Credit: Google Images [1, 2]

Egg Freezing Guide

I finally froze my eggs after years of debating and seeing other friends go through the process. All in all, it was a rather easy and successful process. Here, I share my experiences and all the details I learned to help others make this important decision for themselves. My experiences are specific to the RMA clinic in San Francisco (which I highly recommend) and limited to the technology and financing instruments available in 2021.

Table of Contents:

1. Whether/when to freeze eggs?

You’ve probably heard the numbers. At age 35, women start declining in reproductive capacity. For those of us who are not ready to have kids by then, egg freezing is increasingly becoming a viable option.

  1. IVF and embryo selection technology is getting better and better every year. However, what does not get better are my eggs themselves. In order to take advantage of new advances, it’s better to freeze my eggs while I’m younger for both the egg’s health and that the procedure would be less taxing on my body.
  2. Stem cell technology might one day be useful for my own health in the future. That’s why I saved my bone marrow with Forever Labs. Might as well save my eggs too.

How many eggs to save?

The numbers hugely depend on your goals and number of follicles you have. We reduce in follicles as we age (average 15 follicles before 35 years old). Perhaps 50–70% of those follicles will produce mature eggs, then ~70% of them will fertilize, ~45–50% grow to a blastocyst, some percent will be chromosomally normal. You are now looking at only 2–3 embryos for one baby (see estimate tool).

2. Choosing a Provider

The IVF market is booming and every few months there’s a new private provider for IVF and egg freezing. Many of my friends who did egg freezing years ago went to UCSF, but there are all kinds of smaller fertility clinics. I was recommended places like Spring Fertility and Laurel Fertility Care. I ended up going with RMA due to two factors: their amazing scores on FertilityIQ and that I was able to book an appointment the following week instead of waiting 3 months (as UCSF and Spring Fertility tried to offer me).

  1. Staff consistency and communication: while you will be assigned to a primary doctor, the intermediate visits to monitor your egg development are often done by different doctors or nurses. Working with a smaller clinic might have more consistency and communication between staff. You can get a peek of how different clinics work via FertilityIQ.
  2. Trust: As humans we are swayed by our emotions. If a doctor or clinic doesn’t feel quite right, it may influence your trust in the procedure. I found FertilityIQ reviews very helpful to gain more trust in the doctors I was working with. It calmed my anxiety and made me feel like I was taken care of.

3. Cost Breakdown

Clinics can charge anywhere between $5,000–10,000 for the procedure, then $2,000–5,000 for drugs (dosing and length of injections varies depending on how you respond), and $600/year for storage. Most clinics will have a discount (~10%) to do subsequent procedures, but the drugs will cost the same.

¹ RMA uses a third party for anesthesia, so the cost is billed separately. Most other places will include anesthesia into the procedure price. ² On the website, it says lab consultation is $400. I think it was an estimate as mine came out to be lower for the particular tests they ordered.

Insurance

As egg freezing is considered an elective procedure, I had to pay all of this out of pocket. There are insurances that cover egg freezing, such as Progeny, but often they must be provided as a benefit from your company. If you undergo the procedure as a part of IVF, most insurance will have some form of coverage. RMA worked with my insurance and was able to bill some parts of the labs and anesthesia through my insurance provider. This at least counted towards my deductible for the year.

Storage

At RMA, retrieved eggs are stored in liquid nitrogen tanks that are constantly monitored and refilled. Some people decide to split up the eggs into two different facilities to mitigate any accidents (which is unlikely but can happen). RMA recommended Reprotech in Nevada. Personally, I decided not to do a backup because freezing eggs was already my backup plan, and I wouldn’t be heartbroken on the very slim chance that the backup failed. For those who see their eggs as a lifeline, it might be a good idea to split the storage.

4. The Appointments

Part of the reason I chose RMA as my provider was because they were able to schedule a consultation appointment a week from when I first called them. Other providers I had inquired from only had appointments in 3 months.

Consultation Appointment

My initial consultation was about 1.5 hours where the nurse practitioner patiently went over every aspect of the procedure and answered all my questions. She asked for my medical history and family’s medical history.

When to Start

The doctor will instruct when in your cycle to start. Usually it’s after the 3rd day of your period. For some people, birth control pills are needed to sync your cycle more precisely. I have a hormonal IUD and it actually made it easier. As long as the follicles were in a resting state, I was able to start immediately. (See FAQ: Egg freezing with IUD?).

Monitoring Appointments

Ultrasound monitoring of my eggs. Retrieval happens when the majority of eggs reach 15–22 mm in size.

5. The Drugs

So, what are the shots and what do they do?

Credit: Google Images
Credit: Google Images
Credit: Google Images
Credit: Google Images

6. The Surgery

Throughout the process, I had been limiting my activity, partly to avoid catching COVID and to avoid ovarian torsion. The last two days before my surgery, I was feeling some pressure from my ovaries and it was cramping when I stood or sat up. Luckily it was the weekend, so I gave myself the excuse to lay down and watch movies.

7. FAQ: Egg freezing with IUD?

Yes! The whole procedure can be done without removing your IUD. It’s actually easier to start with a hormonal IUD because you don’t have to sync up your cycle. The doctors can tell by blood tests and ultrasound when it’s good to start. Because the doctor uses a syringe to pierce into the ovaries from the side wall of the vagina to extract the eggs, there is no disruption to the uterus and any contents within.

8. FAQ: What are the biggest risks and how to prevent them?

There are 3 major risks (all of which happen very rarely):

  1. Ovarian Hyperstimulation Syndrome — this can happen after the egg extraction when fluid fills into the empty follicles and leaks into the abdomen. This often is experienced as cramping and bloating. In extreme cases, surgery will be needed to drain the follicles of fluid. If you are at high risk of OHSS, your doctor may prescribe Lupron as the trigger shot, which does not have the side effect of OHSS.
  2. Anesthesia — there are always risks when undergoing anesthesia. The procedure knocks you out for only 30 minutes, but allergies and other side effects can happen.

9. FAQ: Lupron & Ovarian Hyperstimulation Syndrome

I had a very high AMH number, so my doctors told me that I would for sure get OHSS. It was one of the reasons why I delayed my egg freezing. My doctor recommended Lupron, an agonist to the traditional trigger shot, which avoids OHSS. I’m not sure what other factors are involved for the doctor to prescribe Lupron over traditional trigger shots. I had no side effects from Lupron that I know of.

10. FAQ: Does egg extraction reduce the number of eggs left in me?

I got asked this question a lot by friends and family. We all heard that women are born with all the eggs she will every have and every month that reservoir is depleted. The misconception though is that we think only one egg is depleted each month, when in fact it’s more than that. You have about 8–15 follicles across both ovaries and every month, all those follicles start developing eggs. At one point, your body will decide to mature one of them to release into the fallopian tubes. This is probably the body’s mechanism to create redundancy since the egg maturing process is so delicate and important (similar to how millions of sperm are created and then compete for the best one). The remaining eggs during that cycle die off. So every month, you actually use up 8–15 eggs. The egg freezing process simply matures all those follicles and extracts all the eggs that would have died anyways.

11. Miscellaneous Tips

Alto Pharmacy is amazing for getting prescriptions delivered same-day. The app and billing are super easy to use, and especially if you are feeling bloated, it saves you a trip to the drugstore.

IndieBio | Chief Science Officer & Partner