The Egg Freezing Process
If you are thinking about freezing your eggs or preserving your fertility it’s most likely that the first thing you consider is the concept, rather than the practicality.
In this article we describe the egg freezing process at WHM in 6 easy steps:
Why consider egg freezing?
When considering egg freezing, there are three important aspects of egg health - egg number, egg quality and female age.
Female fertility is time and age limited. Human eggs biologically are healthier and more fertile when we are young. Eggs are created very early in female development and are never replenished.
Our chance of being reproductively successful, aka having babies, depends on multifactorial elements, some outside of our control (such as meeting the right partner/deciding on the right sperm source).
Putting healthy young eggs away creates an asset we can turn to later. It’s not a guarantee of having a future live birth as IVF is not always successful. However most women today who freeze a recommended number of eggs at a relatively young age (ideally not too much over the age of 30) will predictably be able to give birth through IVF using their frozen eggs in the future.
You may or may not need the eggs you freeze to conceive in the future. However the future is uncertain and having the asset of frozen eggs can stack the odds of your personal reproductive success in your favour.
I like the idea of freezing my eggs. What do I have to do?
The biggest decision in regards to freezing your eggs is to take the plunge and do it. Research shows women are very open to the concept of egg freezing. A significant barrier is cost. Egg freezing has been labelled as elitist as certainly not everyone can afford to freeze her eggs. This biological get around is a luxury and it can be expensive.
Most women who freeze the ideal number of eggs take two completed treatment cycles to achieve their goals. With today’s costs of treatment, women considering egg freezing should budget 8 to 10,000 Australian dollars to achieve each complete egg freezing treatment cycle, if your treatment is not Medicare eligible.
You may see egg freezing costs advertised by an individual clinic promoted as less than this amount. However, there will always be an “asterix” where this occurs and often necessary costs that are not directly charged by the clinic are excluded from clinic cost estimates (such as pretreatment appointment costs, medication, anaesthetist and hospital admission costs).
This may sound like a lot of money, however let’s break it down. Costs for an egg freezing treatment includes:
Pretreatment planning, specialist appointments and investigation costs.
Pretreatment support, education and counselling
Medication costs for your egg freezing treatment
Comprehensive support and monitoring investigations during treatment over an approximately 3 week period, before, during and after your egg freezing cycle.
Hospital admission for your egg retrieval, where you and your eggs will be cared for by an expert team of doctors, nurses and scientists, before, during and after your egg retrieval.
Advanced laboratory technology and scientific expertise, vitrification and oocyte storage.
Post treatment care and specialist follow up, which may involve planning of a second egg freezing treatment for you.
Deciding to freeze your eggs can be a trade off – foregoing other choices in life requisite on the same limited amount of savings.
I have thought about freezing my eggs. It’s worth it for me. What do I do next?
Reaching out through Women’s Health Melbourne, our first step is to learn more about you and your current health and fertility. There are some categories of patient for whom egg freezing is considered medically indicated. An example is women with endometriosis (which represents 1 in 9 Australian women) or other fertility impacting conditions.
The first step in the egg freezing process is a thorough medical and gynaecological evaluation of your health and circumstances. If you are eligible, Medicare and Pharmaceutical Benefits Scheme support approximately halves the out of pocket costs to freeze your eggs. If you have taken out private health insurance this can help further. Women of reproductive age should be encouraged to consider their fertility needs while researching private health insurance policy options and their associated waiting periods.
1. Fertility assessment
What tests will I be asked to attend in my work up for the egg freezing process?
Your WHM specialist team will ensure several basic facts about you are known, relating to your general health. This includes ordering a full blood count, liver function tests and kidney function tests.
We’ll also do some ovarian function tests. We’ll look at your hormone levels made by your ovary (oestrogen, progesterone, AMH (anti-Mullerian hormone). We’ll also look at some other hormones produced by your pituitary gland at the base of the brain to ensure all is in balance before embarking on the process of egg freezing. These central “brain hormones” include FSH (follicle stimulating hormone), LH (Luteinising hormone), prolactin and thyroid stimulating hormone.
We’ll screen you for STIs (sexually transmitted infections). We’ll chat to you about genetic testing and may request you undertake a karyotype evaluation .
You’ll be offered assessment of your immune status for viral illnesses. This is opportunistic screening for anyone thinking about having a baby in the future. Immunity for viral conditions including Rubella and Varicella (Chicken Pox) can wane over time and some people benefit from an immunization booster. It’s good to identify women at risk prior to pregnancy because catching these conditions when pregnant can harm your baby. While we are doing fertility assessments for you, we like to opportunistically check in on this.
Finally we will need to know your blood group and you’ll be asked to undertake a pelvic ultrasound assessment. This is to ensure that gynaecological problems can be diagnosed and to assess the surgical safety of attempting to collect eggs for you.
Egg collection is most commonly performed by a transvaginal method, using ultrasound and a special fine needle that is passed through the roof of the vagina into the ovary. Your ultrasound assessment helps us try to recognise/assess your level of surgical risk having your eggs collected.
For most people egg collection is technically easy and a very low risk procedure with a complication rate far less than 1 in 1000. However for some women the risk may be higher.
Women who are extremely overweight are often asked to attempt weight loss prior to egg freezing as body shape can make attempting egg collection less successful and more dangerous. There are some cases where an ovary can not be physically accessed for safe egg collection on the day.
If your ovaries are very easily mobile, accessible and normal on ultrasound, egg collection will likely be uncomplicated for you.
2. Personalised cycle planning
Treatment design and individualised care
After we have gathered lots of information about you from your medical history and the tests you have undertaken, your WHM fertility specialist will meet with you and discuss all your test results in detail.
We’ll explain how many eggs we think you can expect to achieve in one cycle of egg freezing and therefore how many treatments you personally are likely to require to get the 20 to 30 eggs to the freezer that we recommend you bank for your future self.
Creating a powerful asset of frozen eggs can provide a greater than 90% probability that you will succeed in becoming a mother if you need to use your frozen eggs to conceive.
Your WHM fertility specialist will design a treatment plan, choosing medications for you based on the following criteria:
To achieve your best outcome, banking as many eggs as we can for you per treatment.
To keep you safe: avoidance of medical complications of egg freezing such as ovarian hyperstimulation syndrome (OHSS) is our absolute priority.
To keep you comfortable – we will always aim to choose treatment options that minimise your side effects during your egg freezing treatment.
Next steps will be to provide you with written and audio-visual resources so that you feel you 100% understand everything you need to do during your egg freezing cycle.
3. Supportive education
Everything you practically need to know about egg freezing
WHM partners with Life Fertility Clinic Melbourne to provide your bespoke, personalised egg freezing treatment experience in a non-corporate environment.
You will meet with our brilliant nursing team who will teach and support you. We will provide you with supportive counselling and will offer you the opportunity to ask questions and to formally document your consent for treatment. Finally we will provide you with transparent and comprehensive cost information so that you can accurately budget for your egg freezing treatment and decide whether egg freezing is the right thing for you.
The egg freezing process: two weeks of stimulation
Egg freezing can be planned in advance at WHM. We can schedule a planned start treatment cycle so you will know approximately the treatment window where your egg collection will fall. The exact date of your egg collection will be determined during your treatment cycle, but you’ll know approximately when that will be from the start of your egg freezing therapy.
You’ll use three types of medication during your egg freezing treatment process in the lead up to your egg collection:
A form of follicle stimulating hormone (always injectable): Its job is to encourage a batch of your ovarian follicles and the eggs with to mature, grow and prepare for egg retrieval.
A form of medication to prevent ovulation (several choices exist, the most common classes being an oral progestogen or an injectable GnRH antagonist)
A trigger shot: Most commonly an injectable GnRH agonist medication.
You can see most medications used in egg freezing treatment are injectable. This idea can be off-putting or scary. Reassuringly most women ultimately find self injection easy and achievable after getting over the initial ick factor. Modern injecting devices are easy to use. Injections are superficial into a skin fold of the tummy. Our nurses are here to support you. Many patients ultimately feel proud, confident and empowered conquering the challenge of self-injection.
4. CREI specialist directed cycle monitoring
The egg freezing process: Having an ultrasound check
We like to check in on your ovarian follicles to help us most optimally time your egg retrieval procedure. There is never one perfect day for egg collection. Follicles on the ovary are never all the same size. Some will be larger, some will be smaller and most will be somewhere in the middle. This follows a normal distribution pattern, or bell curve.
We’ll be considering the clinical days available for planning your egg retrieval procedure (also known as egg pick up (EPU) or ovum pick up (OPU). Your WHM specialist will endeavour to choose the day of egg retrieval for you that is a clinical “best pick for most” follicles available.
If it is well timed, it’s possible that you’ll need only once ultrasound assessment prior to planning your egg retrieval. However, if it’s not quite obvious yet when you will be ready for egg collection, we may ask you to attend a second ultrasound a few days after your first.
We do our best during your egg freezing treatment to minimally impact your life. Most people continue their normal daily work and life activities during the two week preparation phase of you egg freezing treatment cycle.
5. Egg retrieval
The big day! Your egg collection procedure
Prior to your egg collection procedure – you will be given a trigger time for the final medication for your egg freezing treatment.
This will usually be administered 35-37 hours prior to your planned procedure time, depending on the type of trigger medicine your WHM fertility specialist has chosen for you.
On the day itself, you will fast from midnight and attend your procedure in hospital. You’ll have a light sedation anaesthetic so you won’t remember your procedure and you will feel no pain. A WHM fertility specialist will gently extract your eggs via transvaginal ultrasound and will be able to tell you how many we have found by the time you wake up.
Our scientists will later confirm your egg quality and alert you to how many eggs have made the grade for vitrification and storage. We only freeze eggs that we think might have potential to make future babies. Some eggs don’t make it and that is normal and expected for everyone.
Not every follicle we see on ultrasound results in an egg being found and conversely there is never more than one egg per follicle. It’s normal and should be expected that the number of eggs we retrieve at your egg collection will be lower than the total number of ovarian follicles counted on your ultrasound assessment. It’s important to be mentally prepared for this as it nearly always happens and is completely normal and expected.
6. Vitrification and storage
The scientific process of freezing your eggs and keeping eggs safe for future use
Once in the IVF Laboratory, your eggs will be denuded of their surrounding cumulus complexes (outer fluffy cell layer) and inspected for maturity. Mature (MII) oocytes are selected for vitrification. Oocytes are vitrified as single oocytes or in pairs loaded on specialised vitrification devices. This means that when we warm oocytes, we can decide how many to warm at one time in the future.
Oocytes are electronically labeled, tracked and stored in specialised, monitored storage tanks and lovingly cared for as they wait throughout the years until you are ready to use them to have a baby.
Scientists monitor and check in every day, ensuring your oocytes are safe and secure. IVF Clinics need to charge maintenance storage costs every year to pay for the upkeep of your oocytes.
After your egg collection
Depending on the medication used during your treatment cycle, it can be normal for your period to arrive 4 or 5 days after your egg retrieval. Until that time, feeling bloated, a little tender and emotional is expected and normal. These feelings are due to hormonal changes happening in your body. Hormones during your cycle have run high and they will be transitioning rapidly back to baseline. You may need a day or two off work, TLC and a packet of tissues to help you get through these few days. These feelings should not alarm. They are expected and short lived and hopefully all in all worth it to have your eggs frozen.
You will have an appointment with your WHM fertility specialist after your egg retrieval. The purpose of this review appointment is:
To check in on you and make sure you are feeling ok
To debrief regarding your cycle and assess where you are at compared to the goals we set from the outset of your egg freezing treatment
If you have not yet reached your end goal, to plan a further treatment cycle after a break. Most women do require two treatments to reach their end goal.
At every stage during your egg freezing treatment our experienced team of fertility specialists, nurses, scientists and administrative support team are available to ensure you have a positive experience navigating the egg freezing process and WHM and Life Fertility Clinic Melbourne.
If you want to learn more about the egg freezing process, book a consultation with one of our friendly WHM fertility specialists. We are your CREI trained experts in egg freezing.
References:
Lew R, Foo J, Kroon B, Boothroyd C, Chapman M; Australasian CREI Consensus Expert Panel on Trial evidence (ACCEPT) group. ANZSREI consensus statement on elective oocyte cryopreservation. Aust N Z J Obstet Gynaecol. 2019 Oct;59(5):616-626. doi: 10.1111/ajo.13028. Epub 2019 Jul 22. PMID: 31332788.
Sandhu S, Hickey M, Koye DN, Braat S, Lew R, Hart R, Norman RJ, Hammarberg K, Anderson RA, Peate M; Eggsurance Collaborative Group. Eggsurance? A randomized controlled trial of a decision aid for elective egg freezing. Hum Reprod. 2024 Jun 15:deae121. doi: 10.1093/humrep/deae121. Epub ahead of print. PMID: 38876980.
Peate M, Sandhu S, Braat S, Hart R, Norman R, Parle A, Lew R, Hickey M. Randomized control trial of a decision aid for women considering elective egg freezing: The Eggsurance study protocol. Womens Health (Lond). 2022 Jan-Dec;18:17455057221139673. doi: 10.1177/17455057221139673. PMID: 36448651; PMCID: PMC9720825.
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Prior E, Lew R, Hammarberg K, Johnson L. Fertility facts, figures and future plans: an online survey of university students. Hum Fertil (Camb). 2019 Dec;22(4):283-290. doi: 10.1080/14647273.2018.1482569. Epub 2018 Jul 30. PMID: 30058411.
Ong J, Mathew J, Choolani M, Wong PC. Oocytes on ice: Exploring the advancements in elective egg freezing for women. Ann Acad Med Singap. 2024 Jan 30;53(1):34-42. doi: 10.47102/annals-acadmedsg.2023226. PMID: 38920213.
Anderson RA, Davies MC, Lavery SA; Royal College of Obstetricians and Gynaecologists. Elective Egg Freezing for Non-Medical Reasons: Scientific Impact Paper No. 63. BJOG. 2020 Aug;127(9):e113-e121. doi: 10.1111/1471-0528.16025. Epub 2020 Feb 26. PMID: 32102111.
Arendt M, Oxlad M. Australian women's views concerning non-medical egg freezing and factors motivating freezing decisions. Br J Health Psychol. 2023 Sep;28(3):639-650. doi: 10.1111/bjhp.12646. Epub 2023 Jan 24. PMID: 36693677.
Written by Dr Raelia Lew
RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
Co-host of the Knocked Up Podcast, Co-founder of Lovers intimate wellness solutions. Raelia has a PhD in Preconception Health Promotion and Genetic Screening. Raelia is a leading Australian expert in IVF and egg freezing, pioneering a bespoke model of care.