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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.

Freezing your eggs can be a major expense. With most clinics and egg freezing companies, the cost of freezing your eggs can run between $10,000 - 20,000, including upfront consultation costs and the retrieval process. Once the retrieval is complete, you can expect to pay an additional storage fee, which ranges depending on the clinic or facility. 

We believe the best time to freeze your eggs is when you can least afford it. While we provide more affordable — even free! — egg freezing options, if you do not qualify for our Split program, where you can freeze your eggs for free when you give half to another family who can’t conceive, we’ve still lightened the financial load of egg freezing with partnerships and discounts as part of our Keep program. That said, we always recommend taking a closer look at the fine print of your health insurance policy to see what you’re entitled to.

As of June 2022, there are 20 states in the US that have laws on the books requiring health insurance companies provide some type of coverage for infertility. However, for those looking to be proactive about their fertility and freeze their eggs without an infertility diagnosis, coverage is even more sparse.

In a 2020 study tracking the coverage of employer sponsored fertility benefits, Mercer discovered that just 42 percent of employers with 20,000 or more employees provide coverage for IVF. Unfortunately, those numbers drop significantly for those looking to help offset the cost of proactive egg freezing, with just 19 percent of employers in that same size employee pool providing coverage. 

If you don’t live in a state with mandated fertility coverage (or work for one of the 19 percent of large companies that include egg freezing as part of their benefit package) there are a few things you need to know about how your health insurance policy stacks up when it comes to freezing your eggs. 

Your health insurance may cover some costs

According to the journal Dovepress, the process of freezing your eggs is called vitrification. There are several steps involved in completing the vitrification process. While your insurer may cover parts of this process (like some basic blood work) other parts may require you pay out of pocket (like the cost to store your eggs after they’ve been frozen). 

• Consultations: You will likely have a sit down meeting with your doctor to discuss your fertility plans. If your insurance covers fertility procedures like having your eggs frozen, your insurer may cover these types of visits in full. If they're not covered you may need to foot the bill for a portion of the visit like a co-pay.       
• Blood tests and lab work: You’re going to have to have to undergo a few different types of tests throughout the process of freezing your eggs to monitor important things like the quantity and quality of your eggs (ovarian reserve testing), as well as an  ultrasound of your ovaries (to check their function), and screens that will confirm your overall health (which include a variety of tests including routine lab work like a Complete Blood Count). 
• Medications: Typically your doctor will prescribe synthetic hormones to help manage your ovulation. There are a few different different types of medication used, depending on what stage of the process you're in, including drugs that can help your ovaries produce multiple eggs ahead of the retrieval and ones that will prevent premature ovulation so that you and your medical team can get the timing of your retrieval just right.      
• Retrieval: Once it's time for your egg retrieval, you'll do this on-site as an outpatient procedure where you go home the same day. You'll be under anesthesia for this procedure, requiring the expertise of a few different medical professionals.   
• Storage fees: After your eggs have been successfully retrieved they will need to go into storage. Depending on the type of facility you used for your retrieval, this may be handled by them or taken care of by a third party.

Questions to ask your insurer

To get the best picture of what your insurance covers when you freeze your eggs you should call your benefit hotline to ask a few key coverage questions like: 

• Are all of my medical consultations covered, especially if I meet with a few different facilities before choosing one?
• Do I have to have a diagnosis or preexisting condition to have any portion of freezing my eggs covered?
• How does the coverage for freezing my eggs factor into my lifetime limit for fertility treatment? 
• Does my coverage change depending on whether the retrieval was successful? 
• Will you cover any of the ongoing costs of freezing my eggs (like storage) and is there a time limit on how long that coverage lasts?
• What are my coverage options if I decide to use my eggs later on?

Making freezing your eggs more affordable

Through our Split program, members are able to freeze their eggs for free when they give half to another family in need of donated eggs. This could include LGBTQ+ parents, couples with infertility, or those with other fertility-impacting medical conditions. 

If you’d rather keep all of the eggs from your retrieval, our Keep program still offers a more affordable way of freezing your eggs when your insurance won’t cover the total cost. Depending on where you live, some of the benefits of Keep may include lower medication costs, egg storage fees, and discounted consultations discounts. 

Summing it up

Through most avenues, egg freezing can be pretty cost prohibitive. We’re excited to change this, while supporting reproductive choice for all women and helping intended parents seeking egg donation to help complete their families.  

Egg freezing, also known as oocyte cryopreservation or fertility preservation, is a process where they stimulate the follicles in the ovaries and retrieve unfertilized eggs to preserve them for future use. While egg freezing has taken off in recent years, the cost of the procedure can be a significant barrier for many. Why is egg freezing so expensive and what are your options? Let’s dive in.

So how much does egg freezing really cost?

The question of how much does it cost to freeze your eggs will come down to a few factors. These include the clinic, your geography, and how long you keep the eggs in storage. On average, egg freezing patients will spend $30,000 - $40,000 on treatment and storage. 

Let’s look at one case of a 23-year old egg freezer whose insurance did not cover the procedure. Here’s what she paid out of pocket at a New York City clinic:

Fertility workup and blood work - $1,500

Monitoring, blood work, and ultrasound - $2,500

Medications - $4,479

Oocyte retrieval, anesthesia, egg freezing - $15,650

One-year of egg storage-  $1,500

Total - $22,629

This specific patient retrieved 34 eggs, which gives her a good chance at a live birth if she uses those eggs down the line. But most people don’t have an extra $20,000 laying around.

But why is egg freezing so expensive?

One major reason for the high cost of egg freezing is the expense of the technology and equipment required for the procedure. The process of freezing eggs involves:

• Anesthesia and the cost of an anesthesiologist at your egg retrieval
• An operating room and equipment for the egg retrieval
• A freezing process called vitrification, which requires specialized equipment and materials
• A cleanroom IVF laboratory with good air quality
• Safe gamete storage with backup generator in case the power goes out

There’s also a high cost for the people who make egg freezing possible. Reproductive endocrinologists – also known as fertility doctors – make between $236,472 and $315,827 a year according to Salary.com. And anesthesiologists make between $359,300 and $470,200. There are also embryologists, nurse practitioners, physician assistants, and patient coordinators. All these specialists go to school for years and have specific training to ensure the process is successful and safe. 

Another reason for the high cost of egg freezing is the cost of the medication used during the process. The medication used to stimulate the ovaries in preparation for egg retrieval can be quite expensive, and the cost of these medications varies depending on dosages you are given and your insurance coverage.

According to the GoodRx list price index, the list price for drugs used in egg freezing has increased 50% from 2014 to 2020. There are several medications used to stimulate your eggs during egg freezing: Gonal-F, Menopur, and Follistim AQ. And they are all brand drugs without a generic option… meaning the manufacturer gets to set whatever price they want.

Lastly, egg freezing is so expensive because most health plans don’t cover it. Health insurance companies have a lot of leverage; and if they’re good at one thing, it’s negotiating prices. 

How can I get more affordable egg freezing?

If you’re looking for a more affordable option, you’re in the right place. Cofertility was founded to reshape the cost structure of egg-freezing, specifically through our Freeze by Co platform.

We have discounts with clinic partners, egg storage facilities, and pharmacies that we pass along to our members. Also, our members get access to our active online community, where you can connect openly with others freezing at the same time.

We stand for choice and offer two accessible programs:

• With our Split program, those who qualify can freeze their eggs for free when you give half of the eggs retrieved to a family who can’t otherwise conceive, including couples with infertility, gay dads, and more. 
• Those in our Keep program can freeze their eggs and store them all for their own later use, while taking advantage of discounts throughout the process to lighten the financial load. 

Summing it up

If you want children someday, egg freezing may help keep that option on the table. But egg freezing can be an expensive process. That’s because of the cost of the technology, equipment, and people required, as well as the cost of medication. Cofertility can help make your egg freezing journey more affordable – or even free. Take this 1-minute quiz to see which programs you qualify for!

So you’re freezing your eggs - congratulations! This is such an empowering step in your life, and we hope that you can experience the process with positivity and hope for the future. 

We know the process can also be confusing and overwhelming, especially when it comes to understanding what activities are safe and not safe during egg freezing. First and foremost, it's important to understand that egg freezing is a medical procedure and should be treated with the same level of care and attention as any other medical procedure. This means that you should always follow the instructions of your provider and avoid any activities that may put your health at risk.

In this article, we will explore some of the things you can and can't do during egg freezing. Let’s go!

Can I work out while freezing my eggs?

Exercise is generally considered safe during the egg freezing process, but it's important to note that you should avoid any intense or high-impact activities. Because your ovaries will be enlarged from being stimulated, exercise could increase the risk of a rare condition called ovarian torsion, when the ovary twists on the surrounding tissues.

Gentle exercise such as yoga or walking is recommended. If you are someone who has a serious workout regime, we recommend talking to your fertility doctor about what’s safe.

Can you go to work during egg freezing?

Working during the egg freezing process is generally considered safe, but it's important to be mindful of any physical demands or stressors that may be associated with your job. Your fertility doctor may recommend taking some time off work to rest and recover if you're experiencing any side effects from the medication used in the egg freezing process. And after the egg retrieval, it’s recommended you give yourself time to rest (although I know women who felt fine enough to go back to work!). Most people are able to return to work within a day or two of an egg retrieval.

Can you drink coffee during egg freezing?

Caffeine consumption is generally considered safe during the egg freezing process, but it's important to be mindful of your intake. Some experts recommend limiting your caffeine intake to less than 200 milligrams per day, which is roughly equivalent to one cup of coffee. While most of the research on the impact of caffeine is on pregnancy, we think it’s better to play it safe during egg freezing too. 

Can you drink alcohol during egg freezing?

Alcohol consumption is not recommended during the egg freezing process. Studies have shown that alcohol consumption can negatively impact fertility and may also increase the risk of certain complications associated with egg freezing. The good news is there are loads of EANABs (equally-appealing, non-alcoholic beverages) these days. Try a soda water with lime and no one will bother you!

What about smoking?

Smoking is not recommended during the egg freezing process (or ever!). Studies have shown that smoking can negatively impact fertility and may also increase the risk of certain complications associated with egg freezing. Smoking can decrease the number and quality of eggs retrieved, and increases the risk of ovarian hyperstimulation syndrome (OHSS), a potentially serious complication of the egg freezing process.

Can you have sex during the egg freezing process?

(Gentle) sexual activity is generally considered safe during the egg freezing process, but it's important to be mindful of any potential risks associated with the fertility medications. After all, your ovaries may be enlarged and sensitive. Some fertility doctors may recommend avoiding intercourse or using contraception during certain parts of the process, due to higher risk of pregnancy. This is one you should definitely ask your doctor about.

Note: If you’re participating in our Split program, where you freeze your eggs for free by donating half of the retrieved eggs to another family, you’ll need to avoid sex entirely, since becoming pregnant or contracting and STD would result in your cycle being canceled.

What can you eat during egg freezing?

Eating a healthy and balanced diet is an important part of overall health and wellness, and it's especially important during the egg freezing process. Eating a diet rich in fruits, vegetables, lean protein, and healthy fats can help support your overall health and may improve the success of the egg freezing process. Once the eggs are retrieved, you can indulge in dessert, a cocktail, and resume your normal diet!

What supplements can I take during egg freezing?

In addition to eating a healthy diet, taking supplements may also be beneficial during the egg freezing process. Folic acid, for example, has been shown to improve reproductive outcomes and is often recommended for women undergoing egg freezing. Other supplements such as CoQ10, DHEA, and omega-3 fatty acids may also be recommended by your fertility doctor. It's important to note that you should always talk to your fertility doctor about what you’re taking – and what you want to be taking – before you start egg freezing, as some may interact with fertility medications.

Can you use a hot tub or steam room during egg freezing?

There’s conflicting info here. Some doctors say hot tubs, steam rooms, and saunas should all be avoided during the egg freezing process, citing that they can cause a spike in body temperature, which can be harmful and may negatively impact the success of the egg freezing process. While others say it’s fine. Knowing that there’s always a small risk that public hot tubs are carrying bacteria or can cause allergic reactions, it’s safest to wait until after the egg retrieval. 

Can you take a hot bath during egg freezing?

This is another controversial one – some fertility clinics say hot baths are fine, while others say you should stick with showers. Some providers even recommend avoiding baths from the day of your retrieval and several days after, in order to allow your body to safely heal. Ask your doctor what they think, or just stick to showers to play it safe!

Summing it up

Egg freezing is such an intense (and often expensive) process. In order to get your best outcomes possible, it’s probably better to err on the conservative side. Always follow the instructions of your fertility doctor, and avoid any activities that may put your health at risk. We are wishing you the best!

‍Cofertility is in the “family” business, striving to make egg freezing and third-party reproduction more human-centered and accessible for all. Our Freeze by Co program allows you to freeze your eggs for free, when you give half to a family who can't otherwise conceive.

One of my biggest regrets in life is not freezing my eggs in my 20s – it’s what led me to help co-found Cofertility and make this process radically more accessible. 

Egg freezing, also known as oocyte cryopreservation, is a medical procedure that allows women to preserve their fertility for future use. Whether you're focused on your career, dealing with medical issues, or simply not ready to start a family yet, egg freezing can give you the peace of mind of knowing that you have options in the future. But if you're considering egg freezing, where do you start?

First things first: get educated

The first step towards freezing your eggs is knowing what you’re getting into. We have a wealth of knowledge here that you are free to access. I recommend starting with these articles:

• A Step-by-Step Guide to Freezing Your Eggs
• How Much It Costs to Freeze Your Eggs
• The Egg Freezing Process: a First-Timer’s Overview
• A Breakdown of Egg Freezing Success Rates by Age

You can also talk to friends who have gone through the process, or join a Facebook group to hear from others in your shoes. 

What are the chances it even works?

We measure the “success” of egg freezing in a couple of ways. Since we don’t know if the eggs will turn into a healthy baby many years from now, the goal is to have a large, but safe, number of healthy eggs retrieved in a single cycle. 

Retrieving 10-20 eggs is ideal. That’s because for a woman under 35, she will need nine eggs to achieve a 70% chance of having at least one live birth. If you’re trying to conceive in your mid to late 30s, you may need double as many eggs to achieve that same 70% success rate. That’s because egg quality (along with quantity) declines as we age. 

Read more in How Many Eggs Should I Aim to Freeze?

It's important to note that egg freezing is not a guarantee of future pregnancy, and success rates vary depending on various factors such as your age at the time of freezing and the quality of the eggs. 

Next steps: find the right clinic

Once you get a better idea of the process and decide if egg freezing is right for you, the next steps are to schedule a consultation with a fertility clinic. During this consultation, the doctor will evaluate your overall health, discuss your reasons for considering egg freezing, and review the risks and benefits of the procedure. They will also likely conduct some initial tests (like AMH) to assess the quality of your eggs and your ovarian reserve, which will give you a better idea of your chances of success with egg freezing.

If you work with Cofertility, we will help you schedule an appointment with one of our local partner clinics. If you participate in our Keep program, we can help you get the best prices on clinic fees, medication, and storage.  

Know your AMH

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, you can interpret 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 treatment and/or specific fertility medications or treatments. When AMH is over 5.0 nanograms per deciliter, for example, it’s worth addressing if there are other potential signs of PCOS. 

Figure out how you will pay for it

Egg freezing can be an expensive procedure, with costs typically ranging from $10,000 to $20,000 for one cycle plus the cost of storage. This varies widely based on the clinic and the medications your provider prescribes. But, there are ways to make egg freezing more affordable. Here are a few options to consider when paying for egg freezing:

• Insurance coverage: A minority of insurance plans may cover a portion of the cost of egg freezing and/or medications. It's always best to check with your insurance provider to see if they cover the procedure, and if so, what the specific coverage details are.
• Employer-provided benefits: Some employers offer coverage for egg freezing as a benefit to their employees. Check with your handbook or HR department to see if this is an option for you.
• Financing options: At Cofertility, we have financing partners which can make the procedure more affordable. 
• Donate half your eggs: Our Freeze by Co Split program allows you to freeze and store your eggs for free for 10 years, when you give half to a family who can't otherwise conceive.

To see if you're eligible for our Split program, take our quiz to tell us more about yourself.

Benefits of working with Cofertility

Cofertility is a human-first, tech-enabled fertility ecosystem that provides people agency over if, how, and when they have babies — today or someday. We have two programs for egg freezers:

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

In our Keep program, you can freeze and store your eggs for your own future use, with lower prices on things like storage and medication – as well as our team’s support and access to our community.

The benefits for of working with Cofertility include:

• Power of choice: Freeze your eggs more affordably or, if you qualify, freeze for free when you give half to a family who can’t otherwise conceive. 
• Community: Our inclusive online spaces allow you to connect with others going through the process in our private online community.
• Compassion: We’ll always treat you with care, and our Split program gives you the opportunity to make someone’s family building dreams a reality. 
• Data-driven: We provide you with trustworthy guidance and evidence-based research so you can make informed decisions about your fertility. 
• Free egg freezing: Freeze and store your eggs for 10 years, entirely for free if you qualify for our Split program.

Ready to learn about more affordable (even free!) egg freezing with Cofertility? Fill out this quick quiz to learn about our accessible egg freezing options and see if you qualify for our programs — it only takes one minute.

Egg freezing, also known as oocyte cryopreservation, is a procedure that allows women to retrieve eggs when they are most healthy and have them for use later in life. The process of freezing eggs involves a series of steps, including ovarian stimulation, egg retrieval, and cryopreservation. One of the most common questions that women have about egg freezing is whether or not it is painful. In this article, we’ll review all your questions about the egg freezing process and pain.

Egg freezing shots

The first step in the egg freezing process is ovarian stimulation, which is done using fertility medications. These medications are designed to stimulate the ovaries to produce multiple eggs, rather than the single egg that is produced during a typical menstrual cycle. These medications are typically administered subcutaneously (under the skin) using a small needle. The shots themselves aren’t pleasant, but they’re quick. 

Some women may have a higher pain tolerance than others and some may have more discomfort than others. I personally have a really low pain tolerance, so I was nervous about the shots. But the process was super manageable, and the pain was not as bad as I thought it would be. Here’s what helped for me:

• Icing the spot for a few minutes to numb the area
• Laying down during the process
• Having my husband give me the shots instead of doing them myself
• Remind myself that “you have to want it more than you’re afraid of it”
• Having a good show and some chocolate ready for right after 

After a few days of injections in the same area, you may find some bruising. The bruising is usually normal and should disappear within a few days. Most people also experience mild bloating during the process, but it is generally not considered to be painful.

Vaginal ultrasounds

During the egg freezing process, you will get to know “Wanda” – what many in the fertility community affectionately call the ultrasound wand. Vaginal ultrasounds use high-frequency sound waves to create images of the uterus, ovaries, and fallopian tubes. This helps your doctor understand how your follicles are growing, and if the medications are working. 

The ultrasound wand (covered in a condom and gel) is inserted into the vagina, which can cause a feeling of pressure. The procedure itself is not considered to be painful, but some describe it as short-lived mild discomfort.

Blood draws

You will likely need several blood draws during your egg freezing journey to see how your hormones are responding. Blood draws, also known as venipuncture or phlebotomy, is a procedure in which blood is taken from a vein in your arm for laboratory testing. 

The pain associated with a blood draw is usually minor, and often described as a "sharp" or "stinging" sensation that lasts for a moment. The discomfort can also come from the tightness of the band that is often used to make the vein prominent and easier to find the vein.

Pain tolerance can vary from person to person, some people may experience a minimal discomfort while others may experience more pain. To minimize the discomfort during the blood draw, it's recommended to relax and breathe deeply during the procedure. If you have a fear of blood draws or needles, inform the technician who may be able to use a smaller needle or a different technique to minimize pain. And if you are prone to experiencing lightheadedness when getting your blood drawn, make sure to let your technician know. Asking if they can do the blood draw while you’re laying down rather than sitting up can make a huge difference!

The egg retrieval

The final step in the egg freezing process is the egg retrieval, where the eggs are then removed using a transvaginal ultrasound-guided needle. This is typically done under anesthesia or sedation, so you are fully relaxed during the procedure. Anesthesia is administered through an IV (intravenous) line so the amount of medication can be adjusted to achieve the desired level of sedation. Because it is not general anesthesia, you can breathe on your own and don’t need breathing tubes (phew!). Okay let’s break down this process and how painful it is:

• Getting the IV line: An IV line will be inserted into a vein, typically in your hand or arm. Some people describe a "sharp" or "stinging" sensation that lasts for a moment when the needle is inserted into the vein. 
• The egg retrieval: If you use anesthesia (and most people do), you will be unconscious and unable to feel pain or sensation during the 30-minute procedure. 
• Post-retrieval: After the egg retrieval procedure, it's normal to experience some mild to moderate cramping or bloating, similar to the discomfort experienced during menstruation. Your fertility doctor may prescribe pain killers, or give you over-the-counter pain medication to manage any discomfort.

Overall, the egg retrieval is not too painful. The bloating (and constipation) afterwards is considered the most unpleasant part, similar to period cramping.

What to do if you have a low pain tolerance

Even people with low pain tolerance can successfully freeze their eggs. But if you’ve had bad prior medical experiences, the entire process can feel daunting.

First and foremost, it is important to communicate this with your fertility doctor. Let them know that you have a low pain tolerance and ask about the level of pain you can expect at each step, and if there are safe pain management options.

There are a couple of other techniques to help make any pain more manageable:

• Therapy. If your low pain tolerance is rooted in medical anxiety, talk to a therapist. They can help you find techniques (or even medication) to help you go into the procedure with  more confidence.
• Practice deep breathing or relaxation techniques. Focusing on your breath and practicing mindfulness can help to distract you from the pain and reduce your perception of it.
• Ice packs. Applying a cold compress to the affected area before and after shots can help to reduce inflammation and numb the area.
• Acupuncture or massage. These therapies can help to reduce pain and promote relaxation.
• Music. I find it helpful to listen to music through headphones during any medical procedure (from a cavity filling to a blood draw). Music can help transcend you to a calmer place, and distract your mind.

Everyone's pain tolerance is different and what may be unbearable for one person may be manageable for another. Don’t ever be ashamed or embarrassed about having a low pain tolerance, it’s totally normal (and manageable!). 

Is egg freezing safe?

Yes - egg freezing is considered a safe and well-tolerated procedure. However, like any medical procedure, there are risks.

Anesthesia, which most people opt for during the egg retrieval, is considered safe. Overall, there is only one death per every 200,000 to 300,000 cases. However, this number is even lower for women freezing their eggs. The biggest risk factors for complications from anesthesia are being male, being older, being obese, and having inpatient surgery – none of which are likely for egg freezers 

Ovarian hyperstimulation syndrome (OHSS) is the most common complication of egg freezing, but it is also rare. About 3-6% of cases experience mild or moderate OHSS (headaches, fatigue, nausea, irritability, breast tenderness, abdominal pain, weight gain, and enlarged ovaries). Severe or critical OHSS is less common at 1–3% of cases and presents as ascites and pleural effusion, shortness of breath, dehydration, vomiting, oliguria, hemoconcentration, thromboembolic events, and massive ovary enlargement, which are potentially life-threatening. If you have any of those symptoms, it’s critical to reach out to your doctor ASAP. 

There are other risks such as pelvic pain, intraperitoneal bleeding, pelvic infection, damage to organs, and ovarian torsion. It’s best to talk to your doctor about the risks of egg freezing.

Summing it up

Egg freezing is considered to be a safe procedure, with most women reporting mild to moderate pain or discomfort. If you have any concerns about pain or pain management, it’s best to talk to your doctor up front. Let them know your concerns and ask about the level of pain you can expect at each step, and ask if there are safe pain management options. We are here, rooting you on!

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

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

What’s the difference?

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

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

Things to consider

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

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

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

Now, let’s look at the research.

Is freezing embryos really better?

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

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

Pros and cons of freezing eggs vs embryos

Freezing/thawing process

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

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

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

Quality

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

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

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

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

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

Chances of a healthy baby down the line

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

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

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

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

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

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

‍

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

Cost

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

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

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

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

Additional Resources

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

What do I ask my provider?

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

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

Do You!

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

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

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

Egg retrievals, which take about 30 minutes, are considered a minimally invasive procedure. Women undergoing egg freezing often ask me if they are “put to sleep” (under anesthesia) during that time… and the answer is, usually yes. Not only is it important for you to remain still during the procedure, but anesthesia can help you relax and block pain. In this guide, we’ll review some of the most common questions we get about anesthesia and egg retrievals:

• What happens during an egg retrieval? 
• What is anesthesia and is it safe?
• What type of anesthesia is used for an egg retrieval?
• Is propofol used for egg retrievals?
• How is sedation administered during an egg retrieval?
• How long are you under anesthesia for egg retrieval? 
• What happens during anesthesia in an egg retrieval?
• How do you prepare for anesthesia during egg freezing?
• Why do you need anesthesia during egg freezing?
• Can you do an egg retrieval without anesthesia or sedation?
• What can you do if you’re afraid of anesthesia?

First, let’s review what happens during an egg retrieval

The egg retrieval is the final culmination of the egg freezing process. During an egg retrieval, the eggs are removed from the ovaries and frozen for your future use. 

Here is a general overview of what happens during an egg retrieval procedure:

1. You are usually given medication to help relax and reduce anxiety.
2. You are usually given a local anesthetic to numb the area where the eggs will be retrieved.
3. A thin needle is inserted through the vagina and into the ovary, guided by ultrasound imaging.
4. Fluid is gently suctioned through the needle to remove the eggs from the follicles.
5. The retrieved eggs are examined under a microscope to determine their number and quality.
6. The eggs are then frozen and sent to long-term storage.

The entire egg retrieval procedure typically takes about 30 minutes, and you can go home the same day knowing how many eggs were retrieved.

What is anesthesia and is it safe?

Anesthesia is a medical treatment that blocks the sensation of pain and other sensations during surgery or other medical procedures. It is administered by anesthesiologists, doctors who are specially trained to manage pain and other aspects of care during and after surgery.

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.

It's important to discuss any concerns you have with your anesthesiologist and other members of your healthcare team before your surgery or procedure. They can help you understand the potential risks and benefits of different types of anesthesia and help you make an informed decision about your care.

There are several types of anesthesia:

• General anesthesia is used to render a patient unconscious and provide full body muscle relaxation. 
• Regional anesthesia numbs a larger area of the body, typically involving a nerve block.
• Local anesthesia numbs a small area of the body, such as a single tooth.
• Monitored anesthesia care (MAC) is a form of sedation used to keep a patient relaxed and comfortable during a procedure. 
• Sedation is used to help people relax and feel comfortable during a medical procedure. It can range from minimal sedation (also known as "conscious sedation") to deep sedation, in which the person is not conscious but can be aroused.
• Twilight sedation or twilight anesthesia is another term you may hear for sedation, when a patient is sedated but remains conscious in a “twilight state”.

The type of anesthesia that is best for you will depend on your medical history and your preferences. Your healthcare team will help you decide which type of anesthesia is best for you.

What type of anesthesia is used for an egg retrieval?

For egg retrieval procedures, a common type of anesthesia used is sedation, a combination of medicines to help you relax (a sedative) and to block pain (an anesthetic). Conscious sedation lets you recover quickly and return to your everyday activities soon after your procedure.

According to board-certified anesthesiologists Dr. Steven Alfond of Extend Fertility, “There’s light sedation, like taking a dose of Valium; during light sedation, patients are awake, and they’ll probably remember what’s going on. Light sedation might be used for simpler procedures. The fertility procedures require something a little deeper; we call it deep sedation. Most patients require just one medication—propofol—and, depending on pain, a pain medication.”

Sedation for egg retrievals is generally a combination of propofol, fentanyl, and midazolam, and designed to keep you still (so the doctor can successfully perform the procedure) as well as relaxed and comfortable. In some cases, such as when a larger procedure is required, general anesthesia may be used. This type of anesthesia is designed to put the patient into a deeper sleep, allowing them to remain unaware of the procedure.

Propofol for egg retrievals

Propofol is a sedative-hypnotic medication that is used to produce sleepiness or drowsiness and to relieve anxiety before and during the egg retrieval. It is often used for intravenous (IV) conscious sedation, which means that you remain awake but relaxed and comfortable during the procedure. Propofol is a popular choice for conscious sedation because it takes effect quickly and wears off rapidly, so you typically feel alert soon after the procedure. 

How is sedation administered during an egg retrieval?

Propofol is administered through an IV line, and the amount of medication can be adjusted to achieve the desired level of sedation. Because it is not general anesthesia, you can breathe on your own and don’t need breathing tubes (phew!).

How long are you under anesthesia for egg retrieval? 

Here’s the good news – the egg retrieval is a relatively quick procedure that typically takes 30 minutes. The length of time you are “under” or “asleep” depends on the type of anesthesia being used and your response to the medication.

If general anesthesia is used, you will be unconscious for the duration of the procedure and will not be aware of the time passing. If conscious sedation is used, you will be awake but relaxed and comfortable, and may not remember much of the procedure.

Regardless of the type of anesthesia used, the anesthesiologist will carefully monitor your vital signs and adjust the medication as needed to ensure your safety and comfort during the procedure. After the procedure, you will need to rest in a recovery area until the effects of the anesthesia have worn off, which can take anywhere from a few minutes to a few hours. (This is why it’s important to bring a buddy to drive you home!)

What happens during anesthesia in an egg retrieval?

If your doctor uses conscious sedation during the retrieval, the medication can take effect quickly (within seconds), so you’ll begin to feel relaxed and drowsy soon after receiving it. You’ll remain conscious and able to respond to commands during the procedure, but may not remember much about it afterwards.

If you choose deep sedation, you will go into a state of unconsciousness or near-unconsciousness rather quickly. You will not be fully aware of your surroundings and may not be able to respond to commands or communicate with the doctor. In other words, you’ll be in a deep sleep. 

If your doctor uses general anesthesia, you will be unconscious and unable to feel pain or sensation. General anesthesia is typically administered through an intravenous (IV) line or with a gas that you inhale. It is used to relax and incapacitate the muscles in your body, so that you do not move during a surgical procedure.

In any of these situations, your vital signs, such as heart rate and blood pressure, are closely monitored by the anesthesiologist to ensure your safety. The anesthesiologist will adjust the dosage of the medication as needed to keep you in a deep state of unconsciousness. After the retrieval is completed, the anesthesiologist will slowly reduce the level of medication, and you will begin to wake up. It is common to feel groggy and disoriented when you first come out of a deep sleep, but you’ll be back to yourself in no time.

How do you prepare for anesthesia during egg freezing?

Here are some ways to prepare for your egg retrieval:

• Inform your doctor about all the medications you are currently taking, including prescription and over-the-counter drugs, supplements, and herbs.
• Follow any instructions given by your doctor or anesthesiologist regarding eating and drinking before your egg retrieval.
• Arrange for someone to drive you home after the egg retrieval.
• Remove all jewelry and leave it at home.
• Wear comfortable, loose-fitting clothing to the clinic.

Your doctor will give you instructions for preparing for the egg retrieval, and it is important to follow their instructions to reduce the risk of complications during and after the procedure. 

Why do they use anesthesia and sedation during egg freezing?

Sedation and anesthesia are often used for egg retrievals to keep you still (so the doctor can successfully perform the procedure) as well as relaxed and comfortable.

You can work with your doctor to determine which method to use, based on your preferences and medical history. It is important to discuss the options and any concerns you have before the procedure. Your doctor can help you understand the potential risks and benefits of different types of sedation and help you make an informed decision about your care.

Can I do an egg retrieval without anesthesia or sedation?

While sedation is standard of care for an egg retrieval procedure, it is usually not required. Some women have had medical reasons for not wanting sedation, while others are concerned with the drugs used during sedation and are looking for a more natural course of treatment. If you don’t want to use anesthesia for your egg retrieval, it’s important to talk to your doctor in advance of the procedure. 

Most women prefer egg retrievals under sedation/anesthesia. But doing an egg retrieval without anesthesia is cheaper and faster, and does not require the presence or assistance of an anesthesiologist. Research has shown that it results in good satisfaction among the patient and the physician. 

A study of 100 women undergoing egg retrievals found that women who chose to skip sedation were significantly more likely to express fear of anesthesia. Those women experienced more pain during egg retrieval, but all but one said they would do the same in future cycles. 

What to do if you’re afraid of anesthesia

If you are afraid of anesthesia, it is important to communicate your concerns with your healthcare team in advance of the procedure. They can help you understand the process of anesthesia, your options, and what to expect. It may also be helpful to speak with an anesthesiologist, who can explain the specific medications and techniques that will be used during your egg retrieval.

You may also choose to bring a trusted family member or friend with you to your appointments, so that you have someone to support you and ask questions (you should also have someone with you at the retrieval as well).

Lastly, you may benefit from practicing relaxation techniques, such as deep breathing or progressive muscle relaxation, in the days leading up to your retrieval. I also found it helpful to listen to music through my headphones as the IV was put in and I went under sedation. Remember that your doctors are trained to keep you safe and comfortable throughout the procedure. You’ve got this!

Cofertility is in the “family” business, striving to make egg freezing and third-party reproduction more human-centered and accessible for all. Our Freeze by Co program allows you to freeze your eggs for free, when you give half to a family who can't otherwise conceive

People come into the doctor’s office often with concerns that they may never be able to have children, either because of their age or because of their lab results. The result they are usually referring to is their anti-Müllerian hormone (AMH) test. When an AMH comes back less than promising, people get anxious real quick.

But a single hormone level can never tell you that you can or cannot get pregnant. There is more to fertility than a person’s hormone level or their age, though the two are important. Let’s dig deeper into AMH and age and what they can really tell us about fertility. 

What is AMH?

An AMH test is a simple blood test commonly used to assess ovarian reserve. Ovarian reserve is defined by the National Cancer Institute as “the total number of healthy, immature eggs in the ovaries” but I find this to be a bit misleading. Let me explain why.

AMH is released by antral follicles, which are small, fluid-filled sacs in the ovaries that each contain a single oocyte (immature egg). Your AMH level is positively correlated with the number of antral follicles you have in your ovaries. Simply stated, the more follicles you have, the higher your AMH level typically is. 

The actual number on an AMH report is typically a single digit number that, again, corresponds to the number of healthy follicles you have but it isn’t the actual total number in your ovaries if we were to count them. For example, an AMH of 3.5 does not mean you have 3.5 follicles. It does mean that you likely have the expected number of healthy follicles in your ovaries and we expect that each of those follicles contains an egg that has the potential to lead to pregnancy. And since AMH is thought to be stable throughout the menstrual cycle, it’s considered to be the best lab indicator we have for a person’s reproductive potential (in combination with age). 

What AMH is actually very good at is predicting the timing of menopause. Research shows that AMH becomes very low or undetectable about five years before menopause. Other research has shown that the time of menopause may be predicted with a mathematical model using only one AMH value and the age of the patient. 

TL;DR? Your actual AMH number is not the total number of healthy follicles (with eggs in them) that you have, but it does correspond to your overall ovarian reserve, or your reproductive potential based on the number and quality of eggs you have. AMH is actually a better predictor of the timing of menopause, since it becomes very low or undetectable about five years beforehand.

AMH and age

So how does AMH relate to your age? ​​In younger people, a gradual increase in AMH levels is seen from the first day of life. Maximum levels are reached in the teenage years and they stay pretty steady until around the age of 25. After that, AMH and age are inversely correlated, meaning that as a person gets older, their AMH goes down. Additionally, the rate at which someone’s AMH goes down varies from person to person so it’s impossible to guess where someone’s AMH will be in the future.

What is a normal AMH for my age?

Unfortunately, there is no international standard for AMH levels. However, some studies have tried to assess AMH levels and create models for what is considered normal for specific ages. One study looked at the median AMH levels (in ng/mL) in 2,741 participants. Their results are listed below:

• Under 25 = 5.13
• 25 = 5.42
• 26 = 4.91
• 27 = 4.12
• 28 = 4.96
• 29 = 3.87
• 30 = 3.53
• 31 = 3.59
• 32 = 3.44
• 33 = 2.70
• 34 = 2.49
• 35 = 2.58
• 36 = 2.28
• 37 - 1.85
• 38 = 1.66
• 39 = 1.72
• 40 = 1.27
• 41 = 1.26
• 42 = 1.20
• 43 = 0.81
• >43 = 0.72

If you have a lower or higher AMH than the numbers above going into your 30s or 40s, I encourage you not to freak out! Remember that these are medians, which means many people have AMH levels above or below them. Multiple studies have shown that AMH doesn’t correlate with how likely you are to get pregnant. In fact, one study looked at AMH, FSH, and inhibin B levels and tracked people for a year. They found that there was no correlation between someone’s ovarian reserve and their ability to conceive and that a low ovarian reserve was not associated with lower fertility. As a result, they did not recommend the use of FSH or AMH levels to “assess natural fertility.”

Lastly, It’s also important to keep in mind that the interpretation of AMH levels is laboratory assay-dependent. This means it can be different from lab to lab and test to test. Your provider should give you the reference range for their specific lab. If you get your AMH tested in one lab and then get it tested at another lab later, let your provider know before comparing those numbers. 

Is AMH or age better at predicting egg quality?

Based on the research, AMH levels alone probably do not accurately reflect egg quality. Though, when AMH is combined with age, it can be a better indicator than when it’s used alone. There is unfortunately no single test or number that can tell you with certainty how likely you are to get pregnant.

Age, on the other hand, has been proven by countless research studies to be one of the biggest determinants of egg quality. As a person ages, their eggs are more likely to become aneuploid, meaning they’re “genetically abnormal.” This can lead to difficulties with both getting and staying pregnant (i.e, higher risk of miscarriages). Once a person reaches their mid to late thirties, research shows that the quality and quantity of eggs declines rapidly. 

Unfortunately, there’s not a lot we can do about aging or about the decline in AMH that goes with it. However, it does no good to stress about either of these numbers. As stated earlier, AMH and age are each just one value your provider looks at to assess your overall reproductive potential. Neither value alone can completely predict your chances of conceiving naturally and neither defines your fertility.

Is AMH or age better at predicting how many eggs will be retrieved during egg freezing?

A lower ovarian reserve can mean fewer eggs are retrieved during egg freezing. This means both age and AMH factor into the success of an egg freezing or IVF cycle. 

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

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

At what AMH level should I freeze eggs? 

So when should you consider freezing your eggs? Honestly, the sooner the better. There is no specific AMH level at which you have to freeze your eggs. However, we know AMH only goes down as a person gets older, so the earlier you’re able to freeze your eggs, the better your response to the medications will be and, hopefully, the more eggs you’re able to have retrieved to keep your options open later.

When thinking about your AMH, these general guidelines for AMH values (ng/mL) and egg retrieval can be helpful:

• AMH <0.5 = predicts difficulty getting more than three follicles to grow in one egg retrieval cycle (this in turn reduces the chance for pregnancy with IVF)
• AMH <1.0 = suggests a limited egg supply and a short window of opportunity to conceive
• AMH 1.0 - 3.5 = suggests a good response to ovarian stimulation
• AMH >3.5 = suggests an ample egg supply (also indicates that your doctor may need to be cautious in order to avoid ovarian hyperstimulation syndrome (OHSS), a possible complication of ovarian stimulation)

So can you still freeze your eggs if your AMH is low? The simple answer is yes, you can. But you will be more likely to need more than one cycle to reach the ideal number of eggs.

You are not a number

With all the nuances involved here, it’s important not to get lost in the weeds. Fertility is impacted by so many factors that you can drive yourself crazy trying to manage all of them. Remember, you are more than any number. This process can be overwhelming, but focusing on the things that you can control can help you feel more grounded during your fertility journey, whatever it may look like. 

Freeze by Co is here to help you every step of the way on that journey. Our Split program allows people between 21 to 34 years old to have the chance to freeze their eggs for free! In a “Split” cycle, you would donate half of the eggs retrieved to a family that’s trying to conceive and freeze the remaining half for yourself. If you’re over 34, you can still participate in the Keep program up to age 40. In the Keep program, you’re able to freeze your eggs and keep them all for yourself, on your timeline. In addition, you’ll have access to our online support community, the Nest. This valuable resource lets you engage with other people freezing their eggs at the same time! 

Whatever your journey looks like, our team is here to guide you through it and keep your family-building options open.

Intro 

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

What is egg freezing?

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

Should I freeze my eggs?

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

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

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

Pros of egg freezing

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

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

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

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

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

Cons of egg freezing

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

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

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

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

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

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

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

When should I freeze my eggs? 

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

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

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

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

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

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

You might have heard at some point that freezing your eggs can help you preserve your fertility options for your long term future. But just how many eggs should you freeze? Is there an optimal number for egg freezing?

Let’s take a look at how many eggs you can expect to get during the retrieval process and how many eggs you should be freezing for fertility preservation. 

How many eggs do I have?

Before we talk about the number of eggs you should freeze during oocyte cryopreservation — more commonly known as freezing your eggs — we should probably talk about how many eggs are in your ovaries right now. 

Your fertility doctor may have mentioned the term ovarian reserve a few times. When they do that, they’re talking about the number of eggs in your body. But how many eggs are in that reserve?

There is no exact answer here. On average, women are born with anywhere from one to two million eggs. Some women are born with more. Some women are born with less. 

It may sound like a lot either way, but most of the eggs we’re born with don’t stick around. By the time most of us hit adolescence,we have about 300,000 eggs left. From there, the number of eggs in the body naturally decreases by about 1,000 every year, and the decline becomes more rapid after age 35.  

That’s where egg freezing comes into play. The doctors of the Association of Reproductive Medicine (ASRM) states that planned oocyte preservation is “ethically permissible” because it provides women with more autonomy over their reproductive choices. 

Doctors can get a sense of how large your ovarian reserve is before egg freezing by testing the level of the anti-Müllerian hormone (AMH) in your body. This test looks at both your ovarian reserve and how well your body may or may not respond to medications that will stimulate the ovaries. What it can’t determine, however, is the quality of those eggs. And ultimately, you need both quantity and quality.

How many eggs do I need to freeze?

OK, so you may have a lot of eggs in your ovarian reserve — or maybe not. But how many do you actually need to freeze?

This answer varies from person to person and depends on a few individual factors:

• How old are you right now?
• Do you plan to freeze all of your eggs or do you hope to also donate some to help intended parents grow their family? 
• If you think you may want to have children one day, how many do you have in mind?

This list presents a lot to think about, so let’s dive a little deeper to help you make informed decisions about the number of eggs you freeze. 

The right number of eggs to freeze for your age

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

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

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

How many eggs are retrieved?

For  egg donors aged 25-29, the average number of eggs retrieved is 18, and that number drops to 16 for people age 30-35 — although it varies from person to person.

Your reproductive endocrinologist will be able to tell you the day of your retrieval how many eggs were retrieved. This number will include both mature and immature eggs, so it’s not necessarily the total number of eggs that can be frozen. 

Immature Eggs

• May be partially or completely damaged or have its quality compromised in some way
• Lower chance of fertilization

Mature Eggs

• Have good egg quality
• Are more likely to be fertilized
• Can be frozen

After your retrieval, all of your eggs will be sent to an incubator to check maturity. The lab technicians will look for eggs to achieve meiosis, a kind of cell division that occurs in egg cells. 

The eggs that achieve meiosis will be frozen, and you will be notified of the total number. 

Should I do multiple egg retrievals?

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

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

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

Of course, you should talk to your doctor about any risks or benefits that come with additional rounds. 

The right number of eggs to freeze to have multiple children

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

For example, the studies show that a woman under age 35 will need to freeze about nine eggs to achieve a 70% chance of a live birth. If you’re under age 35 now and thinking you might want to use frozen eggs to conceive twice in your future, you will want to freeze closer to 18 eggs to achieve that 70% chance each time. 

That number will increase with each number of children you foresee — provided your expectation is that each child will be conceived with the use of the eggs you are currently freezing. 

Bottom line

There is no “magic number” when it comes to freezing your eggs. Your age, your future plans, and more all come into play. 

We’re here to answer any questions you might have, and the Cofertility community is also here to lend support as you consider all the important factors to make the choice that is right for you.

It may not come as a surprise to learn that the prime time for freezing your eggs is actually a lot earlier than you think. According to the American College of Obstetrics and Gynecologists (ACOG), freezing your eggs while you’re still in your 20s can help boost your chances of a successful pregnancy—and a 2010 report from the Center for Disease Control and Prevention (CDC) says that those eggs have a higher chance at resulting in a live birth no matter your age when you decide to start your family. 

For many women, that means the best time to freeze their eggs is likely the moment they start wondering when they should start. Read on to see what you need to know about why freezing your eggs before you’re even sure what you want to do with them is the best way to ensure you’ll be able to make the decision for yourself when the time is right. 

Your body produces a different number of eggs at different times

Your late 20s and early to mid-30s are considered the peak time to retrieve eggs—with a 2015 study from the American Society for Reproductive Medicine saying you’ll see the best results prior to the age of 34 — because your body has reached complete development and your eggs are at their most healthy and plentiful point.

That doesn’t mean that the quality of your eggs takes a major dip when you celebrate your 38th birthday. Instead, it means that as you add more and more candles to your birthday cake each year your body begins to produce fewer eggs. This becomes important when you realize how many eggs you’ll need to retrieve when you begin the process of freezing your eggs.  

Take the 2020 study from Assisted Reproduction Technologies (ART) that showed women under the age of 35 were retrieving an average of 21 eggs during their first round of egg freezing while women between the ages of 35-37 were retrieving an average of 17. Four eggs may not seem like that big of a difference at first, but once you take into account how many eggs experts say you should have on hand when it comes time to start fertilization you’ll begin to realize just how quickly those numbers add up. 

Producing fewer eggs may increase costs

The saying less is more doesn’t apply too much in the world of fertility, where your chances of going on to have a live birth increase based on the number of eggs you have on hand when it comes time to fertilize and implant them. 

That 2020 ART study that showed the average number of eggs retrieved each cycle also showed that if you're under the age of 35 you will need 9 eggs for a 70% chance at having a baby. However, if you’re looking to hit that same 70% mark in your later years (think 38-40), you’ll need closer to 18 eggs to have the same chances at a live birth. With women in that age range only averaging 17 eggs per retrieval, that may mean multiple cycles, and with a $10,000-20,000 price tag that can quickly add up.

The best time to freeze your eggs is, unfortunately, usually before you can afford it

Not many people have that much money readily available in their 20s, which is why egg freezing is often financially out of reach for those who would benefit most from it. With programs like Freeze by Co you can take advantage of those peak fertility years even if you can’t exactly swing the costs. 

One program offered by Freeze by Co is Split. Split Members benefit by offsetting the cost of freezing their eggs by donating half of them to a family that cannot otherwise conceive. Split Members match with intended parents, and undergo an egg freezing cycle where half of their eggs are donated to the perfect intended parents (after testing and meeting qualifications, of course). The other half are then stored (for free) for the split member for up to 10 years. 

If you’d rather hold onto all your eggs until you’ve decided what your fertility future holds, you can use Freeze by Co’s Keep Member plan. These members can still benefit from lower costs, thanks to things like reduced medication fees, consultation discounts, and more. 

This is the most cost-effective age to freeze your eggs

With all these numbers flying around you may be wondering where the health benefits and the financial benefits meet. According to a 2015 study published in the journal Fertility and Sterility, the two numbers seem to cross paths at the age of 35.

Women who freeze their eggs at 35 for use by the age of 40 spend an estimated $15,000 less than those who are trying to have a baby at 40. And that’s not the only good news, that math seems to hold up all the way until the age of 38. 

Freezing your eggs should be a positive experience

With the accessibility Cofertility gives women to take control of their fertility process, you can feel empowered to make decisions based on what’s in the best interest for you and your body without having to worry about your bank account. 

Getting an earlier start at freezing your eggs through Freeze by Co (even if you don’t have a partner or aren’t even sure that your dream future includes children yet) will: 

• Give you a higher chance at eventually achieving a live birth even if you wait until your late 30s or early 40s.
• Allow you to wait on making major decisions about your education, career, and future until you’re ready.
• Offer you the freedom to make medical decisions based on what’s right for you instead of what type of coverage your employer offers at the time. 
• Provide peace of mind because no matter what your future family may look like you’ve already taken the first step to making your dreams a reality. 

Even if you’ve missed that peak window into your fertility there are still plenty of benefits to freezing your eggs. With all of the new plans offered by Freeze by Co you’re likely to find one that will fit your current needs while giving you a chance to plan for your future.

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

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

You could get a heads up about certain reproductive concerns

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

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

You’ll get a better picture of your reproductive schedule

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

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

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

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

Your doctor will find out how many follicles you have

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

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

There will be additional health screenings 

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

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

Getting proactive can save you money

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

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

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

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

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

Affordable egg freezing programs

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

Paying for keeps

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

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

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

The Split cycle

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

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

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

Important X factors

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

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

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

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

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

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

Logistics

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

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

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

Can you freeze your eggs? 

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

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

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

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

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

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

Female doctors and fertility

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

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

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

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

What’s going on?

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

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

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

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

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

But delaying reproduction is only part of the puzzle.

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

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

How can female doctors preserve their fertility?

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

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

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

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

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

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

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

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

Bottom line

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