The Ins and Outs of Egg Freezing
Written by Alisa Malyavko, MS
With the percentage of female physicians rising over the years, a greater emphasis has been placed on open communication regarding the challenges that women in the medical field face. One of these challenges is balancing medicine with life outside of medicine, specifically, family planning.
As a female, I’ve attended several presentations discussing the “right” time to start a family. What I gathered from these talks is that there is no right time as all levels of medical training are demanding in their own way. However, a common thread of advice that was passed around was preserving fertility via egg freezing.
There are many reasons why someone would want to freeze their eggs. Some women are working on building their careers before having children, other women may be uncertain if they want to have children now but would like to have that option later in life, and others may be suffering from a medical condition that makes it difficult to become pregnant naturally. Whatever your reason is, this process can seem daunting and I’m here to provide some tidbits from my personal experience with egg freezing!
I’m currently in the middle of my medical school journey and turning 28 this year. While 28 may not seem old to some, learning about all the potential fertility complications as women age convinced me that egg freezing was a good option for me at this time.
What is egg freezing?
Egg freezing refers to the process of hormonal stimulation of the ovaries followed by transvaginal retrieval of mature oocytes and subsequent cryopreservation of the oocytes.
Who specializes in egg freezing?
While your OBGYN can provide you with information regarding the process, there are specialized fertility clinics that focus on various fertility treatments ranging from egg freezing to intrauterine insemination (IUI) to in vitro fertilization (IVF). Most fertility clinics have guidelines regarding the maximum age of patients who want to proceed with egg freezing as well as their own recommendations for the number of eggs an individual should freeze. For some women, one cycle may be enough to extract a reasonable number of eggs, however, others may have to undergo several cycles.
What does the process involve?
The process takes approximately 1 month to complete one cycle of egg freezing. You will be working with a team of physicians, nurse practitioners, and administrative staff. The process begins with infectious disease blood work, a baseline blood draw to determine your starting hormone levels, and a baseline ultrasound to ensure there are no structural abnormalities and to determine your ovarian reserve (the number of follicles that could potentially develop via hormonal stimulation). Your care team will start you on an oral birth control pill that you will take for 2-3 weeks to regulate your cycle and prepare your body for further hormonal stimulation. During this time, you will have to complete a lot of paperwork regarding the risks/complications of egg freezing, consent forms, and financial forms. Depending on the fertility clinic, you may be provided with educational videos which help explain the process more thoroughly.
At the end of the pill cycle, you return for another round of bloodwork and ultrasound to determine if you are ready to begin the stimulatory medication. The stimulatory medications consist of daily subcutaneous injectable medications which replicate your body’s natural hormones but at a higher level. You will start out by injecting a follicle-stimulating hormone (FSH) (i.e. Gonal-F) and a combination medication that contains FSH and luteinizing hormone (LH) (i.e. Menopur) which stimulate egg production in the ovaries. After a couple of days, you will add in a gonadotropin-releasing hormone (GnRH)-antagonist (i.e. Cetrotide) which prevents you from ovulating. Some of these medications come in an applicator pen while others you have to mix yourself. Each person has different side effects of the stimulatory medications, however, some of the common side effects are bloating, headaches, injection site rashes, and injection site bruising. Once you start the stimulatory phase, you will be coming into the office for routine bloodwork and ultrasound every couple of days, then every other day, and then every day as you get closer to your retrieval date. The rise in estrogen level and size of follicles are used to determine whether you need to make dosage changes and when your trigger injection will occur.
Thirty-six hours before your retrieval, you will be instructed to administer the “trigger” which may consist of a Leuprolide injection, a GnRH agonist, or a human chorionic gonadotropin (hCG) injection. Both medications promote the completion of egg maturation in preparation for extraction.
What is the egg retrieval procedure?
The egg retrieval procedure is scheduled for 36 hours after your trigger injection. The procedure is performed under general anesthesia using transvaginal ultrasound guidance to identify follicles and guide the needle to the follicles. The egg and fluid within each follicle are aspirated and sent to the embryology lab. The procedure takes approximately 15-25 minutes with a 30-minute recovery period. You are required to have someone come with you to the center and to be responsible for driving you home afterward. Your doctor will let you know how many eggs were retrieved during the procedure and will let you know the number of mature eggs that were able to be cryopreserved the following day.
Some pain and cramping are normal for a couple of days following the procedure. Heat pads and Tylenol are your best friends!
Who pays for egg freezing?
Unfortunately, a lot of the egg-freezing costs are not covered by insurance. Fertility clinics offer different packages depending on if you want a single egg-freezing cycle, multiple egg-freezing cycles, or if you plan to proceed with IVF. In addition to these packages, you will be responsible for paying the anesthesia fee, the medication costs, and the egg storage fee.
Some fertility clinics do offer financial assistance if you are a military member or if you’re a surgical resident. Additionally, I’ve seen some scholarships here and there for medical students interested in egg freezing.
Am I happy with my decision to do this?
Overall, despite the uncomfortable side effects and having to do multiple injections a day for almost two weeks, I’m glad I froze my eggs! It takes some of the pressure off “the ticking clock” and lets me focus my energy on studying and finishing medical school.
