Everything You’ve Wanted to Ask About Egg-Freezing, Answered

It’s the topic that’s started to infiltrate your group chats, to dominate your girls nights and TikTok For You pages: egg-freezing. As you creep into your late 20s and 30s, the process of preserving your eggs and family planning becomes more and more prevalent — but no less mind-boggling. In November, NYLON Editor-in-Chief Lauren McCarthy moderated a panel discussion with Spring Fertility’s Dr. Kolbe Hancock and By Dria founder Dria Murphy, a former patient of the clinic, to answer every question attendees had about the process. Here, we’re bringing it online, with a breakdown of the most burning questions and biggest takeaways.

What is the biggest question that you, as a doctor, get about egg-freezing?

There’s two questions that I get. One is “If I freeze my eggs now, is it going to change my fertility in any way in the future?” And the short answer is no. Then the other question is “I’ve been on birth control for ‘X’ number of years, is that going to impact my fertility and how does it impact the egg-freezing process?” Those are the main two big things. And so for the first one, absolutely not. And the way to kind of understand that is to learn a little bit about the process. You’re born with a whole bunch of eggs. Each month, your body actually releases a whole pool of eggs, and that could be anywhere from five to 20 eggs, but then you actually just ovulate one. And so let’s say your ovaries released 15 eggs, you would ovulate one and then the other 14 actually just disintegrate and completely die off, and they don’t go back into your reserve to be ovulated another month.

Your body’s actually wasting all these eggs each month, so that you only ovulate one in an effort to protect you from being an octomom, right? When we do egg-freezing or IVF, what we’re actually doing is just giving you a little bit of extra medication to support the growth. There’s no change to your egg count; there’s no change to your egg reserve, no change to your AMH [Anti-Müllerian hormone], no change to your ability to get pregnant in the future naturally. No change to your ability to do in vitro fertilization (IVF) in the future. And you don’t have to use the eggs, because you’ll just continue on ovulating that same pattern every single month. For a lot of people, the eggs ultimately become like a backup or for baby No. 2, or if they end up running into an infertility diagnosis where they need IVF. And instead of doing IVF when you find out that you need it at 39, you actually just come back and use your eggs that you froze earlier, and the efficiency of your IVF cycle is what it would be when you were at the age that you froze your eggs. So it definitely doesn’t change fertility or ability to get pregnant or your ability to do IVF in the future.

And what about any impact of prior or current birth control on the process?

For all forms of contraception, except for getting your tubes tied, it doesn’t change your fertility. ... Your body’s still releasing the eggs, but the birth control pill just prevents the ovulation signal. Theoretically, when you stop taking the birth control pill, your brain should pick right back up and start ovulating. And then the IUD is so easy. You just keep your IUD in the whole time; we don’t have to take it out. It doesn’t impact the egg-freezing process, doesn’t impact the amount of medications you need, doesn’t impact the egg retrieval; it just stays in and does its thing because it’s in the uterus, so we’re going out to each side to the ovaries.

How long does the process take? Is it all within one menstrual cycle?

Yes, because we’re replacing one menstrual cycle. Usually, you start right before you get your period, and then you take injections for about 10 to 12 nights. You come in maybe five times during that time period. And then Day 12 to 14, you have the egg collection, which is midcycle. The egg collection is the equivalent of your ovulation because the eggs are coming out, and then you get a period about 10 days after the egg collection. It’s like a 26-day process, just shy of a menstrual cycle.

Do most women only need one round?

It depends on your count. AMH levels determine how many eggs we’re going to be able to get. We can use ultrasound and blood work to assess how many eggs do we think are left in the ovaries. That is less of a fertility marker, more so [it] tells us if we’re going to do a treatment cycle, how many eggs do we think we’re going to get.

The way your ovaries work is if your reserve is low, appropriately, your ovaries each month are like, “Oh, we don’t have that many eggs left. We don’t want to waste too many. We don’t want to use up too many, so let’s just offer up, like, five eggs each month.” And so for that person, no matter how much medication we give them, if there’s only five eggs available, that’s the max in terms of the number of eggs that we’re able to retrieve. If somebody has a high reserve, their ovaries give out more eggs, there’s more available to grow. And so when we’re checking your AMH and the egg count and the ultrasound, we’re actually getting an assessment — “Hey, we think you can get five eggs or 10 eggs or 25 eggs” — and so that’s what predicts how many you’re able to get. And then from there, we can sort of calculate based on your age and the number of eggs what’s the likelihood of a pregnancy from these eggs based on the number and your age. So it really depends on how many you can get in a cycle and what your goals are.

You hear age 35 as kind of this buzzy number for fertility decline — is there truth in that?

So this goes back to a little bit of biology. Remember I said you’re born with all these eggs and then they’re stored in your ovary for years and years? Well, that’s really unique. All the other cells in your body — your organs, your blood, your skin — the old cells get turned over and new cells get made to replace them all the time. So it’s really unique that you have all these egg cells that are there for so many years, and at 35 is when they start to accumulate damage and they end up basically making mistakes with the chromosomes that make the eggs nonviable. But when you are ovulating, if you’re trying to get pregnant, your body doesn’t know which is the good one and which are the ones that have the chromosome errors. It just ovulates an egg randomly each month, and so that’s why we see things change at 35, and it’s not a cliff. It does not drop dramatically, I promise. It’s a very gradual change, but it does [change]; the rate of change starts to increase after 35.

If we had a magic wand, I would love for everyone to be able to do their egg-freezing cycle ideally at some point before 35. But between 35 and 45, you’re thinking about doing IVF or egg-freezing, we absolutely can do it. It’s just not as efficient as if you had done it earlier. So it’s still doable, but that’s a scenario where you might be doing more than one cycle because it’s not quite as efficient. We’re not getting as many eggs and fewer of them are going to be able to become viable embryos. So that’s why it changes; not that you can’t do it after 35 or all is lost, it’s just that it’s ideal to do it earlier because it’s more efficient.

Can you briefly describe the actual process, and what it entails for a patient?

So once we’re all set up, you come in, [and] you do an ultrasound. We say, “OK, ovaries look good. There’s no cysts; there’s nothing that we need to alter the schedule.” That night, you start injections. One is in a pen that’s fairly user-friendly. It’s actually the same delivery pen as an insulin pen, so it’s manageable, easy to use. The other one that you use, you do have to mix, and that one’s a little bit more tricky. And then third medication also requires a little bit of mixing.

You do injections at the same time every day for about 10 to 12 nights. It requires you to come in usually about five times for ultrasound and bloodwork in the mornings, so fairly frequently. At our clinic, we’re a private practice, so you see your own doctor for all your ultrasounds. Once the eggs get to a certain size, we know you’re ready for the final injection called the trigger, which is timed at a specific time in the evening, and then 36 hours later, we do the extraction.

On the day of the retrieval, we give you the same anesthesia that you get for a colonoscopy, so you’re totally asleep; you don’t feel anything; you don’t remember anything. The procedure’s transvaginal, so there’s no incisions or anything. We see on ultrasound all the eggs in the ovary, we basically drain each little pocket that has an egg in it. And then in terms of recovery, you’re pretty crampy for two or three days afterward. By Day Four or Five, the pain is going down, and you’re just sort of bloated, and then by about a week out, you’re feeling back to yourself.

How do the injections affect your hormones?

The injections that you’re taking are actually just extra of the signal hormones, so instead of one growing, all [of] them grow, so you’re actually not taking hormones as you think of a birth-control pill. You’re not taking estrogen and progesterone; you’re just taking more of this signal. And so what we’re measuring of your hormones during the cycle is your estrogen, which is your body’s own bioidentical estrogen made by your own eggs, and the level that your estrogen goes to is about the same as what it is in the first trimester or pregnancy. So it’s like your own estrogen, it’s a level your body’s meant to be able to handle, and so most people feel OK.

You feel emotionally OK during the cycle. You’re tired, so that can make you a little bit on edge and grouchy. After the eggs come out, your estrogen is up here, and it comes down really fast, and that actually I find is the part where people feel emotionally the worst because you’re exhausted after those two weeks. After the retrieval, you want to make sure you have your tribe, your friends, people who are going to support you.

What is the average price for one cycle of egg-freezing?

It's about $10,000 for the cycle, and then somewhere between $2,000 to $5,000 for the medication, depending on how much medication you need. And I would say certainly before you come in or in the very beginning of the process, go to your [insurance] benefits and look carefully at your them because a lot of people have fertility benefits. Then storage is about $1,000 a year.

How long can you keep the viable eggs that were retrieved frozen?

As long as you want. There’s no benefit if you use them next month or in 15 years. There’s no difference in terms of the outcome.

This discussion has been edited and condensed for clarity.