If You've Ever Wondered About Egg Freezing, This 101 Guide Answers The Basics

Up until 20121, egg freezing was reserved for women with medical infertility concerns caused by chemotherapy or chronic health conditions. Today, it's an elective procedure often billed as a way for women to extend their fertile window, increasing the chances that they will be able to have children on their own timeline.

Now that people have the ability to freeze their eggs for personal reasons (even with a steep price tag), it has become significantly more popular among 20-and-30-somethings. Some research suggests the prevalence of elective egg freezing has jumped 39% just since the COVID-19 pandemic2 . But even with this shift, egg freezing is still a very hush-hush procedure. Many parts of the process are not openly discussed, and the average person looking to get pregnant might have no idea what it entails before they reach out to a doctor.

To shed some light on egg freezing and gather the need-to-know basics, I contacted board-certified reproductive endocrinologist and OB/GYN Rachel Gerber, M.D., who conducts this procedure on a daily basis. Here's her 101 on freezing your eggs. 

Hannah Frye: How important is age in terms of planning this procedure?

Rachel Gerber, M.D: "There is an age-related fertility decline, which happens for two reasons: The first reason is that women are born with all the eggs they will ever have... Ultimately, we can't give you any eggs back. So you don't know what you're starting with or where you're at until you check.

"The other thing that leads to this fertility decline is that your eggs have less reproductive potential per egg [as you get older]. So an egg that you ovulate in your 20s or early 30s has a higher chance of being fertilized and growing into a healthy embryo.

"The higher the number of eggs you get [via freezing], the higher the chance that one of those eggs will produce a baby. And the lower your age, the higher the chance that any one given egg will produce a baby."

So, should you always assume younger is better for egg freezing?

"There have been some studies that look at it as a cost-benefit analysis3, and the answer is probably early 30s to about 35. That's when you're still in a good position to have a positive outcome from the eggs retrieved if and when you need them.

"You are also old enough to have a better chance of actually needing them. Because let's say you freeze your eggs when you're 25 and single. You may meet someone at 27 and decide to have children at 29. People tend to be pretty fertile in their early 30s. And so if you want one or two kids and freeze your eggs at 25, there's still a good chance you could do that without ever using those eggs.

"If you're in your 20s and in a relationship–you've identified the sperm source that you want to have children with—that's a different story because you may consider embryo freezing."

How much does it cost to freeze your eggs?

"A general range is $10,000 to $12,000, but it will depend on your insurance and the fertility center you go to. (Editor's note: This covers one procedure, so if you only get six eggs in your first round and you want to reach the average recommended 10-12 eggs, you’ll have to do another round at the same cost.)

"Medication can cost an additional $5,000 and isn’t covered by many insurance companies. Plus, you’ll need to pay an annual fee for your eggs to be held at the facility, which ranges from $500 to $1,200 in general. For those residing in areas without a local fertility clinic, travel to and from the clinic is another cost to consider."

What does the process look like?

Here's a summary of what to expect when freezing your eggs, according to Gerber:

First, you'll undergo an egg count to get an idea of the success percentages you can expect. This is done using two methods: You get an ultrasound to count how many follicles are present in your ovaries and receive a test of your AMH (anti-müllerian hormone).

Important note: If you are on a long-term birth control pill (not necessarily an IUD but specifically a birth control pill), the pill can put your ovaries into a bit of "hibernation." In other words, it can make it seem like your ovaries have fewer eggs than they do. So Gerber recommends getting off the birth control pill for a few months before receiving these tests, to allow the ovaries to become more hormonally active and reset your egg count.

Initial testing gives practitioners an idea of what medication doses you'll need and how many cycles you'll likely need to undergo. The goal is to find the best dosage to maximize the eggs you can get out without overstimulating the ovaries. If you do overdo this medication, you may feel bloated and lousy.

From there, you can order the first dose of your medication to be sent to your house and start taking it at around day 2 or 3 of your natural period.

In a normal cycle, your body picks just one egg. The point of the medication is to encourage your body to pick all of the eggs this month. In order for that to happen, you'll have to take two to three injections a day for 10 to 12 days. During that period, you’ll need to come into the fertility office for bloodwork and ultrasounds about every other day.

On average, it's a two-week process, but it does require a significant time investment. During those two weeks, you shouldn’t have to take off time from work as you should feel fine, but some women still choose to take off work if they have vacation time available. At the end of those two weeks, practitioners decide when the eggs will be retrieved based on your hormone levels (which is why they draw the bloodwork) and the size of the follicles (which they see via the transvaginal ultrasound). 

Once your provider decides it's time, you'll do a final injection (often called a "trigger shot"). After about 36 hours, the egg retrieval procedure will take place.

What does the procedure entail?

"The egg retrieval in our clinic and in most clinics is done under IV sedation. You are hooked up to monitors to make sure your vital signs are okay, and you are breathing on your own. The procedure itself is about five minutes.

"We take an ultrasound probe and attach a needle to the end of it, then line up the ultrasound probe against the ovary and advance the needle through the vaginal wall into the ovary. Then, we enter the needle into each follicle and use suction to extract the fluids and eggs. We go from follicle to follicle on the right (until we've collapsed all the follicles and removed all of the fluid and eggs), and then we go to the other side and do the same thing. By the time the patient wakes up, they'll know how many eggs were retrieved."

What about recovery?

“The recovery should be quick and many people are able to go to work the next day. The most common complaints are cramping (similar to a painful period) and some vaginal bleeding. Patients can also feel bloating and fullness from the stimulation and high estrogen levels. That typically goes away in a week or so. The more eggs retrieved, the higher the chance of feeling this bloating and fullness.”

What’s one common misconception about egg freezing you hear often?

“That freezing your eggs depletes your egg stores sooner than someone who doesn’t freeze their eggs since multiple eggs are removed in the egg freezing process. This is not true because we can only stimulate follicles that are already hormonal responsive and available to be selected for ovulation. These are called antral follicles and can be seen on ultrasound.

"The eggs that reach this stage in any given month cannot 'go backward' into the long-term storage, so if the antral follicle is not selected for ovulation, it degrades and is part of the continual egg loss that happens in the menstrual cycle. In egg freezing, all we are doing is rescuing the follicles that would have otherwise degraded to allow for them to mature and be available for future use. Egg freezing is only increasing the efficiency of the reproductive system and not depleting eggs from it that can be used in the future.”

What kind of medical situations call for early egg freezing?

"There are certain cases where we see even people in their teens or very early 20s. This can happen in horrible situations where someone is diagnosed with cancer and is going to be undergoing chemotherapy—and we know that chemotherapy can be toxic to eggs. In those cases, we work with the oncologist to attempt to freeze some eggs before cancer treatment. 

"Endometriosis is another condition that might make you want to undergo the procedure when you're younger. Some people have endometriosis lesions on the ovaries that can eat away at healthy ovarian tissue and decrease egg counts. In many cases, people with endometriosis have to get repeated surgeries to remove ovarian cysts. Every time they remove that cyst, a little bit of ovarian tissue comes with it. So those are special situations.”

The takeaway

Every egg-freezing process—from initial consultation to recovery—will vary from person to person That said, knowing the basic framework can help you decide if you want to invest in it, and what to expect upon your first visit.

In general, the best time to freeze your eggs is between your late 20s and early to mid-30s. This way, you'll have a greater chance of pulling peak reproductive eggs and actually needing them, making it a more cost-effective process. The procedure itself can range from $10,000 to $12,000 (without insurance), but the final cost will depend on the clinic you visit and how many rounds you'll need to reach your goal. Medication and yearly holding expenses will add to that cost. The process shouldn't be too uncomfortable, apart from some cramping in the days after the retrieval.

It's important to speak with a professional at a clinic near you and find a team that makes you feel comfortable and confident in this process. There are many questions you'll likely have beyond these, so be sure to bring any other concerns to the clinic to have answered at your consultation.

This interview has been edited for length and clarity