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Egg Freezing: Managing Expectations with Informed Decisions

Jessica Joseph, RN, BSN, MHA
March 25, 2023
Group of fertile young women sitting on outdoor stairs
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Prevailing wisdom claims that the biological clock should dictate when women should have children. Women under duress feel a sense of urgency to have children by a certain age.  Egg freezing is an option for women who are not ready to have children but want assurance that delaying the process may not impede their chances of getting pregnant.


Guided Fertility™ interviewed fertility specialist Joshua U. Klein, MD, FACOG, for his professional standpoints.  Dr. Klein is an assistant professor of OB/GYN and Reproductive Science at Icahn School of Medicine, Mt. Sinai, a leading expert in egg freezing, and co-founder of Extend Fertility in Manhattan, New York.  


What age range should women freeze their eggs in?

Ideally, women should consider egg freezing in their 20s to mid-30s. However, ovarian reserve testing varies considerably between individuals, and most fertility doctors will make recommendations on a case-by-case basis. Ovarian reserve testing may include the hormones AMH, FSH, and antral follicle count, which is the number of follicles containing eggs visible on a pelvic sonogram at the beginning of your menstrual cycle.  Typically, these hormone levels and follicle count decrease with age, decreasing the sensitivity and response to fertility medications, and indirectly, the chances of getting pregnant in women in their mid-late 30s or older.


Is there a recommended number of eggs that should be frozen?

The appropriate number of eggs women should freeze is based on two main factors:

  1. How many children do women want to have later in life

  2. The current age of the woman, which is correlated with the health of the eggs we are freezing


For women in their mid-30s or younger, freezing at least 10-15 eggs should result in a >50% chance of at least one baby resulting from those eggs. For women in their late 30s or older, it would be ideal to freeze 20 or more eggs in order to have a high chance of success when thawing and fertilizing those eggs.


Managing expectations is important, and fertility centers customize treatment based on the woman’s family-building goals and test results.


What are pregnancy success rates using frozen eggs?

First, women should realize that undergoing egg freezing does not guarantee they will have children later but may increase their chances.  These chances are further amplified if a woman focuses on freezing her eggs at an opportune time, such as in her 20s and early 30s, as egg quality and quantity are better in this age range. Live birth rates are greater when women freeze their eggs under age 38. Other factors that need to be considered for pregnancy success are sperm quality used for insemination, hormone levels, and uterine lining thickness at the time of embryo transfer.

Ultimately, for women who freeze a good number of eggs at a younger age, the success rates of freezing are excellent. For women who freeze a smaller number of eggs at an older age, the chance of success will be quite limited.


How is the egg-freezing procedure performed?

Egg freezing involves taking a short course (approximately 8-12 days) of injectable hormone medications, which are given to stimulate the ovaries for multiple egg production. Once the eggs are mature enough, based on follicle sizes and hormone levels, instructions are given to take a trigger medication to induce ovulation. A scheduled egg retrieval will be performed based on the timing of the trigger medication. Women can expect to find out how many eggs were retrieved and frozen within 24 hours of their procedure being completed.


Are there risks involved with egg freezing?

Undergoing any procedure involves risks.  However, egg-freezing risks are minimal since no incision is involved, and mild sedation (anesthesia) is used. Women typically recuperate well after the procedure.


The side effects of being on injectable hormones can include ovarian hyperstimulation syndrome (OHSS), when the ovaries become filled with fluid resulting in abdominal distention, nausea, and weight gain. Fertility clinics monitor closely for this and can tailor treatment to minimize risk and decrease symptoms.


A rare side effect is ovarian torsion, in which the ovaries can twist and rotate. The ovaries' blood supply can be cut off due to decreased venous return, resulting in pain. Not all women are at risk for this, and those that might be are advised to limit vigorous activity during the short course of treatment.



Who are candidates for egg freezing?

Generally, any woman of reproductive age and has not yet reached menopause can freeze eggs electively. However, women in their late 30s or older may not respond as well and may have to do multiple cycles to have enough eggs to increase the chances of a future pregnancy.


Some women need to freeze their eggs for medical reasons, such as cancer patients who are about to undergo chemotherapy or radiation. Women with progressive chronic diseases like lupus or sickle cell anemia may also choose to do egg freezing while young.  Women without a uterus, surgically removed via hysterectomy, or born without a uterus, can also consider egg-freezing.  

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