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10 questions you should ask before choosing an egg freezing provider

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10 questions you should ask before choosing an egg freezing provider

March 7, 2019 in Ask the Doctor, The Real Deal

Egg freezing is an important decision, and women should fully understand their options before they commit. We’re here to help. Here are 10 questions you should ask a potential egg freezing provider before moving forward, and our answers (to save time—we know you’re a busy woman).

1. What doctors would I be seeing, and are they fertility specialists?

Fertility specialists, known as reproductive endocrinologists, have substantial specialty training in the field of fertility and assisted reproductive technologies like egg freezing and in vitro fertilization. REs go through medical school, then a residency in obstetrics and gynecology (just like OB/GYNs), and then three years of additional training to qualify them to practice fertility medicine. This subspecialty training is a fellowship in reproductive endocrinology and fertility, which focuses on treating fertility cases and performing research in the field. REs also take two separate board tests—one for obstetrics and gynecology, and another for reproductive endocrinology and infertility. All told, it’s about 11 years of post-graduate schooling.

Want to learn more about egg freezing with Extend Fertility?

While OB/GYNs are typically exposed to some fertility medicine as part of their residency training, their expertise can’t compare to that of an RE. (And, in contrast, while all REs go through OB/GYN residency, most of them don’t regularly deliver babies and wouldn’t consider that a specialty.) It’s a lot like seeing an orthodontist vs. seeing a general dentist—a dentist has enough expertise to know when to refer a patient for orthodontics, but they’re not trained to fit braces.

Some egg freezing practices cut costs by hiring OB/GYNs, but this isn’t best practice. To ensure you’re getting the highest quality care, it’s important the the doctor you’re seeing for egg freezing is a fertility specialist (RE). All of our doctors at Extend Fertility are REs with extensive experience. Meet our team.

2. Do you have a lab on-site?

Studies have demonstrated that the quality of an egg freezing lab can impact success rates dramatically; a high quality lab can increase chances of success with fertility procedures by up to twofold. So it’s important that your egg freezing provider’s lab use all of the most up-to-date, evidence-based technology and equipment to ensure the optimal environment—and the highest possible success rates—for your eggs.

The first step is to ask a potential provider if they have their own egg freezing lab on site, and if they use that lab for all of their patients. According to FertilityIQ, 15–20% of fertility clinics use another laboratory. “This isn’t necessarily a problem,” they write, “but it may be harder to get concrete answers on how that laboratory operates,” and success rates may vary. For example, FertilityIQ compares the success rates of a major US clinic and the outsourced lab that handles half of their patients; the major clinic had a 43% singleton (one baby—ideal!) birth rate for women under 35, while the outsourced lab’s singleton birth rate for the same population was only 36%.

Extend Fertility has created a state-of-the-art egg freezing lab at our midtown Manhattan location. Our lab was “purpose-built” for egg freezing, meaning we paid special attention to optimizing the process of egg freezing through the design and technology of our lab.

3. What technology and equipment does your lab use to freeze eggs?

The second step of evaluating a potential provider’s lab is to ask about their technology and equipment. There are a lot of variables here—in fact, we’ve written a whole separate blog post on evaluating an egg freezing lab—but the important factors include:

  • The method of cryopreservation the laboratory uses. The two methods are slow freezing, which is the older, less effective method; and vitrification, the new method that made egg freezing an effective treatment. All egg freezing practices should be using vitrification in 2019, as egg survival rates (the percentage of eggs that are still viable after being frozen and thawed) for vitrification are around 90% (compared to around 60% for slow freezing). If your potential provider is using slow freezing, it’s a no go. We use an advanced vitrification protocol known as the Cryotec method, designed to ensure the highest possible success rates for frozen eggs.
  • The type of incubator used in the lab. Incubators are used in the lab to keep eggs at the ideal temperature and pH until they’re frozen. At some labs, they use a large “box incubator” that contains many patients’ eggs. The problem with a box incubator is that, every time the incubator is opened to access a patient’s eggs, the environment inside changes—and because box incubators are larger, it takes longer for their interiors to return to the optimal temperature and pH. A superior piece of equipment is a benchtop incubator, like we use in our lab. The six small chambers of the benchtop incubator each contain only one patient’s eggs, allowing precise control and stability of the incubator environment.

4. Where will my eggs be stored after they’re frozen?

In order to stay preserved, your eggs must be stored at a stable -196ºC in liquid nitrogen storage tanks; a highly monitored, secure storage facility is imperative. Unfortunately, “on-site storage” at many clinics is often insufficiently safe, without the benefit of surveillance, security, or backup nitrogen refill systems—which could put valuable frozen materials at risk.

We’ve partnered with New England Cryogenic Center (NECC) for off-site storage for our patients’ eggs. NECC is not a clinic—it’s a dedicated frozen tissue storage facility with a spotless record for over 40 years. At NECC, frozen eggs are protected via 24/7 monitoring and staff on-site 365 days a year; each storage tank has its own separate monitor and multiple monitoring systems in place to ensure proper tank temperature and liquid nitrogen levels. NECC is protected from power failures by backup generators, and a 9,000-gallon gravity-fed liquid nitrogen tank is on premises in case of an outage. Learn more about keeping frozen eggs safe.

5. What will happen if/when I want to use my eggs?

Frozen eggs must be thawed in a lab and fertilized in a process known as in vitro fertilization, which creates embryos that can then be transferred back into your uterus. While many women freezing their eggs in hopes that they’ll never need to use them, it’s important to understand what will happen if you do.

You need to know: Does your potential provider offer the option to use your eggs with the same facility and team? And how much does that service cost? We have built a sister practice, Expect Fertility, that offers our patients a seamless and affordable experience when using their eggs (in addition to offering affordable full-service fertility care).

And what if you move, or want to use your eggs with another facility for any reason (like, say, your insurance covers one particular clinic but not another)? It’s important that your provider offers an easy option to transfer your eggs to another laboratory, and is able to communicate lab protocols to allow for the optimal thawing of your eggs.

6. What does the price of an egg freezing cycle here include?

It’s only recently that fertility providers are transparently listing the cost of egg freezing in an upfront way (we like to think we had something to do with this change, since we’ve been doing this since 2016). But even if the cost of a cycle is clearly listed, it’s important that you understand what that cycle price includes. Does it cover the cost of your consultation, or is that a separate charge? Is anesthesia for the egg retrieval included? Is additional required testing included? Make sure you fully understand the breakdown of what you’re paying, so you can accurately compare providers—and avoid any surprise bills later.

At Extend Fertility, the price of one egg freezing cycle is $6,500. That includes anesthesia, and there’s no separate charge for a fertility assessment or a consultation. It doesn’t include medications, which run about $2,000–$5,000 (and are sometimes covered by insurance). It also doesn’t include the price of some “checklist” testing, like STD testing, which is typically covered by insurance or easily accessible via your primary care doctor. Learn more about the cost of egg freezing.

6. How many eggs should I freeze?

There isn’t a general answer to this question—it depends not only on your age, but also on your family and future goals. Because egg quality declines with age, the number of eggs you need to freeze for a high chance at pregnancy is higher for women who freeze at later ages. For example, according to a model developed by Brigham & Women’s, a woman who is under 35 has about an 85% chance of having a baby with 15 frozen eggs. If a 38-year-old freezes the same 15 eggs, that would represent only a 60% chance of having a baby. In order for the 38-year-old woman to have the same 85% chance, she would need to freeze 30 or more eggs.

The other factor is your own goals. Do you want three kids? One? Or are you not even sure you want kids, but you want to preserve that option for yourself? Are you planning to start trying at 35, or 40? If you want a bigger family, or want to start your family later, it makes sense that you’ll need a bigger “bank” of eggs to work with. Learn more about how many eggs you should freeze.

No matter what your age and goals, your doctor should be able to give you a number that represents a good chance at success—whatever success looks like for you.

7. How many eggs do you think I’ll be able to freeze in one cycle?

Predicted egg yield is different for everyone; the way to find out yours is to have a fertility assessment, which includes an AMH blood test and an ultrasound, then discuss the results with a reproductive endocrinologist. The RE should be able to give you an idea of how many eggs they expect you to be able to freeze in a single cycle, based on your age and the results of your testing.

At Extend Fertility, we use a proprietary algorithm, based on the nearly 2,000 egg freezing cycles we’ve performed, to estimate with 90% confidence the range of eggs you’ll be able to freeze in one cycle. This information is provided to you at your consultation, and is based on the results of your fertility assessment.

9. What are my chances of having a baby with my frozen eggs?

The next step after understanding how many eggs you’ll probably freeze in one cycle is to understand what that means for you. One egg ≠ one baby. Your chance of having one baby (or more) with frozen eggs is based on your age at the time of freezing and how many eggs you freeze, and your doctor should be able to give you a realistic, evidence-based understanding of your chance of pregnancy using your frozen eggs later.

This is one of the most misunderstood aspects of fertility medicine, especially egg freezing. Critics argue that women aren’t getting realistic information about their chances of conceiving later with frozen eggs, and are undergoing egg freezing with inflated expectations that will lead to disappointment later on. We agree that it’s absolutely critical to give women all the information they deserve and trust them to make an informed choice that’s right for them. That’s why our consultations include an in-depth explanation of how egg freezing will really benefit you.

10. Will I need to do multiple cycles?

While it’s important to discuss this with your potential doctor, the decision will ultimately come down to you and your goals. Once you understand how many eggs you should freeze in total, and your likely results in one cycle, you’ll need to do some thinking: What chance of motherhood makes this process “worth it” for you—or are you simply trying to make sure you’ve done everything you can to prevent later regrets? And, of course, how much of an investment (of time and money) are you able to dedicate to egg freezing?

These discussion points will help you and your doctor decide whether one cycle will be enough for you, or if you should plan on doing two or more. At Extend Fertility, we offer discounted pricing for additional egg freezing cycles to make it a little easier to reach your goals.


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