Abbey Sangmeister always knew she wanted to be a mother. But like so many women, she focused on grad school and her career throughout her 30s and hadn’t found the right partner to become a parent. By the time she was 35, she thought about freezing her eggs but worried about the expense and the physical toll it might take. Plus, she was still holding out hope that she would find the right partner.
Then the COVID-19 pandemic hit, complicating her fertility journey further. She found support in a Facebook group for single moms by choice and started to focus on her next steps. “When I turned 40, I knew I couldn’t wait any longer,” says Sangmeister, a Philadelphia-based life coach. Though she tried her primary care doc first, he didn’t have much info for her—so she started researching fertility clinics.
At first, she was discouraged by the long waitlists and pricey procedures (which average $15,000 per cycle). Then, she found a clinic an hour from her house that had experience helping both women in their 40s and single mothers by choice. It felt like she’d hit the jackpot. Yet what she discovered was eye-opening.
“There were things about my body I should have known, like my ovarian reserve level,” she says. “But you never really focus on that stuff when you’re younger.”
Stories like Sangmeister’s are becoming increasingly common, as more women than ever delay pregnancy. In fact, according to the CDC, the number of women giving birth in their 40s has continued to rise by an average of 3% every year since 1985.
While egg-freezing is sold as a way to preserve your fertility forever, the procedure isn’t foolproof, especially for women in their 40s. But there are ways to understand your own risks based on your body and improve outcomes. We spoke to top fertility specialists to understand how.
Testing 1, 2, 3
Any fertility process starts with a lot of research and finding a clinic and doctor team you’re comfortable with. Sites like FertilitySpace can help narrow down your search by showing stats like its success rate at certain age groups (including over 40) when compared to the national average.
Once you’ve signed up with a clinic, the doctors typically do a round of diagnostic testing at certain times in your menstrual cycle to understand your current hormone levels. These hormones can give a good indication of ovarian reserve, or how many viable eggs a woman might have left. This number doesn’t matter at all for a woman who might be trying to get pregnant naturally, but it’s absolutely crucial to understand for those considering freezing their eggs and eventually undergoing IVF.
“We can only mature and access the eggs that are recruited and available,” says Dr. Lucky Sekhon, a reproductive endocrinologist and infertility specialist at New York City-based IVF center RMANY. “Egg count can impact the chance of success when undergoing treatment like IVF, which is always more successful if starting with a high number of eggs.” After age 35, women lose eggs at a faster rate, which means fewer available for extraction and freezing. Understanding your number can provide a helpful jumping off point for a productive, realistic chat with your doctor.
“It’s important to have an honest conversation with the fertility doctor about the odds of success with IVF and how many cycles it might take,” says Christina Burns, L.Ac, a Doctor of Chinese
Medicine and founder of Naturna. A low ovarian reserve, high follicle-stimulating hormone (FSH), or signs of perimenopause (like irregular periods or hot flashes) may make it more challenging to get enough viable eggs for freezing. Going in with eyes wide open can make you more prepared for the financial and physical costs of the procedure.
Quality Over Quantity
Even if your ovarian reserve levels are low, it doesn’t necessarily make getting pregnant a long shot. After Sangmeister was tested, she found she did have a lower ovarian reserve number but was otherwise healthy. Her doctor gave her a 15 to 20 percent chance of getting pregnant on the first round of IVF, while other statistics she found online for a woman her age and reserve put it closer to 11 percent.
One thing diagnostic testing can’t determine before egg extraction is the quality of the eggs, which matters more than the overall quantity when it comes to a successful pregnancy.
“As we age, it becomes more common to ovulate an egg that is missing DNA or has extra chromosomes,” explains Sekhon, “which can lead to the formation of an abnormal embryo. Embryos with genetic errors will either not implant, result in miscarriage, or in the birth of a child with major medical issues.”
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The stats degrade fairly rapidly as women age past 35. As Sekhon explains, they see 20 to 25 percent of errors in eggs extracted from 20-year-olds. That likelihood of chromosomal errors rises to 50 percent by age 38, reaches 70 percent by age 42, and approaches 90 percent by age 43. “When eggs are removed from the ovary and frozen, they no longer undergo this degradation of quality and quantity over time,” says Sekhon. Translation: The younger you are when you go through the egg extraction and freezing process, the higher your chances of putting high-quality eggs on ice.
The Removal Process
Once a woman decides to go forward with the egg extraction process, she has to inject herself with hormones daily for a few weeks to stimulate her follicles to produce the maximum number of eggs available for retrieval. This part of the process isn’t side-effect-free, and doctors recommend finding a strong support system—like family, friends, and a good therapist—to lean on for support.
“It’s an emotional journey and everyone responds to it differently,” says Sangmeister. “I put on 10 pounds in a week, which is just from the medication and from your follicles growing. You’re just puffy and swollen and you feel the follicles jumping around in there, like water balloons.”
The fertility clinic will continue to monitor hormone levels and follicles and determine when they are primed for egg retrieval. When the levels look ideal, a doctor will administer a final trigger shot, which signals to the eggs that it’s time to release. The actual retrieval process only takes about 10 to 15 minutes, but you do undergo anesthesia for the procedure which means you’ll need someone to drive you home.
Eggs vs. Embryos
It’s important to decide whether to freeze eggs or fertilized embryos, which may mean finding a sperm donor for unpartnered women.
“For single women in their 40s considering fertility preservation, I always ask, ‘What is the bigger priority? Being able to have children linked to your genetics or linked to that of a future partner?’” says Sekhon. If it’s important to do this with a future partner, she recommends egg freezing; if it’s your DNA that’s your priority, she highly recommends embryo freezing with donor sperm.
“Egg freezing doesn’t guarantee being able to conceive in the future,” Sekhon explains. “We aren’t able to predict how many eggs will thaw successfully, fertilize, turn into embryos, be genetically normal (with 46 chromosomes), and implant. So, when you freeze eggs, you are freezing potential.” In contrast, if you freeze embryos, you will know upfront how many healthy embryos you have. What’s more, they thaw better than eggs, increasing your odds of a successful pregnancy.
Sangmeister took the sperm donor route, though it was an added upfront expense. After her extraction, the hardest part was waiting, as the doctors need to evaluate the quality of the eggs and embryos. After a few days, the clinic confirmed they were able to fertilize six of the nine egg retrievals. After a few more days of watching the embryo growth, they confirmed that four were healthy enough to be implanted or frozen for future use.
Once frozen, the eggs or embryos can be stored indefinitely, though it requires a yearly “storage fee,” which averages about $500.
Before even starting the egg freezing process, women who might have the slightest luxury of time (those who are in their young 40s versus their mid-40s) should consider spending a few months fully prepping their body for the best chance of success, say experts.
“It can pay dividends to prepare your body first,” says Burns. “I recommend giving yourself at least three months to optimize your hormones and body. It takes time to improve egg quality.”
The most effective strategy for improving egg quality is to battle the free radicals that can cause chromosomal damage to eggs. You can help do this by reducing stress and upping your antioxidant intake, says Burns. Numerous studies point to acupuncture improving egg and embryo quality. (It’s believed to increase blood flow to the ovaries and reproductive system.) Chinese herbal medicine has also shown to improve fertility outcomes in many women, though it requires a consultation with a practitioner to understand the unique root needs of a patient.
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Both Sekhon and Burns recommend the supplement COQ10 to improve egg quality. Sekhon prescribes 600mg per day, which may help slow the progression of declining egg count and quality. One study showed women who took the supplement for 60 days had both a higher number of egg retrievals, a higher fertilization rate, and higher quality embryos.
Men aren’t off the hook when it comes to improving fertility outcomes either. Sperm quality has been shown to have an increasingly important effect on embryo success. “Men make new sperm every 72 days,” says Sekhon, “and sperm quality can be improved with lifestyle changes and supplements.” If a male partner is involved in the freezing process, this might mean giving up alcohol and marijuana and taking multivitamins for a few months before sperm is used in the fertilization process.
No Time Like the Present
Regardless of any superpower supplement, the most valuable resource a woman has for her fertility is her time.
“If you want a family, and you’re specific about how you want to do it, act now,” advises Burns. In her practice, she has seen women who waited too long and were never able to get an egg despite numerous IVF cycles, which takes a toll mentally, financially, and physically. When her patients come to the end of their egg freezing road, she counsels them in all the other ways that family can be created.
“I tell women to try until you lose hope, or to try until you feel like your desire to be a mother outweighs how you get there,” she says. She also coaches her patients in the idea of epigenetics, and how much external factors can affect a child. “I have lots of patients who used a donor egg and the kid looks just like them,” she says.
As for Sangmeister, now 41, she’s glad those initial statistics for success didn’t turn her off giving egg retrieval and embryo freezing a try. She’s currently pregnant with her first child, due in late August. And though she says she’s going to see how parenthood goes, she’s glad she has embryos on ice for the possibility of giving her child a sibling someday.