Proactive Egg Freezing

There are several reasons to consider proactive egg freezing. If you have medical conditions that may impact your ovarian reserve, most notably endometriosis, you may want to consider pursuing proactive egg freezing sooner rather than later.

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Another reason to consider proactive egg freezing may be the choice to delay childbearing. Whether or not you have a partner, egg freezing allows females reproductive autonomy and an opportunity to delay the decision about whether to bear children until the future.

With the introduction of vitrification leading to higher freeze-thaw survival rates (80-90%), egg freezing is no longer considered experimental and has become more popular. As discussed on our page on age-related fertility decline, both egg quantity and quality decline with age. In addition, not all eggs will survive the freeze-thaw process, not all eggs will fertilize (70-80%) and not all fertilized eggs will become embryos. The more eggs that are frozen, the more likely it is that a single batch of eggs will lead to the live birth of a child in the future. The graph below demonstrates the prediction of a live birth according to a female's age and the number of eggs frozen. Some people may require multiple egg freezing cycles to obtain higher numbers of frozen eggs. Frozen eggs cannot be genetically tested. At this time, there is no way to know the quality of eggs frozen until they are thawed and fertilized.

Image citation : Goldman RH, Racowsky C, Farland LV, Munné S, Ribustello L, Fox JH. Predicting the likelihood of live birth for elective oocyte cryopreservation: a counseling tool for physicians and patients. Human Reproduction [Internet]. 2017 Apr [cited 2022 Oct 28];32(4):853–9. Available from: https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/dex008

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So when should I freeze my eggs?

This question is hard to answer. Though there is a higher likelihood of live birth with younger eggs, the difference under the age of 35 appears to be minimal. In addition, younger women are less likely to use frozen eggs for conception in the future. Therefore, it is thought that the greatest cost-benefit is for people to freeze eggs around age 35-37. That being said, if you are certain that you plan to delay conception, would like to have a large family but plan to start later or would like to have some reassurance about the possibility of child-bearing in the future, the younger the better, as it means more higher quality eggs.

Proactive Sperm Freezing

There are several reasons to consider proactive sperm freezing. If you have medical conditions that may impact your sperm, you may want to consider pursuing proactive sperm freezing sooner rather than later.

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Another reason to consider proactive sperm freezing may be the choice to delay childbearing. Although not talked about often, this is an option that more and more men are considering. There are risks with aging. On average, 30% of frozen sperm does not survive the freeze-thaw process.

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Proactive Embryo Freezing

It is also an option to freeze embryos. If you have medical conditions that may impact your sperm or egg quality, you may want to consider pursuing proactive embryo freezing sooner rather than later. Embryos can be genetically tested prior to being frozen; euploid embryos have a higher chance of implantation. Embryo freezing may be done with partner eggs/sperm or donor eggs/sperm. It may be a consideration for a couple who are thinking of delaying the decision to bear children. It may also be a consideration for older people who want to know the genetic quality of embryos prior to freezing.

Proactive Egg Freezing​

You will need to ask for a physician's referral to a fertility specialist. After your first meeting with a fertility physician, you will complete ovarian reserve testing (serum anti-muellerian hormone (AMH) and antral follicle count (AFC) via transvaginal ultrasound). You will then have a discussion with your physician about reasonable expectations for number of eggs and medication dosing. A typical egg freezing cycle may include priming (starting a 1-3 weeks prior to stimulation), ovarian stimulation (lasts 10-12 days), and transvaginal ultrasound-guided egg retrieval (1 day)​. You will know how many mature eggs were frozen at the time of your egg retrieval.

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During ovarian stimulation, you may require 4-5 early morning (7 - 9am) appointments for bloodwork and transvaginal ultrasounds. On the date of the egg retrieval, you typically receive sedation which requires you to be off-work for 24 hours and you will require a ride home. Most people feel well enough to work during priming and stimulation and return to work the day after retrieval.

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Proactive Sperm Freezing

You will need to ask for a physician's referral to a fertility specialist. You may have a semen analysis prior to discussing banking, or you may proceed with banking with a semen analysis at the time of banking. Sperm is washed and processed in the laboratory. It is then divided into different vials. The number of vials per ejaculate varies One vial of sperm is typically used in treatments such as IUI or IVF.

Proactive Embryo Freezing

You will need to ask for a physician's referral to a fertility specialist. If you are partner with eggs with a partner that produces sperm, then the female partner will complete ovarian reserve testing (serum anti-muellerian hormone (AMH) and antral follicle count (AFC) via transvaginal ultrasound) and the male partner will complete a semen analysis. You will then have a discussion with your physician about reasonable expectations for number of eggs/embryos and medication dosing. A typical embryo freezing cycle may include priming (starting a 1-3 weeks prior to stimulation), ovarian stimulation (lasts 10-12 days), and transvaginal ultrasound-guided egg retrieval (1 day)​. The eggs will then be fertilized via traditional in vitro fertilization or intracytoplasmic sperm infection and embryos will be cultured until day 5-7. You will receive periodic updates about the growth of embryos. Embryos that reach blastocyst stage can be biopsied to assess genetic makeup. They will then be frozen. You will receive an update about how many embryos were frozen.

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During ovarian stimulation, the female may require 4-5 early morning (7 - 9am) appointments for bloodwork and transvaginal ultrasounds. On the date of the egg retrieval, the female will typically receive sedation which requires them to be off-work for 24 hours and will require a ride home. Most people feel well enough to work during priming and stimulation and return to work the day after retrieval. The male partner produces sperm on the date of egg retrieval.

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If donor sperm or donor eggs are used, these need to be sourced. This can be directed (identified) or non-identified.

Proactive Egg Freezing

Cost per cycle: Costs for egg freezing include procedural costs, medication costs, and storage costs up front. In the future, there are costs to fertilization, embryo transfer and storage of embryos.

• Procedural Costs of egg freezing : $7000 - $9000

• Medications: $3000 - $8000, average $5000

• Storage of eggs: $500-900 per year

• Fertilization of eggs: $2500 - $5000

• Frozen Embryo Transfer Costs : $1600 - $3000

• Storage of embryos: $500-900 per year

• PGT-A of embryos (optional) : $4000 - $7000

In Ontario, you are able to use your one cycle of IVF funding to cover the costs of fertilizing frozen eggs and transferring any embryo created from the fertilization of frozen eggs (in the FUTURE, as it has to be used for current conception); some people choose not to apply their funding to previously frozen eggs and instead, undergo IVF again and use the funding for that retrieval, fertilization and embryo transfers. Some provincial union drug benefits cover the medications (i.e. PARO covers 100% of fertility medications). Similarly, some medical association drug benefits cover fertility medication (i.e. OPIP through OMA covers $7000 lifetime maximum)

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Proactive Sperm Freezing

Cost per cycle: ​

• Sperm processing + procedure: $600-1000

• Sperm storage: $300 -900 per year

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Proactive Embryo Freezing

Costs per cycle: Costs for IVF include procedural costs, medication costs, storage costs, embryo transfer costs and add-on costs. A popular add-on is pre-implantation genetic testing for aneuploidy (PGT-A), which is optional but may be quoted to you by clinics.

• Procedural Costs of IVF : $11 000 - $15 000

• Medications: $3000 - $8000, average $5000

• Storage of embryos: $500-900 per year

• Frozen Embryo Transfer Costs : $1600 - $3000

• PGT-A (optional) : $4000 - $7000

In Ontario, proactive embryo freezing is not covered by funding. Some provincial union drug benefits cover the medications (i.e. PARO covers 100% of fertility medications). Similarly, some medical association drug benefits cover fertility medication (i.e. OPIP through OMA covers $7000 lifetime maximum)

There are risks associated with egg and embryo freezing. The risks are outlined below :

• medication side effects (nausea, breast tenderness, mood swings, bloating)

• stimulation risks (ovarian torsion, Ovarian Hyperstimulation Syndrome)

• procedural risks during transvaginal ultrasound guided egg retrieval (bleeding, infection, injury to bowel/bladder/blood vessel)

• cycle risks (cancellation, poor ovarian stimulation, no eggs within follicles at time of retrieval, no mature eggs, fertilization failure, embryo arrest, poor quality embryos that cannot be frozen)

• risks in IVF-conceived pregnancies (pre-eclampsia, large for gestational age babies, multiple pregnancy)

Embryos used to be a lot more stable when frozen/thawed than eggs. This is no longer the case. 95% of embryos will survive the freeze/thaw while 80-85% of eggs will survive the freeze/thaw. Once eggs are thawed, there is attrition, meaning that they then have to be fertilized and grown to an embryo and you will have natural loss of numbers at each stage.

Eggs cannot be genetically tested and you may not know what you have in the bank. Embryos can be genetically tested so you may have more reassurance that it

If you would like reproductive autonomy - freeze eggs. Embryos frozen with a partner can get complicated unless you are certain you will remain with that partner.

If you are older and want to be more certain about what you have in the bank, freeze embryos, either with partner or donor sperm.

There is no effect on your natural fertility if you choose to freeze your eggs. It does not deplete the number as it is drawing from the available pool of eggs that would have died off anyway if they were not the "chosen" one to ovulate.

Many people train in a province or city that is different from where they plan to practice. Eggs/embryos/sperm can be moved to another clinic, but there are some clinics that do not accept transferred eggs/embryos/sperm for liability concerns. You may have to travel back to the location where the gametes are frozen to complete treatment. It may be possible to do some monitoring locally but do the procedure where the gametes are located.

Some clinics will accept a self-referral, some will not. The reason for this is primarily billing. Some clinics may also see you with the self-referral program but then ask you to obtain a referral from a physician after (again for billing purposes). Other clinics will connect you with a doctor who could provide a referral if you are unable to obtain one on your own.