Fertility doctor answers most common egg freezing questions

Considering freezing your eggs but feel like you want to do some research before seriously moving forward?

A lot of women now have the option to freeze their eggs in order to preserve their fertility so that they can have children later in life.

Egg freezing was considered experimental up until 2012 when the American Society for Reproductive Medicine removed the experimental label after assessing the data and concluding that using frozen eggs had comparable outcomes to using fresh eggs in IVF.

Many employers are starting to cover egg freezing under insurance for their employees as a competitive benefit and women are taking advantage of this expensive procedure to family plan.

Just 6% of large US employers covered egg freezing in 2015 and as of 2021, a fifth of large US employers offer egg freezing benefits.

Because the ability to do planned oocyte cryopreservation (AKA freezing your eggs), has only been around for about 10 years, a lot of women don't know much about what the egg freezing process actually entails or when it makes sense to even take the plunge.

We sat down with Dr. Matrika Johnson, a reproductive endocrinologist and the founding physician at Reproductive Specialists of the Carolinas in Charlotte, North Carolinas, to ask her all our questions about egg freezing.

We covered all the things we'd want to know before deciding to freeze our eggs.

We asked:

What is the best age to freeze your eggs?
What is the most common question you get about egg freezing?
How many eggs should I freeze?
Can fertility testing predict how many eggs I'm able to freeze in one cycle?
What are the steps of the egg freezing process?
What are the common side effects of fertility medications?
Can I have sex during my egg freezing cycle?
How long after the egg retrieval do you get your period again?
How long can my eggs stay frozen after egg freezing?

Here are her answers to our questions.

What is the best age to freeze your eggs?

Surprisingly, we thought that "the sooner, the better", would be the case for age and egg freezing.

However, Dr. Johnson had a great point.

You don't want to freeze your eggs too early because you run the risk of not needing to use them later in life and having gone through a procedure unnecessarily.

But you don't want to wait too long because then your egg quality won't be as good and you're less likely to have success getting pregnant from the eggs you freeze when you're older.

There's a sweet spot.

The short answer is, the best age to freeze your eggs is 34 years old.

Women are considered to be of advanced maternal age when they hit 35.

Fertility starts to significantly to decline after age 35 and as women age, their egg quality diminishes making it more difficult for them to get pregnant.

Many women will decide to start a family in their late 20's or early 30's and have no problem getting pregnant.

But if you're heading into your mid-30's and are not ready to start a family yet, then egg freezing would definitely be something you should speak with a reproductive endocrinologist about, such as Dr. Johnson.

Dr. Johnson recommends women aged 32-36 are at that "sweet spot" for egg freezing.

What is the most common question you get about egg freezing?

The most common question Dr. Johnson gets is around how egg freezing affects fertility down the line.

Some may be concerned that egg freezing might affect their fertility negatively, making it harder for them to conceive naturally or that egg freezing will cause early menopause.

Dr. Johnson assured us that egg freezing does not impact your fertility.

She also adds that freezing your eggs will not cause you to go into early menopause.

When women do an egg freezing cycle, there are only a certain number of eggs available each month that can be frozen. The next month, the ovaries recruit a new set of eggs to develop and usually just one will actually ovulate in a cycle.

Dr. Johnson says of this that she "cannot steal eggs from the future, I can only take what's there."

"I cannot steal eggs from the future, I can only take what's there."

So rest assured, she's not taking you for all you have when you go in to freeze some eggs in case you need them in the future. Women can still get pregnant naturally after egg freezing and may not need to use their frozen eggs, it just depends.

How many eggs should I freeze?

The question of how many eggs a woman should freeze is so dependent on the individual and her unique fertility status and fertility goals.

However, Dr. Johnson says a good rule of thumb is to freeze 10 eggs for each child that you would like to have.

So if you want two children, aim to freeze about 20 eggs.

But your age and ovarian reserve highly affect how many eggs you should freeze.

We broke down the recent research in anther article for you where we list out how many eggs you should freeze based on your age and your AMH levels.

Can fertility testing predict how many eggs I'm able to freeze in one cycle?

The first step to a consultation with a fertility doctor is to get your fertility tested to see if there are any issues you should be aware of and check whether you're in normal ranges for your age.

You can even get at-home kits now to check your fertility levels before even setting foot in a doctor's office. But the test Dr. Johnson focuses on for this question can't be done with an at-home kit.

Dr. Johnson focuses here on the antral follicle count to give her an idea of how many eggs you're likely to get out of an egg freezing cycle.

An antral follicle count is done by ultrasound and counts the number of follicles your ovaries have at the start of your cycle. Each follicle contains an egg.

Your antral follicle count +/- 4 will be the number of eggs you can expect to freeze in one egg freezing cycle.

For example, Dr. Johnson explains, "So, if we see 10 eggs , we might only retrieve 6, or if we see 10 eggs, we might retrieve 14".

But she also stresses that on top of how many eggs you retrieve, the number of eggs that are mature is what's important.

"We can only freeze mature eggs", Dr. Johnson notes.

What are the steps of the egg freezing process?

The egg freezing process takes about two weeks from start to finish.

The egg freezing process takes about 2 weeks.

You can check out the step by step timeline of the egg freezing process here.

You will start by having an ultrasound and blood work appointment where your doctor will clear you to start your egg freezing cycle.

From there, you will take injectable fertility medications for about 10-14 days. These medications encourage your ovaries to grow as many follicles as possible to maximize the number of eggs you can freeze in the cycle.

During this time, you will go in for monitoring appointments at the clinic where your doctor will check the progress of your follicle growth.

Once your follicles are large enough, you will take one final shot known as the trigger shot. This shot causes your eggs to mature and begin the process of ovulation.

Your egg retrieval takes place 36 hours after your trigger shot, which is usually administered at night.

"So, if you take your trigger injection at 9PM on Monday, your retrieval will definitely be at 9AM on Wednesday", Dr. Johnson explains.

After your eggs are retrieved, your eggs are frozen on the same day.

An embryologist will count how many eggs you got, how many eggs were mature, and will then prepare and freeze the mature eggs.

What are the common side effects of fertility medications?

Those medications you're injecting for two weeks for your egg retrieval, they're hormones.

And having excess hormones can cause some side-effects in women that are similar to premenstrual symptoms that you may get around your period.

Common side effects of fertility medications for egg freezing are:

headaches
breast tenderness
mood changes
changes in vaginal discharge
changes in sex drive

Then the egg retrieval itself usually has some symptoms as well.

Many women experience post-egg retrieval:

constipation
bloating
weight gain

The weight gain is most likely water weight, as your body is holding a lot of excess fluid in your ovaries than normal, due to a high number of eggs developing all at once.

Dr. Johnson says "it does take about 7 to 10 days for all those things to go away and for your favorite jeans to fit again".

Can I have sex during my egg freezing cycle?

Yes and no.

Dr. Johnson suggests that you may want to avoid sexual intercourse while you're taking fertility medications simply because you may experience more discomfort than normal, as your ovaries will be much larger in size than they normally are.

She notes, "Your ovaries are usually the size of an almond, and when you're gong through stimulation, they can get on the upwards size of an orange or even a grapefruit and so, you can feel that and it just might not be comfortable".

But if it doesn't bother you, there's no other reason not to abstain.

However, Dr. Johnson strongly recommends against sex right after your egg retrieval.

During an egg retrieval, your doctor will try to retrieve all of the eggs from your ovaries. But there are cases where eggs are released from the ovary that aren't retrieved and Dr. Johnson warns that, "people have gotten pregnant after retrievals before".

How long after the egg retrieval do you get your period again?

Remember when we talked about the trigger injection? The final shot you take that matures your eggs and you have your egg retrieval 36 hours later?

When your period will come again after an egg freezing cycle depends on the type of trigger injection you use.

When your period will come based on trigger shot type

Lurpon-only trigger: Period will come 7 days after your trigger injection
Dual trigger: Period will come 7-10 days after your trigger injection
hCG-only trigger: Period will come 7-10 days after your trigger injection

Dr. Johnson also notes that, "after that, your menstrual cycles are going to go back to being completely normal again".

How long can my eggs stay frozen after egg freezing?

If you're going to go through all that work to preserve your fertility, you probably want to make sure that your eggs will still be viable by the time you're ready to get pregnant.

Although egg freezing has not been a common practice for too long, frozen egg storage thus far has had a great track record.

"There's no shelf life, there's no use-by date", assures Dr. Johnson.

We don't know exactly how long eggs can stay frozen, as we haven't yet reached that threshold with egg storage thus far.

Dr. Johnson says that so far, the longest she's seen where frozen eggs were later used and resulted in a live birth of a baby, were eggs that had been frozen for 10 years.

After mentioning that we are only just coming up on 10 years of egg freezing since the experimental label has been removed, Dr. Johnson concludes, "I think that at this point, we don't have a use-by date".

Read next: How low AMH affects egg freezing