Should I Freeze My Eggs or Embryos?

Mariana

When I first started thinking about freezing my eggs, there was so much information, but it also felt really overwhelming. I come from a family of folks in the medical field–  but I'm not one of them. So, I didn't know all of the options. And that’s in part why I put off freezing my eggs. I didn’t really understand the differences between embryos and egg freezing, and what options I had available. I would go in to have a conversation and would get all of the information at once. I couldn't really decipher which option was right for me. I didn’t have a partner, so I didn’t know if I should freeze embryos or eggs. So when you’re seeing patients, how do you break down their options for them?

Dr. Kofinas 

This is a very common question. And the answer would be different 10 years ago than what it is now. 10 to 15 years ago, egg freezing wasn't as successful. Eggs didn't survive the thawing process as well. The freezing technology wasn't mature at that point. So freezing embryos was encouraged because patients had a better shot at success. As the egg freezing technology has greatly improved, we’ve approached 80 to 90%, sometimes even 95%, survival of eggs during the thawing process, which is getting really close to the 99% survival rate for embryos during the thawing process. This has created a situation where patients don’t need to worry as much about the success of their eggs successfully unthawing long term. So, more people are more comfortable freezing their eggs instead of an embryo when they don’t have a partner.

Before this technology improved, this would be a big question for patients who didn’t have a partner. They’d have to consider whether they’d want to use a sperm donor. Then what does that mean if they end up finding a long term partner? Would this partner accept this situation? Sometimes patients would freeze half of their eggs from their retrieval as embryos, and the other half as eggs so they would have both options in the future.

Today, I think the only advantage freezing embryos gives you is that it allows you to know if you have a healthy embryo right away. Versus, if you are freezing eggs, you don’t know how many eggs you need to freeze to get a certain number of embryos. 

Mariana

Because there is the option to come back to the clinic and go through another round of egg freezing over and over again, depending on the number that you were able to retrieve. So today, patients have more optionality- which is great.

This optionality is why I knew that I wanted to move ahead with egg freezing. But at the same time, I had a different experience than a family member of mine who froze embryos. They at least knew how many of these embryos would be viable.

Dr. Kofinas

Yes, today we can genetically test embryos to see if they are genetically normal. Versus ten to fifteen years ago, it wasn’t commonplace to do that. So patients would freeze embryos, but there was no guarantee that they were genetically normal. Now, having this information, patients don’t have to do as many cycles if they reach a certain number of genetically normal embryos- of course, depending on their family planning goals. Compared to the past, we didn’t necessarily know how many embryo transfers a patient would need to have a live birth.

These success rates are also a testament to the improving technology, the increased utilization of IVF, and also, hopefully, decreasing the number of cycles people have to go through to get to the results they want.

Mariana

But the overwhelming nature of getting all of this information can leave patients wondering, “All right- where do I land?” And it’s not only the options you have, it is also about the treatment plans you can have depending on your body or hormones. I remember seeing this video during one of my first consults that the clinic showed us, and it was very complicated. We were told,  “Some of you will use this medication, and others will use that medication. Or, some of you will inject in your front, but some of you will inject on your backside.” Can you explain the different treatment plans? There was such a range that was overwhelming.

Dr. Kofinas

Right. I think that's the danger of counseling patients on all of the existing options through a video. There aren't a hundred treatment options, but there are a few different medication administration techniques, and they are individualized to the specific patient. So, when you're going through the process, I think it's important that you ask these questions about where you fall into these different types of treatment. Say, “Okay, I understand this video went through every type of medication with every single type of needle in every location I could inject- where do I fall into this?”

Because otherwise it's overwhelming. When you watch the video at home, you are thinking, this needle looks small- should this needle go in my belly? Or wow, this needle is really big- and it goes in my leg? There are videos now that are more targeted for what medication you're using. Obviously, in-person teaching is an important aspect of this.

Mariana

And it is getting more refined. And that’s the beauty of the evolution of this. Whether it’s your hormones, or your age, or the types of hormones you need. I remember that it can also get a little confusing because the medications have different names.  As someone who is not very well versed, you can be a little scared to ask those questions. I didn’t realize some of the medications had interchangeable names.

Dr. Kofinas

To your point- there aren’t that many different medications. Sometimes we can get caught up with the alternative when we're communicating with each other. But if you don't ask, you'll never know. I encourage all my patients to ask these questions. You don't want to get into a situation where you're two or three days into your cycle  and you realize you were injecting the wrong medication because this is a big time commitment as well as a financial one. Don't be scared to ask.

Mariana

As adults, there's fear of what we don't know, so we're just afraid to ask. Especially if we think it's a dumb question. But at the end of the day, there are no dumb questions. You’re doing something important for yourself and your body.