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.

First of all, egg freezing is a deeply personal decision. It should not be influenced by what your partner wants or whether your friends are doing it.

I had debated for years whether to undergo the procedure and held back because it’s a large chunk of money ($12–15K), comes with potential side effects (see FAQ), and my fertility number (AMH) was still pretty high that I thought I probably could just have a kid naturally.

This year, I finally decided to do it because of a few unusual reasons:

  1. Ideally, I would like to have my first kid naturally in my late 30’s. However, freezing my eggs now would be helpful for a future second kid who I may want in my 40s.
  2. 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.
  3. 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).

I decided to aim for freezing 20 eggs to give me a good chance of having two babies from them. I was preparing to do two cycles if I needed to.

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).

Some other important factors when making a decision:

  1. Location: you will need to visit the clinic (usually early in the morning) 6–8 times during the procedures. You might also experience cramps in which it may be difficult for you to drive. Finding a clinic close to home that you can take a Lyft to is very convenient.
  2. 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.
  3. 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.

Here are my exact costs (yours may vary):

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.

There are options to get your egg freezing paid for by donating half the eggs to a family in need. Programs like Freeze and Share and My Egg Bank can pass on the egg extraction costs to a beneficiary. This was an attractive and altruistic option I considered, however, because I wanted to save 20 eggs, it was unlikely I could donate and have enough from one cycle. I would end up paying for a cycle myself anyways.

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.

Storage costs $600 per year with the first year free. As part of the paperwork, you can decide on what happens to the eggs in case you default on the bills. The options are to throw the eggs away or to donate it to research. You can also assign custody of the eggs to a partner or family member in case of your passing.

Often institutes don’t keep your credit card on file, so definitely mark it in your calendar to pay your bills proactively to prevent your eggs being tossed.

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.

They required a host of blood tests and an ultrasound exam to count the number of follicle and see their state. For banking, they need to verify that I had no STDs. You can submit any tests that were done within the last year, otherwise they would run a test during the consultation appointment.

The tests were:

The consultation appointment was billed separately and cost $269.43 for me. I had some of the tests done recently at my yearly physical and didn’t have to do them again.

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?).

Once you start injections, you can not drink more than one cup of caffeine per day and absolutely no alcohol. They recommend avoiding exposure to chemicals, X-rays, or other medication. To prevent the risk of ovarian torsion, do not engage in intense exercise or intercourse starting on day 5 of injection. Ovarian torsion is when the ovary twists around the surrounding supportive tissue and cuts off blood flow. If this happens, you will feel extremely sharp pain in the abdomen (the crying on the floor type) and will need to immediately go to the Emergency Room for surgery. This is very rare (<0.1% chance).

Monitoring Appointments

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

Every couple of days, you will go in for ultrasound and blood tests (for estrogen and progesterone) to monitor the progression of the follicles developing. The first week will be two shots per night (FSH and Menopur). Then, a third shot will be introduced (Cetrotide) until the follicles reach 15–22 mm in diameter, as monitored by ultrasound. When it is time, the doctor will instruct you to administer the trigger shot (mine was Lupron) exactly 36 hr before the surgery and then another dose 24 hrs before. More about these drugs in the next section (The Drugs).

My schedule looked like this (yours may vary):

5. The Drugs

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

The first week comprises of two drugs to mimic your natural Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH). These hormones normally are made in your body to start the follicle development process. Menopur is a combination of FSH and LH. FSH is then supplemented with another drug that comes in two brands (Gonal F or Follistim). Depending on your bloodwork, you will be assigned specific doses to follow and these doses may be adjusted by your doctor. All injections need to be prepared (some already liquid and others need to be dissolved) by their respective procedures, cleared of air bubbles, and injected 90 degrees into the abdomen.

Credit: Google Images

Gonal F comes as a neat pen where you can dial in the dose. Each pen is about 350 units, so for my dose of 150 units, I would dial in 150 after priming the needle. I would recap the pen and use it the next night. The needle on this was very thin and didn’t hurt at all going in. I would push the button slowly and watch the counter move. I had no problems with this injection.

Credit: Google Images

Menopur comes in powdered vials. Since I needed two vials, I would draw up 1 mL of sterile saline to dissolve one vial, and then transfer all the liquid to dissolve the second vial. The preparation is rather easy once you get the hang of it. I did experience slight discomfort when injecting Menopur. As the liquid is being injected, there is a slight sense of burning. However, it went away as soon as I was done injecting.

Credit: Google Images

After the first week, I was instructed by my doctor to incorporate a third drug while continuing the first two. This was Cetrotide (or Ganirelix, another brand), which is used to prevent ovulation. As your body is getting all the FSH and LH hormones, your estrogen will start to increase to a point where normally ovulation will happen. We want to prevent this, so Cetrotide is used. It keeps all the eggs in place until they get to the right size to be harvested.

I had the most symptoms with this injection. The injection itself went in easy with no pain, but a minute later I would develop a histamine response where my skin would get itchy and red. This lasted for a few hours. The doctor did assure me this is a common side effect for the drug. Additionally, I found the preparation of this to be more challenging than the others. It came as a pre-filled saline syringe that you would use to dissolve the vial of powder. This drug took longer to dissolve than Menopur. The syringe itself also was a bit finicky to work with.

Finally when the eggs are at the desired size, your doctor will give directions to inject the trigger shot precisely 36 hrs before your surgery appointment. This shot is human chorionic gonadotropin (hCG) or Lupron (an agonist of hCG). This mimics a high dose of Luteinizing Hormone, which gets the eggs to mature, but does not cause ovulation. Traditionally, the trigger shot can be Ovidrel, Novarel, or Pregnyl.

Credit: Google Images

My doctor prescribed me Lupron. Lupron is a newer drug used in IVF especially for those at risk of Ovarian Hyperstimulation Syndrome (OHSS) and requires a second dose 24 hrs before surgery. OHSS is higher risk for those with high AMH and can cause fluid to leak into the abdomen after egg retrieval, creating a lot of pressure. In severe cases, the fluid will need to be surgically extracted. If this happens, it will be in the couple of days following surgery. OHSS does not happen with Lupron.

Lupron is provided in liquid form and simply drawn out with the provided syringe to the dose instructed by your doctor. I did not have any issues with administration.

Last note is that it was common for me to have a drop of blood after injection. I would press a tissue paper on my injection site and it would stop bleeding rapidly. I also ended up bruising myself a few times, which is all normal.

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.

On the surgery day, I was to arrive an hour early and have someone pick me up because I would be undergoing general anesthesia. It was also advised that I should take the rest of the day off from work and not make any important decisions that day.

All of my checkup appointments were done in typical primary care type rooms. The surgery was in a completely separate wing that looked more like the ER. I changed into a gown and laid on a hospital bed while the doctor and nurses checked in with me and installed an IV lead into my arm.

When it was my turn, I was led into the operating room, which was rather intimidating as a team of nurses started to strap me into the table. The anesthetist gave me an oxygen tube in my nose and started my IV. I very quickly fell asleep.

And that was it. I woke back up in the hospital bed. I was probably out for 30 minutes. It took me another 20 min to feel well enough to get up.

I experienced more cramping than before the surgery for the next few days. Sometimes the pain was intense, but often did not last long and may be due to my badder pushing on my ovaries. Definitely take the time to rest and drink electrolytes. It is still recommended not to do strenuous activities or exercise until your next period to prevent ovarian torsion. Spotting is also normal.

Not all your eggs will be at the right size for harvesting and not all of them will be mature. On the afternoon of the surgery, the doctor told me the final number of mature eggs that were frozen. And we rejoiced!

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 torsion — this is when the ovary twists on its surrounding tissue and cuts off blood flow. If this happens, you will experience extremely sharp pain and will need to rush to the ER immediately for surgery. Ovarian torsion can be prevented by limiting exercise, including intercourse, starting on the 5th day of injections and through to 2 weeks after the surgery.
  2. 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.
  3. 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.

Other common side effects from the medication may include: menstrual cramps, bloating, anxiety, and moodiness.

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.

If you are afraid of needles, I recommend taking a deep breath in and holding the breath as you inject. It felt very calming for me and also provided the motivation to not back out in that moment.

For abdominal discomfort, I recommend applying a heated pad.

Mark your calendar to pay your annual storage fees! Many institutes don’t do automatic billing and especially if you change addresses, make sure you are on top of paying your bills so that they don’t toss your eggs.

Egg freezing is a deeply personal decision. While it is mostly safe, it does come with some serious potential risks, costly expenses, and discomfort. Results and procedures vary from person to person. Hopefully this guide provided some answers to your questions. Feel free to reach out if you have additional questions.

IndieBio | Chief Science Officer & Partner