But what I’m really afraid of is that it’s neither of these things. And so for what feels like the hundredth time, I type “signs you are pregnant” into Google. My periods had been irregular for years—the real periods I had before I got on the Pill, and the fake ones while on it—which made it hard to know whether I was late or it was just my cycle that was off. For a long time, I didn’t understand why I still bled a bit every month or so if I wasn’t ovulating, since I was on the Pill. (I hadn’t yet learned about withdrawal bleeding.) And during our travels around balmy, humid Sri Lanka, it had been difficult to remember to refrigerate my birth control pills. The heat, the doctor who’d prescribed them had warned me, could make them less effective. It used to be that sharp pain in my lower abdomen only made me worry I might have another cyst threatening ovarian torsion. But since I started having sex, I worried that anything more than a mild ache near my abdomen meant either that I was about to lose my ovary or that I was pregnant. When the cramps subsided, my worries did, too—until the next time it happened and the anxiety spiral repeated itself.

One night months later, in another part of Sri Lanka, I found myself in the back of a tuk-tuk speeding to a hospital. I remember the hot, spiced air and my lower left pelvic area feeling as though it were on fire. My ovary, I’d convinced myself, was twisting, again, under the weight of another cyst. In the emergency room, I waited for hours, my thoughts spiraling. What if I lose my remaining ovary? What if I really cannot have babies? In a poorly lit exam room, I described the throbbing to a slightly taken-aback doctor. I explained what I needed him to do, and when he wheeled in the ultrasound machine—which looked as if it hadn’t been used since the 1980s—I sighed in relief, nodding. This piece of medical technology has, on three different continents, conveyed to me what is happening within my reproductive system. It’s not always good news, but this time it was: The doctor saw nothing abnormal. I left the hospital that night with one more black-and-white photograph to add to my collection. The mental seesawing—anxiously suppressing my fertility now, anxiously worrying about my ability to conceive in the future—would continue for years.

All of this was on my mind when, several months after my first appointment with Dr. Noyes, I called her office to schedule a second one. The nurse on the phone didn’t remember me and asked me the usual questions. I was getting used to this—the repetitive back-and-forth, the questions about my fertility and desire to freeze eggs, my well-rehearsed answer about my one ovary. We scheduled the appointment and a few weeks later I was back in the waiting room at NYU Langone Fertility Center. More paperwork. Still single. This time, in addition to the regular questions, Dr. Noyes asked me a bunch of questions about my love life.

“You’re smart, pretty, ambitious,” Dr. Noyes said matter-of-factly. Then: “Why don’t you have a boyfriend? You’re so cute.”

What are you supposed to say when a world-famous fertility doctor tells you you’re cute—and asks why you’re single?

“I—uh, thank you, Dr. Noyes.”

“Well, I’m not worried about you, you’re very young. But…I am surprised a little bit.”

I cringed slightly at her comment (and, later, wondered why she’d made it at all). I felt some pressure to reassure this somewhat intimidating doctor that I occasionally went on dates, had a healthy sex drive, was mostly fine. I did not feel like telling her about the ham sandwich. I mumbled something about having a major crush on my brother’s best friend, whom I’d known since I was nine years old and had lately been daydreaming about more than usual. About how witty and kind he was. About his meaningful work in international education. About the way he’d intently listen when we were having a conversation, the way he held my gaze and released it. About how—

“Oh, so you have a dream guy out there?” Dr. Noyes asked brightly.

“Well,” I said weakly. I wanted to go back to talking about my ovary and fertility fears, which, compared to dissecting my personal life, struck me as very pleasant topics of conversation.

“Does he know?”

My face felt hot. Were my dimples blushing? It felt like it, even if dimples don’t blush.

“He does, I think. Kind of. I—it’s not easy talking about this.”

Dr. Noyes waved her hand as if to sweep all the awkwardness out of her office. “Your life’s on the right track,” she said, closing the folder containing my medical records that had been lying open on her desk, as if the matter had been decided. I wrung my hands in my lap. At the moment, neither my life nor this appointment felt the least bit on track.

“Anyway, I remember you saying you definitely want biological children,” she continued, getting back to safer ground. “And especially if you want more than one child, then we’re probably gonna do two cycles. Because I want to have a really good number of eggs.

“Whether you freeze eggs or just bite the bullet and have a baby…” She paused, as if interrupted by nostalgia. “To go through life without kids—well, I really can’t imagine my life without kids.”

We got to the risks. What I was most worried about was overdoing it, hyperstimulating my ovary and causing irrevocable harm. “I’m just so nervous that if I do this and lose my one ovary…that’s what really scares me,” I said. “That’s what’s holding me back.”

But Dr. Noyes had the confidence I was lacking. “I’m not at all worried about freezing your eggs,” she announced. “Since I met you, I’ve done another three thousand. I’m not worried at all.”

Three thousand what? I wondered, but didn’t ask.

—

I was once again led to an exam room, where a nurse instructed me to undress and put on a thin soft gown. The strings dangled at my sides. I shivered; the gown’s open front left me chilled. I lay on the table and slipped my heels into the stirrups, shifting my hips down before the nurse told me to.

“You’ve really done your homework,” said Dr. Noyes as she squished lube onto the knob of the ultrasound wand and slid it inside me. It was cold and uncomfortable. I took a breath and tried to focus on the facts. The doctor examining me was one of the most respected in the field. She’d determined I was a good candidate for egg freezing. And while her demeanor could be a bit patronizing, I had to admit that her optimism—and clear enthusiasm for my ovary—was drawing me in. I glanced at the monitor, to where Dr. Noyes was motioning with her free hand. “Here’s a picture of your ovary—whoops, sorry, it’s this part that’s the ovary. Okay?”

“Okay,” I said, and there was something about the moment when Dr. Noyes found my ovary that allowed me to find my feelings about all this. I wanted to do it, I realized. I wanted to freeze my eggs. It felt good, such a relief, to decide. Legs spread wide, wand still inside my vagina, I told Dr. Noyes: “I’m going to do it. I’m going to freeze my eggs, here, with you, and it’s gonna be great.”

Mandy: “Ticking Time Bomb”

One June morning, thirty-year-old Mandy woke with a jolt. Finally, she thought, reaching for her phone to silence the alarm. After eleven days of hormone injections, the day of her egg retrieval was finally here. She’d been up late, hunched over her laptop checking egg freezing forums and reading blog posts with titles like “What to Expect on Retrieval Day.” Had she done everything she was supposed to? With egg freezing, she’d learned, there wasn’t much room for error. And yet the process seemed error prone. Just the day before, Mandy had opened the injections kit and realized the shot she was supposed to give herself that morning was missing. She then rushed to her doctor’s office, where the nurse injected her with the Menopur she needed just in time.

Mandy’s husband, Quincy, stirred next to her. She lay back in bed, knowing his phone would buzz soon; most mornings, they set their alarms five minutes apart. They’d both taken the day off from work. The outfit Mandy had picked out the night before lay waiting: black leggings and her favorite worn gray sweater. It was a warm early summer day in Oakland, California, where Mandy and Quincy lived, but she had been in enough chilly doctor’s offices and exam rooms lately to know she’d be glad for the sweater.

Mandy was freezing her eggs at her doctors’ urging. Two surgeries in her twenties had left her with half of one ovary and a quarter of the other. When Mandy was twenty, a dermoid cyst—a small, usually non-cancerous abnormal growth—on her right ovary ruptured, requiring emergency surgery. When she was twenty-eight, she had surgery to remove another dermoid cyst, on her left ovary. Unlike the more common follicular and corpus luteum cysts—the ones we talked about earlier that form in response to a woman’s menstrual cycle—ovarian dermoid cysts are often present at birth, meaning they form in utero. They’re not unusual but are removed if they grow too large or are at risk of rupturing, as Mandy’s did.[*1] She was lucky, doctors had told her more than once, to still have her ovaries—even if they were partial ones. A woman can still have babies with partial ovaries, but Mandy now faced an increased risk of trouble getting pregnant if and when she chose to.

It was after her second surgery that Mandy’s doctor, worried about Mandy facing fertility issues, recommended she try to get pregnant sooner rather than later or consider freezing her eggs. Then, two years later, when Mandy was thirty, she learned she had a third ovarian dermoid cyst. A ticking time bomb if it was to grow like the others over the next few years—years in which Mandy’s currently good eggs would start slowly diminishing. And if she needed to have yet another surgery to remove this cyst, her fertility could be further compromised. She needed to make a decision about egg freezing—now.

Mandy had first contacted me after what she referred to as “a Google-search spiral.” An attempt to learn more about egg freezing after recalling the experts’ advice had turned into a twisty, alarming deluge of unhelpful social media posts and aggressive ads that left her feeling overwhelmed. When she happened upon some of my articles on the subject, she got in touch right away. “The more I read, the more confused I get,” Mandy said the first time we spoke on the phone. “I really can’t tell if egg freezing is a good thing or a bad thing.” Unable to distinguish marketing from medical advice, she was put off by what she found on the internet: fertility clinics with one-, two-, or five-star ratings; glamour shots of women next to their glowing egg freezing success stories; bitter writings detailing how the procedure had gone horribly wrong.

Having kids felt like a far-off possibility; Mandy and Quincy hadn’t meaningfully broached the topic yet. Both Americans, the two had met in southeastern China while teaching English to high school students in a remote town in the province of Hunan. Eventually they moved back to the States, found jobs in the Bay Area, and got married. They began to save money and set goals. Things started to feel somewhat stable; Mandy and Quincy’s shared life together was just beginning. They weren’t ready to start a family just yet.

“It had always been, like, ‘Oh, I have to go get my oil changed,’ ” Mandy told me when we first started talking. “ ‘Figure out my ovary situation’ was on my long-term to-do list.” But it was time to make a decision. “I’m hoping that if I ignore the problem long enough, it will just go away,” she said. I heard the tension in her voice, an inner conflict just beginning to bubble up. “But time is not on my side, especially with my medical history.”

A few months after her thirtieth birthday, she decided to freeze her eggs.

At Mandy’s initial consultation at Spring Fertility, the clinic she’d decided to go with, a doctor advised her to freeze embryos instead: combine Quincy’s sperm with her eggs and put the resulting healthy embryos on ice. So that’s what she’d do. Next, she attended a two-hour orientation at the clinic, where a nurse demonstrated to Mandy and several other women about to freeze eggs or embryos how to self-inject the drugs. There were boxes and vials of medications and various sizes of needles. Some meds needed refrigeration, others not. Some had to be taken at a certain time of day, others not. It was a lot of information and words Mandy had never heard before—too much for her to absorb. Later, at home, she turned to YouTube to get a grip on the process, watching hours of videos that explained, step by step, how to prepare and administer the shots. Fertility medications are usually injected either into the skin at the lower belly or upper thigh or into the muscle just above a butt cheek. Typically, ovaries are around one inch in diameter; during an egg freezing or IVF cycle, they increase to four to five inches, about the size of a clementine.[*2] Mandy dreaded the painful shots so much that she wasn’t able to do them herself; Quincy did them instead. The first injection hurt enough to make her cry, at which point she briefly considered abandoning the whole thing.[*3] Quincy learned to go as slowly as possible with the needle so the shots hurt less.

Before long the nightly injections began to feel like a kind of ritual, and Mandy was surprised by how easily she and Quincy had fallen into such an odd routine. Each night around nine o’clock, for ten days, Mandy changed into her pajamas while Quincy surreptitiously prepared the shot in the kitchen. In the living room, Mandy lay on the couch with their dog, an Italian Greyhound Chihuahua mix named Doe, sometimes turning on Netflix to distract herself. She always looked away while Quincy iced and cleaned the bit of belly fat he’d inject the medication into.

On a warm night in late June, when Mandy’s ovaries were lush with what she hoped were lots of mature eggs, Quincy injected the last injection—the trigger shot, a hormone called human chorionic gonadotropin, or hCG—just above Mandy’s left butt cheek. It was exactly eleven o’clock. The timing of the trigger shot is crucial, whether the woman is preserving her eggs for later (egg freezing) or fertilizing them with sperm to become pregnant now (IVF). The follicles holding the eggs have been developing steadily throughout the days of hormone injections. The trigger shot is the final kicker, stimulating the eggs’ final bit of maturation, and the carefully timed egg retrieval is thirty-six hours later.

The morning of her egg retrieval, Mandy dressed quickly and reread the procedure paperwork. In the kitchen, she glared at the coffeemaker, as she had most mornings since she’d begun the egg freezing process and had to forgo caffeine and exercise.[*4] Her phone lit up with a text message from her mother, part of it written in Chinese: Go celebrate with Quincy after it’s done, it read. Love you! I am with you, sweetie. Mandy let the words and heart emojis on the screen sink in. It had been a long several days of needles. The egg retrieval seemed like the easy part after all those shots, she thought. It was also the only part of this process completely out of her hands. She would be under sedation and had no control over how many or how few eggs her ovaries had produced. As she puttered around the kitchen, a wave of exhaustion came over her. She was ready for all that had led up to today—the blood work and all the tests, the worry about success rates and probabilities, the feelings of being tired and bloated and anxious—to be over. Tomorrow’s going to be a regular day, Mandy reminded herself, and for a moment she felt lighter. No more shots. No more stress. And all the coffee she wanted.

They piled into their reliable old Toyota Corolla, Quincy at the wheel. Mandy had gotten the car when she was in high school, a decade and a half earlier. She had driven it to take her SATs, to get married, and, now, to freeze her eggs. It was after rush hour and they had an hour to get into San Francisco to make her eleven o’clock appointment. Plenty of time.

“Wait, what’s going on?” said Mandy, leaning forward to better see out the windshield. Standstill traffic stretched along the San Francisco Bay Bridge—a massive traffic accident. She looked down at her phone. The maps app showed they were now due to arrive at the clinic half an hour late. She closed her eyes and tried to stay calm. No way was she going to miss her retrieval—a procedure for which she’d put several weeks of her life on hold—because of traffic.

Cars inched along. Quincy’s hands were tight on the steering wheel. It was, Mandy thought, the longest hour she’d ever experienced.

Finally, Spring Fertility came into view.

—

In addition to aiding with age-related fertility issues, ART helps people overcome infertility problems caused by medical conditions. Some women freeze eggs and/or undergo IVF because of factors associated with female infertility such as ovulatory disorders, fallopian tube blockages, structural problems with the uterus, and low egg count. Two common diagnoses that can affect fertility are polycystic ovary syndrome, or PCOS, and endometriosis. PCOS, a disorder caused by hormonal imbalances in which a woman’s ovaries develop many follicles but don’t actually release an egg, can prevent ovulation. It affects about 10 percent of women in the United States, although experts estimate that more than 50 percent of women with PCOS remain undiagnosed. And endometriosis, a painful inflammatory condition in which tissue similar to uterine lining grows outside the uterus—roughly one in ten women of reproductive age in the United States have it—often interferes with ovulation and can lead to scar tissue and ovarian cysts that can impair fertility. Women who suffer from either of these conditions are more likely to have trouble conceiving and, on average, take longer to become pregnant.

The most common medical condition typically aided by ART is medically induced infertility, which is when a person experiences fertility issues or becomes infertile due to a procedure to treat another problem—most often, chemotherapy or radiation for cancer. One of the thousands of women with cancer who froze her eggs is twenty-five-year-old Olivia, a freelance music teacher from North Carolina who worked part-time at Starbucks for the health insurance. On a chilly day in March, Olivia woke up and dressed carefully for the day—makeup, hair, a determined smile, and her favorite pink purse. She was headed out to get her recent biopsy results. If I’m about to get a cancer diagnosis, I refuse to look like crap when they tell me, she thought. She slipped on her lucky pink sneakers. Then she drove to her doctor’s office.

She was diagnosed with breast cancer later that day.

Olivia’s specific cancer treatment required medication that would put her in menopause for five to ten years. Her doctors urged her to freeze her eggs right away. “It was do or die,” Olivia told me. “We needed to get my ovaries turned off five days before I started chemo.” She ultimately couldn’t freeze her eggs but was able to freeze two embryos fertilized with her boyfriend’s sperm.

While Olivia’s case is a straightforward example of medical egg freezing—thousands of women like her urgently preserve eggs before undergoing fertility-compromising cancer treatments—Mandy’s situation, like mine, is less clear-cut. While our medical charts don’t constitute the same solid rationale to freeze eggs as Olivia’s does, we are both what doctors call “cyst-formers”—as in, prone to developing problematic cysts—which, in addition to our history of gynecological surgeries and lack of two healthy ovaries, means we are at higher risk of diminished fertility in the future.

—

In Spring Fertility’s waiting room—they’d arrived just in time—Mandy looked around at the familiar warm, calming hues. The mood lighting and modern decor gave off the vibe of a fancy spa but didn’t quite mask the typical sterile feel reminiscent of a doctor’s office. The place was a little over the top; I see what you’re doing, Mandy often thought while she sat and waited before her appointments. She took a deep breath, trying not to fidget. Next to her, Quincy—her mostly serious, reliably calm Quincy—was absorbed in a Garth Greenwell novel.

A nurse called her name and led her to a small room. Mandy changed into a pink surgical gown, medical bonnet, and oversized grippy socks. In the photo Quincy took just before the procedure, her thick-rimmed glasses are slightly crooked, her spill of shiny black hair partially covered by the pink cap. Her hand is raised in a wave; her smile, nervous. Quincy kissed her and promised to save her a cereal bar from the waiting room. It was her little tradition; Mandy took one every time she visited the clinic. She didn’t exactly enjoy the appointments, but at least she had the cereal bars to look forward to.

She sat alone in the procedure room, waiting. She felt anxious. Vulnerable. She couldn’t stop thinking about the limitations of her body, if pushing it to the extreme with medications and hormones had been the right thing to do. Egg freezing, Mandy decided, felt like something between giving birth and being in a science experiment. And even though it was finally Retrieval Day, she still felt conflicted about the whole process. She had invested so much time, money, and emotional energy in this process that was supposed to put her in control. But all she wanted now was for the worry to cease, for relief to settle in. Almost there, she thought. This will be over soon. From the procedure room, she could see the clinicians through a large glass window. Clipboards in hand, they peered through microscopes and handled lab equipment. Look at these men playing God, Mandy thought. A doctor saw her staring and waved. It reminded her of the movie Ex Machina: technology, money, the future. She waved back at the god.