Signs of depression and when to talk to a doctor about it

Most people experience majority of the symptoms of depression at some point in their lives, to one degree or another, and it can be hard to tell which moods and feelings are symptoms of disorders which require treatment. For this reason, many people who do have depression or other mood disorders are diagnosed many years after noticing symptoms, or are never diagnosed or treated at all.

Watch out for these symptoms and signs of depression

There are a wide range of symptoms of depression, and some of them are physical, which can make it easier for some people to figure out how and when to reach out and ask for help. Both physical and emotional symptoms may be signs of depression if they last for two weeks or longer. Physical symptoms of depression include:

• Changes in sleep, whether that’s sleeping more often than usual, or insomnia
• A loss of appetite, or increased craving for food, causing either over- or under-eating
• A loss of sex drive
• Tiredness or lack of energy
• Aches and pains or headaches with no obvious cause

The emotional effects of depression can vary widely, from a consistent level of negative feelings all the way to feeling suicidal or hopeless. Emotional symptoms of depression can include:

• Feelings of sadness, hopelessness or feeling on the edge of tears
• Anger, irritability, or frustration, especially anger or frustration that feels excessive to events
• A loss of interest or pleasure in favorite things or interests
• Slowed thoughts, speaking and movements
• Agitation, twitchiness or restlessness
• Feelings of guilt, inability to let go of past mistakes or blame
• Thoughts of death or suicide

Thoughts of suicide should be treated as a medical emergency and you should go to your local emergency room right away.

Depression can be caused and set off by different things at different times. Sometimes depression is triggered  more by life events and stressors. Other times, it’s more determined by brain chemistry, regardless of life and stressors. Often, it’s some combination of the two. In any case, when depression affects your life, reaching out to a healthcare provider  for treatment and support is one of the best ways to start to work towards recovery.

Talking to your provider

Depression is a serious condition, and not something that one snaps out of by force of will. The earlier treatment starts, the faster and more effectively one can begin to start feeling better.

Primary care providers tend to be the first line of defense against depression. Starting the conversation about your mental health with the healthcare provider you’re the most comfortable with is never a bad idea, but it’s also good to remember that most PCPs don’t specialize in mental health treatment, and mental health providers like psychiatrists can be fantastic resources as you start to figure out what your needs around treatment are.

Nerlandes’ Story

Nerlandes Themistocle is a pharmacist and Pharmacy Manager at CVS Caremark, having worked in pharmaceuticals for over 25 years. She is a wife and a mother of two, currently residing in Rhode Island and finds joy with her family, listening to music, dancing, traveling, and exploring new foods. Nelandes Themistocle shares her truth about menopause, from what she experienced to what she wishes she knew about this important part of the reproductive health journey.

Can you tell us a little bit about your menopause experience?

I didn’t experience symptoms or body changes during the perimenopause stage as many others have. All of the symptoms started once my periods stopped very suddenly at the age of 50. What I’ve learned throughout this process and when talking with others is that not everyone experiences menopause in the same ways. Some may experience vaginal dryness, while others may feel more irritable or depressed. No experiences are one and the same.

What symptoms did you experience?

My symptoms were mainly hot flashes and night sweats, as well as trouble sleeping. The hot flashes, however, were pretty severe for me. I’d have to have fans on me at all times at work and when I go to bed.

Were there any other symptoms that caught you by surprise?

The symptom that really caught me by surprise was anxiety. I started to feel anxious about things I normally wouldn’t. For instance, I never felt or experienced anxiousness when it came to my work, especially because I have worked at the same place for years, however, one day I had such an overwhelming experience I had to call my husband. The palpitations were very intense, and this lasted for an entire week. I still feel anxiety from time to time, but I find ways to manage.

Did you feel prepared going into menopause?

Going into menopause is not something any woman can ever be fully prepared for. It took me an entire year to realize that I was going through the change . I definitely was not prepared. I did not have any idea what to expect or even how to identify if I was really experiencing it.

What do you wish more people knew about menopause?

Menopause is not as simple as people think. It is a very complex process that can be long and at times frustrating. The symptoms can last several years after your period stops and can be disruptive to your everyday life. Everyone experiences menopause differently, like I mentioned earlier, no experience is one and the same, so be patient with yourselves.

What do you think is the biggest misconception about menopause?

Menopause is still considered a very sensitive topic. I think that a lot of women struggle with this idea that once they go into menopause, their womanhood is stripped away. They may feel life is going to change forever, and people, including their spouses, will not look at them the same way. I felt that at one point, but my husband still treats me the same. Life may change in some ways, but the most important things don’t. People, not just women, need to be more educated about menopause to help with these feelings.

Is there any message you’d like to give to someone going through or preparing for menopause — maybe someone experiencing the same symptoms as you?

Menopause is not a medical condition but a natural process that will become a part of your life. Our bodies go through a lot of changes during this time, but there are so many ways to manage it. Don’t be afraid of talking about your symptoms; there is absolutely nothing to be ashamed of. Challenge yourself, change your lifestyle, exercise, keep yourself hydrated, lastly and most importantly, seek medical advice or talk to your provider. There are also so many drugs on the market that can help with the symptoms. I have learned to live with it and be happy.

Learn more about menopause

Menopause

Menopause 101

Menopause symptoms

Let’s start with the basics, how often should someone be STI tested? Can you tell us a little more about what exactly to expect?

The guidelines are that everyone who is under 25 and sexually active should be tested at least once a year for gonorrhea and chlamydia. Many STIs can be asymptomatic (particularly in women), so it’s important to make testing part of your annual care. Every annual preventive visit should include a conversation about STIs. Certain people may be at higher risk and require more frequent screening. 

Women 25 years and older with risk factors such as new or multiple sex partners or a sex partner who has an STI should also be tested for gonorrhea and chlamydia every year.

All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.

Everyone who is pregnant should be tested for syphilis, HIV, hepatitis B, and hepatitis C starting early in pregnancy. Those at risk for infection should also be tested for chlamydia and gonorrhea starting early in pregnancy. Repeat testing may be needed in some cases.

Are there other options for testing besides at a primary care visit?

Yes. Urgent care is an option, as are retail health clinics, community clinics and OB/GYN providers. Home tests are also available.

Can you tell us more about specific STIs and how they’re tested for?

Gonorrhea and chlamydia are tested with a urine sample, a cervical sample, or a swab. 

HIV, hepatitis, and syphilis can be tested for with blood tests. 

We’ll test for herpes (HSV1 and HSV2) with a swab of the lesion if you have symptoms. 

What are your recommended best safe sex practices with a new sexual partner?

It’s great if both people can discuss STI testing before they forgo using barrier methods like condoms. This way you know where you’re starting out. 

And what if someone doesn’t feel comfortable having those conversations with a new or more casual partner?

These can be hard conversations, especially early on in a relationship. 

To start off, everyone can empower themselves and at least get testing for themselves. These conversations can certainly sometimes put pressure on relationships about the future of the relationship or expectations around monogamy. If you’re not there yet, that’s a good reason to continue using other methods to protect yourself. Then when you both feel comfortable you can test again. 

What are some common symptoms of STIs to pay attention to? 

Women and people with uteruses will typically experience symptoms like pain with urination, vaginal discharge, and painful bumps or sores. 

Gonorrhea can also infect the throat, this can be asymptomatic or cause a sore throat. 

HIV can look like an acute illness with viral symptoms — think swollen lymph nodes and a fever. These symptoms are often missed because they can be mistaken for another type of virus. 

Can you get an STI from oral sex?

Yes. We commonly see gonorrhea which can present as a very painful sore throat. The good thing is that providers are more informed and educated about this symptom as a potential sign of an STI, so they should be taking a swab and testing. 

Herpes (HSV) is often spread during oral sex as well.

Which STIs are treatable vs. curable?

Gonorrhea, chlamydia, trichomonas, and syphilis are all curable. We give medication and we may recommend a test for cure. HIV, as we know, is a chronic infection, which is treatable and we have great therapies and treatments, but it requires lifelong treatment and monitoring. 

An initial outbreak of HSV is treated with a high dose of an antiviral treatment, which shortens the amount of time a person is symptomatic, and most likely the time they’re infectious as well. And then depending on how often a person has outbreaks, we may recommend that they go on suppressive therapy, which is a daily antiviral medication. This can be a lifelong medication.

After a number of years of being on antiviral medication, most people have very low rates of outbreaks. I say that because when people are told that they have HSV, it can be very upsetting. They might be worried about navigating conversations with sexual partners given some stigma that’s still lingering around HSV. People also worry that they might pass it on if they’re pregnant. But we have great medication that is safe and generally has minimal side effects, so most people can go back to living a normal life. We do recommend that they tell new sexual partners. 

Any tips for how to have these conversations with a partner?

HSV is transmitted through skin contact. And we know that there can be transmission of HSV even when a person doesn’t have an outbreak or an outbreak that’s visible to them. This is particularly true right before they have an outbreak, when there can be a high level of virus. And condoms don’t protect anyone 100%. 

These conversations can be hard with a new casual partner before you have any sexual contact. You might say, “I just wanted to let you know that I tested positive for HSV [X] years ago. I’m on suppressive therapy, which reduces the risk, but I just wanted to let you know.” 

Because it’s such a common virus, many people are in this situation, so hopefully the conversation is met with kindness and appreciation that you disclosed it.

HIV can be a more challenging conversation, but it’s similar in many ways. This is a conversation to have earlier rather than later. In relationships with two people who have discordant HIV infection, the partner who is not HIV positive often chooses to go on PrEP therapy to prevent their chance of being infected. Also, here condoms are very effective, because HIV is not transmitted through the skin. 

There is a lot less stigma than there used to be, but these conversations can be hard.

How long should someone be on suppressive therapy before it kicks in?

Those who are HIV positive need to wait until they’re controlled before having sexual contact. Their HIV specialist or internist will help them manage their treatment plan. 

And for other STIs, how should we think about testing timelines? 

If you were sexually active with a new partner recently, your current testing might not reflect your status. It’s good to get tested when you haven’t been with anyone else for 6 weeks, so waiting until you’re 6 weeks or so into a relationship can make sense. This is because it can take 6 weeks for the body to mount an antibody response to the virus so that it can be detected in blood work. 

Certain STIs have recommendations for follow up — in those cases, we recommend that people get tested for cure to make sure they’re fully treated. If both partners are positive for an STI, both should be treated at the same time and there should be no sexual contact during treatment to prevent transmission back and forth.

Any tips if you don’t feel comfortable talking to your provider about sexual health?

There are on-demand tests that you can use, which can be a great option. You can also email or message your provider to ask for certain tests/labs if you don’t feel you can ask in person. We like to minimize barriers for testing for important health issues.

Read more

• 5 Things you should have learned in sex ed class
• The complete glossary on sexually transmitted infections

When the pregnant person’s life is in danger

Some preexisting health conditions as well as some pregnancy complications can put your pregnancy health and safety at risk. Expert provider can help manage many of these conditions to allow a pregnancy to progress long enough that the baby is viable (able to survive outside of the womb). But some health conditions and pregnancy complications cannot be managed safely long enough to reach this point. Continuing the pregnancy in these cases would mean certain or high likelihood of death, loss of uterus, or other long-term medical complications — like stroke and other permanent disabilities for the parent. 

Recent federal legislation aims to secure abortion rights in all cases when a parent’s life is in danger, but it is in dispute in several states. Even a delay in care in these situations can have devastating short and long-term health impacts. 

Before we explain the conditions and complications you should be aware of, there are some steps you can take before you become pregnant to support your health. 

Understand the laws in your state

Abortion access varies depending on your state — and in many places your pregnancy trimester, your provider, and your age. In some states, if you’re a minor, you’ll need one or both of your parents’ consent. You can find a state by state breakdown here.

Schedule a preconception visit with your provider 

A pre-pregnancy checkup helps your healthcare provider make sure that your body is ready for pregnancy and often includes some health screenings. During this appointment, you can ask your provider any questions you have about your general and fertility health. 

Consider pre-pregnancy carrier screening

You may discuss this at your pre-pregnancy appointment. A carrier screen is a genetic test that can help you understand your risk of having a baby with a genetic disorder. And you can request it before you’re pregnant. Carrier screening is one of many tools to help you go into starting or growing your family with more information about your risks and options. 

Let’s review conditions and complications that can happen during pregnancy. If you experience one of these, then your state abortion laws could impact your care.

Ectopic pregnancy 

Ectopic pregnancies are early pregnancies that implant and grow in the wrong part of the body — outside of the uterus. The most common location of an ectopic pregnancy is in a fallopian tube, but can happen anywhere within the abdomen, including on the liver or bowel. 

Ectopic pregnancies can never result in a healthy pregnancy and lead to severe internal bleeding and death if left to grow. The only medical treatment available is abortion. The earlier these pregnancies are identified by ultrasound, and treated, the safer it is. If you live in a highly restrictive state, it’s important to know how your provider treats this type of situation. Will you have early ultrasounds? Will you have to travel if you need an abortion? Is there a local hospital that has experience navigating the legal difficulties of this situation? 

Severe hypertensive disorders 

Severe hypertensive disorders of pregnancy most commonly occur later in pregnancy. But, when they happen before viability (around 24 weeks), they are incredibly dangerous for parents. If the pregnancy is not ended, it can result in seizure, stroke, bleeding, and death. The only “cure” for these disorders is immediate delivery. There is no known long-term management option to safely allow the pregnancy to reach viability. Especially for parents with any history or high risk of hypertensive disorders, it’s important to discuss an emergency plan with your provider and any possible preventative steps.

Sepsis and bleeding 

Sepsis and bleeding are two other life threatening complications that can happen in early pregnancy where your body starts to miscarry or labor before about 24 weeks. In these situations, a pregnant person can experience their water breaking or heavy bleeding while their baby is still alive. The treatment for these conditions is delivery.

In states that don’t recognize the life of the parent as a valid reason for abortion, this can end in the death of the parent and the fetus. Even delaying care can increase the risk of serious infection (sepsis), need for blood transfusions and surgery, and death. Again, discussing your options with your provider early in pregnancy can help you feel at ease or make a necessary emergency plan.

When the fetus is at-risk or will not survive after birth

Finding out your baby has a complication or severe illness is one of the most devastating pieces of news to receive as a parent. Modern medicine has made enormous strides to treat certain conditions during pregnancy and work miracles for some people. However, there are chromosomal and genetic conditions that make it more likely for a fetus to die during the pregnancy or immediately after birth. There are also complex fetal differences that may survive birth, but not all parents feel they have the capacity to manage medically, emotionally, financially, or physically. Many people choose to end a pregnancy in these circumstances to reduce suffering for everyone and potential medical complications for the pregnant parent. 

The impact of abortion bans and restrictions

The abortion bans in many states do not have exceptions for these situations. These laws can be confusing and cause delays in care of the pregnant person. Knowing your state’s guidelines, and where you can travel to safely get the care you need is essential. In some states, specialized OBGYNs, called MFMs (Maternal Fetal Medicine specialists), will help identify and explain what is happening with your fetus, but they may be limited in discussing options. They may be able to refer you for a virtual appointment with an MFM out of state to have a more open discussion inclusive of more care options. Early genetic testing and counseling can leave more options open in states that only restrict abortion after a certain gestational age. 

If you find yourself in need of support or information after a devastating diagnosis here are some resources to explore: 

• Empty Arms
• Rare Disease information
• Neonatal donation
• Medical Ethics and Decision Making

Reviewed by the Ovia Health Clinical Team

Ovia’s goal is to support the health and wellness of our members throughout their reproductive health journeys. Ovia cannot, however, encourage or discourage the very personal decision of whether to have an abortion or counsel on whether and how an abortion may be performed in a particular case. Abortion may or may not be legal in your state and in your particular personal situation. None of the information made available through Ovia is intended to provide you with legal advice regarding abortion. Ovia may refer you to third-party websites or publications for additional information on reproductive health issues, including abortion. Ovia is not affiliated with these third parties and is not responsible for any information that they make available to you.

While medicine may have expanded fertility options, it can feel like there are so many more decisions to make about when to start a family or how to preserve fertility. If you’re wondering: should I freeze my eggs? you’ve come to the right place. Make sense of egg freezing and why it might be an option to consider.

What Is egg freezing?

Known in official medical circles as mature oocyte cryopreservation (OC), egg freezing is the process by which a doctor takes eggs (oocytes) from your ovaries. These eggs can then be frozen and stored until you decide you’re ready to use them. At that point they are thawed, mixed with sperm in a laboratory, and re-inserted into your uterus (womb) through your cervix, hopefully leading to pregnancy.

Who’s freezing their eggs in the U.S.?

Nationally, the number of egg freezing cycles increases every year. The Center for Disease Control (CDC) reports there were more than 22,000 egg freezing cycles in 2019, up from around 18,000 in 2018 and 14,500 in 2017.

• It’s becoming more common for people under the age of 35 years to preserve their fertility through egg freezing.
• White patients freeze their eggs more than people of color, although more minority groups are freezing their eggs, especially Asian women.
• University-educated or professional people are more likely to pursue elective egg freezing.

Why might you want to freeze your eggs?

People choose to press pause on becoming a parent or growing their family for many reasons. Elective egg freezing is now safer, more affordable, and more common. Some of the reasons people give for choosing electively to freeze their eggs include:

• Not being in a relationship with a partner they want to parent with 
• Wanting to be financially stable before starting a family
• Working in a demanding career where being pregnant could come at a professional cost
• Having access to employer-subsidized egg freezing benefits

Other people may turn to egg freezing because they have a medical condition that threatens their future fertility. One out of five women in one study reported choosing egg freezing because of underlying health conditions. Women and their health care providers may consider egg freezing if they:

• Have a condition impacting fertility such as sickle cell anemia, autoimmune diseases such as lupus, or premature ovarian failure
• Have a cancer diagnosis or other illness and need to receive chemotherapy or radiation that could harm their ovaries

Egg freezing also helps LGBTQ+ people keep their parenting options open. Gender-affirming surgery or medical treatments can limit fertility so some transgender men choose egg freezing before beginning their transition.

When should I freeze my eggs?

According to the American Society of Reproductive Medicine (ASRM), elective egg freezing is most successful for women younger than 38 years. The more eggs you can harvest and freeze, the better your chances for pregnancy down the road. As you get older, it gets harder to harvest enough high-quality eggs. Here’s what the science tells us:

• Egg quality peaks between 16 and 28 years old
• Women in their mid-reproductive years (29 to 37 years old) produce enough high-quality eggs to make egg freezing cost effective
• People who freeze their eggs before age 34 have the highest overall live birth rates.
• One 2015 study found that the biggest difference in live birth rates between people who did and didn’t freeze their eggs was at age 37. At younger ages, the differences in live birth rates in people who did and did not freeze their eggs were smaller.
• There is little benefit (no comparative increase in the number of live births) for women ages 25-30 to freeze their eggs

From a straight biological perspective, the younger you are when you freeze your eggs, the better your chances for good egg quality and number harvested.

Egg freezing and deciding what’s right for you

Decisions about fertility and parenting are individual and personal — egg freezing is no different. It can be helpful to think of egg freezing as an insurance plan rather than a guarantee for a baby. It is a way to increase your chances of being able to be a parent, without being limited by your biological clock or life circumstances. That said, it can be very expensive and so is not a good option for everyone.

Reviewed by the Ovia Health Clinical Team

Read more:

• Egg freezing step by step
• Egg freezing FAQ

Sources 

• Katler QS, Shandley LM, Hipp HS, Kawwass JF. National egg-freezing trends: cycle and patient characteristics with a focus on race/ethnicity. Fertil Steril. 2021 Aug;116(2):528-537. doi: 10.1016/j.fertnstert.2021.02.032. Epub 2021 Mar 30. PMID: 33795141.
• Inhorn MC, Birenbaum-Carmeli D, Birger J, Westphal LM, Doyle J, Gleicher N, Meirow D, Dirnfeld M, Seidman D, Kahane A, Patrizio P. Elective egg freezing and its underlying socio-demography: a binational analysis with global implications. Reprod Biol Endocrinol. 2018 Jul 23;16(1):70. doi: 10.1186/s12958-018-0389-z. PMID: 30037349; PMCID: PMC6056999.
• Mayo Clinic Staff. “Egg Freezing.” Mayo Clinic. Mayo Foundation for Medical Education and Research. April 23, 2021. https://www.mayoclinic.org/tests-procedures/egg-freezing/about/pac-20384556. 

• “Assisted Reproductive Technology (ART) National Data.” Centers for Disease Control and Prevention (CDC). CDC. 2019. https://nccd.cdc.gov/drh_art/rdPage.aspx?rdReport=DRH_ART.ClinicInfo&ClinicId=31&ShowNational=0. 
• Kylie Baldwin, Lorraine Culley, Nicky Hudson & Helene Mitchell (2019) Running out of time: exploring women’s motivations for social egg freezing, Journal of Psychosomatic Obstetrics & Gynecology, 40:2, 166-173, DOI: 10.1080/0167482X.2018.1460352
• Amato, Paula. “Fertility Options for Transgender Persons.” UCSF Transgender Care. University of California, San Francisco. June 17, 2016. https://transcare.ucsf.edu/guidelines/fertility. 
• “Can I Freeze My Eggs to Use Later If I’m Not Sick?” ReproductiveFacts.org. American Society for Reproductive Medicine. 2014. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/can-i-freeze-my-eggs-to-use-later-if-im-not-sick/. 
• Mesen, Tolga B et al. “Optimal timing for elective egg freezing.” Fertility and sterility vol. 103,6 (2015): 1551-6.e1-4. doi:10.1016/j.fertnstert.2015.03.002

Step 1: Choosing your fertility clinic or doctor

The American Society for Reproductive Medicine (ASRM) suggests scheduling a consultation with prospective fertility clinics to ask about their egg freezing methods, success rates, costs, storage, and policies for disposing of unused eggs. Most importantly, you should choose a doctor you feel comfortable with and trust. 

Step 2: Your baseline fertility evaluation

Once you choose your doctor, you will have several appointments and evaluations. These include appointments for:

1. Consultation with your fertility doctor (aka reproductive endocrinologist)
2. Transvaginal ultrasound to count the number of eggs (follicles) on your ovaries. (If this baseline testing is encouraging, you might decide to opt out of egg freezing completely or to delay egg harvesting.) 
3. Blood test examining your fertility hormones
4. Follow-up appointment several weeks later to review lab test results and your ovarian stimulation protocol

Ovarian stimulation protocol is the name for the sequence of medications you will give yourself over the next 3 to 4 weeks to stimulate your ovaries to produce multiple mature eggs.

Step 3: Ovarian stimulation

In a normal monthly cycle, your ovaries form multiple fluid-filled sacs called follicles, but only one mature egg, which your ovaries release when you ovulate.

Ovarian stimulation medications mimic your natural menstrual hormones (estrogen and progesterone), but fool your ovaries into growing multiple mature eggs simultaneously.

Most of the medications used for ovarian stimulation must be injected with a needle. You or your partner or family member can do this. You will have another appointment with a nurse to review the medicines, how to mix them and inject them, and to review the timeline and plan for your egg retrieval process.

Where you are in your cycle, timing, and the results of your fertility evaluation determine the best protocol for you. Here is a typical ovarian stimulation protocol and commonly-used medications:

1. A short course (1-2 weeks) of birth control pills, estrogen, Lupron, or Aygestin (a form of progesterone) before starting injections. 
2. Self-administered hormonal injections medications for the next 9-12 days. The injections will most likely be some combination of follitropin alfa or beta (Follistim AQ, Gonal-f) or menotropins (Menopur) to stimulate your ovaries.
3. Hormonal injections on days 9-12 to prevent your ovaries from releasing an egg too soon. Medications could include leuprolide acetate (Lupron) or cetrorelix (Cetrotide).
4. A trigger shot 36-37 hours before your scheduled retrieval procedure time to complete the “ripening” of your eggs. These injections are usually Lupron (leuprolide acetate) or hCG (human chorionic gonadotropin), sold as Ovidrel or Novarel. 

The purpose of the first 1-2 weeks of medications is to help align your follicles so they all start maturing simultaneously.

During days 9-12 of the fertility injections, you can expect to have 5-7 monitoring appointments with blood tests and vaginal ultrasounds to evaluate your response to the medications. These appointments typically take about 30 minutes.

Step 4: Egg harvesting

Your doctor will schedule your egg harvesting or egg retrieval appointment once ultrasounds and bloodwork show that you have enough mature eggs. Egg retrieval is usually 9-12 days after starting the fertility injections in a typical cycle.

The actual harvesting procedure only takes about 15 minutes and is not painful. You will be given anesthesia and pain medication to keep you comfortable and very briefly asleep (conscious sedation). Next, your doctor will use ultrasound to safely direct a special suction needle through your vagina to remove mature eggs from your ovaries.

Clinics usually monitor you for one to two hours after the procedure before sending you home to rest. Plan on taking the rest of the day off from work and avoid heavy lifting or intense exercise for the next week to protect your ovaries.

Step 5: Flash freezing your eggs

After harvesting, your eggs are quickly frozen in a process called vitrification. Vitrification prevents harmful ice crystals from forming and results in higher egg freezing success rates. Eggs will be stored at subzero temperatures until you are ready to use them.

Once you’re awake, your care team should tell you how many eggs they retrieved. It will probably take 24 hours to know how many mature eggs were frozen.

When the time is right, your eggs can be thawed, and hopefully fertilized with sperm in a lab, and implanted in you or a gestational carrier’s uterus through in vitro fertilization (IVF).

Step 6: Live your life and plan your future fertility

The decision to freeze your eggs is as complicated as all the steps in the egg freezing process. Egg freezing can offer you more options, but it does not guarantee you a future baby. If you have more questions about the egg freezing process, head over to our FAQ. 

Reviewed by the Ovia Health Clinical Team

Read more

• Should I freeze my eggs
• Egg freezing FAQ

Sources

• “Transvaginal Ultrasound: Medlineplus Medical Encyclopedia.” MedlinePlus. U.S. National Library of Medicine. April 1, 2022. https://medlineplus.gov/ency/article/003779.htm. 
• Mayo Clinic Staff. “Egg Freezing.” Mayo Clinic. Mayo Foundation for Medical Education and Research. April 23, 2021. https://www.mayoclinic.org/tests-procedures/egg-freezing/about/pac-20384556.

When should I freeze my eggs?

According to the American Society of Reproductive Medicine (ASRM), elective egg freezing is most successful for women younger than 38 years. Elective egg freezing is when you voluntarily choose to freeze your eggs as a type of insurance plan against natural aging — not because you have a medical condition such as cancer that might harm the eggs in your ovaries (called oocytes).

With age, the likelihood of problems with the chromosomes inside your eggs increases. Chromosomes are the building blocks of your DNA or genetic information. Egg freezing allows you to use “younger” eggs when you want to get pregnant. With age, there are:

• Higher rates of infertility
• Fewer eggs can be harvested
• Lower IVF success rates
• Increased rates of miscarriage
• Higher rates of congenital disabilities
• Higher-risk pregnancies for people who are pregnant when they are older than 35 increase

People who freeze their eggs before age 34 have the highest overall live birth rates. So, while egg freezing does help you slow down your biological clock, you can not push pause forever. Data from fertility centers indicate that most women 38 and younger can expect to harvest 10-20 eggs per cycle. The more eggs your doctor can collect, the higher your chances of a successful live birth. So, the ideal window for egg freezing is somewhere between 34-38 years old.

How much does egg freezing cost?

You can expect to pay $30,000-$40,000 to freeze your eggs. The average cost per cycle of just the medical procedure (harvesting) ranges between $10,000-$20,000. It will cost $500-$600 per year to store your eggs.

Costs will increase or decrease depending upon how many cycles you need to do to freeze the recommended number of eggs (usually around 10). The average person must go through about two cycles to reach this number. The older you are, the more likely you will need multiple cycles, and your medication costs may increase. 

Some commercial health insurance plans will cover the cost of some of the prescription medications used to stimulate your ovaries. However, without any insurance coverage, drug costs can run $2,000-$5,000 per cycle.

Where you live in the country can impact how much egg freezing will cost you, and costs vary even city by city within the same state. If you live far from medical centers, lost wages due to medical appointments and transportation costs can add up quickly.

Employer-financed egg freezing or fertility benefits changed many people’s financial calculus for egg freezing. As of 2020, about one out of every five (20 percent) US companies offered coverage for egg freezing. Apple and Facebook pay their employees up to $20,000 for egg freezing.

Egg freezing costs do not include the cost of thawing and implantation via in vitro fertilization (IVF), which as of 2019, ranged from $10,000-$15,000 per IVF cycle, according to the Society for Assisted Reproductive Technology (SART). Some people will also need to factor in the potential purchase of donor sperm (around $1,000), other assisted reproductive technologies (like assisted hatching or ICSI treatment), or embryo freezing ($200-$800 annual storage fee).

How long does the egg freezing process take?

One egg freezing cycle takes approximately 3-4 weeks. This includes:

• 1-2 weeks of birth control pills or other medication to temporarily turn off your natural hormones
• 9-10 days of hormone injections to stimulate your ovaries and ripen multiple eggs.

During the ten or so days of hormone injections, you will have to make frequent visits (usually at least five appointments in ten days) to your fertility clinic or doctor for vaginal ultrasounds to monitor your eggs and find the right time for harvesting.

The actual egg retrieval procedure takes only about 15-30 minutes, however, you will need to spend several hours after your retrieval at your clinic for observation before you can head home. People report that they usually can return to work and other normal activities within 1-2 days.

It takes most people 2-3 cycles to harvest the recommended 10-20 eggs for freezing. So, depending on your baseline fertility, age, and response to the ovulation stimulation medications, you can count on your egg freezing endeavor taking somewhere between 9-12 weeks, best case scenario.

Is egg freezing safe?

The actual procedure to harvest your eggs is a very low-risk surgical procedure. Egg harvesting carries about the same amount of risk as undergoing IVF. Surgical procedures like egg harvesting and IVF have small risks such as:

• Problems with the anesthesia (the medicines used to put you to sleep for the procedure)
• Injury from the needle passing through your vaginal wall to remove the eggs from your ovary
• Infection after the surgery

The main risks associated with egg freezing come from the regimen of fertility medications you take before egg harvesting (the ovarian stimulation protocol). These medications send your ovaries into overdrive, stimulating multiple eggs to develop simultaneously.

Fertility medications can cause something called ovarian hyperstimulation syndrome (OHSS). If the medicines over-stimulate your ovaries, they can swell, become painful, and cause fluid to build up in your belly, making you nauseous and bloated. One out of three women has symptoms of mild OHSS during controlled ovarian stimulation, but very few women go on to develop severe OHSS, which requires hospitalization.

Egg freezing also carries the emotional risk of undergoing a complicated and uncertain medical procedure. Many fertility medications can cause mood changes. The stress of navigating complex medication injections, multiple doctors’ appointments, and the unpredictability of the results can take a mental toll.

Navigating fertility or infertility can have psychological, financial, and socio-cultural consequences and it’s essential that you look out for your mental wellbeing. 

How many eggs should I store?

This calculation is based upon the biological reality that not every egg makes an embryo, not every embryo makes a pregnancy, and not every pregnancy makes a baby. Eggs are lost at each stage, from thawing, to fertilization, to development into an embryo, to transferring the embryo into a womb. And so, the chance that a single frozen egg will lead to a live birth is about 2 to 12 percent, according to the American Society for Reproductive Medicine. 

So what is the magic number? Fertility experts and clinics worldwide seem to land on the number ten. Research shows you may expect to retrieve about 14 mature eggs on average if you’re 36 and under, about ten if you’re 37-39, about nine if you’re 40-42, and about seven if you are 43 or older.

How long can eggs stay frozen?

Babies have been born from eggs frozen for as long as 14 years. Most people store eggs for five to 10 years. In vitrification, scientists remove the fluid from your eggs and replace it with a chemical version of antifreeze that increases successful fertilization, implantation, and live birth rates.E mbryos do tend to thaw better than unfertilized eggs. If there is a partner in the picture or already a plan to use donor sperm, it’s worth considering freezing embryos. It’s possible to do a mix of both embryos and unfertilized eggs.

The bigger time limits on egg freezing are age and the cost of storage. As people become older (in their 40s and 50s), IVF success rates decline, and they are at higher risk for miscarriage and other pregnancy complications. The chance of becoming pregnant after implantation is roughly 30 to 60 percent, depending on how old you are when you freeze your eggs. Some people opt for a surrogate, which carries a separate set of considerations and costs. 

Your egg freezing decision

The decision to freeze your eggs can seem almost as big as deciding whether you want to become a parent. Egg freezing is one option that can buy you some time as you consider parenthood. However, it’s not for everyone. If you’re in the process of making this decision, speak with your provider for guidance and to your community for support. 

Reviewed by the Ovia Health Clinical Team

Read more

• Should I freeze my eggs
• Egg freezing step by step

Sources

• Mesen, Tolga B et al. “Optimal timing for elective egg freezing.” Fertility and sterility vol. 103,6 (2015): 1551-6.e1-4. doi:10.1016/j.fertnstert.2015.03.002. 
• Cil AP, Bang H, Oktay K. Age-specific probability of live birth with oocyte cryopreservation: an individual patient data meta-analysis. Fertil Steril. 2013 Aug;100(2):492-9.e3. doi: 10.1016/j.fertnstert.2013.04.023. Epub 2013 May 24. PMID: 23706339; PMCID: PMC3888550.
• “Cost of Egg Freezing.” USC Fertility. University of California, San Francisco. January 27, 2019. https://uscfertility.org/egg-freezing/cost/. 
• Carnegie, Megan. “More Companies Offer Fertility Benefits. It’s Only the Beginning.” Wired. Conde Nast. December 1, 2021. https://www.wired.com/story/fertility-benefits-work/. 
• “Frequently Asked Questions.” SART. Society for Assisted Reproductive Technology, https://www.sart.org/patients/frequently-asked-questions/. 
• “Ovarian Hyperstimulation Syndrome (OHSS).” Reproductive Facts. American Society for Reproductive Medicine. 2014. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/ovarian-hyperstimulation-syndrome-ohss/. 
• Kumar, Pratap et al. “Ovarian hyperstimulation syndrome.” Journal of human reproductive sciences vol. 4,2 (2011): 70-5. doi:10.4103/0974-1208.86080. 
• Hasanpoor-Azghdy, Seyede Batool et al. “The emotional-psychological consequences of infertility among infertile women seeking treatment: Results of a qualitative study.” Iranian journal of reproductive medicine vol. 12,2 (2014): 131-8.
• Vaughan DA, Leung A, Resetkova N, Ruthazer R, Penzias AS, Sakkas D, Alper MM. How many oocytes are optimal to achieve multiple live births with one stimulation cycle? The one-and-done approach. Fertil Steril. 2017 Feb;107(2):397-404.e3. doi: 10.1016/j.fertnstert.2016.10.037. Epub 2016 Dec 1. PMID: 27916206.
• R.H. Goldman, C. Racowsky, L.V. Farland, S. Munné, L. Ribustello, J.H. Fox, Predicting the likelihood of live birth for elective oocyte cryopreservation: a counseling tool for physicians and patients, Human Reproduction, Volume 32, Issue 4, April 2017, Pages 853–859, https://doi.org/10.1093/humrep/dex008
• Mayo Clinic Staff. “Egg Freezing.” Mayo Clinic. Mayo Foundation for Medical Education and Research. April 23, 2021. https://www.mayoclinic.org/tests-procedures/egg-freezing/about/pac-20384556. 
• “Can I Freeze My Eggs to Use Later If I’m Not Sick?” ReproductiveFacts.org. American Society for Reproductive Medicine. 2014. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/can-i-freeze-my-eggs-to-use-later-if-im-not-sick/. 

To help guide you along your IVF journey, we answered some of the most commonly asked questions about IVF. 

How many eggs will I get? 

During your fertility testing, and at the start of your IVF cycle, you will have an ultrasound to measure the number of antral follicles (tiny fluid-filled sacs within the ovary that contain one egg each) you have. This count gives you a rough estimate of how many eggs you may retrieve during your cycle. 

The injectable medications you use during IVF will help grow these follicles. Follicles must be at least 12mm for an egg to be retrieved, but doctors typically like to see follicles a lot larger. Research shows follicles between 17-19 mm are the most likely to have a mature egg inside. 

It’s normal to not get a lot of eggs from your first round. In fact, most people, especially those over the age of 35, need more than one egg retrieval to bring a baby home.  

What happens if an egg isn’t mature? 

Eggs need to be mature in order to be fertilized. Sometimes, embryology labs can mature eggs that aren’t quite ready yet in the lab, but this isn’t always the case. 

My doctor mentioned ICSI, what is that? 

IVF is often used as a catchall to describe egg fertilization done in a lab, but if your partner has male factor infertility, your doctor may offer ICSI, intracytoplasmic sperm injection. The ICSI process looks nearly identical to IVF for you and your partner. You still need an egg retrieval and your partner still needs to provide a sample. The difference between the two happens in the lab. With ICSI, the embryologist picks a sperm to inject directly into an egg, manually fertilizing the egg. Some clinics offer ICSI as an add-on, even without male factor infertility, but research shows it only benefits fertilization rates for couples with male factor infertility. 

How many eggs become embryos? 

Unfortunately, not all eggs become embryos. While this is disappointing, it’s totally normal. A day after your egg retrieval, you will get a fertilization report. Typically, 80% of the eggs retrieved fertilize. The next report typically comes on day three. Most embryos that fertilize make it to day three. In the past, most embryos transfers occurred on day three, but today most labs have the ability to grow embryos to day five. Most clinics prefer to transfer embryos on day five, especially if you have a lot of day three embryos to choose from. Only 30-50% of embryos make it to day five. Although it may feel disappointing to see your embryo count drop significantly, the embryos that make it to this point are the ones more likely to succeed. 

How many embryos can I transfer? 

Twin, triplet, and higher-order pregnancies are high-risk pregnancies. To minimize the risk of complications, doctors typically prefer to transfer one or two embryos. If you are older or have had failed transfers, your doctor may be open to transferring two or more embryos depending on your medical history. 

Reviewed by the Ovia Health Clinical Team

Sources

• Abbara, Ali, et al. “Follicle size on day of trigger most likely to yield a mature oocyte.” Frontiers in endocrinology 9:193. April 2018. https://www.frontiersin.org/articles/10.3389/fendo.2018.00193/full  
• Murdock, Cynthia. “IVF Attrition Rate: Why Don’t All Eggs Create Embryos?” April 2020.  https://www.rmact.com/fertility-blog/ivf-attrition-rate
• Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies. “Intracytoplasmic sperm injection (ICSI) for non–male factor indications: a committee opinion“ July 2020. https://www.fertstert.org/article/S0015-0282(20)30523-9/fulltext 
• Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies. “Guidance on the limits to the number of embryos to transfer: a committee opinion.” July 2021. https://www.fertstert.org/article/S0015-0282(21)00563-X/fulltext 

Dear Ovia, My husband and I have been trying for a third kid for the last year and a half. He wants to stop trying and says it’s taking away from us appreciating the beautiful babies we do have. But I’ve always dreamed of a big family and I don’t feel ready to give that up. 

First of all, secondary infertility isn’t something we talk about enough — and I hope this answer helps you know for certain that you’re not alone! 

So many families hesitate to talk about fertility struggles. And when you’re already parents you may feel the social pressure to just be grateful for the kiddos you have (which I am sure you are!). I’m here to tell you that feeling like there is an empty seat at your family’s table is a valid feeling whether you have 0, 1, 2, 3 or 9 children. The tough part is that you’re both having valid feelings — and they’re not the same. There may be middle ground in taking a break from TTC for a period of time or continuing to try for “X” number of months before starting a break. 

At the end of the day, it sounds like expanding your family is something that would make you both happy if it could happen with the wave of a wand. So, try to focus your conversations with him around the challenges of the journey (the process of TTC), rather than the destination (the decision to have another baby).

In any case, you need an ongoing and open dialogue, but it can be hard to find a good and private time to talk (especially when you have other children in the house). It’s common for people to either avoid tough subjects or to bring them up at times that are not conducive to conversation (like when you’re getting into bed). 

If you’re avoiding the conversation or one of you is bringing it up at less-than-ideal times, it’s essential that you create a space where you can both actively listen to each other. Try scheduling some time to talk, that way you can both come to the conversation prepared to share and listen. 

Having a disagreement hanging over your heads makes the whole situation more stressful.

Some tips:

• Avoid talking about it before bed when everyone is tired and sex is on the table. 
• Sometimes a drive is helpful because you have a little bit of emotional distance, can break endless eye contact, and sex is (usually) off the table. 
• Agreeing on how to move forward may take more than one discussion, but it should be simple to make a plan for more chats. Breathe, you’ve got this. 
• Fertility journeys start, pause, and end for a variety of reasons, and it often takes a toll. It’s always okay to look for more support from family, friends, or professionals. 

More from this series

• Dear Ovia, My partner isn’t sure if he wants kids
• Male fertility testing

Here, we’ll break down the basics of male fertility and what to do if you and your male partner are having trouble getting pregnant.

What typically happens when sperm meets egg

A healthy male produces tiny reproductive cells called sperm, which are made in the testicles. When he ejaculates, the sperm mixes with fluid from the prostate, forming semen. During vaginal intercourse, ejaculation carries the semen into the vagina where it travels through the cervix and into the uterus and fallopian tubes. During ovulation, an egg is released from the woman’s ovary and, if fertilized by the sperm, a ball of cells (called the oocyte) is formed. Fertilization occurs in the fallopian tube and the embryo then implants inside the uterus. If the egg is not fertilized, it disintegrates and sheds during the next menstrual period.

When to see a doctor

It’s generally recommended to see a doctor for a fertility evaluation if you and your partner have been trying to conceive for at least a year with regular, unprotected sex with no success. Depending on your and your partner’s medical history, your doctor may decide to check one or both of you for a fertility workup. You may want to seek care sooner if the female partner is over 35 years old or if the male partner has certain medical conditions such as:

• Past surgery on the groin, testicle, scrotum, or penis
• A history of testicular or prostate problems
• Problems with erection or ejaculation, low sex drive, or other issues with sexual function
• Pain, lumps, or swelling in the testicular region

What to expect when seeking care

For men having trouble with infertility, a doctor may order tests to  measure the amount and quality of the sperm. This is called a sperm analysis. Your partner will provide a semen specimen at the doctor’s office and the doctor will look at the sperm under a microscope. There are 3 factors doctors look for in a sperm analysis. 

• Sperm count: This shows the amount of sperm produced in an ejaculation. A healthy number is 20 to 150 million sperm per milliliter of semen.
• Sperm motility: This test shows how well sperm are moving. At least 60% of sperm should have normal forward motion. Sperm that move erratically or not at all can affect the ability to conceive.
• Sperm morphology (size and structure): Normal sperm have an oval head with a long tail. Damage to any part of the sperm can affect fertility by decreasing the ability to reach and penetrate an egg. Many conditions affecting the shape of sperm are genetic.

Remember that infertility is no one’s fault. It can be difficult and frustrating to experience any kind of fertility troubles on your journey to getting pregnant. Communicating and empathizing with your partner can help make the journey to parenthood a little easier.

Reviewed by the Ovia Health Clinical Team

Sources

“How common is infertility?” National Institutes of Health. National Institutes of Health. February 8, 2018. https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/common

Mayo Clinic Staff. “Male infertility.” Mayo Clinic. Mayo Clinic. August 13, 2021. https://www.mayoclinic.org/diseases-conditions/male-infertility/symptoms-causes/syc-20374773

“What is male infertility?” Urology Care Foundation. American Urological Association. n.d. https://www.urologyhealth.org/urology-a-z/m/male-infertility

Cedars-Sinai Staff. “Optimizing male fertility.” Cedars-Sinai. Cedars-Sinai Medical Center. May 31, 2017. https://www.cedars-sinai.org/blog/optimizing-male-fertility.html

Bradley D. Anawalt & Stephanie T. Page. “Patient education: Treatment of male infertility (beyond the basics).” UpToDate. UpToDate. November 11, 2020. https://www.uptodate.com/contents/treatment-of-male-infertility-beyond-the-basics