Onscreen and IRL, women are pondering whether to freeze their eggs.
The fictional TV character Siobhan Roy talked about it on the most recent season of Succession as she mulled over her future with husband Tom Wambsgans. Real-life artist Anna Marie Tendler “Intends to Freeze Her Eggs Following John Mulaney Divorce,” a recent Vanity Fair headline declared. And Kourtney Kardashian gave hope to those holding out to see her have a baby with new beau Travis Barker in an interview with Ellen Degeneres last year, saying freezing her eggs at age 39 gave her “peace of mind.”
The prevalence of such discussions in the media mirrors a growing trend in the US, where the procedure has spiked in popularity over the past decade. Just 475 women in the US froze their eggs in 2009. But by 2019, that number had grown to more than 16,000, according to the Society of Assisted and Reproductive Technology.
There are plenty of reasons behind the uptake in egg freezing: scientific developments that have made the procedure safer and more effective, a proliferation of new startups offering the procedure, and the fact that more people in the US are delaying having children. But egg freezing (or oocyte cryopreservation, as it’s known in medical parlance) has only been widely for about a decade, and it can be tricky to gauge whether the costs of the procedure outweigh the benefits.
Evaluating whether freezing your eggs is worth it is a deeply personal question, influenced by everything from the procedure’s success rates to the state of your personal finances to your age. Here’s a closer look at what we know—and don’t know—about the process.
The process of freezing your eggs involves hormone injections meant to stimulate your ovaries in order to produce multiple eggs. Then patients undergo a minor surgery so the eggs can be retrieved from the follicles in their ovaries. The process is similar to in vitro fertilization (IVF), a type of assisted reproductive technology geared toward people having trouble conceiving naturally. Whereas the goal with IVF is to produce an embryo that will then be implanted in a patient’s body, oocyte cryopreservation banks unfertilized eggs for later use.
Every patient’s experience is different, but you can generally expect the following steps during egg freezing, according to Dana McQueen, a physician who specializes in reproductive medicine at the University of Chicago:
- Preliminary assessment. The procedure starts with a visit to a reproductive endocrinologist, who will run tests to evaluate your ovarian reserve. “You’re born with all the eggs you’re going to have in your life, and that egg quality does decline with age,” McQueen says. Assessing hormone levels and performing an ultrasound gives the doctor an idea of how many eggs they can expect to retrieve from one egg freezing cycle.
- Scheduling. If you decide to go through with the procedure, the clinic you’re working with will schedule the process around your menstrual cycle.
- Hormone injections. Next, you’ll be prescribed hormones which are administered by injection each day for one to two weeks. You typically inject yourself with these medications. During this time you’ll go into the clinic on a regular basis so the doctor can monitor follicle development and hormone levels, and adjust your dosage if need be.
- Retrieval day. Once your follicles have grown to a certain size, you’ll take a “trigger shot” to prompt the release of eggs. Thirty-six hours after that shot, you’ll go in for the procedure: A doctor will extract eggs from follicles using a transvaginal needle, which is administered while you’re under anesthesia. Generally the hope is to extract 10-15 mature eggs from one cycle, but some patients produce fewer.
- Put those oocytes on ice. You should be notified how many mature eggs were retrieved from the procedure shortly after it’s over. From there these eggs will go to an embryologist and stored at -196°F (-126.7°C), at which point all biological activity, including aging, stops.
Some women may do multiple cycles to retrieve more eggs. That’s because not all eggs will develop to become embryos. The more eggs you have frozen, the better your shot at a healthy embryo leading to a live birth, particularly as you age.
There’s no limit on how long you can bank your eggs in the US once they’re frozen. If you decide to use them at a later date, the eggs will be thawed and fertilized with sperm to produce an embryo that may hopefully result in a successful pregnancy—completing the IVF process where egg freezing had left off.
In recent years, new fertility startups have started to market egg freezing as a form of self-care. Kindbody, which counts Gwyneth Paltrow and Gabrielle Union as investors, purposefully sought to avoid the “cold, sterile ambiance of a traditional doctor’s office,” in designing its Flatiron clinic, which took design cues from women’s coworking space The Wing and private clubs like the Soho House. The now-defunct fertility company EggBanxx raised eyebrows when it hosted egg freezing “parties” for New York City women back in 2015.
Such marketing tactics can appeal to women navigating a health system that’s long been uninviting and discriminatory. But “it can also give the impression that [egg freezing] is less of a big deal than it is,” says Lucy van de Wiel, a sociology researcher at the University of Cambridge and the author of the book Freezing Fertility.
The reality is there are side effects and risks associated with egg freezing. The biggest risk is perhaps ovarian hyperstimulation syndrome, which occurs in about 5% of IVF and egg freezing cycles. This is an exaggerated response to excess hormones, and can have symptoms ranging from bloating to vomiting and blood clots.
Many women experience also side effects from fertility drugs, which can cause mood swings, nausea, insomnia, among other symptoms.
Freezing your eggs can also be a time-consuming and emotionally draining process, a side effect that isn’t always widely discussed. A 2018 study of 200 patients who froze their eggs at a US clinic found 16% regret the decision, often because they felt they didn’t produce enough eggs, weren’t well-informed about the procedure, or lacked proper emotional support.
The average cost of one egg freezing cycle is about $11,000 in the US, but you also have to factor in the cost of hormone medications ($5,000) as well as storage fees (often around $500 annually). All told, the average cost of freezing your eggs and storing them for five years adds up to an estimated $15,000 to $20,000, according to FertilityIQ, a website that provides data and tools about fertility services. Those costs can easily go up if you do multiple cycles.
Some countries offer egg freezing at a much lower cost on average, which has spurred more US women to freeze their eggs abroad in recent years rather than receive the procedure domestically.
More US employers and states are starting to cover fertility benefits, too, so if you have a health insurance plan, it’s worth taking a close look to see if any egg freezing costs are included.
There are tons of reasons patients decide to freeze their eggs, whether the desire to prioritize career goals, wait to find the right partner to have children, or planning for a family with a same-sex partner. It’s hard to know exactly how successful the average cycle is, though, because most people who freeze their eggs never use them. Rates of usage for frozen eggs are anywhere between 3% to 9%, as many patients who freeze their eggs get pregnant naturally or decide not to have children.
Still, a few studies offer some insight on how often frozen eggs produce safe and successful pregnancies. An analysis of data from two of London’s largest fertility clinics found that between 2008 and 2017, about one-fifth of all women who had frozen their eggs ended up using them. Of this group of 129 people, the success rate was 21%, meaning that about one in five women who used their frozen eggs ended up becoming a parent through those eggs.
The age at which you freeze your eggs plays a factor in your likelihood of success. Generally women who are younger produce more eggs during one egg freezing cycle. Those eggs also tend to be of better quality, meaning that they’ll have a better chance of producing an embryo that leads to a healthy, live birth. From women who freeze their eggs before they turn 35, McQueen typically expects 65% of embryos from those eggs to be genetically normal. For women who freeze their eggs at age 41 or 42, she expects just 30% of those eggs to produce normal embryos.
Thawing issues are also associated with age. A 2017 US study by researchers at Harvard’s Brigham and Women’s Hospital found women who froze their eggs under the age of 36 had a 95% chance of successfully thawing their eggs, while women over that age had an 85% thaw success rate. A successful thaw doesn’t always translate to a viable pregnancy, though. The researchers developed a calculator that predicts a 37-year-old woman who freezes 10 eggs, for example, has a 50 percent chance of producing a live birth with one of those oocytes.
Depending on how long you wait to use your eggs, age can affect chances of success as well. Whether eggs are used right away or frozen for future use, CDC data shows IVF tends to have higher rates of live-birth deliveries when patients are younger.
A lot of patients report feeling more relaxed after freezing their eggs, says Van de Wiel, and it’s certainly understandable that they’d seek peace of mind in a world where women face tough decisions and lots of pressure about when, whether, and how, to have a child. But they should keep in mind that the return on investment from freezing your eggs is far from certain. “Egg freezing is a backup plan,” McQueen says, “but it’s not a guarantee of having a baby.”
For some women, however, a plan without guarantees can still be money well spent.