Egg freezing
Age is the single most important factor affecting fertility for people with female reproductive organs. In people ages 30 to 35, there is a gradual decline in the ability to become pregnant. After age 40, there is a sharp decline in conception and an increase in complications, making it difficult for a person to conceive. Egg freezing can help preserve future fertility and family-building options.
Getting started is simple. The first step is to schedule an egg freezing consult in which you will also schedule ovarian reserve testing. At your consult, you and your physician will review your current fertility and if egg freezing is a good option for you, right now.
Common indicators for egg freezing
Biology aside, the best time to have a baby is an incredibly personal decision and one that takes significant thought and consideration. As part of this decision-making process, you may choose to freeze your eggs for the following reasons:
Timing
Education, career, travel, the right partner — these are all reasons people are choosing to postpone parenthood.
Future family planning
You may already have a child, but you know that by the time you’re ready for more, you may be older and your ovarian reserve (egg supply) may be affected. By freezing when you’re in your early- to mid-30s, your fertility at that point in time will be preserved for the future.
Uncertainty
Some people are getting to that age when people are asking about kids but may not know if they want children. Egg freezing allows for the possibility of family building later.
Known medical conditions
Certain medical conditions may impair your ability to have children: endometriosis, family history of premature ovarian failure, or treatment for cancer, to name a few.
Basics
People with female reproductive organs are born with two ovaries, each containing resting eggs or follicles. At 20 weeks gestation, you have about 6 million eggs, which is the largest amount of eggs you will ever have in your lifetime. At birth, you will lose approximately half of your eggs, and by the time you reach puberty, you will only have about 200,000 eggs left. As you age, your egg quantity will continue to decrease, and the quality will as well. Understandably, diminished egg quality and quantity can significantly impact your ability to conceive.
Egg freezing by vitrification
Egg freezing represents a way to suspend your fertility in time, preventing the decrease in quality and quantity that inevitably comes with age. You will, of course, still continue to age. But the eggs that you freeze will stay suspended in time at the quality you possessed at the time of the freeze.
Vitrification, or flash-freezing, is a very efficient and effective method of freezing your eggs that demonstrates strong survival, fertilization, and embryonic development rates after your frozen eggs have been thawed. By applying this newer technology, Shady Grove Fertility has seen a sharp increase in survival rates of the eggs after thaw. Pregnancy rates have also been reassuring. This technology is instrumental in helping you freeze enough mature eggs now, so that when you are ready to use them, you will have multiple opportunities to become pregnant in the event that a cycle is unsuccessful.
When to freeze your eggs
On average, the most optimal time to freeze is in your early to mid-30s while your fertility potential is still near its peak. However, at our practice, you can freeze your eggs between the ages of 30 and 40. It’s about finding a balance. Some people may need to freeze younger, while others have more time. This is dependent on medical history and ovarian reserve function.
The reason these age guidelines exist is due to female fertility’s age-based decline. In your early 20s, fertility begins to decline, but conception rates remain high into the 30s. By your mid-30s, this decline accelerates to reach minimal pregnancy potential. In addition, women in their late 30s and early 40s have an increased risk of age-dependent changes in egg quality, sometimes resulting in miscarriage and/or genetic abnormalities in their children.
Process
Number of eggs to freeze
Human reproduction is quite inefficient—many are surprised to learn that the chance of conception each month is only around 10 to 20 percent, depending on age. As a result, the average couple takes 5 to 7 months to conceive naturally.
At the beginning of each cycle, several follicles containing an egg are present, with only one that will develop, mature, and release through ovulation. The remaining eggs die off and are no longer available for conception. Not every egg will result in a pregnancy when couples try to conceive on their own, and the same truth applies when you freeze your eggs.
Thus, we recommend that people 37 or younger who have excellent ovarian function freeze between 15 to 20 mature eggs. For people over 38, or who have a diminished ovarian function regardless of age, we recommend freezing 25 to 30 eggs. This provides you with multiple attempts to conceive if a cycle is unsuccessful.
Egg freezing cycle timeline
After you complete ovarian reserve testing, attend the physician consultation, and decide to move forward with egg freezing, you will work with your physician and nursing team to determine a timeline of when to start an egg freezing cycle. On average, the entire process takes 1 month, but the most time-intensive portion lasts for only 10 to 12 days. The cycle is comprised of five main steps:
Birth control (2 to 3 weeks)
We use birth control pills to initiate your cycle and help follicles grow at the same rate. We may also use birth control pills to manipulate your cycle based on when you want your egg retrieval to take place. Upon selecting a retrieval week, we can work backward to select a start date.
Cycle day 1 (10 to 12 days; 6 to 9 monitoring appointments)
Upon the start of your menstrual cycle, you will initiate daily injectable medications. The medications are higher doses of hormones that replicate the natural hormones your body produces to mature one egg. Our goal is to stimulate a larger number of eggs (than what your body would do naturally) in order to freeze. During this time, you will come to Shady Grove Fertility for regular monitoring appointments—which include bloodwork and ultrasound—to ensure follicles are growing appropriately and to change medication dosages, if necessary.
Trigger injection
At the end of the stimulation period, you will get a trigger injection. This injection helps the eggs mature and signals the body to release the eggs.
Egg retrieval
Two days following the trigger injection, you will go to one of our three ambulatory surgery centers for your egg retrieval. This transvaginal procedure takes a total of 20 to 25 minutes while you are under anesthesia.
Recovery will take about 30 minutes and you will be able to walk out on your own. It’s important that a responsible adult drive you home after the procedure, as it is unsafe to drive after receiving anesthesia. The person who is driving you will need to stay at our center during your procedure—he or she should anticipate being at our center for approximately 3 hours in total.
Freezing the retrieved eggs
Once your eggs are retrieved, embryologists in the laboratory evaluate the eggs to determine which ones are mature. We will then freeze these eggs using vitrification, or fast-freeze technology, and store them in liquid nitrogen. We will contact you the following day to let you know how many of your eggs we were able to freeze. Two weeks later, you can expect to have your period.
Success rates
Of the people who have pursued egg freezing, a limited number have returned to use their eggs to date making success rates using frozen eggs difficult to find. Shady Grove Fertility is one of the only fertility centers in the U.S. with published egg freezing pregnancy data.
New data
In a published study, Shady Grove Fertility assessed the performance of 1,171 egg freezing cycles for 875 women. At the time of the study, 117 of these women had returned to undergo 128 egg thaw cycles, using a total of 1,283 frozen eggs.
The results from these 128 egg thaw cycles included 51 viable pregnancies, resulting in 55 children and 8 more on the way at the time of the study (12 of the pregnancies were twins). In addition, 62 good quality blastocysts remain in storage from these warming cycles for future attempts.
70 to 80 percent chance of taking home a baby
For women younger than 38, we recommend freezing 15 to 20 mature eggs, which is estimated to provide her with a 70 to 80 percent chance of at least one live birth. For women 38 to 40 years old, we recommend freezing 25 to 30 mature eggs, giving them a 65 to 75 percent chance of at least one live birth.
Probability of taking home more than one child
Women 37 and under who freeze 15 to 20 mature eggs have up to 50 percent chance of having two children, and up to a 20 percent chance of having three children. Women 38 to 40 years old who freeze 25 to 30 mature eggs have up to 40 percent chance of having two children, and a 15 percent chance of having three children. And women 41 to 42 years old with 25 to 30 mature eggs frozen have up to 17 percent chance of two children, and a 4 percent chance of three children.
Egg freezing costs
There are a range of options available for individuals looking to freeze their eggs, including single cycle packages and multi-cycle plans. Financing is available for easy monthly payments.
Using your eggs
The first step to using frozen eggs would be to schedule an appointment with you Shady Grove Fertility physician to discuss your course of treatment, timeline, and how many eggs to thaw. If you return with a male partner, they would need to also attend the consultation.
Should you not have a partner but are ready to use your frozen eggs to have a baby, donor sperm is an option. In this case, you would need to schedule an appointment with your physician as well as a social worker to discuss the emotional aspects of using a donor. SGF works with several certified sperm banks where you are able to select a donor. Following your consultation, both you and your partner (if applicable) would need to complete basic diagnostic testing. While we have the eggs, we also need to evaluate your uterus, Fallopian tubes, as well as your partner’s sperm count and quality. Should you be using donor sperm, you would only need to complete the female fertility evaluation.
Fertilization
When you are ready to use your frozen eggs, either some or all of your eggs will be thawed and then fertilized using Intracytoplasmic sperm injection (ICSI). ICSI is necessary as the coating that surrounds the egg is hardened when it’s frozen. Therefore, we need to select a single sperm and inject it into the egg in order for it to fertilize.
Embryo transfer
Prior to thawing the eggs, you will be given estrogen to thicken the endometrial lining–preparing your uterus for the embryo to implant and grow. When the lining is thick, you start progesterone and we time it to in relation to when the eggs are thawed and fertilized. After you have been on progesterone we transfer the embryo inside the uterus.
The embryo transfer is a simple procedure that takes about 5 minutes to complete. There is no anesthesia or recovery time needed following an embryo transfer.
