If you find yourself faced with the complex decision of possibly egg freezing for medical reasons, you're in the right spot. This Guide to Egg Freezing for Medical Reasons is here to help simplify the process. Navigating if egg freezing is right for you, especially after a new diagnosis, can be overwhelming. That’s why we compiled a resource to help with suggestions, things to consider and actionable next steps to support you along the way. From explaining the medical aspects of egg freezing to outlining the financial, time and other important considerations, we intend to help you make an informed decision so you can navigate this journey with confidence and clarity, ensuring that you have the information and support you need.
What is Medical Egg Freezing?
Egg freezing, also known as oocyte cryopreservation, is a medical procedure that allows women to preserve their eggs for later use. Women may choose to freeze their eggs for medical reasons, such as when they need to undergo cancer treatment or have a medical condition that could impact their future fertility. Keep in mind that egg freezing does not guarantee future fertility considering there are many factors that contribute to fertility and the ability to be pregnant.
Medical Indications for Egg Freezing:
Radiation therapy
Radiation treatments use high energy rays to kill rapidly dividing cells localized to a certain area, such as the pelvis, which can cause the ovaries to absorb much of the radiation dose. Radiation to the brain can affect the pituitary gland, which is responsible for making hormones such as FSH and LH which signal the ovaries to produce estrogen and progesterone that allow ovulation to occur. If this pathway is disturbed, ovulatory disorders and infertility can occur.
Women who may undergo pelvic radiation therapy include women with uterine cancer, cervical cancer, colon cancer, vulvar cancer, or vaginal cancer.
Chemotherapy
Chemotherapy works to kill diving cells in the body via cytotoxic medication, such as cisplatin, doxorubicin, and cyclophosphamide, that affects the entire body. Oocytes are cells that divide quickly and are often highly impacted by chemotherapeutic agents, which can lead to early menopause or premature ovarian insufficiency.
Examples of conditions that may require chemotherapy include leukemia, lymphoma, multiple myeloma, Hodgkin’s disease, and lung, breast, and ovarian cancers.
A family history of early menopause
Family history of premature/early menopause or primary ovarian insufficiency is a predictor supported by limited research. Some studies show that genetic variants are known to contribute to ~50% of the variation in age at menopause, while other studies state that family history is not a strong indicator. However, this is a factor that many women consider when choosing to freeze their eggs.
This may affect women with family members that have a first degree relative who underwent menopause before the age of 45 (early menopause) or before the age of 40 (premature menopause).
Endometriosis
Endometriosis is a condition in which tissue similar to the tissue lining the inside of the uterus grows outside of the uterus in other pelvic organs such as on the bladder, fallopian tubes, or ovaries. This often requires surgery to correct, posing a risk of damage to the ovaries. A study conducted by Oxford University in 2010 showed that the frequency of severe ovarian damage following surgery to remove ovarian endometriomas was 13%.
Signs of endometriosis include long standing pelvic pain around the time of the menstrual cycle, pain with urination or bowel movements during periods, and excessive or intermenstrual bleeding.
Gender-affirming care for people assigned female at birth
People assigned female at birth may be undergoing gender-affirming therapies that can affect their ability to have children later in life. Transgender men who are on testosterone therapy as part of their path to transition may experience cessation of ovulation and menstrual cycles in less than 6 months from the start date. In order to undergo egg freezing, testosterone therapy must be paused to have the return of the menstrual cycle and in order for ovarian stimulation medications to take effect before egg retrieval. The long term effects of testosterone therapy on AMH (an indication of egg reserve) and ovarian function is unknown, but most transgender men are likely to take hormone therapies for the rest of their lives. Egg freezing can be done prior to starting or early in the transition process.
Autoimmune diseases
Women with autoimmune disorders, such as lupus, systemic sclerosis, myopathies, scleroderma, vasculitis, or rheumatoid arthritis may require medications such as cyclophosphamide which can cause premature ovarian insufficiency. Cyclophosphamide is known to damage the DNA of dividing and non-dividing cells, which destroys both growing and dormant ovarian follicles leading to a decrease in ovarian reserve of oocytes.
Removal of an ovary or ovaries (oophorectomy)
For some women, the ovaries may require removal for either emergent or non-emergent reasons. Since egg freezing is a process that requires several weeks, women who need oophorectomies for non-emergent reasons, such as endometriosis, ovarian cysts, or prophylac removal due to family history of breast/ovarian cancer, can plan for the process accordingly. Some women, however, require urgent removal of the ovaries due to reasons such as ovarian torsion, pelvic inflammatory disease, or abscesses that may develop in the fallopian tubes. In these cases, it is likely that only one ovary will be removed, allowing for egg retrieval from the other ovary if desired.
Other conditions
Women with chromosomal abnormalities or genetic disorders may consider egg freezing as well. For example, in Turner’s syndrome, women face infertility due to rapid loss of ovarian reserve. Fertility preservation is an option post-puberty for these patients. Other chromosomal conditions are also associated with risks of premature ovarian insufficiency, such as Fragile X Syndrome.
Important things to keep in mind when deciding if you should freeze your eggs for medical reasons:
The process itself is much like elective egg freezing but below are other considerations that are specific to women who are evaluating egg freezing for medical reasons.
The timeline of egg freezing
The process of egg freezing is typically between two and three weeks and requires the time commitment of monitoring appointments and the retrieval procedure. Aside from the procedure itself, it will take some time to decide on which fertility clinic. Women who are freezing for medical reasons often must delay their treatment for their medical condition. Therefore, expediting this decision-making process of which clinic to freeze at is very important.
Risks of the egg freezing procedures:
Egg freezing, like any other medical procedure, has minor risks associated with it. Injectable hormone medications are required to stimulate the ovaries before eggs can be retrieved, which can cause some side effects including bloating, fatigue, headache, and mood changes. Egg retrieval is an extremely safe procedure, with risks including a less than 1% chance of bleeding, infection, and injury to surrounding organs.
Ovarian hyperstimulation syndrome is a condition that certain women, such as those with PCOS and high follicle counts, may be susceptible to. In this condition, the ovaries may become hyperstimulated due to overprescription of FSH resulting in a high number of large follicles and high estradiol levels, which could indicate that the ovaries are swelling. However, with newer ovarian stimulation and trigger protocols, the risk of this occurring is low.
It is important to note that there are no increased risks of birth defects or chromosomal abnormalities in babies born from frozen eggs. Additionally, hormones used in ovarian stimulation do not increase the risk of cancer. Egg freezing is encouraged in patients with cancer prior to starting treatment, as the procedure may not be as successful post radiation, chemotherapy, or surgery due to the impacts on the ovaries. There are also no additional risks of egg freezing in people with genetic conditions.
A multidisciplinary approach
It is important to coordinate the decision to undergo egg freezing with multiple physicians and a care team to ensure that it is the best option in the setting of certain medical conditions or treatments. A physician can best advise if there are any contraindications, medication interactions, or long term side effects that may result from undergoing fertility preservation. Egg freezing for medical reasons will require communication with not only a Reproductive Endocrinologist and Infertility Specialist but also doctors in other disciplines, depending on the medical condition. Ultimately, if egg freezing is deemed a safe option for patients with certain medical conditions, it is the patient’s autonomous decision whether or not to pursue it.
Future costs
While the bulk of the egg freezing cost is upfront with the cycle and retrieval, you will be responsible to pay a recurring storage cost - which is typically billed annually. If you choose to use your eggs later, there will be additional costs for the IVF procedure.
Tip: Storage costs can be paid by your HSA or FSA card. This is a cost-saving strategy to save money by using pre-tax money or employer-contributed funds.
No guarantee for future pregnancies
Although the goal of egg freezing is to have younger, healthier eggs for use at a later date to have children, there is no guarantee that the eggs will develop into viable embryos that can successfully be implanted. According to research done at the NYU Langone Fertility Center, being younger when having the egg retrieval procedure tends to lead to more success due to the ability to retrieve an increased number of healthy eggs. The chance of having a baby from frozen eggs is as high as 70% if a woman less than 38 years old freezes 20 or more eggs; however the overall chance of a successful pregnancy from egg freezing is 39%, according to the NYU study. It is important to remember that egg freezing is a chance to get pregnant, not a guaranteed future baby.
What’s the process and specific steps of medical egg freezing?
The medical egg freezing procedure typically involves the following steps:
Discussing fertility preservation with your physician and the clinical team who is managing the care of your medical condition.
Choosing a clinic and planning how to pay for it.
Taking medications and hormones to prepare your ovaries for 9-14 days. During these days leading to the retrieval, you can work and attend school as normal. You will be required to go to the clinic for monitoring appointments for bloodwork and ultrasounds.
Undergoing the egg retrieval. The eggs are retrieved from the ovaries using a needle guided by ultrasound and under anesthesia. While the procedure itself is only 10-15 minutes and a 30 minute or so monitoring period after anesthesia, women typically take the entire day off of work to allow their bodies to rest. Light exercise and walking is allowed.
Freezing of the eggs. The embryologist will vitrify the viable eggs and keep them stored in frozen nitrogen. Keep in mind that not all retrieved eggs will be frozen.
What is the age range that women can freeze their eggs for medical reasons?
There is no legal age limit for egg freezing in the United States. While the typical candidate for egg freezing is a woman of reproductive age, children who undergo chemotherapy and radiation may also be eligible for fertility preservation. For some children, chemotherapy and radiation may only temporarily affect their fertility. For others, it is irreversible and long-term. Fertility preservation programs for children, such as the one at Hackensack Meridian Children’s Hospital, include ovarian tissue cryopreservation for pre-pubertal female patients later followed by transplantation and egg freezing for post-pubertal female patients.
What factors should I consider when deciding if I should freeze my eggs for medical reasons?
There is no algorithm or one size fits all way to decide if medical egg freezing is right for you. Below are some questions you can ask yourself and work through alongside the guidance of your physician.
How strongly do I want the option of biological children in the future?
How urgently do I need to begin treatment or medication for my medical condition?
Is the cost to me of freezing my eggs too high of a financial burden?
How likely is my condition or treatment likely to impact my ovarian reserve (number of eggs)?
What’s my AMH/ovarian reserve? How old am I?
How can I afford medical egg freezing?
Insurance coverage
As of June 2023, the following states must cover egg freezing for specific medical conditions: Maine, New Jersey, New York, Maryland, Connecticut, Rhode Island, New Hampshire, Delaware, Kentucky, Illinois, Louisiana, Texas, Colorado, Utah, and California. The following states have legislation in progress: Massachusetts, Washington DC, Montana, and Oregon. The Alliance for Fertility Preservation website has more information on state laws and legislation.
Tip: Leave the insurance-related heavy lifting to the clinic. Fertility clinics work with insurance companies every day and will help get your egg freezing procedure approved. Don’t feel the burden of navigating insurance coverage needs to be on you.
Grants
Grants are typically not the quickest way to pay for egg freezing especially if you are on a shortened timeline due to needing to start treatment. Don’t let this deter you from looking at grants as there are many organizations on both a national and local level that provide resources to help women preserve their fertility due to medical reasons. For example, the Chicago Coalition for Family Building provides a list of grants for residents from Illinois and surrounding states who are pursuing fertility preservation treatments in Illinois. The Resolve website also provides an additional list of scholarships and grants, some national and some more geographically specific.
Employer coverage
Ask your company to see if there’s any benefits for covering family planning-related costs. In order to compete and attract the best candidates, businesses are continuing to add more fertility benefits. It never hurts asking your HR team to see if a new benefit is available. Some companies that offer coverage for egg freezing include Adobe, American Express, Chobani, Gusto, Google, the Walt Disney Company, and Tesla.
Discounts
When freezing for medical reasons, fertility clinics, storage companies and pharmaceutical companies often provide discounts. Always ask! The Alliance for Fertility Preservation offers a list of programs that provide discounts, free medications, and other forms of financial assistance for women with cancer choosing to freeze their eggs.
Financing
If your state doesn't have mandatory coverage and you are unable to afford egg freezing out of pocket, many clinics provide financing options. Some fertility clinics have their own payment plans. Traditional fertility clinics often work with third party partners like CareCredit and CapexMD. Recently, new startups like Future Family and Sunfish have been addressing the growing need for financing egg freezing. Resolve has a large list of financing programs.
Actionable Next Steps If You’re Considering Egg Freezing For Medical Reasons
1. Decide if medical egg freezing is right for you
It is a multi-factor decision to decide if you should freeze for medical reasons. Women have described the decision and process as overwhelming especially when receiving a new diagnosis and need immediate treatment. Talk with your physicians, trusted friends and family to explore the questions mentioned above and other factors which may pertain to you. The OncoFertility Consortium has a guide in both English and Spanish for cancer patients to help them determine whether egg freezing is the right decision.
2. Find a clinic
Start by determining which elements are important for you in a clinic. Cost? Location? Specific expertise of a physician? Next, use the free Compare Clinics tool. When making appointments, always mention urgency if you are putting off treatment for your medical condition.
Tip: Make sure to explain to the clinic that you are making an appointment to freeze your eggs for medical reasons. Most clinics will try to work you into their schedule as soon as they can.
During the initial consultation appointment, ask doctors about their experience with patients who have your same or similar medical condition. This will help determine if the provider and the clinic is a fit.
3. Plan for (and reduce) the costs
The suggestions and resources listed earlier in this post include grants, insurance coverage, discounts and financing. The Guide to Freezing Your Eggs for Free (or Extremely Discounted) can also be a useful resource.
The Society for Assisted Reproductive Therapy (SART) has a podcast with fertility experts. Check out the episode on Medically Indicated Fertility Preservation to hear a breast cancer survivor’s decision to freeze her eggs.
Have a question that was not answered? If yes, please send us a note. Our goal is to provide a straightforward, comprehensive guide to help women when faced with an important decision for their health and for their future. Also, if The Guide to Egg Freezing for Medical Reasons helped you, we’d love to hear from you as well.