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What does it take to freeze your eggs, and how well does it work?
After U.S. Rep. Alexandria Ocasio-Cortez, D-N.Y., publicly announced her plan to freeze her eggs, 32-year-old Lorenza Zebell got a text from a friend.
“All the cool kids are doing it,” the message said, along with a screenshot of Ocasio-Cortez’ Instagram video about her decision.
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File video above: COVID-19 pandemic causes spike in egg freezing, fertility experts say
Zebell was a few days into her recovery from her own egg retrieval procedure — a step she decided to take after her older sister struggled to get pregnant.
“I know that I want to have kids one day,” Zebell said. But she hadn’t reached a place in her relationship or career where launching into parenthood made sense.
From 2014 to 2021, the number of U.S. women who froze their eggs quadrupled. Yet as few as 5% used them.
What began as an experiment in the 1980s has evolved, especially in the last 15 years, into a popular option for women seeking to balance health, career and relationships alongside parenting goals.
But the procedure’s costs and reliability are still significant hurdles for people who may otherwise be candidates.
This story was originally published by PolitiFact.
Who is a good candidate?
Generally, women between ages 27 and 36, and those who encounter serious illness earlier in their lives, are best positioned to benefit from egg freezing.
Cancer treatments and some conditions, such as endometriosis and certain autoimmune diseases, can harm a woman’s egg supply or ovarian tissue, making egg freezing an option to preserve their future fertility.
What does it cost?
It’s roughly $10,000 per retrieval cycle, doctors said, but can vary regionally. And egg storage is another expense — $500 to $1,000 annually.
Unless egg retrieval is done for a medical reason, most insurers view it as an elective procedure requiring patients to pay out of pocket. Some large companies, such as Google, offer coverage as a benefit, but that practice is not widespread.
Zebell said her employer, a manufacturing company, provided up to $20,000 for fertility treatments, making her choice feel like “a no-brainer.”
Doctors retrieved six eggs during Zebell’s procedure, short of the nine she’d hoped for, so she’s opting for a second cycle. That will likely use up her entire $20,000 benefit.
Why is age relevant?
Whether egg freezing results in a successful pregnancy depends largely on a woman’s age at the time her eggs are harvested.
Every woman is born with a finite number of eggs that declines throughout life. During every ovulation cycle, eggs are lost or die off.
Genetic or health conditions play a role, but generally the younger a woman is, the greater her egg supply. More eggs retrieved means more chances for successful fertilization, healthy embryos and pregnancy.
Egg quality also declines as women age. Eggs are more likely to have chromosomal abnormalities later in a woman’s life, which can lead to fertilization failures, miscarriage or genetic birth defects.
The biggest decline in a woman’s quality egg supply happens between 35 and 40, so fertility experts recommend the late 20s to early 30s as a good window to undergo egg freezing.
Because uterine tissue doesn’t age as quickly as ovaries, women can still carry healthy pregnancies in their 40s and early 50s using younger frozen eggs, although older mothers face increased health risks.
When and how are eggs harvested?
Fertility doctors begin the process by checking a woman’s ovarian reserves and hormone levels. They also provide the patient with counseling, education and many consent forms. This may take several appointments.
Near the beginning of a patient’s menstrual cycle, she will start self-injecting hormonal medications to stimulate the ovaries and cause multiple eggs to mature at once. These daily injections, administered at home, typically last eight to 12 days.
Doctors monitor the patient’s egg maturation every few days using transvaginal ultrasounds. Women also have their blood drawn during this period to measure hormone levels. All this information helps the doctor to change medications as needed.
Zebell said doctor’s appointments during this period were constant, and the hormones left her tired and more emotional than normal.
“It really took over my life for a while,” she said. “I did not have a social life really, because I was exhausted.”
Once enough eggs have matured, patients take medication to trigger their final maturation and release. Thirty-six hours later, doctors begin retrieving eggs during an outpatient procedure that takes about 30 minutes, typically under IV sedation. Using an ultrasound as a guide, a fertility specialist passes a thin needle through the inner wall of a woman’s vaginal canal into both ovaries to collect mature eggs.
Zebell said the procedure itself felt like a blip: “You just go to sleep and then you wake up.”
It’s generally safe, said Dr. Kutluk Oktay, a Yale University professor and expert in fertility preservation.
How are eggs frozen?
Eggs are flash-frozen through a process most clinics adopted 10 to 15 years ago called vitrification, liquid nitrogen immersion that cools eggs to -196 degrees Celsius.
“We typically retrieve anywhere from five to 15 eggs on average, depending on the patient’s age,” said Dr. Paula Amato, a reproductive endocrinologist at Oregon Health and Science University.
Doctors can’t tell just by looking at the retrieved eggs whether they have chromosomal abnormalities or will develop into healthy embryos. Once they are fertilized with sperm, which won’t happen until they are thawed, doctors can conduct such tests.
“You put them in the freezer and you hope for the best,” Dr. Nicole Noyes, a retired reproductive endocrinologist. “That’s why you want a good number of eggs.”
What is the recovery process like?
Women often experience cramping and bloating that can last for a week. Zebell said she was a little surprised by how uncomfortable she was afterwards.
Hormones and egg production enlarge the ovaries, and the sudden change in hormones post-procedure can change how the body retains fluid. For most people these symptoms of ovarian hyperstimulation syndrome are mild and resolve on their own, but in rare cases it can require hospitalization.
Zebell said she took a few days off work after her eggs were harvested because of the intense bloating and cramping. Ocasio-Cortez also posted about her bloating symptoms following retrieval and said she was managing pain with ibuprofen and Tylenol.
What are the chances an egg retrieval will result in live birth?
The length of time eggs are in storage doesn’t affect their quality. Yet many women never use the eggs they freeze — they may get pregnant naturally or with in-vitro fertilization using freshly extracted eggs, or they may choose not to have children.
When they are used, eggs are thawed, fertilized with sperm and grown as embryos in a petri dish for a few days. Not every egg survives this process. One study found about half of the thawed eggs resulted in mature embryos that could be implanted into the woman’s uterus.
The likelihood of having a child from previously frozen eggs is influenced by two factors — age at retrieval and number of eggs frozen. Many clinics offer online calculators to estimate results.
Among women who froze eggs before age 35, data shows success rates as high as 80%.
“There are no guarantees,” Amato said, “but even if ultimately it’s not successful or the eggs aren’t used, most women derive some psychological benefit from having done something proactively.”
Zebell said she feels relief from going through the process. Though it was uncomfortable at times, life is less rushed.
This story was originally published by PolitiFact.
