More and more women are marrying at a later stage of life, but fertility—specifically egg quality and quantity—declines with age. This creates an impetus to explore fertility preservation through egg freezing.
The process involves stimulating the ovaries to produce multiple eggs, and then retrieving and freezing those eggs. Pregnancy from frozen eggs is achieved through IVF (in vitro fertilization). Eggs are thawed and fertilized in the laboratory, and one or two resulting embryos are transferred into the uterus. (These embryos can also be frozen for future use.)
Many women pursue egg freezing when single. Others pursue it following marriage at a more advanced age, or at a younger age when there is a specific medical concern.
Women typically initiate the egg-freezing process by consulting with their health-care providers and social networks for referrals to appropriate physicians or clinics. Some women go through the process together with friends, creating a mutual support system. All women are welcome to reach out to Yoatzot Halacha Fertility Counselors for free consultations about egg freezing, at any stage of the process.
The first stages of egg freezing are much like the initial stages of IVF. First, a woman undergoes medical screening and plans her egg freezing cycle.
For egg freezing to lead to a live birth, the egg (or oocyte) should be mature, i.e., after meiosis. In a typical menstrual cycle, one egg will mature about a day before ovulation. To stimulate the ovaries so that more eggs will mature for freezing, a woman has eight to twelve days of hormonal injections, which she can administer herself. At this time, she will also take medications to ensure that she does not ovulate prematurely. A trigger shot is then used to stimulate ovulation when desired. The hormonal injections and medications prior to ovulation can lead to some uncomfortable side effects. Many women find that they can keep up most of their regular schedule during the injection phase, but it can be helpful to arrange for more flexibility and some extra support at this time.
Ovulation is followed by egg retrieval, a short outpatient procedure performed under local anesthesia. Recovery can be painful, and doctors generally recommend taking a day or two off after egg retrieval.
Once the eggs have been retrieved, mature eggs undergo vitrification, a flash-freezing technique. The frozen eggs are metabolically inactive and can remain preserved in this state indefinitely.
The number of cycles performed is typically a function of the number of mature eggs retrieved, the woman’s age, and individual financial considerations.
The best age at which to freeze eggs depends on a woman’s personal medical profile, on finances, and on her availability to devote the necessary time for injections and retrieval.
The success of egg freezing depends on the number of eggs retrieved and the likelihood those eggs will lead to a healthy baby, based on the age of the eggs. As women age, their egg supply dwindles, and chromosomal errors are more likely to occur in the eggs that remain, preventing them from leading to healthy pregnancies. Thus, younger women tend to be able to freeze more eggs per cycle, with more of them likely to lead to live births.
In order to optimize egg quality and future reproductive odds, women are typically encouraged to pursue egg freezing in their early thirties, ideally by age 34. From ages 30-34, one freezing cycle can yield ten eggs, with a 65-70% chance that attempts to conceive with them will result in at least one live baby. Twenty eggs would lead to an 80-90% chance of a live birth. By ages 38-40, more cycles are usually required, and the probability of a live birth for ten eggs goes down to 45-50%.
Financing Egg Freezing
Costs typically come to several thousand dollars per cycle, not including the price of medication and storage, or of future fertility treatment.
A woman’s first step should be to check with her insurance or health fund and her employer to see what coverage or support is available for elective egg freezing (also known as oocyte preservation or cryopreservation). Prices also vary by facility, with some clinics offering payment plans, so financial research can also be a part of choosing a clinic.
A number of Jewish organizations, including Bonei Olam, A TIME, Puah, and free loan societies may be able to help finance fertility preservation. Some of these organizations, however, may make support contingent on specific criteria, such as arranging for halachic supervision for retrieval.
There is no halachic obligation to pursue reproductive technologies in order to fulfill the mitzva of procreation (peru urevu) or of causing the world to be inhabited (shevet). This is especially the case when we take into account the physical and financial burden involved, and women’s exemption from the mitzva of peru urevu.
There is also no halachic barrier to egg freezing. The procedure is considered permissible because its ultimate goal is to enable fulfillment of the mitzva of procreation, and because it is fairly low risk, with complication rates at less than one per thousand. In the past, some halachic authorities questioned whether egg freezing would inspire women to deliberately delay marriage, but those voices have faded.
The injections are intramuscular, and thus permissible on Shabbat, though the syringe should be fully prepared in advance. A woman should make it clear from the outset that her retrieval should not be scheduled for Shabbat. In most cases, egg freezing cycles should not be scheduled for holiday periods, when there are additional days on which retrieval should be avoided.
Halacha permits the destruction of excess frozen eggs. After they are done with childbearing, some women might consider donating excess eggs to others who cannot otherwise bear children. We encourage women considering this option to consult with a local halachic authority or a Yoetzet Halacha Fertility Counselor about the halachic considerations involved.
We thank Bat-Sheva Maslow, MD, MSCTR, FACOG, Medical Curriculum Director for Nishmat’s Miriam Glaubach Center, and Reproductive Endocrinologist and Director of Research at Extend Fertility in NY, for her contributions to this article.