How to freeze your eggs in Pakistan

There is a specific flavour of panic that colours the existence of the Pakistani woman. It develops as she becomes cognizant of society’s Three Holy Ms: Money, Marriage, and Motherhood, all three for which she is expected to stick a landing within a tyrannically slim opening in time.

One of them, Rubab Shahid, had spent what some would call her biologically prime years, focusing on the M of her own damn choosing: Money. She went full throttle on her career and like other women, mused that marriage would eventually find its place in the grand scheme of her things.

Fast forward to her year 37. Rubab was a boss lady at work, but her relationship status still checked the single box on intrusive government forms. She had navigated a mediocrity-soaked dating pool into her early 30s but had not come close to finding someone who wouldn’t make her grind her teeth at night. It became clear then that time waits for no man, and certainly no husband. By 38, she had resolved to preserve her fertility.

In 2020, she booked her first consultation with one of Pakistan’s well-known In-Vitro Fertilization (IVF) specialists, who also happened to be her mother’s friend. “Oh my God, if you do this, you will delay marriage even more,” he oozed. “We can freeze your eggs, but why now? You’re still young. Find a guy!” He did not supplement his moral prescription with clinical investigation.

Rubab’s foray into reproductive autonomy explains one of the reasons why few women take this route.

To separate the science from the judgment and demystify the process of cryogenic baby-making, we spoke to Dr Nida Najmi, an Assistant Professor of Obstetrics and Gynaecology at Aga Khan University. She has worked at St. Bartholomew’s Hospital in London and is setting up an IVF clinic at AKU.

If you or your partner are exploring viable options down the line, or simply curious about how the process works, this is a rough guide to freezing your eggs in Pakistan.

Phase 1: Patient selection and consultation

The first stage is all about figuring out if egg freezing actually makes sense for you and your body. The doctor will look at your overall health, medical history, and, the big one, your age. It is the primary factor that dictates both quantity and quality of your eggs. If you’re between 25 and 40 years of age, you’re in the sweet spot. (This isn’t to say you cannot freeze your eggs if you’re past 40 but undergoing the procedure at the time has historically yielded little clinical benefit.)

During this chat, you and your OBGYN will narrow down your why. This falls into one of the two camps. The first is social, wherein a woman elects to delay pregnancy to focus on education, career development, or life goals. The second, and a much more common one, is medical. Women preserve fertility prior to treatments or due to conditions that damage ovarian reserve. This could be, for example, a cancer diagnosis, in which case immediate egg freezing must take place before the woman starts chemotherapy, which heavily impairs fertility. Endometriosis is another condition that degrades egg quality and ovarian function over time. Catching this early (say in your 20s) and freezing eggs will protect your options before the condition worsens.

Once you’ve discussed your case and are green-lit, you will give formal consent and prepare for the upcoming cycle.

Phase 2: Protocol briefing and the waiting game

The timeline of the actual procedure is synchronized with your menstrual cycle. The team will chart your medication schedule designed to prevent premature ovulation and stimulate your ovaries to produce multiple egg-containing follicles (fluid-filled sac where an egg lives while it matures). Then, you wait for your period. As soon as it arrives, you call the fertility clinic for a heads-up. That first day of menstrual bleeding is “Day 1” of the countdown, setting the baseline for everything that comes next.

Phase 3: Ovarian stimulation

For a young, healthy patient, this phase takes about two weeks (12-14 days) and looks a lot like the first half of a standard IVF cycle.

On day 2 or 3 of your period, you’ll head to the clinic for a transvaginal ultrasound. If the scan shows your ovaries are ready, the cycle is cleared to begin.

You will start receiving your daily hormone injections. For that, you can either pop into the hospital or clinic or self-inject at home (it’s a tiny needle, like an insulin pen’s). You’ll be given two types of medications: one to temporarily control your body’s hormones so you don’t release an egg too early, and another to nudge your ovaries into growing multiple egg-containing follicles.

Since you will be receiving high doses of hormones, your body must be monitored to prevent complications such as ovarian hyperstimulation (overdose). Every alternate day, you’ll head back to the clinic for a two-part check-up. Internal ultrasounds will be conducted to measure how the follicles are responding and growing, followed by blood tests to keep an eye on your hormone levels so they don’t spike out of control.

Based on those results, the doctor will adjust your daily dosages, bumping them up or dialing them back, until your follicles hit the size they need to be. The ideal follicle size for conceiving is between 18mm and 24mm in mean diameter.

Phase 4: It’s D-Day!

Once the follicles are sufficiently large, you’ll be scheduled for a minor surgical procedure that goes on for about 20 to 30 minutes. You’ll be put to sleep via deep sedation or anesthesia. Using the ultrasound as a guide, the doctor will pass a specialised needle through the vaginal wall directly into the ovaries. One by one, they will suction out the fluid inside those mature follicles, which is where the eggs are floating. This will be sent into sterile collection bottles.

Because eggs are sensitive to temperature and environmental shifts, the surgical room is located directly next to the embryology lab. As soon as a bottle is filled with eggs and fluid, it is passed directly through a window into the hands of the waiting embryologist.

Phase 5: Laboratory grading and cryopreservation

Once the eggs leave the operating room, the spotlight shifts entirely to the embryologist, who operates within the controlled environment of the IVF lab.

They will immediately review the follicular fluid under a microscope to confirm the presence of eggs and grade them into one of the three categories:

Freezable: Mature eggs capable of being fertilised in the future.

Possibly freezable: Borderline or slightly less mature eggs that may still hold viability.

Discardable: Completely immature or non-viable eggs that cannot be used.

Here is the catch. Extracting a high number of eggs doesn’t mean you get to freeze all of them. It’s quality over quantity. A woman might have 30 eggs retrieved, but if just 10 are structurally mature, only they make the cut. Only mature eggs can survive the thawing process later on.

The selected freezable eggs are placed inside a cryopreservation unit or a time-lapse machine. This machine maintains a strict sub-zero environment, independent of any external room fluctuations, locking the eggs in their current state.

Freezing preserves the exact quality of the egg at the moment of extraction. It does not degrade, age or change. The quality upon thawing will be identical to the day it was frozen, whether it’s been two years or 10.

Phase 6: The recovery

The last phase is all about giving your body a break.

The second you wake up from sedation, you are officially done with the daily hormone shots. Your system will naturally recalibrate over the next couple of weeks, and your next period should arrive right on schedule, about 14 days post-retrieval.

To give yourself the best statistical shot at a successful pregnancy down the road, fertility experts generally recommend saving a bank of up to 30 mature eggs. It is rare to hit that 25-30 egg golden number in just one go, so most women end up doing two or three rounds to build up their stash. You can choose to dive straight into another cycle with your very next period, or wait a few cycles before stimulating your ovaries again.

Once the target number of mature eggs is safely stored, the process is complete. They’ll stay perfectly frozen until you decide you’re ready to use (or discard) them.

Let’s say you’re ready to use your frozen eggs. Now what?

The process begins with the warming of the cells out of their liquid nitrogen storage, and while technology allows roughly 85 to 95 per cent of frozen eggs to survive the thaw, any that show cellular damage will be discarded.

From there, traditional fertilisation methods are off the table because the freezing process causes the egg’s outer shell to harden, meaning embryologists must step in with a highly specialised technique called ICSI — intracytoplasmic sperm injection — where they select a single healthy sperm (of a partner or donor) and inject it directly into the centre of each surviving egg.

These newly fertilised eggs are left to grow in an incubator over the next four to six days to see which ones develop into embryos. To prepare your body for pregnancy, you’ll be given estrogen and progesterone, whether through pills, patches, or shots, to help thicken your uterine lining. During a precisely timed hormonal window, a fertility doctor will transfer only the healthiest embryos into the uterus for implantation using a thin, flexible catheter through the cervix. Any remaining viable embryos can be re-frozen for future attempts, should you want that.

About 10 to 14 days after the transfer, you will take a blood pregnancy test to see if the implantation was successful.

When you look at the big picture, this whole process is really about beating the biological odds for one incredible outcome. Women are born with up to two million eggs, but our bodies naturally cycle through and waste the vast majority of them month after month. The grounding truth of fertility preservation is that out of those millions of possibilities, you ultimately need a single high-quality egg to make a baby.

The preparation no one talks about

The clinical side of freezing your eggs is overwhelming but that may just be the easier part.

In Pakistan, the process starts the moment you try to negotiate the suffocating matrix of cultural side-eyes, financial constraints, and the unspoken rule that a woman’s timeline belongs to almost everyone but herself. Science has come up with a way to freeze your eggs. It has yet to come up with a way to freeze the judgment of society.

Welcome to Part II of the guide, told through the voice of a Pakistani woman who went ahead.

Step 1: It’s a patriarchal world. Resist.

Rubab refused to accept the blueprint for motherhood. “I don’t think you should be marrying for children,” she told Dawn. “You should get married for companionship. What if you end up in a miserable marriage, have a child, and then part ways? That sounds much worse to me.”

As she made her choices, she confronted pushback from doctors and dismissive family members. When she discussed freezing her eggs with relatives, they joked that using donor sperm might mean she end up with a charsi’s kid (an addict’s child).

As an extension of this thinking, fertility treatments and reproductive technologies are still largely built around traditional heterosexual marriage and family models, effectively locking single women out.

But she wanted to separate partnership from parenthood and biology from social pressure. “Fertility preservation doesn’t mean I’m rejecting marriage,” she said. “It’s simply about expanding my choices.”

She found it amusing that no one bats an eye when women spend stupid amounts of money on Botulinum toxin injections (Botox), Polymethylmethacrylate fillers, and Rhinoplasties (nose jobs). “But you draw the line when a woman spends money to preserve her fertility. I’ve heard all types of questions. Is it necessary? Isn’t it unnatural? Why are you planning so much? Why not just get married sooner? Eventually, I realised this isn’t about me. It’s about the overarching standards set in place. It’s only when you step back, recognise that pressure for what it is, and hand it back to the society that created it, can you free yourself to make your own choice.”

Step 2: Do your research and take your time with it.

Once you decide to move forward, you have to choose where to do it. Options in Pakistan are becoming more affordable (relative to options abroad) and available but regulatory and infrastructural hurdles remain.

One concern is the consistency of lab results. After receiving alarming hormone test results locally, Rubab consulted a doctor in Dubai who requested a rerun. The results were completely different. These tests were to determine her treatment plan, dosage and timing of injections. As Rubab learned, ensure your diagnostic tests are done at a reliable facility, double-check your results or seek a second opinion before letting anyone start a cycle.

Most importantly, choose a doctor who will make the journey easy for you. When you walk into a clinic, the first five minutes you spend with them will be crucial. Do they ask about your lifestyle, your medical history, your motivations, and your long-term goals? Or do they immediately push you toward marriage, or worse, dismiss the procedure entirely because your reason isn’t infertility? A good doctor will listen to your case, explain the hormonal variables, and make you feel secure in your decision. If you feel like you are being interrogated or lectured, leave.

Step 3: You will be told the Dos. Here are the Don’ts.

The first time Rubab underwent the procedure, she walked away with only two viable eggs, feeling as if there was something inherently wrong with her body. There wasn’t. She simply hadn’t prepared.

To maximise your yield, you need a three-to-four-month runway of biological preparation. Get on a strict regimen of Omega-3s, prenatal vitamins, and Ubiquinol (CoQ10) to boost egg quality. If you are holding a vape, put it down. “Smoking is the most horrible thing you can do for your egg quality,” said Rubab.

You might think vigorous exercise prepares your body, but during ovarian stimulation, your ovaries become enlarged. Heavy working out puts you at risk for ovarian torsion (a medical emergency where the ovary twists around the ligaments that hold it in place).

By her third round, using this exact preparation, Rubab achieved her highest yield ever, despite being the oldest she had ever been during the cycles.

Step 4: The cycle is a grueling physical and psychological test.

Pumping your body with high doses of synthetic hormones means compressing months of ovarian activity into two weeks. “Those 12 days, my belly was bloated. I gained hormonal weight. I was moody, anxious, and doing all these things with no end goal in sight. It can be hard,” she recalled.

During the stimulation phase, your ovaries will expand significantly as they attempt to grow multiple follicles to a specific millimeter size simultaneously. This causes a very real and heavy discomfort. If you are squeamish about self-administering the daily shots to the stomach, you’ll need a different strategy. Rubab booked a hotel room within walking distance of her clinic and walked over every single evening to let a nurse administer her injections.

Egg freezing forces you to endure physical distress for an abstract possibility, unlike a normal pregnancy in which the tough first trimester holds the promise of a baby. To survive this phase without burning out, clear your social calendar, accept the temporary changes to your body, and remind yourself that the emotional storms are a passing chemical reaction.

Step 5: Understand the shrinking “numbers game”.

Every few days, you will undergo internal ultrasound scans to monitor the millimeter size of your follicles. For women who have anxieties surrounding invasive procedures and virginity, it is worth knowing upfront that a vaginal ultrasound probe is standard for both monitoring and egg retrieval. When the follicles are big enough, they are retrieved under light sedation.

Prepare mentally for the reproduction funnel. If a clinic tells you they saw 20 follicles on the scan, it does not mean you get 20 perfect eggs. The numbers steadily drop as the lab screens for viability.

A luxury for the handful

Class privilege is central to the discussion. The majority of the women interviewed for this piece cited finances as one of the roadblocks. A single retrieval cycle costs anywhere between Rs750,000 to Rs1 million. This does not include charges for initial consultations, each of which cost roughly Rs3,000. The recurring storage fee is an additional Rs27,000 to Rs40,000 every year.

One such woman, Hamna Mehmood, a 32-year-old banker, began looking into the procedure as a ‘just in case’ safety net a few years ago. She’s been married for seven years and had not had children yet.

“The cost was through the roof,” said Hamna. “Honestly, I felt a bit cheated. My mind could not compute how something so natural would cost most people’s entire life’s savings. I understand the science of it is quite technical, but surely there can be a more affordable option?”

Hamna abandoned the idea.

“Institutional bullying”

Maheen Malik, a 37-year-old psychotherapist, acknowledged the privilege of being able to even consider egg freezing, and spoke of a different set of hurdles.

She explained to her consultant that her first marriage had ended and that her ex-husband hadn’t wanted children, only to be met with moralising hostility. The consultant skipped right past any information of value such as her medical history and said:

‘You girls don’t produce a child timely. And then you come here looking for solutions.’

Maheen said that to weaponise a 35-year-old woman’s biological clock against her while she is trying her best to take control of it is a form of “institutional bullying”.

“Why are you working as a senior consultant at a fertility clinic if you don’t have the emotional bandwidth to handle cases gently? What do you know about the reason why someone didn’t have a child? Who are you to judge?” she said.

Fighting a lonely war

For Neha Irfan, a 42-year-old homemaker, egg freezing was a desperate attempt to find breathing room after the immense physical and emotional trauma of back-to-back miscarriages. She wanted to preserve her eggs and revisit the possibility of a family when her body and mind had healed.

“As well-meaning as my in-laws are, eyebrows were raised. Hell, my own family questioned how I could think in that direction. They all collectively made me feel like I didn’t make sense.”

The compounding weight of not being able to meet familial expectations and dealing with reproductive grief forced Neha to let go of the idea altogether. “I am constantly grieving the babies that didn’t come. I couldn’t handle the added emotional toll of freezing my eggs with no support.”

A divine dilemma

Then there are women who have the financial means and the social independence to consider the procedure, but are uncertain whether it is religiously permissible.

Aina Rehan, a 28-year-old entrepreneur, started her company only a year ago. She knows she wants marriage and children eventually, but for now, her life is consumed by the demands of a budding business. Egg freezing, to her, feels like a way of buying time without surrendering to the pressures of her biological clock.

But she’s stuck in a maze of contradictory religious opinions.

“My understanding is that there is considerable variation across the Muslim world,” she said. For example, in Iran, both civil law and Shia jurisprudence generally permit egg freezing. But the Islamic authorities in Malaysia have issued fatwas prohibiting elective egg freezing for single women, she explained.

For women like Aina, the question is whether preserving fertility today could be interpreted tomorrow as crossing a religious boundary.

“Living in a society that’s so divided, even within one dominant religion, means there is no clear answer to something as important as this. Every scholar seems to have their own take,” she said. “I don’t want to do something that conflicts with my faith, but I also don’t want to lose the opportunity to have children. I don’t know how to navigate this.”

Unlike with issues on which there is near-universal agreement, assisted reproductive technologies often sit at the conflux of competing concerns in Islam. There’s the idea of continuing lineage, protecting family structures, and preventing fertilisation outside marriage (essentially saying you cannot do this as a single woman).

Given that there is no clear consensus, many women are left to piece together guidance from scholars and online fatwas, often arriving at more questions than answers.

The biological blackmail isn’t going to work anymore.

The biological clock has been used as a form of polite blackmail. Cryopreservation pulls the plug on that countdown. But many women walk right up to the edge of this decision, take a look at the hurdles, and turn back. In fact, our hunt for women who had their eggs frozen in Pakistan was like looking for a needle in a haystack. We managed to find just one woman who was willing to talk. That solitary data point speaks volumes.

As Rubab said, normalising egg freezing would mean admitting that women don’t actually need a man to check off every box in life. And heaven forbid we shake up the social order like that.

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