Fertility Meds

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

How birth control works

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

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

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

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

Why someone might go off of birth control

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

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

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

Birth control side effects, nasties and other things to expect

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

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

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

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

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

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

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

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

Trying to conceive after going off birth control 

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

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

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

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

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

Be prepared

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

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

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

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

Your body on PCOS

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

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

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

How PCOS could impact your fertility

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

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

So can I freeze my eggs if I have PCOS?

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

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

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

What your doctor might recommend for managing PCOS

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

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

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

Summing it up

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

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!

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

What’s the process like?

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

Shots/Sonograms/More Shots

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

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

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

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

Retrieval

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

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

Recovery

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

How many eggs will I get?

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

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

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

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

At what age should I freeze my eggs? 

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

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

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

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

How much will it cost?

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

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

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

The AMH (anti-mullerian hormone) test is just one of many tests you may get when seeking answers about your fertility. But we know you’re not about to head to the doctor’s office for a blood draw without understanding what you’re getting yourself into. So here’s the full scoop on what to expect.

The lowdown on the AMH test

Think of the AMH blood test as a peek into a woman’s ovarian reserve. Here’s how it works: The AMH hormone is secreted by follicles in the ovaries. As you may know, follicles are the beginnings of human eggs, and a woman only has a finite number of eggs—the number of eggs decreases with age. This test measures the level of AMH in your blood.

“A higher level of AMH correlates to a higher ovarian reserve, or as we say, ‘the more gas left in the tank,’ says Dr. Joshua Hurwitz, MD, senior physician and partner at Reproductive Medicine Associates of Connecticut (RMACT).

About those eggs...

Unfortunately, women with a lower ovarian reserve may retrieve fewer eggs during egg freezing, so understanding your ovarian reserves is an important step in informing yourself and your doctors about what’s going on in your body. That way, you can make the right plans for you, depending on your goals.

Probably the most common reason to have an AMH blood test is as part of a fertility evaluation for any female patient interested in egg freezing or IVF, says Dr. Hurwitz. Any woman who’s trying to understand her future fertility potential could decide to have her AMH levels tested as well. In other words, you also might want to get the AMH blood test if you fall into any of these categories:

• You’re considering becoming an egg donor
• You might be freezing your eggs
• You’re thinking about getting pregnant and want to know if there’s a reason to act quickly

This isn’t like looking into a crystal ball. While having a normal ovarian reserve gives you a snapshot of what your fertility looks like now, it’s not a guarantee for what will happen in the future. Still, the results could help a woman more confidently decide to wait to try to become pregnant, or to freeze her eggs for potential use in the future, says Dr. Hurwitz.

What AMH do I need to freeze my eggs?

Research has found that AMH is a good predictor of the number of eggs retrieved during egg freezing, independent of age. Because of this, a fertility doctor will use your AMH levels (amongst other biomarkers) to determine the drugs and dosages during the procedure. 

In general, says Hurtwitz, patients can interpret their AMH level this way:

• Above 1.0 ng/ml (nanograms per deciliter): Normal
• Below 1.0 ng/ml: Showing weakness in the ovarian reserve
• Below 0.5 ng/ml: Showing severe weakness in the ovarian reserve

But know that a very high level of AMH could be a sign of polycystic ovary syndrome (PCOS), which may require specific fertility treatment and/or medications. When AMH is over 5.0 nanograms per deciliter, for example, Dr. Hurwitz says it’s worth addressing if there are other potential signs of PCOS. Also, FYI: younger women tend to have higher AMH levels, and older women tend to have lower AMH levels.

What AMH do I need to donate my eggs?

If you are looking to donate your eggs, minimum AMH requirements may be slightly higher. For example, with Cofertility’s Split program, we require a minimum AMH of 2.0, though clinics may have their own unique requirements. This is to increase the chances of retrieving enough eggs to actually split, to ensure positive outcomes for both parties involved.

AMH as part of a full work-up

It’s important to know that the AMH really isn’t a one-and-done test. It’s often done as part a full fertility evaluation, which may also include:

• Hysterogram (a.k.a. Sonohystogram or SHG), an ultrasound in which saline is added to the uterus (sort of a weird sensation but not so bad), so doctors can see inside and identify any problems with the uterus or fallopian tubes.
• Semen analysis, a test of a male partner’s sperm that gauges sperm count, as well as motility (the way they move) and morphology (size, shape and structure). Guys are so lucky this is their only major test.
• Hysterosalpingogram (HSG), an X-ray of the uterus and fallopian tubes (with a liquid dye in your bod!), which also can help identify or rule out certain problems.

In fact, the AMH probably isn’t the only ovarian reserve test you’ll get. It’s often done alongside:

• FSH blood test, another blood test. This is used to measure a different hormone called the Follicle Stimulating Hormone. FSH is released at the beginning of the menstrual cycle, so you’ve got to have your blood drawn at day 2, 3, or 4 of your period. A high level of FSH is associated with low ovarian reserve, and a low level of FSH is associated with a normal ovarian reserve.
• Basal Antral Follicle Count, an ultrasound in which the doctors will count the number of follicles they can see. The more follicles, the greater the ovarian reserve.

A woman’s age is also a huge factor in ovarian reserve and is really the most accurate way of gauging the quality of the remaining eggs, says Dr. Hurwitz.

It’s painless (mostly)

Since this is just a low-key blood test, there’s really not much to worry about. It can be done at any time during your menstrual cycle, and you don’t need to prep for it by fasting or in any other way. Think of it like getting a blood draw at your annual physical. You’ll have blood taken as usual through a needle into a syringe, and a Band-Aid will be placed on the site. Then, you’ll be able to go about your day as normal.

Dr. Hurwitz says his patients usually receive their AMH test results within a few days up to about a week, and they’re given over the phone by a nurse who can answer any questions they may have about their AMH levels. Then, after all their initial testing is done, the doctor sits down with his patients and discusses the results of all their tests to give a 360-degree picture of their fertility status. 

Plotting your next steps

AMH level alone won’t tell you what your next steps will be. If you’ve had all the ovarian reserve testing done, there isn’t anything further that needs to be measured in that regard.

Remember, AMH level should never be the sole measure of a woman’s fertility. In fact, one recent Journal of the American Medical Association study found that AMH levels didn’t predict which women would get pregnant over the course of a year. This is a reassuring sign for women who have low AMH levels, but Dr. Hurwitz notes that it doesn’t mean that the AMH test results aren’t important. They can help your doctor understand what’s going on in your body.

Taking your AMH results into consideration with all your other test results and health history,  you and your doctor will come up with a course of action. There’s no one answer for what this will be based on AMH level, but a low ovarian reserve might prompt a woman to begin egg freezing sooner. 

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

Egg freezing, also known as oocyte cryopreservation, has grown in popularity, with a 46% increase in egg freezing cycles from 2020 to 2021 alone! While egg freezing is generally considered safe and effective, there are potential side effects that you should be aware of before making the decision to undergo the procedure. In this article, we will discuss some of the most common side effects of egg freezing and what you can expect during and after egg freezing.

How does egg freezing work?

Egg freezing is a process by which your eggs are removed from the ovaries, frozen, and stored for your future use. A typical egg freezing cycle is 10-14 days and involves a process called ovarian stimulation, where hormonal medication is used to stimulate the ovaries to produce multiple eggs. Once the eggs have matured, they are retrieved through a minor surgical procedure.

During this time, you’ll have 4-6 appointments at your clinic. For the first, you’ll do some initial testing. Then, throughout the process, you’ll go in for some bloodwork and transvaginal ultrasounds so the doctor can see how your eggs are developing. The last time you go in will be for the actual egg retrieval.

Egg freezing is a low-risk (but not no risk) procedure 

Egg freezing is considered a safe procedure. In a single egg freezing cycle, the risk of a serious adverse event is under 2.5%. Severe OHSS accounts for the majority of complications, occuring in 0.1-2% of cycles. The risk of other acute complications, including pelvic infection, intraperitoneal hemorrhage, or ovarian torsion, is small (<0.5%).

That being said, many women do experience minor side effects – like bloating, constipation, nausea – from the medications and egg retrieval. 

Side effects of egg freezing medication

While fertility drugs for egg freezing are considered safe, they do occasionally cause side effects including:

• Mild bruising and soreness at the injection site
• 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)

The biggest risk to ovulation induction medication is ovarian hyperstimulation syndrome (OHSS) – a serious complication that can occur with the use of these medications. OHSS occurs when the ovaries become swollen and painful due to the overproduction of eggs. 

Fortunately, severe OHSS is rare (0.1%–2% of cycles) and can usually be prevented by carefully monitoring hormone levels and adjusting the dose of medication as needed. Women who experience symptoms of OHSS should contact their healthcare provider right away.

If you are at high risk of OHSS, your doctor may prescribe a trigger medicine called leuprolide 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. 

Side effects and risks of the egg retrieval

The egg retrieval is the final culmination of the egg freezing process. During an egg retrieval, you will be under twilight anesthesia as the eggs are removed from the ovaries. This is done with a thin needle that is inserted through the vagina and into the ovary, guided by ultrasound imaging. Fluid is gently suctioned through the needle to remove the eggs from the follicles. 

Anesthesia is generally safe, but like any medical procedure, it does carry some risks. The type and severity of the risks depend on the individual patient and the type of anesthesia being used. Some common risks associated with anesthesia include allergic reactions, breathing problems, and blood pressure changes. However, these risks are rare and the benefits of anesthesia typically outweigh the potential risks.

The procedure itself can cause common side effects such as constipation, bloating, cramping, spotting, and pain. These symptoms can typically be managed with rest, over-the-counter medications like Tylenol and stool softeners, and staying hydrated. For those experiencing cramping or pain, heating pads can be beneficial. In the case of bleeding, it's important to use pads instead of tampons for easier monitoring of the amount.

Most people can resume normal activities by the next day. However, it is advisable to take it easy and rest at home for the remainder of the day with the presence of another adult just in case. 

There are some post-retrieval red flags to look out for:

• If you notice any of the symptoms below, report them to your healthcare provider asap:
• Temperature above 101 F
• Severe abdominal pain or swelling which does not improve with over the counter pain medications
• Severe nausea or vomiting that doesn’t go away
• Heavy vaginal bleeding (soaking through a pad in an hour; some light bleeding is normal)
• Difficulty urinating, or painful urination
• Fainting or dizziness

If you experience any of the above symptoms, reach out to your doctor immediately. 

Emotional side effects

Egg freezing can be an emotionally challenging experience for some people. Especially for those freezing their eggs because they are concerned about their ability to have children in the future, the procedure can be a source of anxiety and stress. Not to mention the hormone medication used in egg freezing can cause mood swings and emotional instability.

It is important to have a strong support system in place during the egg freezing process. This can include friends, family, and healthcare providers who can provide emotional support and guidance. If you freeze your eggs through Cofertility, you’ll be connected with a cohort of others freezing their eggs at the same time. We offer an online support group, and our entire team of experts will be behind you the entire time. 

Will I gain weight during egg freezing?

Weight gain can also be a potential side effect of egg freezing. The hormonal medication used in the egg freezing process can cause fluid retention and increased appetite, which can lead to weight gain in some patients. However, in just two weeks, it’s unlikely you’ll gain noticeable weight. 

Not all those who undergo egg freezing will experience weight gain (some end up losing weight due to nausea or anxiety). Strategies such as regular exercise and a healthy diet may be recommended to help you feel good during this time.

Rare side effects and complications of egg freezing

While rare, there are some potential complications of egg freezing that can be more serious. These acute complications occur in under 0.5% of egg freezing cycles:

• Ovarian torsion is when a stimulated ovary twists on itself since the ovary is heavier from more follicles, cutting off the blood supply. Surgery is required to untwist the ovary, or in severe cases, to remove the ovary. 
• Intraperitoneal hemorrhage happens when the egg retrieval needle accidentally punctures a blood vessel, causing bleeding within the abdominal cavity.
• Infection can occur if bacteria enter the uterus or ovaries during the egg retrieval procedure.

Your fertility doctor can tell you more about your individual risks based on your health history, and we encourage you to talk to them and ask lots of questions!

Long-term side effects

There is currently no scientific evidence to suggest that egg freezing or donation increases the risk of cancer, including invasive ovarian and breast cancers. The hormones used to stimulate the ovaries to produce multiple eggs for freezing are similar to those used in fertility treatments and are generally considered safe. 

If you have concerns about the potential risks of egg freezing, it's important to discuss these with your fertility doctor who can provide you with personalized advice based on your individual health history and circumstances.

Summing it up

Egg freezing is generally considered safe and effective, with mild and temporary physical side effects being the most common. The most common side effects include bloating, cramping, and breast tenderness. These symptoms are typically caused by the hormonal medication in the lead-up to egg retrieval. These hormones stimulate the ovaries to produce multiple eggs, which can cause swelling and discomfort in the abdomen. Emotional side effects can also occur, but with proper support and self-care, can be managed. 

Some patients may also experience bleeding or spotting after the egg retrieval procedure. This is normal and should not be a cause for concern. However, if bleeding persists or is heavy, let your fertility doctor know right away.

Serious complications such as severe OHSS, infection, intraperitoneal hemorrhage, and ovarian torsion occur in under 2.5% of cycles, and it’s important to understand the symptoms and red flags.

I’ll be honest — prior to my first egg retrieval, I was a little bit nervous about the recovery process. Although everyone says it’s pretty manageable, you never know, especially when anesthesia is involved. At the time (this was in 2019), there weren’t a ton of online resources out there to help prepare myself, so I just trusted my fertility clinic and asked around. As a result, my expectations were only somewhat managed. I just didn’t know what I didn’t know. The good news is, it went smoothly and I now have a beautiful son from this cycle.

After reading this article, your experience, hopefully, will be different. Consider this your guide to egg retrieval recovery: what to expect, how to prepare, and tips and tricks to make sure your recovery process is as smooth and quick as possible. 

Preparing for an egg retrieval

You’ve already navigated your insurance to afford it (or perhaps you froze your eggs for free with Cofertility); you’ve already started injecting yourself with hormones daily…in hindsight, to me, those were actually the hardest parts, compared to the egg retrieval itself. But when you’re in the thick of it, the thought of an egg retrieval itself can feel kind of scary. Especially if it will be the first time you are under sedation.

Not only might you have concerns about sedation, pain, or recovery, but you also might have some nerves about the finality of it all: how many eggs they’ll retrieve, how many of those will be mature, how many of those might eventually fertilize down the line should you need them…it’s easy to let your mind wander. I get it. I’ve been there, too. 

Turns out, my personal retrieval experiences (yes — I did it more than once) actually felt like the best naps I’ve ever had. Honestly, the hardest part was not eating beforehand. If you can help it, see if you can get a time slot as early as possible in the day. The good news is, the retrieval itself is relatively quick (like, 15 minutes quick — though it’ll feel like you slept way longer). Once the sedation wears off, your clinic will likely provide you with some snacks and drinks to get your energy going again. If you’d like to learn more about what an egg retrieval is actually like, we’ve got a whole guide for you. 

What to buy for egg retrieval recovery

All of that being said, if you’re a big planner like I am, you might want to know what to buy in advance to make sure your egg retrieval recovery goes smoothly. Since I want you to be your most prepared self heading into your retrieval, there are a few things I’d recommend purchasing beforehand, even if recovery only takes about a day or two.

Egg retrieval recovery essential #1: heating pad

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When recovering from an egg retrieval, a good heating pad is a must. You might experience some cramping, and gentle heat will help make you feel more comfortable. We love the cute daisy pattern on this one and you can control the heat levels manually. 

Egg retrieval recovery essential #2: comfy clothes 

You probably already have your fair share of PJs, but why not give yourself an extra boost of post-retrieval joy with something new and super soft to lounge in while you get some rest? We love the lightweight jogger fit of these pants and they come in a ton of colors.  

Egg retrieval recovery essential #3: supplements and OTC medicines 

It’s a good idea to stock up on the following, just in case: 

• Fiber or stool softeners: to help you go, since you may experience some constipation or sensitivity in that area (we love this one from Natalist)
• Pain reliever (like Tylenol): for cramping
• Stool softeners: to help you go, since you might be sensitive in that area
• Anti-nausea meds (like antacids): since you might experience a bit of residual nausea afterwards

Egg retrieval recovery essential #4: water bottle

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You’ll need all the fluids you can get as you recover from your egg retrieval. We’re going to guess you already have an emotional support water bottle, but if not — now’s the time! We love this Owala version that comes in a bunch of colors. Bonus points if you fill it with something with lots of electrolytes, like coconut water. 

Egg retrieval recovery essential #5: pads

Because you may experience some residual bleeding after your retrieval (and since you can’t use tampons for at least a week), we recommend stocking up on some pads. This variety pack from August will keep you covered day and night.

Egg retrieval recovery essential #6: binge-worthy content 

Okay, so this isn’t something you necessarily need to purchase, but it’s worth downloading some mindless shows ahead of time so you won’t have to think about what to watch. 

What to expect after your egg retrieval

Now that you’ve done all your prep, you might be wondering what your recovery will actually be like. After your egg retrieval is done, you’ll wake up in your clinic’s recovery area as the nurses (and possibly an anesthesiologist) continue to monitor you. Your doctor or nurse will let you know how many eggs were retrieved, and if you’ve sufficiently woken up and are feeling mostly normal, they’ll give you permission to leave as long as you’re accompanied by someone. Note: you will not be allowed to drive yourself.

How long is egg retrieval recovery?

Some people feel completely themselves that day and technically could even go to work, but we do recommend at least a day of rest after an egg retrieval if possible. Some doctors may recommend refraining from heavy exercise for about a week (though walking or light movement is okay), and staying on pelvic rest for that same period — meaning, no tampons or sex. You may also be asked to avoid taking baths or swimming to avoid infection. 

Egg retrieval recovery side effects

In general, egg retrieval side effects might include: 

• Bloating
• Cramping
• Constipation
• Spotting

Some of the above recommended products, like heating pads and over the counter medicines can alleviate these symptoms. The most important element of egg retrieval recovery, however, is rest. And hydrate, hydrate, hydrate. 

When to call your doctor

After your egg retrieval, you should feel totally like yourself again within a few days. That said, there are a few red flags to watch out for. If you experience any of the following symptoms, report them to your doctor right away:

• Temperature greater than 101° F
• Persistent, severe nausea and/or vomiting
• Severe abdominal pain or swelling 
• Heavy vaginal bleeding (soaking through a pad every hour) 
• Painful or difficult urination
• Fainting or dizziness

You’ve got this

Just by reading this article, you’re already very prepared for your egg retrieval. Like I said, knowledge is power — and that’s what we’re here to give you. 

If you haven’t yet moved forward with the egg freezing process and you’re interested in learning more about how you can freeze your eggs for free with Cofertility, click here to take our quiz and get started. It just takes a minute.