Egg Freezing Process in 8 Steps
STEP ONE: PHYSICIAN CONSULTATION
Every each patient is seen by a board board-certified reproductive endocrinologist.
At the first visit (in office or televisit), there will be a detailed medical and gyn history.
A transvaginal sonogram is done or scheduled is done to visualize the uterus and ovary and determine if there are ovarian cysts, fibroids, or other gyn issues that should be addressed before starting the process of egg freezing.
STEP TWO: FERTILITY ASSESSMENT
To determine the number of eggs present and the quality of the eggs:
- AMH – Blood will be drawn to determine the level of AMH.
- Antral Follicle Count – To assess the number of egg cells available.
- Baseline Hormone – Estradiol, FSH, LH, Progesterone, during the first five days of menstrual cycle.
- Important reproductive health blood test – Thyroid Panel, Prolactin, DHEA, CA-125
STEP THREE: POST-FERTILITY ASSESSMENT MEETING
A one-on-one meeting with your fertility specialist to discuss in detail the results of your fertility test.
This comprehensive evaluation is used to provide a realistic idea of how many eggs are likely to be retrieved and the chances of these eggs to be fertilized after they are thawed.
In addition, a treatment plan to discuss plan the medications and doses that will be needed to stimulate your egg cells.
We attempt to individualize the stimulation protocol base upon age, height and weight (BMI). The results of your AMH and antral follicle count.
It is also helpful to review the results of you past fertility cycles
STEP FOUR: A TIME-TABLE MEETING
Meet with your clinic coordinator and/or fertility expert to discuss the specific timing of your stimulation cycle.
At that session, we will discuss again the medications to be use for egg/follicle stimulation.
We will also discuss how to administer these medications, what happens during office visits for vaginal sonograms and blood drawing for hormonal levels, how the eggs are retrieved, how the eggs will be frozen and stored.
STEP FIVE: OVULATION INDUCTION – Stimulation of Egg Cells for Egg Freezing
During a natural menstrual cycle, the pituitary gland in the brain produces FSH and LH hormones that stimulates the growth of one or several egg cells in the ovary.
As the egg cells grow, there will be a increase production of Estradiol from the follicles (tiny sacs in which the egg cell grow until they are retrieved)
The medications we administer are:
- Gonal-F – FSH only
- Menopur – combination of FSH and LH
- Low-dose hCG – a medication that closely resembles natural LH
- Cetrotide – an “anti-gonadotropin-releasing hormone” used to prevent ovulation (the release of an egg from the ovary) during the 10 days of stimulation
Our sincere caring goal – stimulate as many mature eggs as possible – hopefully 10-20 mature eggs depending upon your fertility potential.
We prefer to monitor you at least every other day from days 1 to 6, and everyday 7, 8, 9, 10.
Monitoring includes: blood test (estradiol), vaginal sonogram (number/size of follicles)
Every patient has a different response to these medications and each patient has a different response cycle-to-cycle.
Monitoring the Rise in Estradiol in 10 Days of Stimulation
Usually, the estradiol level at the start of the cycle is 30 to 70 pg per mL.
Estradiol level rises from 300 to 500 from one follicle in a natural cycle and up to or over 3,000 with stimulation on day of retrieval.
The reason why the estradiol level rises so high is that instead of one follicle developing under the influence of natural low-levels of FSH and LH, we now have 30 follicles developing under the influence of injectable high-dose FSH and LH.
Monitoring the Size of the Follicles in 10 days of Stimulation
At the beginning of the menstrual cycle, the size of the follicle/s is usually 4-5 millimeters. This is about the size of the head of a pencil eraser.
The follicle containing the egg will start to increase in size after about 3-4 days of stimulation.
Typically, after the follicle starts to increase in size from 4 mm in the first few days.
The follicle will increase in size, 2 mm a day. – as seen below
Table 1: A typical response in follicle size and estradiol level to fertility medications
during stimulation for egg freezing
STEP SIX: EGG RETRIEVAL (OOCYTE RETRIEVAL)
It is necessary to fast the night before the retrieval because the procedure is done with light intravenous anesthesia sedation to ensure that your retrieval will be painless and you will be comfortable both during and after the procedure.
The retrieval is accomplished using the same type of ultrasound machine that is used for your daily monitoring.
A needle guide is attached to the vaginal ultrasound probe through which a thin special aspiration needle can be inserted through the opening into the needle guide.
Once you are fully asleep, the vaginal probe with the needle guide is gently introduced into the vagina and then the needle is inserted into the guide and passes through the vaginal wall to reach each ovary.
Using ultrasound guidance, the follicles in each ovary can be easily identified. The fluid in each follicle contains the egg cell and this fluid with its egg cell is gently removed with very mild suction from the ovary into a special test tube – which is then handed to the laboratory technician.
Egg retrieval itself takes about 20 minutes. Most patients are awake within 20-30 minutes and usually able to go home within an hour. As a precaution, most patients are given several days of antibiotics to decrease the likelihood of an infection which is extremely uncommon.
On the day of the egg retrieval, please have a family member or friend available to bring you home after the procedure.
STEP SEVEN: CRYOPRESERVATION IN THE LABORATORY
The egg cells are frozen in the same day as the procedure.
STEP EIGHT: STORAGE
The egg cells are frozen in special straws. We usually place 2-3 eggs in each straw but sometimes, only one egg in each straw – depending upon on the patient and her requirements.
The straws are put into a special container that contains liquid nitrogen, so the egg cells remain frozen solid.
We usually the frozen eggs to a long-term storage facility – ReproLab, located in downtown Manhattan.
We have a 30-year relationship with ReproLab and highly recommend them the annual storage fee ($400).
