For me, the decision to preserve my fertility was a matter of timing. I knew that due to my extended medical training (which included 4 years of medical school, a 4-year OBGYN residency and a 3 year fellowship in reproductive endocrinology), my childbearing was going to be delayed by my own choice. I wanted to have options should I find out that my husband and I had infertility in the future and I decided to freeze embryos because I was with a partner who I knew I wanted to have children with one day.
Why are more women electing to freeze their eggs?
Egg freezing (also known as oocyte cryopreservation) has gained significant attention since the American Society for Reproductive Medicine (ASRM) removed the experimental label from it and major corporations like Apple, Google and Facebook started covering the expense for their employees.
The purpose of egg freezing is to allow women the opportunity to freeze eggs at their current age for future use, should they need them. Unlike men, women’s fertility naturally declines with age, slowly at first in our early to mid-30’s and then more rapidly in our later 30s and early 40s until we have no remaining eggs and go through menopause. While it is not a guarantee of success in the future, many women feel empowered after freezing their eggs because it allows them to have some control over their own reproductive process and perhaps takes some of the pressure off from having to find the right partner, right now.
What is egg freezing?
During the egg freezing process, a woman will go through in-vitro fertilization (IVF) which consists of giving themselves 10-12 days of injectable hormones to stimulate the ovaries to produce multiple follicles with the hope of retrieving multiple mature eggs to be frozen. The egg retrieval occurs about 36 hours after a final trigger shot, which is given to induce the final maturation of the eggs in the ovary. During the egg retrieval you will usually be put to sleep, but you are still breathing on your own, and your physician will retrieve the eggs using a needle under ultrasound guidance. The procedure itself takes 5-20 minutes depending on the number of follicles in the ovary. We recommend taking off work the day of the egg retrieval since you did receive anesthesia. After the procedure, you can expect to feel cramping, similar to your menstrual cycle, as well as some brown-red spotting. Women with a high number of eggs retrieved may feel worse bloating 2-3 days after the procedure, but that should resolve within a week. You can expect a period 7-14 days post retrieval (the timing depends on which injection you took to “trigger” ovulation) and it will likely be heavier than what you are used to.
What is the difference between egg vs. embryo freezing?
Egg freezing involves freezing mature eggs that can be fertilized in the future with either partner or donor sperm. Women with a partner may elect to freeze embryos, which involves fertilizing the mature eggs with sperm and allowing them to grow into a blastocyst (day 5 or 6 embryo) and freezing at this stage. By creating a blastocyst, you also can elect to genetically test those embryos to assess whether they have a normal number of chromosomes and the sex of the embryo. The advantages of creating embryos allows you to have more information up front because they have made it to an embryo. They were able to fertilize and grow and develop into a blastocyst. With eggs, you have less information up front, we do not know how many eggs will fertilize or whether they will develop appropriately. The major advantage of freezing eggs is that they are solely yours and you have the ultimate decision-making ability regarding those eggs. The eggs are solely yours and you have the ultimate power in deciding what happens with them. If you chose to create embryos and you and your partner break up, those embryos belong to both of you and you may lose control of those embryos. And as I said before, a woman’s fertility declines with age, while a man’s fertility stays relatively consistent, so freezing eggs affords women more options for the future.
Ok, about these injections…
While I am a physician, I had never personally had to inject myself with a needle so for me that was probably the most anxiety-provoking part. But, once you start the injections, the process gets significantly easier. You develop a sort of routine and it just becomes part of your evening. My tips (that worked for me) to minimize discomfort include icing the area of skin prior to injecting, alternating sides of injections every couple of days and pinching (hard) the skin where I was going to inject.
My other recommendation is to go through your medicines the night before and lay them out, so you feel comfortable with what you have. The box of medicines you receive is large and filled with vials and needles and syringes and can be very overwhelming, so it helps to go through it before starting.
How will I feel during the process?
For the most part I felt the same during the injections, but I did experience the two most common symptoms associated with the process, which are bloating and constipation. The amount of bloating you may feel is usually a direct correlation to your ovarian reserve. A woman with a large ovarian reserve (remaining egg supply) may notice more symptoms than someone with a lower ovarian reserve. During the egg retrieval you will usually be put to sleep, but you are still breathing on your own, and your physician will retrieve the eggs using a needle under ultrasound guidance. The procedure itself takes 5-20 minutes depending on the number of eggs you have. You will wake up and be able to go home about an hour later. We recommend taking off work the day of the egg retrieval since you did receive anesthesia and we don’t want you making important work decisions. After the procedure, you can expect to feel cramping, similar to your menstrual cycle, as well as some brown-red spotting. Women with a higher ovarian reserve may feel worse bloating 2-3 days after the procedure, but that should resolve within a week. You can expect a period 7-14 days post retrieval (timing depends on which injection you took to “trigger” ovulation) and it will likely be heavier than what you are used to.
Do I really have to give up exercising?
Most fertility doctors will recommend that you stop exercising at the start of IVF treatment or within the first week of injections due to the increased risk of ovarian torsion. Ovarian torsion is a very rare but serious complication of IVF that occurs when the ovary flips on its blood supply, often leading to intense pain and can be a surgical emergency. During IVF, as your ovaries grow, we recommend discontinuing exercise when your ovaries increase in size due to the increased risk of the ovary being jostled during vigorous exercise and potentially increasing the risk of twisting on its blood supply.
Most common questions we get asked with regards to egg freezing
Will I go through menopause sooner?
No! Every month our ovaries have a group of small follicles that all have the potential to respond to our brain’s hormones and stimulate one follicle to grow that will eventually ovulate (usually one) egg. All of the remaining follicles that do not grow that month dissolve and the process starts over the next month. With IVF we are rescuing the follicles that would have dissolved by giving them the hormones they need to grow. We are not removing excess eggs and it will not make you go through menopause sooner.
Does the number of eggs I have mean I will get pregnant easily in the future?
No! Egg freezing does not predict future fertility. I will say that again, egg freezing does not predict future fertility. If you have a high ovarian reserve, it does not mean you will get pregnant faster than someone with fewer eggs and a low ovarian reserve. Your ovarian reserves tells us two important facts: how well you may respond to our injections and how many mature eggs we can expect to freeze.
Does egg freezing cause breast or ovarian cancer?
No! There have been large population-based studies with thousands of women that demonstrate that egg freezing does not increase your risk of invasive breast or ovarian cancer.
If I freeze my eggs now, will those eggs guarantee me a baby in the future?
No. And this is an important take home message: egg freezing does not guarantee you that the eggs you freeze today will result in a future child. It does give you additional options in the future to have a biological child should you chose to delay childbearing or if you find you have infertility, but it is not a guarantee.
Final thoughts after the process
After going through this process, I felt empowered that I was able to make a proactive decision regarding my reproductive health. I had no idea what my fertility would be once we decided to have children and I wanted to have options as I knew we were delaying child-bearing due to my education and starting my career. Egg freezing is not for everyone, but I feel strongly that all women should be educated on their options regarding their reproductive health and feel empowered to make an informed decision regarding whether it is right for you.
Dr. Temeka Zore is a Fertility specialist and Board-certified OB/GYN, who completed a fellowship in Reproductive Endocrinology and Infertility (REI) at the University of California, Los Angeles (UCLA). Dr. Zore was raised in Indiana, and graduated with honors from the University of Texas at Austin, where she also received high honors for her academic excellence as well as her athletic achievements in Track and Field. She was then awarded a full merit scholarship to medical school and returned to her home state, where she graduated from Indiana University School of Medicine.
Following her fertility fellowship at UCLA, Dr. Zore worked at Reproductive Medicine Associates of Southern California in Los Angeles. Dr. Zore has contributed to several peer-reviewed articles related to topics including PCOS and pre-implantation genetic testing of embryos. She is passionate about educating women about their reproductive health and fertility preservation, which she does as part of the Spring Fertility Family.