Egg Freezing: costs, process, and ovarian reserve testing

Egg freezing: costs, process, and success rates

We scoured all the medical journals to get to the bottom of the egg freezing science. Here's important egg freezing information you can rely on.

An Introduction to Egg Freezing

Okay, here's the tea. A lot of people think egg freezing is 'insurance for later.' The truth is egg freezing works best the sooner you do it, when you have more eggs that are higher quality. But it's never a 100% guarantee.

Plus, what we've seen (and experienced ourselves) is that egg freezing can also benefit present you. For example, it can remove the pressure of having to do  the "dating math" on every first date.

Whether you're motivated by preserving fertility or simply want more options, egg freezing can improve your quality of life.

That said, there are huge hurdles to understand what exactly egg freezing means for you, whether it's reliable, and what the process looks like.

While the procedure itself has become safer, more effective, and less costly, most of this information is locked up in hard to parse journal articles (we know, because we've read them).

So we wrote this guide with the goal of making it easier for women everywhere to understand the pros and cons of freezing their eggs. If you end up deciding to explore further, our team at Lilia is happy to help you take your next steps.

Sciencey Egg Freezing Definition

Egg freezing, or oocyte cryopreservation in scientific terminology, is the term used to describe the process of medically stimulating the ovaries to develop many eggs at once so that a doctor can collect them.

Once they've been retrieved and frozen, they can be stored until you are ready to have them thawed, combined with sperm for fertilization, and transferred to a willing uterus (this could be yours, or that of a surrogate).

What is Egg Freezing?

Freezing your eggs lets you take control of your reproductive future and preserve your fertility. When done early, egg freezing makes it easier for women to do, well, whatever the hell they want.

Oocyte or egg cryopreservation is the collection and cold storage of your eggs in liquid nitrogen to be used for later. This process triggers the development of many eggs in your ovaries. These unfertilized eggs are then retrieved and stored for in vitro fertilization (IVF) when you're ready to become pregnant later.

Deciding to freeze your eggs is no small choice. There are a lot of factors to consider. If you decide to freeze your eggs, it's important to find a clinic and doctor you trust that has a good reputation for successful egg freezing, and for turning those eggs into babies later.

If we can brag for a moment, Lilia has done all of this research for you, partnered with top providers, and makes getting start and finished extremely easy.

Egg freezing models

What's the egg freezing process? 

Overall, the egg freezing process takes about 3-4 weeks per cycle, with all things considered. Each cycle has six main steps: consultation with a physician, pre-treatment, a hormone regime to stimulate eggs' development, an ovulation trigger, egg collection, and egg freezing. Here are the steps:

Step 1: Choosing a Fertility Clinic Provider

One of the trickiest parts to freezing your eggs is deciding which fertility clinic / reproductive endocrinologist (REI) you trust to handle your egg freezing. There are a ton of factors to consider, like clinic success rates, costs, location, and bedside manner.
If you find yourself overwhelmed and not sure who to trust, Lilia specializes in finding you a top-tier provider, so just say hello if you'd like a hand.

Step 2: Visiting the Fertility Clinic

Kicking off the egg freezing process starts with a visit to the clinic. Here, they'll do two tests to get a complete picture of your hormone profile: an AMH blood test and an Antral-Follicle Count (AFC) ultrasound.

For our fellow nerds, there is extensive research describing how anti-müllerian hormone (AMH) levels can predict the overall success of egg freezing.

With your age, AMH, and AFC in hand, the fertility specialist can determine a rough range of how many eggs you might retrieve in one cycle, and so what time of regime you will need to maximize number of eggs retrieved.

Remember, age is THE most important factor when it comes to success rates. The sooner you secure your eggs, the less you'll spend on medication and the higher ROI an investment this will be.

Step 3: Prepping to Freeze My Eggs

Following this, your REI (remember, fertility specialist) will likely either prescribe you birth control pills to quiet your body's natural hormones in preparation for your ovaries to be stimulated by external hormones.

However, if you're already on birth control, some REIs will order you off of it. It really depends on your body and your REI - this is part of why it's so important to choose fertility specialist you really trust.

In some cases, like when a woman has cancer, this pre-treatment might be skipped to save time.

Step 4: The Process Begins (Day 0 to ~14)

Once your treatment plan and hormone stimulation regime has been determined by you and your fertility doctor, you will start daily injections to help as many eggs develop as possible for collection. These injections range from 10-14 days, depending on your hormone profile.

Okay, we're going to get really sciencey for a sec, because you're smart enough to know what's going on.

These injections will include a synthetic hormone, follicle-stimulating hormone (FSH), which does as the name suggests and stimulates follicles to grow and support egg development.

Doctors will typically also prescribe a second drug that ensures you don't ovulate too soon alongside your FSH injections.

This second drug will block the action of gonadotropin-releasing hormone (GnRH). Left unchecked, GnRH would stimulate the surge of luteinizing hormone (LH) necessary for ovulation, preventing your eggs from maturing to the point where they could be collected.

Throughout this process, you will be monitored by physicians and a team of specialists to be sure no syndromes are developing as a result of the treatment.

Expect to be at the clinic every day or two for this monitoring, including vaginal ultrasounds to see how the follicles are developing and when the eggs might be ready to retrieved.

Step 5: Retrieval Day (Day ~14)

At a certain point doctors will say "okay, these eggs look ready to retrieve." So once your follicles are developed and the eggs are ready to be retrieved, you will be given a trigger injection of a synthetic form of human chorionic gonadotropin (hCG).

In most cases, this can be expected around day 14. The trigger injection helps the eggs go through the final steps of maturation so that your body is ready for the egg to be removed from the ovary.

Though you may think that the most intimidating part of the egg collecting procedure is the final collection, this egg retrieval process is surprisingly simple.

For procedure day, you will visit your doctor's office or clinic for a quick outpatient procedure. They will put you under light sedation and perform a surgical procedure called "transvaginal ultrasound aspiration."

Let's unpack that term: A transvaginal ultrasound uses an ultrasound probe to see the follicles that have developed in the ovary. At the same time, a needle is guided through the vagina to those follicles. Aspiration is a medical term for suction, like when you're at the dentist. This process gently pulls developed oocytes out of the follicles where they've been developing for the past few weeks.

In human speak, while you're under light sedation, the doctor will go through your vagina and vacuum out the eggs from your ovaries. No cutting, and limited or no pain.
This is a follicle. The tiny dot at the top is the developing oocyte (aka egg). When the eggs are collected, a needle gently breaks the follicle, and the mature egg is removed.
This process sounds complex, but it only takes about 5-10 minutes, and then your eggs are off to be processed by fertility scientists! They will be flash frozen in liquid nitrogen and stored in a liquid nitrogen tank until you want to use your eggs later.

When you are ready for in vitro fertilization (IVF), the egg will thawed and  injected with sperm through a method called ICSI (intracytoplasmic sperm injection). You can use donor sperm or sperm from a potential partner.

Once your eggs are fertilized, the resulting embryo(s) can be transferred to your own uterus or the uterus of someone else if you wish to have as a surrogate carrier.

Step 6: Post-Procedure (Day 14 to 16)

After the procedure, you can expect some cramping due to your ovaries having been enlarged.

If you think about it, you've just made them do some significant heavy lifting; their productivity has gone from developing one egg a month to developing about 15. Go ovary, go! 

As a result of this, you will probably want to take the day off work, but nearly everyone feels well enough to return to their routine in under seven days. During this time your doctor will likely keep a close eye on you to ensure there are no complications (though these are quite uncommon).

If you are sexually active with a partner who produces sperm while you're stimulating your ovaries, you will want to use contraception.  It's always possible some eggs weren't retrieved, and this could result in unintended pregnancy. 

Does egg freezing hurt? 

We've mentioned some medical procedures that can sound less-than-pleasant, like needles and minor outpatient surgeries. The truth is most women we work with find the process far less painful and inconvenient than they expected.

That said, let's paint a realistic picture of each step here:

First, let's talk about the daily injections. They can be uncomfortable, commonly bringing about a brief pinch of pain, but are quickly forgotten. People get used to them quickly, and they only last about 10-14 days. We're not programmed to enjoy poking ourselves with small sharp objects, so this part is really more of a mental game.

Injections are followed by the egg retrieval procedure, which a doctor does in a clinic, and for which you are sedated. Given this, you can expect that there will be little to no pain.

As we mentioned, there can be some cramping from your ovaries getting a workout over the course of the month, but this should be minimal and similar to most menstrual cramps.

Finally, as many people with uteruses can attest to, when their hormones are changing, they may be prone to fluctuations in mood. While the synthetic hormones are helping the eggs develop, they may also have unpleasant side effects on your mood.

These mood swings aren't necessarily physically painful but might take an emotional toll, so having a friend who’s aware of your treatment and happy to hop on a call would be helpful.

Alyssia egg freezer

Does egg freezing work?

The short answer is: most of the time yes, with the biggest factor in your success being the age at which you freeze your eggs.

Freezing earlier both means more eggs and higher quality eggs (as measured by survival rate), something we'll return to later.

The longer answer is a bit more complicated, largely because the data on egg freezing is skewed by who has traditionally frozen their eggs to date.

Many individuals who've frozen there eggs traditionally were people who needed to for medical reasons; in many cases these folks have far lower odds of success than the average egg freezer today.

Two other factors are end up making this data set rather hard to compare your self against.

First, an average of 8 to12 years typically passes between when someone freezes their eggs and when they would use them, meaning technology has often improved far beyond what is reflected in the data.

Second, many countries don't collect data on assistive reproductive therapy. Very rude.

The end result here is that you should take every survey of average success rates with a grain of salt.

Egg freezing success rates

Pessimistic Estimates

The best (thought still imperfect) data here comes from SART, the Society for Assisted Reproductive Technologies. SART reports that egg freezing has about a 35% rate of successful pregnancy across all ages. However, as mentioned above, this number likely artificially low if you’re healthy and under the age of 40.

Realistic Estimates

A large study on egg freezing in Spain found that the probability of successful pregnancy and birth was as high as 94% for individuals who freeze about 20 eggs and are 35 years or younger at the time of egg freezing.

Rule of Thumb

A rule of thumb you can pull from this data is that your odds of success approach 90% as your frozen egg count approaches 20 or so if you are under 35.

If you'd like to dig further into your odds of success, you can view a simple egg freezing success calculator.

Egg freezing vs. embryo freezing

If you're worried about being able to collect a sufficient number of eggs (for example, if you have endometriosis or diminished ovarian reserve), one option you might consider is embryo freezing.

Egg freezing thaw rates

With egg freezing, only about 70% of eggs survive the thawing process. This is because eggs (oocytes) are massive cells, full of liquids and components needed for fertilization; this makes freezing them quite hard because you run the risk of crystals forming.

Today, a technique called vitrification is used to help mitigate the formation of crystals during freezing.

Embryo freezing thaw rates

When you instead freeze fertilized eggs (embryos), you benefit from the fact that biological make-up of an embryo is quite different.

Embryos have smaller cells and less liquid. As a result, any given frozen embryo has about 40% higher odds of resulting in a live birth than a frozen egg.

Fertility clinic success rates

While many clinics cluster around the same average success rate, some clinics demonstrate far higher live birth rates than others, particularly for older women considering egg freezing.

To make it easy for you, our team at Lilia has combined proprietary data with public success rates to evaluate clinic partners to help make sure you're guaranteeing yourself the highest odds of success.
Egg freezing model laughing

What is the best age to freeze my eggs? 

Briefly, the younger the better. The American Society for Reproductive Medicine recommends that the best time to freeze your eggs is when you’re in your 20’s or early 30’s.

When we go home for the holidays, we're often telling our younger cousins that they should be considering egg freezing as soon as they can afford it.

One common misconception among younger women is that the eggs themselves have an 'expiry date' once frozen.

There is no evidence to suggest that the egg’s quality declines after a certain amount of time, and eggs can be kept frozen for a very long time (though some different geographies impose restrictions here, which we would be happy to talk you through).

Is there an age limit to egg freezing?  

No, not really. There is no exact limit for the age a person can be when they decide to freeze their eggs.

It's important to note that, on average, people who produce eggs experience a severe fertility decline after age 35, both in egg quantity and quality.

That said, if you're willing to do multiple cycles of egg freezing, many women are able to reach 20 frozen eggs despite being much older than 35 years old.

As a result, you'll see that many clinics do not recommend freezing eggs past the age of 38. Our take here is that every person is different, and you won't know until you begin testing what volume of eggs you can expect to retrieve. Many women have success in their late 30's, while others can struggle in their mid 20's based on their unique biology.

There are many conditions that may influence someone's fertility (endometriosis, PCOS, cancer, etc.) and thus impact their assisted reproductive outcomes. If you're thinking about freezing your eggs in your 40's, this could introduce some uncertainty into the process. Most clinics will assess your fertility past age 38 by examining your ovarian reserve.

If you're keen to learn more about your own biology, our team at Lilia can help you understand your personal timeline.

What are the risks associated with egg freezing?  

A look at the risks of the procedure

Though freezing your eggs is a great option to preserve your fertility, like every surgery there are risks to consider.

To start, there are very minor risks inherent to the medical procedures, such as during needle aspiration or when receiving injections. The main risk when undergoing hormone injections is a syndrome called ovarian hyperstimulation syndrome (OHSS).

This is quite rare, with only about one severe case in 1000 women in 2016, with rates continuing to fall annually. OHSS can range from mild to severe and is characterized by abdominal pain, bloating, nausea, vomiting, and diarrhea. Your clinic will be very aware of this risk and requires daily check-ins during the two weeks before your procedure to ensure you won't be impacted.

A look at pregnancy related risks

There are also emerging studies on the effects of egg freezing on both the pregnancy and the babies born from frozen eggs. Most studies examining pregnancy complications as a result of using frozen eggs are in women over 40 years of age. As there are increased pregnancy risks in general for women over 40, it's hard to understand what impacts are simply due to age as a confounding variable.

That said, there seem to be no dramatic differences between pregnancy risks of women who use fresh eggs and women who use frozen eggs. Studies suggest that there are not any additional risks to the baby or developing child. Published data on babies born from frozen eggs have shown that even after six years of follow-up, there are no developmental abnormalities.

The children born from frozen eggs meet developmental milestones, and have comparable weights, heights, and sizes to children born without assisted reproductive therapy. There is, however, the risk that egg freezing will not lead to a successful pregnancy, and there is no guarantee that freezing your eggs will result in a future child.

To ensure you feel extra secure, our team at Lilia deeply evaluates whether a clinic/doctor has any outstanding malpractice suits, so that you can be sure you're engaging with a physician who proceeds with adequate care.

How much does it cost to freeze my eggs? 

If you're looking for a comprehensive egg freezing cost guide, we've written one up just for you. That said, we can give you a quick run-down below.

There are two main costs associate with egg freezing:

1) Egg retrieval: The ovarian stimulation and accompanying clinician appointments cost about $12,000-19,000. The cost for egg retrieval depends on the clinic and whether you will need multiple cycles to obtain your ideal number of frozen eggs.

2) Storage: This is a fee to store frozen eggs within your chosen clinic. According to Yale Medicine, this costs roughly $600 per year that you keep them stored.

Note that when you want to use your eggs you will need to undergo in vitro fertilization and embryo transfer. This varies but costs anywhere from $20,000 -40,000.

Some insurance companies can cover these costs, but it is essential to read the fine print before expecting them to contribute.

The good news is that now with Lilia you can freeze your eggs for $9,000 all-in! You can  get started here.
Egg freezing group

Why should I freeze my eggs?

People freeze their eggs for a wide range of reasons. Many folks with ovaries see egg freezing as a way to preserve their fertility and take control of their biological clocks (us included).

It's a great option if you aren't currently ready to conceive or become pregnant but think you might want to in the future.

There are medical reasons that someone may decide to preserve their fertility:
- Cancer, and chemotherapy treatment
- Polycystic ovary syndrome (PCOS)
- Endometriosis
- Autoimmune disease
- Being gender diverse/non-conforming or transgender 

There are also personal reasons that someone may make this choice:
- To potentially save the highest quality eggs from your 20’s
- To pursue career goals
- Travel dreams
- Waiting to meet the right person
- Religious reasons for freezing eggs and not embryos

The women we've worked with have ubiquitously said that the procedure was an empowering one that allowed them to take hold of their reproductive future.

How do I start egg freezing?

If you’re thinking about freezing your eggs, you can do it quickly (and conveniently) with Lilia and put the whole thing on auto-pilot. You'll work with a vetted, top provider for nearly half the cost and offload all the admin to us.

If you want to go it alone, you can start by consulting the Society for Assisted Reproductive Technologies (SART) data to see which clinics have the highest success rates in your area.
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