What Is Egg Freezing? Who Is It Suitable For?

Plans to have children may not take shape at the same time for every woman. Education, professional life, health problems, the absence of suitable circumstances, or the possibility of undergoing treatment that may affect ovarian reserve may cause pregnancy plans to be postponed.

However, female fertility changes with age. As ovarian reserve declines over time, the likelihood that eggs are chromosomally healthy may also decrease, particularly at more advanced reproductive ages. For this reason, some women who wish to become mothers in the future consider egg freezing in order to preserve their current fertility potential.

Egg freezing is the storage of mature eggs obtained from a woman without fertilizing them. When pregnancy is desired in later years, these eggs are thawed, fertilized with suitable sperm, and the resulting embryos are transferred to the uterus through IVF.

The most important point to understand is this: Egg freezing may help preserve the possibility of pregnancy in the future, but it does not guarantee becoming a mother. Success depends on the age at which the eggs are frozen, the number of mature eggs obtained, laboratory conditions, and future sperm and uterine factors. ASRM also states that age and the number of frozen eggs are the main determinants of future success, but that it is not possible to predict an individual live birth probability with certainty.

Brief Answer

Egg freezing is the storage of mature eggs obtained from the ovaries using a rapid freezing method called vitrification.

The procedure may particularly be considered for fertility preservation in:

1. Women who will undergo medical treatment that may affect ovarian reserve
2. Selected patients planning ovarian surgery
3. Appropriate patients showing loss of ovarian reserve based on AMH and AFC results
4. Women at risk of primary ovarian insufficiency

In Türkiye, egg freezing is not performed solely on the basis of personal preference, but within the framework of medical necessity defined by current legislation. Therefore, eligibility should be determined according to both clinical and legal criteria.

Key Information

1. Egg freezing is a fertility-preservation method.
2. The eggs are not fertilized and embryos are not created during the procedure.
3. One of the strongest factors affecting success is the age at which the eggs are frozen.
4. AMH and AFC may help estimate how many eggs can be obtained during the procedure.
5. Low AMH does not mean that egg freezing is impossible, but the number of eggs obtained may be limited.
6. One treatment cycle may not be sufficient for every patient.
7. Frozen eggs may be used through IVF treatment in the future.
8. The procedure does not guarantee pregnancy in the future.
9. In Türkiye, the conditions for the procedure are evaluated according to medical necessity and current legislation.

What Is Egg Freezing?

Egg freezing, medically known as oocyte cryopreservation, is the process of freezing mature eggs obtained from the ovaries in a laboratory and storing them for future use.

During this process:

1. The eggs are not fertilized.
2. Embryos are not created.
3. Only the woman’s mature egg cells are stored.
4. When pregnancy is desired, the eggs are thawed.
5. The eggs are fertilized with sperm.
6. A suitable embryo among those that develop is transferred to the uterus.

The egg-freezing process is similar to the egg-retrieval stage of IVF treatment. The main difference is that the retrieved eggs are frozen for future use instead of being fertilized on the same day.

What Is Vitrification?

Vitrification is a laboratory method that freezes eggs through very rapid cooling. The aim is to minimize the formation of ice crystals inside the egg cell that could cause damage.

Vitrification is widely used in modern egg-freezing procedures. The success of the procedure depends not only on the freezing technique, but also on the maturity of the egg, the experience of the laboratory, the thawing process, and quality-control standards. ASRM emphasizes the importance of standardizing laboratory practices related to the rapid cooling of oocytes and embryos and monitoring performance indicators.

Why Is Egg Freezing Performed?

The main purpose of egg freezing is to preserve the possibility of using a woman’s eggs from her current age in the future.

The procedure may be considered for the following reasons:

1. Preserving fertility before chemotherapy or radiotherapy
2. Surgery that may damage the ovaries
3. endometriosis or bilateral endometriomas
4. Diminished ovarian reserve
5. Risk of primary ovarian insufficiency
6. A family history of early menopause
7. Clinical findings suggesting a rapid decline in ovarian reserve
8. Certain systemic or genetic diseases that may affect fertility

ESHRE recommends individualizing options such as egg, embryo, or ovarian tissue freezing for fertility preservation according to the patient’s age, treatment plan, and current ovarian reserve.

Who Is Egg Freezing Suitable For?

Egg freezing is not equally necessary or appropriate for every woman. The decision should not be based only on the question, “Do you want children in the future?” Medical necessity, age, AMH, AFC, existing diseases, and legal conditions should be evaluated together.

Women Who Will Undergo Cancer Treatment

Chemotherapy and radiotherapy may temporarily or permanently affect ovarian reserve. Egg freezing may be one of the fertility-preservation options before treatments that are likely to damage the ovaries.

Timing is important in these patients. Planning should be performed jointly by the oncology team and a reproductive medicine specialist without delaying cancer treatment. Current ASRM guidance on fertility preservation for medical reasons recommends referring patients as early as possible and considering age and egg number in relation to future outcomes.

Women Planning Ovarian Surgery

Healthy ovarian tissue may be affected in patients planning surgery for an endometrioma, bilateral ovarian cysts, or repeated ovarian procedures.

Before surgery, the following questions are evaluated:

1. What is the AMH level?
2. Is the AFC result appropriate for age?
3. Is the cyst present in one ovary or both?
4. Has ovarian surgery been performed before?
5. When is pregnancy planned?
6. Is surgery or egg freezing more appropriate first?
7. Is there suspicion that the cyst may be malignant?

Egg freezing is not required before every ovarian cyst operation. However, fertility-preservation options should be discussed in selected patients planning surgery that may affect ovarian reserve.

Women With Diminishing Ovarian Reserve

Low AMH and an AFC that is reduced for age may suggest diminished ovarian reserve.

Low AMH does not mean that egg freezing is impossible. However, fewer follicles may develop during ovarian stimulation, and fewer mature eggs may be obtained. Therefore, some patients may require more than one treatment cycle to reach the desired number of eggs.

Information published by centers affiliated with the Ministry of Health also states that egg freezing may be considered for fertility preservation in appropriate patients with diminished ovarian reserve.

Women at Risk of Primary Ovarian Insufficiency

An earlier evaluation may be appropriate when there is a family history of early menopause, certain genetic diseases, or medical conditions affecting ovarian reserve.

The AMH result is not considered alone. Menstrual pattern, AFC, FSH, estradiol, family history, and genetic assessments when necessary are evaluated together.

Planning before ovarian function declines significantly may increase the likelihood of obtaining more eggs.

Women With Endometriosis and Endometriomas

Endometriosis may affect both ovarian reserve and the chance of pregnancy in some patients. Fertility preservation may particularly be considered in women with bilateral endometriomas, previous ovarian surgery, or a new planned operation.

However, egg freezing is not necessary for every patient with an endometrioma. Pain, age, ovarian reserve, cyst size, and pregnancy plans should be evaluated together.

Who Can Undergo Egg Freezing in Türkiye?

The storage of reproductive cells in Türkiye is regulated under the current Assisted Reproductive Treatment Practices Regulation and related legislation.

According to the legislation, the storage of egg cells is possible in certain medically necessary situations. These generally include:

1. Before treatments such as chemotherapy or radiotherapy that may damage reproductive cells
2. Before surgery that may lead to the loss of reproductive function
3. When diminished ovarian reserve is documented by a medical board report consisting of three specialist physicians

Therefore, a request for egg freezing based solely on career, education, or social reasons may not be considered sufficient under Turkish legislation. Eligibility should be evaluated according to the center applied to and current legal regulations.

Can Unmarried Women Freeze Their Eggs?

Yes. Marriage is not required for egg freezing because the eggs are not fertilized and embryos are not created during the procedure.

However, regardless of whether the woman is married or unmarried, she must meet the medical eligibility conditions defined in Turkish legislation. A medical board report and related documents may be requested during the application process.

What Is the Best Age for Egg Freezing?

There is no single “ideal age” for egg freezing that applies to everyone. However, the younger a woman is when the procedure is performed, the more likely the frozen eggs are to be genetically healthy.

The most important factor affecting success is not the age at which the eggs will be used, but the age at which they were frozen.

In general:

1. Egg quality is more favorable before age 35.
2. The decline in egg quality may become more noticeable after age 35.
3. At age 38 and older, obtaining the desired number of healthy eggs may become more difficult.
4. Freezing after age 40 is technically possible, but the expected chance of pregnancy may be more limited.

These age ranges are not absolute cutoffs. A 32-year-old woman with diminished ovarian reserve and a 37-year-old woman with good ovarian reserve may not follow the same plan.

ASRM emphasizes that younger age is associated with better outcomes in planned egg freezing, but that evidence remains limited for determining one specific “optimal age” or a reliable live birth rate for every age.

Which Is More Important: Age or AMH?

Age and AMH answer different questions.

Age is more closely related to the genetic quality of the eggs.

AMH provides information about how the ovaries may respond to stimulating medication and the number of eggs that may be obtained.

AFC shows the number of small follicles seen on ultrasound.

For example, a young woman with low AMH may produce only a small number of eggs, but their quality may be better because of her younger age.

An older woman with normal AMH may produce more eggs, but the likelihood of creating a chromosomally healthy embryo may be lower.

Therefore, the decision to freeze eggs is not based solely on the AMH value.

How Do AMH and AFC Affect Egg-Freezing Planning?

Before egg freezing, ovarian reserve is usually assessed through AMH testing and AFC measurement.

Low AMH does not prevent egg freezing. However, the patient should be clearly informed that only a small number of eggs may be obtained in a single cycle.

In patients with high AMH or high AFC, a more controlled medication protocol may be selected because of the risk of an excessive ovarian response.

How Is Egg Freezing Performed?

The egg-freezing process is generally completed within one menstrual cycle and consists of several stages.

1. Initial Examination and Ovarian Reserve Assessment

During the first consultation, the following are evaluated:

1. The patient’s age
2. Pregnancy plans
3. Menstrual pattern
4. History of ovarian surgery
5. Presence of endometriosis
6. Medications being used
7. Family history of early menopause
8. History of cancer or another systemic disease

AFC may then be measured by ultrasound. AMH, FSH, estradiol, and other necessary blood tests may be planned.

2. Ovarian Stimulation

During a normal menstrual cycle, usually one egg matures. During egg freezing, hormone medications are used to allow multiple eggs to develop during the same cycle.

Medication treatment generally lasts approximately 8–12 days.

During this period:

1. Ultrasound examinations are performed.
2. The number and size of follicles are monitored.
3. Hormone tests may be requested when necessary.
4. The medication dose is adjusted according to the patient’s response.
5. Medications may be used to prevent premature ovulation.

3. Final Maturation Injection

When the follicles reach an appropriate size, a trigger or maturation injection is administered to initiate the final stage of egg maturation.

Egg retrieval is planned approximately 34–36 hours after this injection.

4. Egg-Retrieval Procedure

Egg retrieval is performed under vaginal ultrasound guidance and generally under short-term anesthesia.

Fluid inside the follicles is collected using a thin needle. The laboratory team identifies the eggs within this fluid.

The procedure generally takes 15–30 minutes. The duration may vary depending on the number of follicles and the position of the ovaries.

5. Assessment of Egg Maturity

Not every retrieved egg may be suitable for freezing.

The embryology laboratory evaluates the maturity stage of the eggs. Generally, mature eggs at the metaphase II stage are frozen.

Therefore, the number of follicles seen on ultrasound, the number of eggs retrieved, and the number of mature eggs frozen may all be different.

6. Vitrification and Storage

Mature eggs are rapidly frozen through vitrification and stored in special tanks.

When pregnancy is planned, the eggs are thawed, fertilized with suitable sperm using intracytoplasmic sperm injection, and embryo development is monitored.

How Many Days Does the Egg-Freezing Process Take?

When the initial evaluation, medication treatment, follow-up appointments, and egg retrieval are considered together, the process can generally be completed within 10–14 days.

However, the starting day and protocol used may vary according to:

1. Menstrual pattern
2. Timing of cancer treatment
3. Ovarian reserve
4. Medications being used

In some patients with cancer, random-start protocols that can begin during different phases of the menstrual cycle may be considered to avoid delaying treatment. ESHRE recommends individualizing fertility-preservation treatment so that it does not unnecessarily delay the patient’s medical care.

Is Egg Retrieval Painful?

Egg retrieval is generally performed under short-term anesthesia or sedation, so the patient does not experience significant pain during the procedure.

For several days after the procedure, the following may occur:

1. Mild pelvic pain
2. Bloating
3. Spotting
4. Fatigue
5. A feeling of abdominal fullness

The treatment center should be contacted if severe abdominal pain, heavy bleeding, shortness of breath, rapidly increasing swelling, fever, or fainting occurs.

Does Egg Freezing Reduce Fertility?

No. The eggs obtained during controlled ovarian stimulation are collected from the group of follicles that have already started developing during that month.

The procedure does not collectively use up eggs that would have been available in future months, and it has not been shown to bring menopause forward.

However, the ovarian response to medication varies from person to person. Fewer eggs may be retrieved in patients with diminished ovarian reserve. This results from the limited follicle pool at the beginning, not because the procedure has depleted the reserve.

How Many Eggs Should Ideally Be Frozen?

There is no single number of eggs considered sufficient for every woman.

The required number varies according to:

1. The age at which the eggs are frozen
2. The number of children desired in the future
3. The egg survival rate after thawing
4. The fertilization rate
5. Embryo development
6. Uterine and sperm-related factors
7. The experience of the laboratory

A smaller number of eggs frozen at a young age does not have the same future pregnancy potential as the same number frozen at an older age.

ASRM states that there is insufficient evidence to reliably determine how many mature eggs should be frozen for a specific probability of live birth in every patient. Therefore, patients should not be given an exact number or a guarantee of pregnancy.

Is One Egg-Retrieval Procedure Sufficient?

Some patients may obtain the desired number of mature eggs in a single treatment cycle. More than one egg-retrieval procedure may be required in cases of low AMH, low AFC, or advanced age.

The following factors are considered when making the decision:

1. The number of mature eggs obtained during the first cycle
2. The woman’s age
3. The remaining time available
4. The starting date of medical treatment
5. The financial and physical burden of the procedure
6. The number of children desired in the future

What Is the Success Rate of Egg Freezing?

It is not appropriate to provide one single success rate for egg freezing.

The process includes several consecutive stages:

1. Obtaining eggs
2. The eggs being mature
3. Freezing and storage
4. The eggs remaining viable after thawing
5. Fertilization
6. Embryo development
7. Embryo implantation
8. The pregnancy resulting in a live birth

The factors that most strongly affect success include:

1. The age at which the eggs were frozen
2. The number of mature eggs frozen
3. Ovarian reserve
4. The laboratory’s experience with vitrification and thawing
5. The quality of the sperm that will be used
6. Future uterine health
7. The genetic structure of the embryo

Evidence remains limited for accurately predicting an individual live birth probability following planned egg freezing. Therefore, centers should clearly explain their own laboratory data and the expected results according to the patient’s age group.

Does Egg Freezing Guarantee Pregnancy?

No. Egg freezing creates an option that may be used in the future, but it does not guarantee pregnancy.

Not every frozen egg will:

1. Survive thawing.
2. Become fertilized.
3. Develop into a healthy embryo.
4. Implant in the uterus.
5. Result in a live birth.

Egg freezing does not completely eliminate the effect of biological aging on fertility. It provides an opportunity to preserve eggs obtained at a younger age.

Therefore, the procedure should be viewed as helping preserve the possibility of future pregnancy rather than “guaranteeing the future.”

How Are Frozen Eggs Used?

When pregnancy is planned, the frozen eggs are thawed in the laboratory.

The following steps are then performed:

1. Mature eggs that remain viable are identified.
2. Sperm is injected into the eggs through intracytoplasmic sperm injection.
3. Fertilization is checked.
4. The embryos are monitored in the laboratory.
5. A suitable embryo is transferred to the uterus.
6. Remaining suitable embryos may be frozen when necessary.

Natural pregnancy cannot occur directly from frozen eggs. Their use requires an IVF laboratory.

How Long Can Eggs Be Stored?

From a biological perspective, eggs frozen under appropriate laboratory conditions may be stored for many years. However, the storage period and extension conditions in Türkiye are regulated by legislation.

According to information published by centers affiliated with the Ministry of Health, eggs may initially be stored for up to five years. Ministry approval may be required for longer storage. Current practice, consent documents, and annual storage notifications should be confirmed with the center where the procedure is performed.

Is Egg Freezing Safe?

Egg freezing is generally considered safe when performed at experienced centers. However, there are certain risks associated with hormone treatment, anesthesia, and egg retrieval.

Possible risks include:

1. Headaches or mood changes caused by medication
2. Abdominal bloating
3. Pelvic pain
4. Ovarian hyperstimulation
5. Bleeding after egg retrieval
6. Infection
7. Injury to surrounding organs
8. Side effects related to anesthesia

Serious complications are rare. The risk may be reduced through individualized medication doses and close monitoring.

Is There an Increased Risk for Children Born From Frozen Eggs?

Current data have not shown a clear additional increase in congenital abnormalities among children born from frozen eggs. However, because planned egg freezing is a relatively new and developing practice, long-term outcomes continue to be monitored.

ASRM recommends clearly explaining to patients the existing uncertainties regarding the effectiveness and long-term outcomes of the method.

What Approach Does Assoc. Prof. Dr. Nurettin Türktekin Follow in This Situation?

The decision regarding egg freezing is not based solely on the woman’s age or AMH result.

In Assoc. Prof. Dr. Nurettin Türktekin’s clinical approach, the following questions are evaluated together:

1. How old is the woman?
2. How long will pregnancy be postponed?
3. Is there medical and legal eligibility for egg freezing?
4. Is the AMH value appropriate for age?
5. What is the AFC on ultrasound?
6. Are the menstrual cycles regular?
7. Is endometriosis or an endometrioma present?
8. Is ovarian surgery planned?
9. Has ovarian surgery previously been performed?
10. When will chemotherapy or radiotherapy begin?
11. Approximately how many eggs may be obtained in one cycle?
12. Might more than one egg-retrieval procedure be required?
13. How many children are planned for the future?

Egg freezing performed at a young age with adequate ovarian reserve does not carry the same expectations as a procedure performed at an older age with diminished reserve. Therefore, simply telling a patient, “You can freeze your eggs,” is not sufficient. The number of eggs that may be obtained, the limitations of the procedure, and the future stages of use should be discussed openly.

In patients with low AMH, the aim is not to increase the laboratory value, but to assess the existing reserve in a timely manner. In women with endometriomas or planned ovarian surgery, the possible effect of surgery on ovarian reserve should be balanced against the potential benefit of egg freezing.

Egg Freezing First or Surgery First?

This question is particularly important for women with endometriomas or ovarian cysts.

Egg freezing may be considered first in the following situations:

1. AMH and AFC are low.
2. The cyst is present in both ovaries.
3. Previous ovarian surgery has been performed.
4. Further surgery is planned.
5. Suspicion of malignancy is low.
6. Surgery is likely to reduce ovarian reserve.

Surgery may be more appropriate first in the following situations:

1. There is suspicion of a malignant tumor.
2. Severe pain or an urgent need for surgery is present.
3. The cyst technically prevents egg retrieval.
4. There is a risk of ovarian torsion or another complication.

The decision should be individualized. The fertility-preservation plan should not unnecessarily delay surgery, and surgery should be planned to preserve healthy ovarian tissue as much as possible.

Which Tests Are Performed Before Egg Freezing?

Depending on the patient’s condition, the following tests may be requested:

1. AMH
2. AFC
3. FSH and estradiol
4. Complete blood count
5. Thyroid tests
6. Infection screening
7. Blood-clotting tests
8. Liver and kidney function tests
9. Anesthesia assessment
10. Genetic testing when necessary

The same tests are not performed for every patient. The medical history and the planned treatment protocol determine the testing plan.

How Should You Prepare Before Egg Freezing?

Before treatment:

1. Smoking should be stopped.
2. All medications being used should be reported to the doctor.
3. Chronic diseases should be brought under control.
4. Herbal or hormonal supplements should not be used unless recommended by the doctor.
5. Follow-up appointments should be attended.
6. The trigger injection should be administered at the specified time.
7. Fasting instructions for the day of egg retrieval should be followed.

Healthy lifestyle habits may support general reproductive health. However, no food or supplement has been shown to restore ovarian reserve or guarantee the success of egg freezing.

Common Misconceptions About Egg Freezing

“Egg freezing is only for patients with cancer.”

Incorrect. Patients with cancer are an important candidate group, but the procedure may also be considered for other medical reasons, such as diminished ovarian reserve or surgery that may affect fertility. Legal eligibility in Türkiye is determined according to medical necessity.

“Eggs frozen at age 40 provide the same chance as eggs frozen at age 30.”

Incorrect. The age at which the egg is frozen affects the likelihood of obtaining a healthy embryo and pregnancy in the future.

“Eggs cannot be frozen if AMH is low.”

Incorrect. Egg freezing may be performed with low AMH, but fewer eggs may be obtained.

“Egg freezing guarantees pregnancy in the future.”

Incorrect. The procedure may help preserve the possibility of pregnancy, but it does not provide a guarantee.

“Egg retrieval depletes ovarian reserve.”

Incorrect. The retrieved eggs come from follicles that had already started developing during that menstrual cycle.

“You can become pregnant naturally with frozen eggs.”

Incorrect. The eggs must be thawed, fertilized with sperm, and transferred as embryos before they can be used.

“The result is the same regardless of how late the eggs are frozen.”

Incorrect. Age is one of the most important determinants of the procedure’s outcome.

When Should You Consult an Obstetrician and Gynecologist?

An evaluation for fertility preservation may be beneficial in the following situations:

1. Chemotherapy or radiotherapy is planned.
2. Ovarian surgery is being considered.
3. Bilateral endometriomas are present.
4. AMH and AFC are low for age.
5. There is a family history of early menopause.
6. Menstrual cycles have started to become less frequent or irregular.
7. Previous ovarian surgery has been performed.
8. A genetic or systemic disease that may affect fertility is present.
9. Pregnancy is desired in the future, but there is a risk to ovarian reserve.

Evaluation should not be delayed in patients planning cancer treatment. Fertility preservation should be planned together with the relevant medical specialties without interfering with the treatment of the primary disease.

Assoc. Prof. Dr. Nurettin Türktekin’s Assessment

Egg freezing is a valuable method that may help preserve female fertility. However, its success depends not only on technically freezing the eggs, but on performing the procedure in the right patient at the right time.

During clinical evaluation, the woman’s age, AMH and AFC results, history of endometriosis or ovarian surgery, medical treatment plan, and future pregnancy goals should be assessed together.

Women with low AMH should be informed that only a limited number of eggs may be obtained in a single treatment cycle. A young patient with diminished ovarian reserve and an older patient with normal reserve do not have the same expectations. Age is one of the main determinants of the biological quality of the eggs.

Patients should not be given a guarantee of pregnancy when deciding on egg freezing. The aim is to preserve eggs obtained at the current age and create an additional option for future IVF treatment.

Conclusion

Egg freezing is an important fertility-preservation option for women who wish to have children in the future and who have medical risks that may affect their fertility.

During the procedure, mature eggs are retrieved, frozen without fertilization through vitrification, and stored for future use in IVF treatment.

The most important factors affecting success are the age at which the eggs are frozen, the number of mature eggs obtained, ovarian reserve, and laboratory experience. Low AMH does not prevent egg freezing, but it may reduce the number of eggs obtained during one cycle.

Egg freezing may help preserve the possibility of pregnancy in the future, but it does not guarantee becoming a mother. Therefore, age, AMH and AFC results, medical necessity, legal eligibility, and realistic expectations of success should be evaluated together before the procedure.

Frequently Asked Questions

Is egg freezing painful?

Egg retrieval is generally performed under short-term anesthesia. Mild pelvic pain, bloating, and tenderness may occur after the procedure.

Can unmarried women freeze their eggs?

Yes. Marriage is not required because fertilization is not performed during the procedure. However, the medical eligibility conditions specified in Turkish legislation must be met.

Is there an age limit for egg freezing?

Technical feasibility and medical eligibility are evaluated individually. However, egg quality and expected success may decline with age. Therefore, the focus should not only be on an upper age limit, but also on the age at which the procedure is most meaningful.

What should the AMH level be for egg freezing?

There is no single AMH threshold that applies to everyone. AMH, AFC, and age are evaluated together. Low AMH does not prevent the procedure, but it may limit the number of eggs obtained.

How long does the procedure take?

Together with medication treatment and follow-up appointments, the process generally lasts 10–14 days. It may vary depending on the patient and the protocol used.

How many eggs need to be frozen?

There is no single number that applies to everyone. Age, the desired number of children in the future, and laboratory outcomes should be considered. It is not possible to provide an exact number of eggs for a specific probability of live birth.

How long can frozen eggs be stored?

They may be stored for many years under appropriate laboratory conditions. In Türkiye, the initial storage period and extension procedures are regulated by legislation, and Ministry approval may be required for storage beyond five years.