

Revisit the conversation often

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

Summing it up

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

Considering egg donation is an extremely rewarding experience, and one that you may want  to share with your family, friends and significant other. And because of the nature of the entire process — the lengthy application that asks about your family medical history, a psychological and medical evaluation, hormone injections and medical retrieval ( where you will need someone to accompany you after) —   it is definitely not something you should do alone. And donating your eggs doesn't just impact you, it can very well impact your partner, your family and future children.  So, if you’re thinking to yourself, “I am ready to donate my eggs to help out another family. Now how do I tell people I’m donating my eggs?” — we’re here for you.

One of the most important people to start this conversation with is your partner. Having an open and honest conversation is a great way to ensure that both of you are on the same page and have a clear understanding of what donating your eggs means. Here are some tips on how to approach the conversation.

Educate yourself first

Since you have already decided that egg donation is for you, you have most likely already done a lot of research. But, explaining it to someone else can be another story.  Especially if they start asking about how it may impact them in the future. our partner might have questions about the egg retrieval procedure and the potential risks, they may also ask about what happens to your eggs after you donate them, and what happens when that egg becomes a human and wants to meet you.  So make sure you spend some time doing the research for yourself. You can do that by talking to Cofertility, an IVF doctor or fertility psychologist. Ask a lot of  questions. Do your homework.  You want to become an expert so that you’re ready to field those important questions that will be asked.

Start with your partner

Once armed with all your egg donation knowledge, start the conversation with your partner. Having an open and honest conversation is a great way to ensure that both of you are on the same page and have a clear understanding of what donating your eggs means. Here are some tips on how to approach the conversation.

Talk about what this means for your future

Donating your eggs is a huge decision that can have an impact on your life far beyond your retrieval, so it’s important to have an open and honest discussion with your partner about what that might look like. For example, if you’re participating in Cofertility’s Split program (where you donate half of your retrieved eggs and keep half for yourself for for free for your own future use) and you and your partner think you may want to have children of your own in the future, it will be important for those children to know about your egg donation. After all, they’ll likely have at least one biological half-sibling out there that they may be curious about someday. Additionally, when you match with intended parents, both parties will agree on a desired disclosure status and outline what the relationship between you (the donor), the intended parents, and the donor-conceived child will look like. So it will be important for your partner to be in-the-know about the details 

Prepare for their questions

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

• Why are you donating your eggs?
• What are the potential risks and side effects of egg donation?
• What is the egg donation procedure like?
• Will donating your eggs impact our ability to have children of our own someday (hint: it won’t)
• What do you imagine our relationship with the recipient family will look like?
• Are there any potential emotional or psychological effects of egg donation?
• Do you think you’ll donate more than once?

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

Revisit the conversation often

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

Summing it up

By donating your eggs, you’re truly making a life-changing impact on another family’s life, by giving them the opportunity to grow the family of their dreams. You should feel 100% confident in this decision before going into it, and having a supportive partner will make the egg donation process infinitely easier. Open and honest communication is key to any healthy relationship, and by involving your partner in this conversation early on, you’ll be setting yourself up for a successful donation experience that you can feel good about.

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

What is OHSS?

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

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

Ultrasound image of severe OHSS (Source)

How common is OHSS?

Data suggest the incidence of mild OHSS is 20%–33%, moderate OHSS is 3%–6%, and severe OHSS occurs in 0.1%–2% of cycles. In rare cases, OHSS can be life-threatening, so it's important to be aware of the potential risks and to inform your doctor of any symptoms (severe abdominal pain, bloating, and nausea). 

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

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

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

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

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

How many follicles put you at risk of OHSS?

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

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

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

Symptoms of OHSS after egg retrieval

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

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

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

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

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

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

Can you prevent OHSS after an egg retrieval?

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

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

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

How is OHSS treated?

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

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

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

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

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

Does OHSS affect egg quality?

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

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

Does OHSS mean more eggs?

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

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

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

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

Summing it up

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

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

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References:

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

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.