Everything you’ve wanted to ask about egg freezing, from a fertility doctor

Posted on 30 September, 2024

Deciding to freeze your eggs is an extremely personal choice and requires extensive research and personal contemplation. I would know – I froze mine earlier this year.

During my research I drew on articles, podcasts, forums and my personal network to do all that I could to understand the process and outcomes. How much would it impact my work? How long could it take? What medications were involved? What comes next?

What I really wanted was a specialist – a fertility doctor who advised people on this process every day – on hand to answer my long list of questions. Isn’t that always the dream?

If you’re in the same boat and wondering whether this process might be for you, we’ve done the legwork for you, asking Dr Tween Low of Genea Clinic Canberra everything you’ve ever wanted to know about the egg-freezing process.

I’m thinking about freezing my eggs – what should I take into consideration before asking my GP for a referral?

Firstly, it’s important to understand why you are considering freezing your eggs. Is it because of a medical condition that you’ve just been diagnosed with, and you are worried about your fertility being affected? Is the medical condition and the medical treatment going to rapidly deplete your ovarian reserve? Or is this something you have read about, or has it been a topic of discussion with your friends?  Have your personal circumstances changed and you are not able to start a family in the near future? Understanding this is important because it will allow your GP to triage you to see if you need to be seen urgently.

It’s also important to understand that not everyone will be suitable for egg freezing. So just keep an open mind and go into the consultation as a fact-finding exercise rather than thinking ‘I must have this done’.

What tests do I have to have before my first appointment with Genea?

To get the most out of your initial Fertility Consultation, we recommend you do some pre-consultation investigations, a pelvic ultrasound which assesses the pelvis, the uterus and the ovaries and what we call an  antral follicle count, it tells us how robust your ovaries are and whether they’re still full of follicles.

Then there’s an important blood test called the anti-mullerian hormone test, which tells us about your ovarian reserve,the number of eggs you have. With this information, we can make more informed decisions.

How long will the process take and how much time will I need off work?

Once you see a Fertility Specialist at Genea and they have prepared your personalised treatment plan, when to commence an egg freezing cycle depends on your own timeline. You can start treatment with your next period if you wish. So, for example, if your period starts in three weeks, things can move quite quickly. You can also discuss with your doctor a suitable time that works for you and your schedule and we can work around that.

The whole egg-freezing process generally takes two to three weeks. The stimulation of the ovaries, to produce the eggs, takes about 10 days – although some people might need longer – most people will have their eggs collected within 14 days. You might need a day or so to recover from the actual egg collection procedure, but most people will be back to normal daily activities by the end of three weeks.

What medications will I have to take and when? 

There are three medications, they’re all hormone injections. The most important medication is called FSH, or follicular stimulating hormone. The role of FSH is to stimulate the ovaries to grow multiple follicles at the same time. Each of these follicles has the potential to contain an egg. In a normal cycle only 1 or sometimes 2 follicles mature at the same time, however FSH promotes growth of multiple follicles in the same cycle.  After five days of FSH injections, we introduce a second injection.

The second injection is what we call the ‘antagonist’, and it is used to prevent your ovaries from ovulating or releasing the eggs prematurely. Essentially we want your ovaries to mature the eggs but not release them before the doctor can collect them. In essence, you will have two injections – one to mature the eggs and one to prevent ovulation, which takes 10-12 days.

During this period, you’ll be having blood tests and ultrasounds every few days at our clinic in Deakin. The blood test is to monitor the rise in the hormone estrogen – rising estrogen is a good thing, as it indicates the follicles are developing – and then the ultrasound is to see how many follicles are developing and their sizes.

By the time the follicles are around 17 to 18 millimetres you’re ready for the egg collection procedure. We will instruct you to use the third and final injection, which is called the ‘trigger’ – this is the hormone hCG  –  this hormone promotes maturation of the egg within the follicle and causes it to be released from the wall of the follicle. 36 hours after the hCG injection, you’ll come into Genea’s Day Surgery in Deakin for the egg retrieval procedure.

What happens during the surgery?

During surgery, you’ll be given a light anaesthetic which we call twilight sedation – you’ll be asleep and won’t feel any pain – and I collect the eggs from your ovaries through the vagina under ultrasound guidance.

When you wake up, you will feel soreness in your lower abdomen because your ovaries will be a bit bruised and just like any bruising it takes a few days for that to settle down.

What happens after egg collection surgery?

After the egg collection surgery, you’ll be looked after by our Day Surgery Nurses until you are well enough to be discharged into someone’s care. This is usually around an hour after your procedure. We will check in with you to make sure you have recovered from the procedure physically and check that your hormone levels trend back down to baseline, you can expect a period 10-14 days after the egg collection. As with any medical procedure there are risks and the major risk when attempting to recruit multiple follicles at once is a condition known as ovarian hyperstimulation syndrome (OHSS). For this reason careful monitoring takes place during the cycle and post cycle should you experience any signs or symptoms of OHSS.

After the egg collection procedure an Embryologist will come and speak to you to let you know how many eggs were collected. The Embryologist will call you later the same day as well to let you know how many eggs were frozen as sometimes eggs are collected that are not mature or may not be suitable to freeze. The next step is a follow up with your Doctor to discuss the outcome of the cycle and determine whether there might be the need to collect more eggs and undertake a second or third cycle of treatment. This depends on your age, how many eggs were retrieved and how many have been frozen.

The chances of successfully having a baby [from the frozen eggs] are based on two variables: the age at which you freeze your eggs – so the younger you are, the better the chances – and the number of eggs you freeze.

What do you wish people understood better about egg freezing?

I would like people to understand that egg freezing is an option. However, we must be realistic that it is not a 100% guarantee that one will have a baby from one’s frozen eggs. Not all eggs will survive the freeze/thaw process, some of the eggs will not be as good as they were before they were frozen – they might not fertilize or develop into a healthy pregnancy. So, it’s not a sure guarantee, and women need to go into this with their eyes wide open, knowing that this is providing hope, but it is not a guarantee.

That being said, most women who freeze their eggs will never come back to use them. A lot of women freeze their eggs because it’s just not the right time for them to start a family, they haven’t met the right partner yet, they want to have options in the future, – then their circumstances change and they don’t need to use their frozen eggs. So that’s an important thing to know.