Own Your Fertility— Should You Consider Freezing Your Eggs?

Women’s fertility has been a long-debated topic. Particularly in India, where numerous studies have highlighted the unfair burden of societal expectations on women being mothers first. Women having autonomy over their bodies has been a pipe dream. This is further exacerbated by the fact that there is a looming biological clock constantly decreasing the odds of bearing children naturally as women age. 

The UNFPA report quoted the NFHS-4 (2015-2016) survey in India to say that only about 12 per cent of currently married women (15-49 years of age) independently make decisions about their healthcare, while 63 per cent make the decision with their spouse. Not anymore, though—oocyte cryopreservation, or egg freezing as it’s more commonly known, is growing in popularity, with more and more women leading the change, making the decisions for themselves. More and more women can take charge of their fertility and control its timeline. Although there is no national data on egg freezing in India, assisted reproductive technology specialists said there has been a 25 per cent rise in the number of single women freezing their eggs over the past year.

When Aashna M* froze her eggs at 30, she wasn’t ready for children, but she considered the possibility that she might want them at some point. “Egg freezing was an insurance plan that I took out. I didn’t really even think about it. It was something I had to get done, and I did.”

Rituparna Som had her eggs frozen at 43; for her, it was research that informed her about the process, “I was reporting on the phenomenon for a few years, and as I spoke to more and more women and doctors, I found myself better informed. I’ve never wanted children, but the arrogance of youth was wearing off, and I realised that one of life’s privileges and demands is that you can and sometimes have to change your mind. I wanted to minimise regret and the more I learnt about how safe and even relatively affordable the process was, I figured, why not do it if I can?” 

Neerja L*, an entrepreneur from Gurgaon, was married for three years when she chose to freeze her eggs at a pivotal point in her career. She says, “I froze my eggs at 33. This is around the age when women begin to spread their wings in the professional space. You begin to get the leadership roles you’ve been working so hard for. It had been two years since I had started my own company, which was beginning to generate positive results. Since day one, my husband and I have been very clear about one thing: if we decide to bring a child into this world, we are going to give our 100 per cent. I felt that if I were to go down the path of starting a family at that point, my work would certainly take a backseat for a while. So, both personally and professionally, I was not ready for it. That’s when I decided to freeze my eggs to have more reproductive autonomy without losing time on my biological clock.” 

Dating back to the late 1970s and early 1980s, egg freezing was first unsuccessfully carried out by scientists due to the delicate nature of the eggs and the formation of ice crystals. Described as the holy grail of fertility, egg freezing finally came to fruition in 1986 with the birth of twins following the procedure in Australia.

Egg freezing as a technology is not directed at starting a family but rather to preserve fertility. Defined by science as extracting a woman's eggs (oocytes) from her ovaries and freezing and storing them at extremely low temperatures, usually in liquid nitrogen, the process is referred to as oocyte cryopreservation. 

Through the egg freezing process, eggs can remain viable indefinitely and can be used at a later date through various reproductive techniques. Egg freezing gives women options for the future of their fertility.

“Just because you have eggs doesn’t mean you must freeze them,” says Dr Duru Shah, one of India’s most prominent gynaecologists and fertility specialists at Gynaecworld, Mumbai. Understanding why you want to freeze your eggs is paramount, and the first step in the process is a visit to your gynaecologist.

Social egg freezing, also known as elective oocyte cryopreservation, is the process of preserving a woman's healthy eggs for potential future use in fertility treatments. It’s purely out of choice and non-medical reasons. 

Medical egg freezing, also known as medical oocyte cryopreservation, is the process of preserving a woman's eggs for future use in fertility treatments due to medical necessity. This means the eggs are frozen before undergoing medical treatments that could potentially harm or damage a woman's fertility. This could include treatments such as chemotherapy, premature ovarian failure, pre-menopause, gender-reaffirming surgery and other medical conditions, treatments and procedures where fertility can be harmed.

Dr Shah highlights the importance of medical egg freezing, “Young girls going for cancer treatment—you must think about your eggs. Before going for any chemotherapy or radiotherapy, freeze your eggs. It doesn’t take more than a week or two. There are different protocols. We give lesser doses.” 

She adds, “Even if you opt for radiotherapy, sometimes we conduct a surgical procedure where we move the ovaries out of the radiation scene so that they are protected. Freeze your eggs before 32-33, and if you're in India, then latest by 34. If your mother has premature menopause, that can be another risk factor.” 

Finding a doctor to be your partner in your egg freezing journey is integral. Choose a doctor who makes you comfortable, works towards ensuring your questions are answered, and makes you feel safe.  

Neerja L* shares, “I was fortunate to have a doctor who gave me a clear picture. I’ve known many people who have undergone egg freezing, and a lot of times, doctors tend to underplay the kind of suffering that a woman can probably experience. Everybody is different. I think it's a medical professional's duty to apprise anybody thinking of undergoing a process like this, with all the possible reactions to it.”

• Most fertility specialists are ObGyns, but some have special certifications in reproductive endocrinology and infertility. These gynaecologists specialise in all aspects of fertility, including egg freezing. 
• Ensure you are comfortable with the clinic staff. Egg freezing is a complex procedure, and while you will have your doctor with you every step of the way, the clinic staff also plays a vital role in your procedure.
• Remember to ask your doctor about their experience in fertility. If you have any medical conditions, ask them if they would be alright working in collaboration with your other healthcare providers. Check with them to see how many successful procedures they’ve completed.
• Trust your instincts, stay with the doctor you feel most comfortable with, and one who tries their best to keep you informed, provides no judgement and is willing to help you to the best of their ability. 

A helpful tip from Neerja L*: “I did a lot of reading, watched a lot of videos and asked my doctor as many questions as possible, no matter how silly. Because at the end of the day, you're literally going to be pumping your body with a lot of hormones, and it's a big deal!”

At this stage, you meet with your fertility specialist, discuss your expectations for egg freezing, and inform them of your comorbidities. First, you need to get tested for eligibility,  “We need to do certain tests on the second or third day of the period, which tells me what the ovarian reserve is,” says Dr Shah.  

The blood test analyses hormone functions and informs you of your current fertility status. A vaginal ultrasound follows this step to check the overall health of the uterus and get an approximation of the eggs that can be retrieved. These initial tests inform how the doctor customises your treatment plan.

In order to produce as many eggs as possible, people with a uterus undergo ovarian simulation with the help of hormonal medication. To restrict spontaneous ovulation, daily hormone injections are given. Once the follicles containing the mature eggs reach the appropriate size, a trigger injection is administered to induce final egg maturation. 

The injections help the eggs to grow well. A daily injection is given for approximately ten days or so, and the patient is monitored through ultrasound and blood tests. The egg size is also monitored, and when the size reaches about 18+ (millimetres), the eggs are mature. Then, an injection called the trigger is administered. This injection helps those eggs get released from the graffian follicle wall. 

The injections for egg stimulation can also be taken at home. Dr Shah explains, “There are many types of injections available, some even in a pen form, and you can take them yourself. We actually train the patient on how to do it.”

Aashna M* has undergone two egg freezing cycles, one in India and the other in the United States, “In the US, it was so impersonal, they hand you the prescription, and you get your injections from CVS, and they basically tell you to inject yourself. I have a phobia of injections, so there’s no way I could do it. It was the most stressful part for me. The experience in India was a million times better than in the US. In the US, there was nobody to talk to if you felt weird, to ask what to do if you missed your injection at a certain time. You have to call some regular landline, wait forever and talk to a random doctor within certain timeframes. In India, I had somebody to talk to if I had any issues. I’d talk to the nurses, and I’d go to them to get my injections.” 

A short procedure - called ovum pick-up is then performed (transvaginal ultrasound-guided egg retrieval, generally under anaesthesia) to collect all the eggs. The procedure takes place 36 hours after the trigger injection is given to the patient. “We take the patient into the operation room on an empty stomach, give anaesthesia and extract the eggs, which is done vaginally, under ultrasound guidance,” says Dr Shah.

The retrieved eggs are then assessed for maturity and quality. The mature eggs are selected for cryopreservation and preserved through a process called vitrification, where they are rapidly cooled to very low temperatures to prevent ice crystal formation.

1. What is the best age to freeze my eggs?
2. Is it possible to freeze my eggs after 40; what are the chances of my eggs being viable?
3. What makes someone non-eligible for egg freezing?
4. Will I be able to freeze my eggs if I have comorbidities or hormonal conditions?
5. What are the scenarios in which you should freeze your eggs?
6. How often can I freeze my eggs? What is the ideal time between egg freezing cycles?

*Sources Birla Fertility | Fertility World | Pristyn Care | Little Angel IVF | Omya Fertility |

Indicure | IndiraIVF

The cost may vary significantly due to factors like clinic location and reputation, doctor's experience, a woman's age and the resulting number of egg retrieval cycles, and even travel expenses, which can influence the overall cost. Additionally, future IVF procedures using frozen eggs would incur separate costs. To navigate these variables and find the most cost-effective option, it's crucial to compare personalised quotes from different clinics, discuss your budget openly, and understand the impact of age and potential additional cycles on the overall financial commitment.

When asked how she navigated the financial aspect of egg freezing, Rituparna Som added, “On a wing and a prayer! I wasn’t in dire straits when I did this, but money was tight. I was, however, privileged enough to prioritise this, even though many around me thought of it as me flushing money down the toilet. I didn’t have to take a loan to do this. But I felt strongly enough about it to stretch my budget.”

IVF (In Vitro Fertilisation) is a complex series of procedures that could lead to pregnancy. During the procedure, mature eggs are collected from ovaries and fertilised with sperm in a lab. These fertilised eggs are called embryos and are placed back into the uterus. IVF can be done using the partners’ own sperm and eggs or through a donor, and the entire IVF cycle can take up to two to three weeks. 

Every individual’s body is different, and how you might react to the procedure is unique. Dr Shah explains why she doesn’t recommend the procedure to her younger patients even though their eggs are more viable at a younger age, “Everything has its pros and cons. There’s nothing that is 100 per cent safe or valid. There has to be a reason why you’re freezing your eggs. I wouldn’t recommend it to an 18-year-old because when you freeze eggs, there is an intervention. You’re putting a needle in and getting it out. It can have its own side effects. If she wants to get pregnant later, it won’t come in the way, but some patients may have a complication during the egg pickup. The risk is very low, but she could pick up an infection or bleed from the puncture site. Eventually, it might prevent her from getting pregnant naturally. So, why would you want to do an intervention when you don’t need it?”

Every individual’s body is different, and how you might react to the procedure is unique. Dr Shah explains why she doesn’t recommend the procedure to her younger patients even though their eggs are more viable at a younger age, “Everything has its pros and cons. There’s nothing that is 100 per cent safe or valid. There has to be a reason why you’re freezing your eggs. I wouldn’t recommend it to an 18-year-old because when you freeze eggs, there is an intervention. You’re putting a needle in and getting it out. It can have its own side effects. If she wants to get pregnant later, it won’t come in the way, but some patients may have a complication during the egg pickup. The risk is very low, but she could pick up an infection or bleed from the puncture site. Eventually, it might prevent her from getting pregnant naturally. So, why would you want to do an intervention when you don’t need it?”

When asked if she encountered any unpleasant surprises during the process, Rituparna Som said, ”I think feeling a wave of ‘mammoth lowness’ (not depression) on the evening after my procedure was unexpected. Much later, I was told it could be a common side effect of the medication I was given during the retrieval process. I’m the kind of person who needs to know all possible scenarios (as humanly possible), and this hit me left of centre. I was upset that no one told me about it beforehand.”

Neerja L* shares an emotional episode she experienced, “While I was going through the process, I had to travel to another city. So I was all alone. While I was absolutely fine, I wasn't handling it quite well. I remember there were two points during this journey where I was just sitting, using my phone. And I read something that triggered me and resulted in a really bad breakdown—I was sobbing and howling. Naturally, I was aware that it was because of the hormonal process that I was going through, but this experience was quite bizarre; I did not see this kind of breakdown coming.”

Aashna M*, who has frozen her eggs twice, experienced physical side effects the second time around, “I think everybody's body reacts differently to hormones. So, the first time when I got the injections, nothing happened. And it was all good. But during the second time, I think it was the last 3-4 days when I felt very heavy and very bloated. And I just felt like I couldn't move. The second time was more intense than the first. I also put on a lot of weight but lost it over time.”

• Eligibility: Women who wish to preserve their fertility for medical or social reasons are generally eligible. Medical reasons include undergoing cancer treatment that could affect fertility. Social reasons involve delaying childbearing due to career goals or other personal choices.
• Age restrictions: There are no strict legal age restrictions, but most clinics have their own guidelines, generally preferring women under 35 to maximise egg quality.
• Process:

Counselling: Mandatory counselling ensures women fully understand the procedure, risks, benefits, and implications of egg freezing.

Informed consent: Detailed informed consent forms are required.

Clinics: Egg freezing must be performed in licensed, accredited Assisted Reproductive Technologies (ART) clinics.

• Storage: The law permits the storage of frozen eggs for up to 10 years, with the possibility of extension based on medical reasons.
• Disposition decisions: In unforeseen circumstances, clear instructions are needed in advance regarding the future use, disposal, or donation of the eggs.
• Social considerations: Single women's access: While egg freezing itself is not restricted for single women, subsequent use of frozen eggs with donor sperm to have a child may face additional legal hurdles related to surrogacy regulations.

Owning your fertility and exercising reproductive autonomy is no easy feat. Women continue to experience social stigma around their choice to have, delay, or not have children. When we asked women who underwent egg freezing about the reactions received from friends and family, Neerja L* beamed, “I feel that I come from a very privileged background. I know a lot of women out there who want to go in for it, but they don't have the support of their family, or they don't even have the resources. A lot of women end up succumbing to the expectations of their friends, family, and relatives. My own friends and family were very supportive and lauded my decision because they felt that it was also very, very brave to get something like this done.”

Rituparna Som added, “I am an oversharer—everyone who came into my orbit for those months before and after knew every gory detail. I also felt it my duty to inform as much as possible through my actual experience, because I felt I had been ‘cheated’ of that at a time when it would have been beneficial. Most reactions were positive. Most were also a bit confused because I was doing it when I was so ‘old’ and I had been so vocal about not wanting children. They did play on my mind a bit, but unexpectedly, I felt very empowered to make this decision about my own body.”

Neerja L* strongly advocates for the procedure, “I feel that any woman in their mid-20s, late 20s, early 30s, whenever they feel ready, should 100 per cent go ahead. It gives you so much autonomy over your own body. I think it is very empowering. It enables you to really focus on your career and explore and enjoy your life the way you want to.”

She adds, “It's also empowering for people who have not found “the one” or are not in a place where they want to settle down or get married. I feel that you should not have to settle down only because your biological clock is running out of time. That pressure is very unnecessary.”

Aashna M* shares the same sentiment, “I would say if you don't know that you want to have kids at some point, you're unsure, but you just need the safety net of having the option to do it later on in life when you're older, then go for it! It’s two weeks of your life.”

Rituparna’s advice is straight to the point: “Just. Do. It.”

*names have been changed to protect identity

Medically reviewed by:

Dr. Uday Thanawala, Obstetrician and Gynaecologist