Egg freezing, or more officially “oocyte cryopreservation,” is evolving into a mainstream backup plan for women who want to — or need to — delay motherhood. “It is what birth control did for women in the '70s,” says Tomer Singer, MD, chief of the division of reproductive medicine at Northwell Health Fertility in New York. “It's an empowering tool to take ownership when you're not ready to have a child.” That theme of empowerment was echoed by several of the 26 women Allure recently spoke to about their experiences with egg freezing. “By taking control of my reproductive options, I found a new sense of agency and peace of mind that I hadn't anticipated,” says Janet, who froze her eggs at 30, during her final year of surgical residency. Katie, 38, conceived naturally last year but is still grateful that she froze her eggs three years ago before she was married — and is keeping them on ice. “I really can't underestimate how the egg freezing process would've made a difference in my life at 25 if I had been able to do it,” she says. “I would've made such different decisions in my dating life in my 20s. I would not have been so panicked in my early 30s about finding the right person.”
Beyond the end goals — preventing pregnancy versus preserving fertility – there are big distinctions between oral contraception and egg freezing as family planning tools, though. Like the massive price differential: The Pill is free under most health insurance plans while one egg freezing cycle can run upwards of $10,000. And then there’s the data gap: The Pill is well proven to be 99% effective at preventing pregnancy if used correctly; there is still limited information on how likely a woman is to become pregnant after thawing frozen eggs.
Here’s some information we do have: In a 2022 study based on 15 years of data from 543 patients at the NYU Langone Fertility Center, the overall chance of a live birth from frozen eggs was 39%. That number went up to 70% if the woman was under 38 when she froze her eggs and she thawed 20 or more eggs. Freezing 20 or more eggs can be a challenge, though. And that brings us to the first of many things that the women we spoke with wish they had known before they embarked on the egg freezing process.
Truth #1: One cycle takes about two weeks — but one isn’t always enough.
When all goes as planned, an egg freezing cycle takes 12 to 16 days from start to finish. “I think there's a misconception out there that it takes months to complete a cycle,” says Dr. Singer. “The more women know that it's a fairly simple procedure, I think the concerns and stigmas that are out there will be removed and more women will pursue it.”
But while each cycle can be completed in two weeks or less, several of the women we interviewed had to do more than one cycle to yield enough eggs for a decent chance of having a baby. What is “enough”? “The rule of thumb that I use with my patients is that half of your age [at the time of retrieval] in eggs is a good number for one baby,” says Dr. Singer. “So, if you're 30 years old, 15 eggs will get you safely to an over 80% chance for a baby.”
At 32, Stephanie froze 14 eggs…over three cycles. At 31, Chandler was able to retrieve only four eggs from her first cycle; she is planning to do a second. “I've learned that it’s fairly common to have to do several rounds in order to retrieve enough eggs, but at the time I took that as a major disappointment and struggled to come to terms with it,” says Nicole, who did two egg freezing cycles at 34 after a cancer diagnosis. “I think I could have eliminated a lot of tears and stress if I had understood and accepted that earlier.”
Truth #2: Your body is in charge.
Even if a woman does only one egg freezing cycle, the bookends of the process often extend well beyond that timeframe, sometimes totaling many months. Last year, 30-year-old Emily planned to freeze her eggs in April but — after she’d purchased all her medications — her period was over a week late for one of the first times ever. “The biggest lesson from this process for me was that you cannot control your body and you cannot control the timing of life,” she says. Between work and travel obligations, Emily was finally able to start her cycle around Thanksgiving. “While I knew that the process would demand daily ultrasounds and frequent office visits over a two-week period, I hadn't fully considered that everything had to align with my menstrual cycle — a factor that isn't controllable,” says 31-year-old Janet, a busy doctor. “This led to multiple delays and a bit more stress than I had anticipated.”
Truth #3: In the egg freezing numbers game, the number of eggs retrieved is just part one.
“Eggs are not embryos and embryos are not babies,” says Dr. Singer. Once a woman decides to use her frozen eggs, not all of them will survive the thawing process. And then not all of the successfully thawed eggs will be successfully fertilized. And then not all of the fertilized eggs will make it to the embryo stage. And then not all the embryos will be viable. When Stephanie and her husband thawed her 14 frozen eggs five years later, only one became a viable embryo. Stephanie became pregnant from that embryo transfer but miscarried at 10 weeks.
“I was so excited and surprised to have gotten a good number of eggs after my retrieval,” says Sue, who began the process at 30 before starting chemotherapy for cancer treatment. “But when my partner and I went to turn them into embryos, the number went down. Because I’d need to use a surrogate, I was advised to test the embryos before freezing them and I was left with even fewer. I thought the egg retrieval was the end, but there were so many more steps.” Ultimately, says Sue, “I felt misled into believing [the process] would be more successful than it was.”
Truth #4: Egg freezing is an ongoing expense.
More and more employers are now offering egg freezing coverage but most insurance plans still don’t cover it. And it costs a lot to freeze your eggs — this is territory that has been well covered. Less discussed, though, is that once your eggs are on ice, you have to pay annual fees to store them — usually somewhere between a few hundred and a couple of thousand dollars per year. And if and when you decide to thaw your eggs to try to get pregnant, you will be entering the IVF process — also known for its high price tag.
As Sue says, “There were so many more steps” and each one comes with a price tag: transferring the eggs out of storage, thawing them, fertilizing them, monitoring your cycle, transferring the embryo(s) into the uterus, more monitoring. Stephanie had a bill of $41,600 for her three egg freezing cycles and five years of storage. When she and her husband decided to thaw the eggs and do IVF, one embryo transfer cycle was an additional $11,199.
Truth #5: Egg freezing can come with side effects, some more fleeting than others.
Bloating, nausea, headaches, and constipation are all common during the approximately two-week process of hormonal stimulation and usually subside within days following the retrieval procedure. But two of the women we spoke with experienced ovarian hyperstimulation syndrome (OHSS). “Right after the egg retrieval procedure, I couldn’t eat or drink for over eight days without throwing up bile,” says Amanda, who froze her eggs at 34, and had an extreme case of OHSS. “Each day, my boyfriend and two friends would take turns driving me to the doctor’s office across town where I would lie in the dark for eight hours hooked up to an IV to get some nutrients while still throwing up.”
The risk of developing severe OHSS during an egg retrieval cycle is about 1%, says Paula Amato, MD, a professor of obstetrics and gynecology at Oregon Health and Science University and the president of the American Society for Reproductive Medicine. These cases are usually characterized by abdominal swelling, severe pain, and persistent nausea. A case as extreme as Amanda’s is “exceedingly rare,” says Lucky Sekhon, MD, a board-certified reproductive endocrinologist and infertility specialist at Reproductive Medicine Associates of New York. Still, “if I had known what happened to me was possible, I wouldn’t have done it,” says Amanda.
Another woman we interviewed, 36-year-old Rachael, gained 60 pounds following her egg retrieval procedure and developed Hashimoto’s disease, an autoimmune disorder that affects the thyroid. After taking thyroid medication, she’s now on Wegovy to bring her weight back down. “Even so, I 100% think this was worth it,” she says. ”I now have a backup plan for my future and am incredibly grateful for that.” (We spoke to two doctors about Rachael's experience and both said that while some weight gain can be part of the egg freezing process, it is usually temporary and this experience is highly unusual. And “ovarian stimulation has never been shown to provoke autoimmune disease,” says Dr. Sekhon.)
Truth #6: The younger you are when you freeze your eggs, the more successful the outcome.
“In your early 30s, about five to seven of every 20 eggs you produce will be healthy,” says Elizabeth Fino, MD, a reproductive endocrinologist, infertility specialist, and director of third-party reproduction at NYU Langone Fertility. “In your 40s, it’s more like one or two out of every 15 to 20 eggs.” That’s why she tells patients to start thinking about egg freezing at 30: “By 32 or 33, that’s when we start to see the success rates drop off.”
That doesn’t mean some people don’t have successful egg freezing cycles at 36 or 37 or even 41 or 42, though. In a study from 2016, women who froze their eggs under the age of 34 had a 60% live birth rate with 10 eggs, whereas women who froze them at 41 to 42 had around a 20% chance of a live birth. With 30 eggs, those percentages increased to about 90% and 55%, respectively. (At 40, a woman is likely to get only 5 to 10 eggs per cycle, so retrieving 30 eggs might not be realistic.)
Although age and success are intricately linked in any discussion of fertility preservation, no doctor we spoke with suggested that healthy women should be freezing eggs before their 30s as a matter-of-course insurance policy. “This isn’t something that everyone should be doing, especially in your 20s. It’s great that we have this technology available, but people definitely need to be counseled and be realistic about the expectations,” says Dr. Amato, who points out that the younger you are when you freeze your eggs, the less likely you are to ever use them. “If you don't have insurance coverage, there might be better things to do with $10,000 in your 20s than spending it on freezing eggs that you may never need to use.”
It’s also worth noting here that whatever age at which a person freezes their eggs, the body will continue to get older (with any luck) so, yes, a 25-year-old egg is much more likely to be viable than a 45-year-old egg. But if that 25-year-old egg is used to create a pregnancy in a 45-year-old body, that pregnancy will still come with 45-year-old challenges. “The success rate is almost entirely based on the age of the egg, but the complications you might experience in the pregnancy are going to start to increase once you get into your mid-to-late 40s,” says Dr. Fino, who counsels patients about finding the “balance between the perfect moment in your life to have a baby and the risks of carrying a pregnancy in your early 40s to approaching 50.” Those risks include hypertension, diabetes, pre-term birth, and the need for a C-section, says Dr. Amato.
Truth #7: Egg freezing technology is getting better and better — but the human reproductive system remains the same.
“There's now much more standardization of the process of freezing eggs,” says Dr. Singer. One of the biggest improvements is the freezing method itself: “Vitrification, which is a form of rapid cooling or flash freezing, minimizes the ice crystals that can form and damage the DNA of the egg,” says Dr. Sekhon. “This has contributed to a major change in success.”
But the success rates of egg freezing are driven just as much by our complicated, imperfect, unpredictable reproductive systems as by anything else. “When I talk to patients, we walk through the fact that the technology is not perfect in that the egg doesn't always survive the freeze and the thaw,” says Dr. Fino. “But a big factor is also just the inefficiency of the reproductive system. Very few eggs — whether frozen or not — will ultimately lead to a healthy pregnancy. And that's why volume and selection become really important.”
Truth #8: There is insufficient evidence to counsel women about the likelihood of live birth after planned oocyte cryopreservation.
These are the words of the American Society for Reproductive Medicine. So far, there just aren’t enough women who have attempted to thaw their frozen eggs to reliably forecast how likely a patient is to be able to turn frozen eggs into a baby. A study published in 2021 looked at data from a large Boston fertility clinic from 2006 to 2020 and found that only 7.4% of women who had frozen their eggs during that period had returned to use them. (Of those that had, 32% had babies.) Further complicating the issue is the fact that because egg freezing technology has improved over time, it’s challenging to extrapolate success rates from eggs frozen years ago to predict outcomes from eggs frozen recently.
For women who need to delay childbearing, though, even the potential to preserve fertility through the egg freezing process can be an incredible gift. “But it’s not the solution to everything,” says Dr. Amato. “I think it should be offered, obviously, but we need to advocate for different social policies too. It’s great that some tech companies offer egg freezing coverage now, but I would push them to also create systems that allow women to have careers and build their families in their 20s and 30s if that's what they want to do.”
