Egg Freezing & Women's Mental Health: Ten Self-Care Strategies
By Peggy Loo, PhD
A brief history of fertility preservation & treatments
The first human born with the help of an IVF procedure was in the UK in 1978, which marked an extraordinary medical advancement. However, fertility treatments and egg freezing would be deemed an experimental and controversial option for years to come. In 2012, the American Society for Reproductive Medicine declared that egg freezing is no longer an “experimental” procedure, leading to more women seeking the option and with it, greater reproductive freedom. From 2020 to 2021, about 24,500 egg freezing procedures were conducted in the US, according to the Society for Assisted Reproductive Technology. In the last few years, you may even have heard of the healthy births of babies from donated embryos that were frozen two to three decades ago!
Why do women freeze their eggs?
Some women pursue egg freezing because of age-related fertility concerns in the context of being single. Others are partnered but ambivalent about motherhood or have invested a lot into their career development and want more time in their professional lives before having kids. Some women have a medical condition or are undergoing medical treatment that may affect later fertility, and have been advised by their physicians to consider egg freezing. In my therapy practice, I’ve worked with women who have been in all of these situations. What they have in common is every woman has wanted a chance to exercise personal agency for the future and ensure fertility preservation in the present.
The egg freezing process and costs
Regardless of the reason, the introduction to the process of freezing your eggs can be like drinking out of a fire hose, especially if you’ve never heard much about the details before. The amount of information, letters or abbreviations, and moving parts can be a lot to take in. Even if you know many women who have frozen their eggs, your own process is likely to be unique because of countless factors, including your age, health, and response to medication. While the process itself can take 2-3 weeks from start to finish, at minimum it includes an initial consultation with a reproductive endocrinologist and bloodwork, a strict medication regimen of self-administered hormone injections, many follow up appointments with blood draws and ultrasounds, and an eventual brief procedure under anesthesia for the egg retrieval itself. If a woman’s body doesn’t respond as hoped to medication or not enough viable eggs can be harvested at the retrieval, a woman may undergo numerous egg freezing cycles. This description doesn’t include how a woman pays for the egg freezing cycle process itself, which can range from $10,000 to $15,000 per cycle as well as continued annual fees associated with egg storage. It’s a lot to process before, during, and after. If you’re interested in more information, a great start is to speak with your gynecologist or seek a reproductive endocrinologist at a fertility center.
Egg freezing and your mental health
Because the process is involved and centers your body, it’s easy to focus on the physical or medical details themselves instead of your mental health. While understandable, the choice and process inevitably brings up a lot of feelings worth processing, because it can bring up how we feel about aging, relationship status, motherhood, gendered expectations, the future, our bodies, and uncertainty or loss of control, to mention a few. A word you’ll hear frequently with egg freezing is that it’s empowering. And many women do feel strong, free, and thankful if they have the option (and financial means) to freeze their eggs. Even if that’s the case, it’s normal and expected that you also feel other emotions like stress, anxiety, and vulnerability. You may feel self-conscious or self-judgment in new ways as the process becomes another lens of evaluation and comparison between women’s bodies and choices. The process may catalyze self reflection in countless other ways that bring up sadness, regret, ambivalence, helplessness, or even anger. All of these emotions are valid and worthy of care and support, but often get swept under the rug.
A list of 10 self-care strategies if you’re freezing your eggs
Here, I’ll offer ten suggestions that help you prioritize your mental health before, during, and after an egg freezing cycle. Please note that these suggestions are by no means comprehensive and are meant for women who pursue egg freezing to preserve fertility. They don’t encapsulate the unique nuances or experiences of medical infertility or IVF.
1. Name your reasons for freezing your eggs and stick to them.
You’re likely to get a lot of solicited and unsolicited opinions about egg freezing. When to do it, why, various statistics about fertility, contingency plans for every situation where having eggs banked would be useful (e.g., if you meet someone or don’t by X age). It can be useful to gather information, but at the end of the day, this is a personal decision that impacts your life and body. Pause and voice your own reasons for egg freezing, and use them to anchor yourself throughout the process.
2. Self-advocate for medical care and information that respects who you are, your body, and your family planning context.
If you’re a person of color, LGBTQ+, or have religious or spiritual practices that influence your decision making or needs in medical spaces - you know health care systems have not always been understanding or respectful. Finding a healthcare provider or fertility clinic that makes you feel seen and supports your family planning goals is incredibly important, especially so your stress levels aren’t higher than they need to be. If you’ve had trouble speaking up or elevating your own needs, this may be a challenge. It can be natural in medical settings for people to defer to the professional in the room because of the imbalance of power between physician and patient. However, if after an initial consultation you don’t feel heard, stating that you’re considering your options and asking for a referral or second opinion can be a practical step towards inclusive and thoughtful medical care. Preferences like having your ultrasounds conducted by a physician of the gender you’re most comfortable with are also small opportunities to communicate what you need to feel okay in a healthcare setting.
3. Clarify your boundaries with people who are uninvolved (coworkers, neighbors, acquaintances).
This is an opportunity to practice making your boundaries and preferences explicit. Think about what would help keep you as calm and healthy as possible during your cycle, and communicate that as clearly as you can. Who do you want to know that you’re going through an egg freezing cycle, and who might simply need to know that you’ll have some “doctor’s appointments coming up in the next month”? Would it be helpful if you could work from home so you can attend early morning appointments or plan for some PTO? Since an egg freezing cycle is timed to your menstrual cycle, you have the benefit of knowing in advance a window of time where accommodations or support may be much appreciated.
4. Cope ahead - make plans to cope through each step.
Think about how you pack for a trip. You might pack with your itinerary in mind, but usually you’re prepared to adjust a little if the weather isn’t as expected. Which means you might pack that umbrella or extra pair of socks “just in case”. Packing those extras is a helpful metaphor for coping ahead when it comes to egg freezing. You may never need that umbrella, but if you do, you’ll be glad for it! Similarly, be proactive about how to manage side effects and physical discomfort if it comes up. For example, in case of fatigue or bloating, plan for some low key evenings or make sure your favorite stretchy clothes are laundered and ready. If you struggle with blood draws or transvaginal ultrasounds, go to your follow up appointments with a breathing exercise or have a feel-good playlist in your headphones once you get to the waiting room. If you’re worried about the self-injections, have a friend with you for support the first few times or ask women who have been there what tips or tricks helped (e.g., putting an ice pack on injection area first). Give yourself some buffer time after monitoring appointments to decompress or grab a treat before moving on with your day. Set an intention about how much time you’ll allow yourself to google things, maybe specifically after your scans when you receive updates. While it’s good to be informed, it’s not great to ruminate or jump to conclusions when so much is unpredictable during the process. It’s helpful to normalize that parts of the process may feel impersonal. Due to the number and frequency of appointments, it’s common for women to be seen by a rotating medical team who conduct blood draws or scans, rather than the same friendly faces. If it helps, plan for personal connections throughout the process so you feel uniquely known and supported.
5. Be mindful of your unexpected feelings and respond non-judgmentally.
Having a range of emotions about egg freezing before, during and after the process is expected and okay. It’s important to acknowledge that there is a longstanding, pejorative social narrative about women, their feelings, and their hormones, which has resulted in women discounting their emotional experiences if it has anything to do with their menstrual cycles or reproductive identities. Checking in with yourself and naming whatever you’re feeling without judgment (or the expectation to act on every feeling) is a good start. Saving time for a check-in and planning some outlets is a form of self-care. For example, what are some places, people, or activities that you find validating, nurturing, or free to be yourself - whatever your mood? What might you want to set time boundaries on or take a break from entirely during an egg freezing cycle that isn’t helpful for your mood (e.g., news apps, social media, Reddit threads)?
6. Identify your support system and be honest about what actually helps.
Use the people in your life who want to support you and their respective strengths. People can support you in preparing for the process, undergoing treatment, or after the retrieval and results. You may have friends happy to join you in abstaining from alcohol. Some may be really good with check-in texts, unflappable by medical details, or willing to share about their own experience. Some may be willing dog walkers the day of your retrieval or volunteer to keep you company afterwards. You may want helpful reminders to cut yourself off or limit online search spirals. You may find messages from certain people helpful, or you may prefer updating people about how it all went whenever you’re ready. Just as important as identifying who and how people can be supportive, be honest about what’s not useful. For example, you may not want to hear about a friend’s very successful egg freezing experience if you’re worried about your own. It’s also perfectly okay to take a break from cheerleading other women’s family planning moments if it’s too much (e.g., pregnancy announcements, baby showers or birthdays) so you can focus on yourself and your needs. Share what works for you.
7. Choose to focus on being as healthy as possible during the process, not the results.
Making the decision to freeze your eggs can feel like a paradox. On the one hand it’s intentional and involved, yet on the other hand you can’t control the outcome. For high achieving, successful women the reality that you could do “everything” right and not get the end result you hope for is hard to accept. During the process, you’ll learn a lot about the desirable outcomes, from rate of follicle growth to an optimal number of eggs retrieved. Focus your energies instead on what you can control (within reason). While we don’t know exactly what makes one woman’s experience more successful than another’s (otherwise there would be a winning formula prescribed to every woman), we do know a lot about what supports our physical health and bodies. Eating well, getting enough quality sleep, social support, a moderate level of exercise, and stress management skills are all things that you can practically take care of through your daily decisions. Finding ways you can exercise healthy control (e.g., throwing yourself into something creative, decluttering your space, making future plans) can also offset relinquishing control in this area of your life.
8. Address your stress levels whenever you can, not just at the finish line.
Speaking of stress management, research is mixed as to whether certain types of stress significantly impact fertility treatment outcomes, but generally speaking less stress is always a good thing. Whether or not you feel stressed, chances are the interruption to your regular routines and daily monitoring of your body are going to increase your stress (even if you’ve been through an egg freezing cycle before). You might wonder how on earth am I supposed to not get stressed during such a disruptive process? Or how can I manage my stress throughout the entire two weeks of treatment? While it’s unrealistic to strive for no stress; you can decide to consistently reduce it in practical ways when you notice it. Think of how you respond to thirst cues - you’d probably head to the kitchen for a glass of water or grab your water bottle. Chances are you don’t obsess about the next time you’re going to be thirsty or assume this water break will take care of all hydration needs in the future. In a similar way, when you’re noticing your stress, do something small in response. Take a stretch break, go for a short walk, rub out your shoulders, nourish yourself, or focus on shifting your attention to something present and grounding.
9. Practice self compassion.
While egg freezing is an empowering option, a regret I’ve heard is women stating they wish they had prioritized it earlier. There can be self-criticism about past health choices, relationships that didn’t work out, or simply letting time go by, which can be consequential when there’s a biological clock. A lot of “if only” statements (e.g., if only I had done this differently, then…”). While these feelings are valid to have and important to share in safe spaces, too much negative self-focus usually backfires. When you’re ready, a small but helpful reframe is thinking about how you’d complete the sentence “At least…”. At least I have this option, at least I’m prioritizing this now and now later, at least I am taking the steps I can, etc. Practicing self-compassion at this time is key, not just because research shows that self compassion reduces stress levels and anxiety. Intentionally using a kind, warm tone of voice with yourself as you would with a friend can help keep you from tumbling into dark emotional rabbit holes. There are many resources for self-compassion online to check out.
10. Seek therapy with a mental health professional familiar with women’s health.
If you’re wanting additional emotional support, consider seeking therapy with a therapist trained in women’s health and knowledgeable about fertility treatments. Being proactive about your mental health can make a big difference. Being the patient or being in medical spaces can feel very vulnerable, as we hope for good outcomes but have to give up control. If you’ve struggled with health anxiety, trauma, or negative experiences with medical providers, parts of this experience may kick up old anxieties or triggers that are difficult or painful. As mentioned before, this process can activate a lot of big feelings or existential questions about yourself, your body, and your future hopes. It’s also a relatively rapid process (2-3 weeks in total) and can be an emotional roller coaster. Please don’t struggle on your own - there can be practical help and compassionate support for your mental health. At Manhattan Therapy Collective, we have a wonderful team of psychologists experienced in women’s health and fertility concerns and would love to connect.
About the Author: Dr. Loo is a licensed psychologist at Manhattan Therapy Collective and she enjoys working with women as they consider the possibility of motherhood and navigate fertility concerns. She is a certified perinatal mental health specialist (PMH-C) through Postpartum Support International and a member of the Women’s Mental Health Consortium.