8 things you should consider before freezing your eggs

If you're thinking about egg freezing and you've started to do your research, you're probably coming across a lot of information that can be legitimately overwhelming. Don't panic! We're here to help you organize your brain with eight important facts about this potentially life-altering surgical procedure.

But before we get into it, what is egg freezing? Egg freezing, or oocyte cryopreservation in medical-speak, is a fertility preservation technique where eggs are extracted from the ovaries and frozen so they can be used for an assisted reproductive technology (ART) procedure, like in-vitro fertilization (IVF), in the future.

Now that we're up to speed, let's dive in.

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Let's start with a common misconception (no pun intended): While egg freezing may take some of the stress off of you in terms of knowing your baby-having timeline right now, it's not necessarily a surefire way of guaranteeing your forever fertility.

Why? Not all the eggs you freeze are going to be viable — think quality as well as quantity in this situation. How many eggs survive the warming process and can be successfully fertilized depends on how old you were when you froze them (more on this later), and how many are healthy and viable once they come out of storage. Plus, fertility does change with age, so if you freeze your eggs at 25 and use them when you're 35, you'll have to contend with the realities of conception and pregnancy at that age.

These aren't arguments for or against freezing your eggs — only you and your doctor can decide if that's the right decision for you — but it's important to know going in that it's not a matter of freezing and forgetting.

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 (the number of eggs in your ovaries) and healthier eggs. Having your fertility hormones tested can tell you a lot about the state of your ovarian reserve and help you decide, with the input of your doctor, if egg freezing is right for you. That said, egg freezing is not recommended for people over age 38.

There's a lot that goes into egg freezing, before you even get to the part where the eggs are actually frozen. First, you'll have blood drawn to evaluate your ovarian reserve and screen for infectious diseases. You might also have an ultrasound done to see what's up with your overall ovarian function. Then you'll take synthetic hormones that stimulate your ovaries to grow a cohort of follicles (the fluid-filled sacs that house and protect your eggs) and, at the same time, medicine to prevent you from ovulating before egg retrieval (sometimes called "egg harvesting").

After an ultrasound has confirmed your follicles are ready for egg retrieval, you'll give yourself injectable human chorionic gonadotropin (hCG) to help with egg maturation. The retrieval itself happens in a doctor's office, along with a transvaginal ultrasound aspiration (yes, you can be anesthetized for this procedure). An ultrasound probe is inserted into your vagina to locate the mature follicles. Then your doctor will insert a long, hollow needle through the vaginal canal to the ovaries, then apply suction to remove the eggs one by one.

You can remove multiple eggs at a time, which is ideal since it gives you the best chances of getting a healthy, mature egg that can be fertilized. After the eggs are retrieved (which usually takes under 30 minutes), they're flash frozen in liquid nitrogen as part of a process called vitrification. Vitrification by liquid nitrogen dramatically increases the survival rate of eggs versus older technology, which now goes by “slow freezing.” A 2009 study revealed that eggs frozen via vitrification had a 91% survival rate versus eggs that were frozen slowly (though almost no clinics use slow freezing anymore), which had a 61% survival rate.

Everyone's bodies are different (write this down and put it somewhere you can see it all the time), but experiencing the following symptoms after egg freezing is totally normal and will abate with time:

• Cramping and pain from the egg retrieval procedure

• Mood swings as the result of all those hormones

You might want to proactively schedule time off for the day of egg retrieval, but after the procedure, you'll likely be able to return to work and resume normal activities within a week. Avoid making any life-changing decisions immediately after retrieval (you know, other than the one you just made to freeze your eggs). As a heads up, it's also possible to get pregnant after the procedure since there could be some eggs hanging around that didn't get retrieved, so steer clear of unprotected sex with a partner who has sperm.

The following symptoms are important to watch out for because they could be indications of ovarian hyperstimulation syndrome (OHSS) — a reaction to the fertility medication that promotes ovulation:

• Weight gain

• Bloating

The likelihood that you'll get OHSS, though, is a lot lower than it used to be — thanks to the establishment of identifying risk factors (polycystic ovary syndrome, for example), measuring anti-Mullerian hormone (AMH) levels prior to using stimulation medications, and individualizing the hormone protocol that preps you for the egg retrieval procedure.

In general, more longitudinal data is needed to really know the long-term effects of the egg freezing process. Because long-term hormone replacement is linked to increased breast cancer risk, the intense amount of hormones used in order to stimulate the ovaries of young egg donors (egg donation involves the same process of egg harvesting) could potentially increase their risk of breast cancer — but the reality is that, right now, we simply don't know.

Egg freezing could be a way to preserve your current fertility if you have cancer that requires chemotherapy or radiation (both of which could affect your fertility), you need to have surgery that could damage your ovaries, or you have a condition that could do the same. Learning you have a family history of early menopause, Turner's Syndrome (a chromosomal abnormality that comes with a risk of premature ovarian failure), or a genetic mutation (like BRCA, which can predispose one to developing breast and ovarian cancer) and deciding to remove your ovaries might also be good reasons to talk to your doctor about whether or not you're a good candidate for egg freezing.

If you're considering egg freezing, it's good to get acquainted with the costs of the procedure and what your insurance may or may not cover. According to FertilityIQ, the cost of an egg freezing cycle is between $15,000 to $20,000, and don't forget to take into account the cost of egg storage, which can run you up to $1,200 a year depending on where you go (sometimes the first year of storage is free!). Should you decide to pull those eggs out and use them, the costs of IVF vary, but you could be looking at cumulative costs of $40,000-$60,000. Many clinics offer shared risk options and packages, as well as loans and other financing options.

Coverage for fertility treatments like egg freezing varies based on what insurance you have. 19 states do require insurance companies to supply coverage for infertility treatments, but that doesn't mean coverage is free — you're still responsible for copays if you have private insurance. You also have to qualify for coverage, and that means meeting the criteria for infertility: being unable to conceive after one year of timed, unprotected sex if you're under 35, after six months of it if you're over 35, or if you've been unable to carry a pregnancy resulting in a live birth after a year. Be vigilant in investigating details if you live in one of these states (and with insurance in general) as there are nuances in each policy.

First, some 101: Eggs are unfertilized, and embryos are eggs that have been fertilized with sperm. Freezing your eggs offers more options — you don't have to know who's going to fertilize those eggs and you can take some time to figure that out.

Embryo freezing is useful if you have a cis male partner or donor and want to get pregnant via an embryo transfer in an IVF lab later on. It's also possible that you'll end up with more embryos than you might want to use and find yourself confronted with what to do with them: Discard? Donate? Keep them frozen? What happens to those embryos if you end your relationship with the person whose sperm was used?

The same issues apply — how many will survive freezing, how many will result in a successful pregnancy — whether you're dealing with embryos or eggs. So, ultimately, the answer as to what to do is between you, a partner (if you have one), and your care team.

It's easy (and understandable) to feel overwhelmed when making decisions about your fertility, not to mention about your healthcare in general. But there are concrete steps you can take now so you can get an idea of whether or not egg freezing is something you might want to consider. For example, learning about what your AMH levels (which indicate your ovarian reserve) are at right now can help you predict ovarian stimulation — that's when you take hormone medication to generate eggs — or IVF success should you decide to freeze your eggs and use them later.

You're not alone with your questions and concerns around egg freezing or any other aspects of reproductive health. We're here for you.