When Should I Freeze My Eggs?

Mariana

My first conversation about freezing my eggs happened when I was around 33. The doctor told me that I was the perfect age. And then my egg retrieval didn't happen until I was 38. At this age, you start hearing that you have a geriatric uterus, and all of a sudden- or maybe subconsciously- you have this biological clock. What is the right time? Can women still freeze their eggs at an older age? I think that's a big question we all have: am I too late in doing this? I was just seeing a friend who just had an egg retrieval cycle done, and she didn’t get as many eggs as she was hoping for. And she’s saying, “I should have done this earlier.”

Dr. Kofinas

Every patient's different. There are some general principles that the fertility field follows based on the data. The age where we start to worry about the quality of a patient’s eggs and the resulting embryos is 40. You can have success after age 40, but the success rate drops rather dramatically. I think the problem is that after the age of 40, you probably need to freeze more eggs than you would if you were younger to get a similar result.

The advice I give to patients 25 years old is different, because I see different levels of counseling from OB-GYNs and primary care doctors. I tell them that they don't have to freeze their eggs at 25. It's a financial stretch for a lot of them. The goal should be to evaluate where you are. You can do an ultrasound and an AMH level testing, and then counsel these patients on whether they should do an egg freezing yet or if they should come back at 28 or 30.

Most fertility doctors recommend egg freezing before the age of 34. And the reason for that is you don't have to freeze as many eggs to get a desirable result. In terms of our practice, we see success with egg freezing all the way up to 43, but it's not a guarantee as the success rate is obviously significantly lower the older you get.

My counseling and advice changes when someone's older. If a patient is 42 and is in my office wondering if they should freeze embryos with donor sperm or their eggs, I tell them if they’re okay with that, they should freeze embryos so they can test them. Age-based decisions play a huge role in this.

Mariana

And even if you freeze embryos, has the likelihood of getting pregnant increased over time?

Dr. Kofinas

It’s pretty steady. Every year is different, but generally the success rate has increased, mainly because the quality of the culture media, the incubators, and air quality control in the lab have improved. Also, genetic testing has improved the success rate as well. We are now able to transfer 1 embryo instead of 2 or 3. The result is that the success rate is as high as transferring 2 untested embryos. Now we have fewer twins and miscarriages because of this. When you look at the overall live birth rate, which is what we care the most about, the success rate has increased per embryo because of all the testing we can do.

Of course, as the age increases of the people using these services, we do see a drop in the ability to implant even when you are 40. But our 41 and 42 year old patients are having a 50% chance of implantation with a genetically normal embryo. Versus, for patients under 34, we see an almost 70% chance. So we see a difference, but the success rates are way higher than they used to be 10 to 15 years ago.