Embryo Freezing (Cryopreservation)

What is embryo freezing?

Embryo freezing, also called embryo cryopreservation, is a process to freeze and store embryos for later use. An embryo is an egg that has been fertilized by a sperm. This process is a way to help people with fertility and reproduction.

Why would you freeze an embryo?

Embryo freezing often occurs after people have treatments to try to get pregnant. Examples include in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

These procedures fertilize eggs with sperm, and they sometimes create extra embryos. You may choose to freeze extra embryos and use them later if you:

• Postpone or cancel implantation into your uterus after an egg is already fertilized.
• Want to delay IVF to a later date.
• Want an option in case early attempts at fertility treatment fail.
• Choose to donate unused embryos to other people trying to get pregnant or to researchers rather than destroy them.

Embryo freezing is also used for fertility preservation. For example, a woman or person designated female at birth (DFAB) with cancer might want to save fertilized eggs before starting chemotherapy or radiation therapy if that treatment could affect their ability to get pregnant. A transgender man (transitioning to male) also might freeze eggs or embryos before taking hormones for the transition or having gender affirmation surgery.

What’s the difference between egg freezing and embryo freezing?

Embryo cryopreservation freezes a fertilized egg. Fertility programs also may offer egg freezing, which freezes unfertilized eggs.

Is embryo freezing worth it?

The decision to freeze embryos is personal. Costs vary widely, and medical insurance may not cover fertility treatments. You’ll have to consider your goals, the costs, ethical issues, your partner’s preferences and other considerations.

Does freezing damage embryos?

Freezing can damage embryos. Thawing them later can also damage them. If multiple embryos are frozen, some or all may not survive the process.

Your healthcare provider will talk to you about whether your embryos are suitable for freezing, thawing and implantation.

Is IVF more successful with frozen embryos?

Scientists don’t yet agree on whether pregnancy has a better chance with a fresh or frozen embryo. Researchers continue to study the issue.

What happens before embryo cryopreservation?

You have to give your permission to freeze embryos. Your healthcare provider will give you consent forms to read and sign. The paperwork should provide details such as:

• How many embryos will be frozen.
• How long they’ll be stored (often 10 years).
• What happens when the storage time expires.
• What happens if you die or become too ill to make decisions before the storage period is over.
• What the embryos are allowed to be used for (for example, only your fertility treatments or if they can be donated to research or to another infertile couple).

Your healthcare provider can also help you decide during which embryonic stage it’s best to freeze one or more embryos. The stages where freezing is possible include:

• Cleavage stage: When the single cell has multiplied to between four and eight cells after about 72 hours.
• Blastocyst stage: When the single cell has multiplied to between 200 to 300 cells after five to seven days.

What happens during embryo cryopreservation?

There are two methods to freeze embryos: vitrification and slow freezing.

In vitrification, fertility professionals:

• Add a cryoprotective agent (CPA) to the embryos. CPA is a liquid that acts like antifreeze and protects cells from ice crystals.
• Place the embryos immediately into tanks of liquid nitrogen at -321° Fahrenheit (-196.1° Celsius).

Slow freezing has fallen out of favor, but some fertility specialists may still use it. In slow freezing, fertility professionals:

• Add smaller amounts of a cryoprotective agent (CPA) to the embryos than used in vitrification.
• Put the embryos in a machine that cools them, slowly decreasing the temperature over about two hours.
• Remove the embryos from the cooler and store them in tanks of liquid nitrogen at -321° Fahrenheit (-196.1° Celsius).

For either process, the embryos are:

• Stored in containers that look like small straws.
• Labeled with details that identify them as yours.

Interestingly, the embryos remain the biologic age at which they are frozen. So if you freeze them at age 35 and come back to use them at age 50, the embryo hasn’t aged.

What happens after embryo freezing?

When frozen embryos are needed later, a fertility specialist will:

• Remove the embryos from the liquid nitrogen.
• Allow them to slowly return to normal temperature.
• Soak them to remove the CPA.
• Use the embryos as indicated (for example, transfer them into your uterus).

What are the advantages of embryo cryopreservation?

Embryo freezing can help people get pregnant later in life if they are facing current barriers, such as:

• Advancing age.
• Gender transition.
• Infertility issues.
• Social/personal reasons like if you’re pursuing higher level education or have professional demands and plan to delay pregnancy for several years.
• Treatment that may damage fertility (for example, chemotherapy or pelvic radiation therapy for cancer).
• Upcoming military deployment.
• Women without a partner may be concerned about advancing age and choose to either freeze eggs or embryos that they create with donor sperm.

What are the risks or complications of this procedure?

Embryo freezing doesn’t pose risks to resulting pregnancies, such as congenital disabilities or health problems. In fact, outcomes research of frozen-thawed embryos show lower rates of preterm birth, low birth weight, growth restriction and perinatal mortality.

The main risks associated with embryo cryopreservation are:

• Damage to embryos during the freezing process.
• Embryos that are not viable for freezing.
• Failure to get pregnant after embryos are thawed and implanted.
• Increased rates of medical issues in pregnancy like preeclampsia and placenta accrete spectrum.
• Multiple births if more than one embryo is implanted (twins or triplets).

Is frozen embryo transfer successful?

Frozen embryo transfer occurs when an embryo is thawed and implanted into a woman’s uterus. The process is often successful. But rates vary widely based on many factors, including:

• Both parents’ overall health.
• Mother’s age at the time of the egg retrieval.
• Presence of fertility issues, such as endometriosis, fibroids and uterine polyps.
• Previous success or failure of fertility treatments and pregnancies.

Your healthcare provider will help you understand the factors that may affect your chances of success.

What if I change my mind about freezing my embryos?

You or your partner can change your mind at any time during the process. If one of the two parents decides not to proceed with the process, the fertility specialist can’t legally continue.

If one parent decides not to proceed after the embryos are already frozen, the specialist might suggest a waiting period to be sure. Then the embryos will be taken out of storage and allowed to perish.

What if I don’t use frozen embryos?

If you don’t use frozen embryos, you can:

• Discard them. The fertility clinic will remove them from the freezer and allow them to thaw, making them no longer viable.
• Donate them to someone else who’s trying to have a baby.
• Donate them to research.
• Donate them for educational purposes (for example, to help train future fertility professionals).

A note from Cleveland Clinic

Embryo freezing, or cryopreservation, is a process that freezes and stores fertilized eggs for later use. It can help people preserve fertility and have options for pregnancy later in life. If you’re considering embryo cryopreservation, talk to your primary care provider, gynecologist or fertility specialist.