So you’ve waded through the research on egg freezing, weighed the pros and cons, and have decided to freeze your eggs, or at least to start looking into it. Here are some things you might want to know before you start
1. Get your blood work done
Women are born with all the eggs they will ever have. Eggs are constantly lost until menopause, when none remain. “Ovarian reserve” refers to the reserve of the ovaries - the remaining egg supply.
The first thing most fertility doctors will want to know is your fertility potential and how you might respond to medication. A 42-year old may have hormone levels of a 37-year old, while some 30-year olds could have the hormone levels of a much older woman, for instance due to premature ovarian failure.
When booking a consultation appointment with a fertility clinic, ask which tests you should have done even before you show up so you can have a more informative discussion with the doctor.
Clinics are likely to require at least these two blood tests, which help measure your fertility potential:
FSH – Follicle Stimulating Hormone: This can help determine the quality of your eggs, especially compared with other women in your age group. (Quality means how healthy your eggs are and how likely they are to produce a child). This blood test is done on day 2-3 of your menstrual cycle. Most clinics want it, so you may want to get it before your consultation with a fertility specialist. Ask your gynecologist for a referral or if she can do it.
AMh – Anti-Müllerian hormone: This is a protein that assesses your ovarian reserve (how many eggs you have left) and your potential response to egg stimulation. This test can be done any time of the month, but not all doctors care about this number, as they believe age is a better predictor. Still, while doing your blood-work, you may prefer to get it done rather than have to return.
Dr. Itai Bar-Hava, the Medical Director of the A to Z Fertility Center in Tel Aviv also recommends an Antral Follicle Count, which is an ultrasound measuring the small resting follicles at the beginning of a cycle. “This is much more accurate than any blood test like FSH or AMH. It actually gives you the estimated number of eggs that are expected to be harvested [in a given cycle] if she does the procedure,” he says. (Antral follicle count varies from cycle to cycle, more so than FSH and AMh.)
You may be asked to do other tests before you start your cycle, including your progesterone and LH, so ask your gynecologist and your fertility clinic.
Even if you’re not considering freezing eggs, you may choose to get the tests done anyway. “It gives you an accurate evaluation of the state of your eggs - so it enables you to make wiser decisions,” Dr. Bar-Hava explains.
2. Do the math: It will cost money
Egg freezing for non-medical reasons is considered an elective procedure in most countries, including Israel, which subsidizes IVF for its citizens but does not cover any part of egg freezing. Only 15 U.S. states provide some type of fertility coverage at all and it usually does not apply to oocyte cryopreservation (though medications might be covered: see #3 below).
Oocyte cryopreservation is costly. In the U.S. it can cost $8,000 -- not including storage fees of $500 per year, although some clinics offer it as low at $6,000. Companies like EggBanxx offer packages starting at $5,400. In Israel, the average cost of the procedure is 15,000 shekels ($4,375).
But beware: In most places doctors charge a hefty sum for the initial consultation, and then for follow-up meetings. Check with your insurance on what is covered, from consultation to ultrasound monitoring to blood tests.
Before you start the process, it’s important to see if you have resources to finance egg banking.
You will begin to take hormones – often injections – at the beginning of your cycle. Just the medications for stimulating egg production can cost thousands of dollars. Israel covers these meds for IVF patients but not for egg-freezing patients. You could ask your clinic: They may have meds to give away.
3. Block time in your schedule
If you are planning on freezing your eggs, you need to be available for multiple appointments. It may take a month or so to get all your ducks in a row prior to the actual egg freezing cycle, between an initial doctor’s consultation, blood-work (see #1) and bureaucratic appointments (dealing with your insurance).
For the egg retrieval process itself, you’ll need about three weeks -- from menstruation to ovulation. During those three weeks, you will be visiting the clinic two or three times a week for blood tests, ultrasounds and instructions on what medications to take. Most clinics are open in the early morning without specific appointments and operate on a first-come first-served basis, so you should allow for wait time.
Many of the medicines must be refrigerated, and must be administered at a certain time each day, so you will probably need to curtail nighttime activities during this period so you can stay close to your refrigerator.
Some women in the U.S. hire nurses to help them administer their daily injections.
When you come closer to your ovulation date (somewhere after day 14 of your cycle), you may need to go to the clinic every day until they schedule the egg retrieval process. And you will not know which day it is, so plans with friends and colleagues will have to be flexible.
For the actual egg extraction, you will need to take the day off. The process will be done under some type of anesthesia and you will need to have someone accompany you to the clinic to take you home.
Expect to recover by the end of the day, although you will need to take it easy (no working out, heavy lifting, intercourse) for the next few days. Your doctor may also give you antibiotics for a week.
4. Be prepared to need another round
When it comes to fertility, there are no guarantees. You may have great “numbers” (hormone levels), but still end up with only half a dozen eggs to freeze.
Now that you know what the process entails, you might consider doing another round of egg harvesting and freezing, after another menstrual cycle. The process isn’t normally done in two consecutive menstrual cycles, to give the body a chance to rest.
5. You may want to hedge your bets
Some women who start the egg freezing process don't necessarily plan to use them.
Ariella, a 36-year-old Israeli, only got eight eggs to freeze in one cycle. Shortly after, she joined a group for religious single women who are considering becoming mothers – and decided to become a mother herself. She didn't use her frozen eggs for that, electing for artificial insemination, but still has her frozen oocytes and hopes to use them too one day--with a husband.
If when harvesting eggs, you decide to proceed with in vitro fertilization rather than freeze them, the process is similar. Instead of freezing the eggs, the doctors fertilize them with sperm. Then three to five days later, the best embryos (the eggs after fertilization with sperm) are transferred back to you. Then you must wait 10-14 days to find out if you’re pregnant. The remaining embryos will then be frozen for future use.
After she did one cycle of egg freezing, Alice, an analyst living in New York, decided not only to freeze eggs, but to freeze embryos too (she used a sperm donor), which have a higher success rate. “I thought if I met someone who wanted his own genetic children, we’d use my eggs, but if I did it on my own, I’d use the embryos,” she explains. Now, five years later, and still single at 47, she’s debating how to proceed. “I still haven’t decided if I want to be a mom yet,” she said.
This is Part 3 of Fertile Ground, Haaretz's series on IVF in Israel. For the rest of the project, click here.
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