When she opened her eyes, she was in the recovery room. A doctor and Quincy stood next to her. “It went really well!” the doctor exclaimed brightly. “You got plenty of eggs—we extracted twenty.” Mandy blinked, trying to clear the fog in her head. Twenty? A wave of relief washed over her. She knew that having partial ovaries meant it was unlikely she’d be able to freeze a lot of eggs; she had been careful to keep her expectations low. At one of her initial appointments, the doctor had told her that her ovaries were working very hard but her follicles weren’t developing as well as he’d hoped. We’re not where we want to be yet, he had said, choosing his words carefully, but I’m sure we’ll get there soon. At a later appointment, he’d counted only eleven follicles. Mandy had lain on the exam table trying to read his expression, as she did at every exam, but at that appointment the doctor was more direct: Not a great number, but we can work with it. So twenty eggs was good—great—news.

Half an hour later, Mandy and Quincy were ready to leave. A nurse handed them a small box of Godiva chocolates on their way out of the clinic. In the elevator, Quincy showed Mandy the inside of his coat pocket, stuffed with cereal bars.

Hope and Heartbreak: Why Most Women Freeze Their Eggs

Lots of people use ART for non-medical reasons as well. One’s ability to be a parent is not limited by genitals; egg freezing and IVF, in particular, have made pregnancy possible for women experiencing or facing age-related fertility decline, as well as scores of people in the LGBTQ+ community. This is an important subject, which I’ll discuss more in chapter 9. While the demographics are beginning to shift as more people from a variety of ethnicities and income levels pursue egg freezing, for the most part the majority of people who freeze their eggs are healthy, mostly young, cisgender women—and, more specifically, white middle- to upper-middle-class professionals. They tend to fall into one of two groups. The first group is made up of women in their twenties or early thirties; a growing number of egg freezers—roughly 35 percent now, compared to 25 percent in 2012—are women under the age of thirty-five. These women know they want to have children someday, perhaps within the next five years or so, but aren’t ready yet. For them, egg freezing is a proactive measure. The second group includes women in their mid- to late thirties or early forties who know their fertility window is closing and want to give themselves the best chance of pregnancy in the near future. Many hoped to be mothers by now. They want children but aren’t in a position to have them yet—usually because they aren’t in a relationship with someone who feels ready.

When I began looking into the research and data behind why healthy young women freeze eggs, I expected the main motivation to be fitting fertility around ambitions and careers. But I was surprised to learn that, contrary to popular belief, egg freezing is rarely undertaken for that reason. It’s actually because of what medical anthropologist and Yale University professor Marcia Inhorn calls “the mating gap”—a lack of eligible, educated, equal partners ready for marriage and parenthood. Inhorn, who embarked on a decade-long study to understand what drives healthy women to freeze their eggs, found that the majority—more than 80 percent—do so because they lack a partner. (While, obviously, one does not need a partner to have children, this cohort of women envisions rearing children with a partner.) Inhorn identified three main categories of those who froze their eggs: women freezing after a breakup or divorce, women still single despite years of dating, and women with partners who weren’t ready for children. The typical egg freezer is a highly educated professional woman in her thirties, well established in her career by the time she walks into a fertility clinic. What she doesn’t have is a suitable partner with whom to start a family. Freezing her eggs is “a reproductive backstop,” Inhorn writes in her book Motherhood on Ice, “a technological attempt to bridge the gap while waiting for the right partner.”

This was the case for thirty-six-year-old Valerie, who, until she froze her eggs, couldn’t look at romantic relationships objectively. Valerie, who lives in Atlanta, has undergone egg freezing cycles on four different occasions, in three different states.[*5] She’s carried hormone injections on planes and more than once has excused herself from a date to self-administer a shot in the restaurant bathroom. As it happens, Valerie is a fertility doctor. The first time she froze eggs, she was twenty-eight and in medical school. Armed with the knowledge that her mother went through early menopause, Valerie initially saw egg freezing as both a means of protecting against possible fertility issues in the future and a way to pursue a demanding career without sacrificing her vision of having three kids down the road.

A few cycles in, she began to also see egg freezing as a worthwhile way to hold on to her reproductive potential while she waited for true love with the right person to come along. When Valerie went for her last retrieval, she had an epiphany. For years, she’d struggled to see her romantic relationships for what they really were, sometimes staying with an unsatisfactory partner only for the sake of the theoretical children she knew she wanted someday. Putting eggs on ice changed all that for her. She credits her frozen eggs for saving her from a miserable marriage. She says of one recent partner, whom she was living with and planned to marry: “He was wonderful on paper, but ultimately he wasn’t the partner I needed for the rest of my life. And, honestly, knowing I had twenty-two eggs on ice helped me have the strength to end the relationship.” What Valerie’s attitude illustrates is that for many women freezing their eggs, the decision is as much about independence now as it is about family in the future. “I’m paying for peace of mind,” she told me. “To be able to make decisions not based on my biological clock—which I still hear screaming in my ear.”

So, egg freezing is often seen as a technology of hope for future romance. But research has shown it can also be described as what some call a technology of despair. Most women who freeze their eggs are hopeful, heartsick, or a mix of both. Inhorn’s work is based on the largest egg freezing ethnographic study to date. What she and her team of researchers learned was that for many women, relationship dissolution, as Inhorn refers to it—divorce, separation, a broken engagement—is one of the primary pathways to egg freezing. A woman pursuing egg freezing at the end of a failing relationship has left or been left by someone she has loved. She’s at a critical reproductive juncture, depending on her age, but even if she’s in her twenties, she’s old enough to internalize the breakup as an assault on her sense of self and her hopes for the future. She freezes her eggs in the midst of heartache, perhaps even a sense of hopelessness. “For women whose anticipated life course trajectories had been disrupted or broken, egg freezing provided them with a temporary biological reprieve, allowing women to heal their relationship wounds [and] recalibrate their sense of identity,” writes Inhorn in Motherhood on Ice. “Egg freezing also fueled some women’s visions for different futures, in which partnership no longer became an end goal.”

—

A few days after Remy’s injections appointment, she went for a long walk after work in her favorite park. She was still processing everything the doctor and nurses had gone over. Her egg freezing to-do list was growing longer. Submit pharmacy paperwork. Ask Sarah in San Diego for her extra hCG shot to save some cash. Apply for a new credit card to help pay for meds. She was all but certain she was going to break the “no caffeine for a month” rule—she simply could not wrap her head around that scenario—and figured if it was the one thing she did off protocol, it wouldn’t be the end of the world.

It was a brilliantly sunny day, a welcome reprieve from the recent dreary ones. As Remy walked and prepared to jog for a bit along her usual loop, she noticed women about her age, one after another, pushing babies in strollers. Normally, the sight of so many stay-at-home moms (she presumed; at least some probably were) would have given her pangs, a stinging reminder that she was single and nowhere close to having children of her own. But today it affirmed for her that her experience of having a baby would likely be quite different from theirs, and that was liberating. She felt run-down and ragged—sleep deprivation was a fact of life these days—but she also felt calm and in control. Yes, she was single, again. But she was taking advantage of the fact that that meant she could live a little selfishly. She had only herself to take care of, to consider; no one depended on her, except, in some ways, her patients. Life consisted of going to work and coming home. She might not have this kind of selfish period in life ever again. That had been on her mind ever since she made the decision to freeze her eggs; it was an optimal time to do it. She was totally on top of the fertility thing now. She was being proactive about motherhood. Her stroller-pushing days were hopefully not too far away, but if they were, that’d be okay.

Everything in medicine was constantly telling her she was late. Late, late, late. At least Remy was two years shy of that dreaded “advanced maternal age” classification. She knew more than she’d like to, maybe, about high-risk pregnancies and how common infertility diagnoses were.[*6] She was determined not to have a high-risk pregnancy and wanted to avoid, at all costs, the heartache that often came with undergoing fertility treatment at an older age. Remy was freezing her eggs to buy herself time to date, pursue relationships, and look for the husband she ultimately hoped to have. He was out there somewhere, putting in the time to develop himself and ready himself to be a committed partner. This was Remy’s way of doing that, too, controlling the unknown as best she could.

Remy loved lists. Even more, she loved checking off items on lists. Life’s big moments and decisions had neat square boxes next to them, and as Remy progressed through her twenties, she checked those things off her list. Go to medical school, get engaged, get married: check, check, check. But life wasn’t always sunshine and checked boxes, Remy learned. Going through a broken engagement with one man and then a divorce with a different man convinced her that choosing the right person—to share life with, start a family with—was one of the most important life decisions she’d make, if not the most important.

She began to jog at an easy pace, her thoughts swirling as they propelled her back to her last egg freezing appointment. She remembered when a woman who identified herself as the clinical business coordinator had poked her head in the door. “Finished reading through everything? There’s one form I have to notarize when you’re done.” Remy held up one of the forms from the pile in her lap. “This is more about, like, couples doing it—IVF, I mean. But I’m just freezing eggs. And the top of this page says it needs to be completed by a significant other.”

“Yeah, you still need to fill it out, though,” the woman said.

Remy read from the paper. “ ‘In the event of my separation or divorce’…‘transfer ownership to’…‘donate reproductive…’ ” She looked up. “Is that, like, in the event that I die?”

“Huh,” the woman said. “I don’t know that you would need to fill that out.” She left the room and returned a few moments later. “Dr. Lewis said to write, ‘Not applicable.’ ”

“Not applicable,” Remy repeated slowly.

“Just put ‘n/a,’ ” the woman said, as if that was that.

Remy ran hard, wanting to wear herself out. She could still feel the heaviness of that moment; it was sad to think about dying before using her eggs. Ultimately she had written her mother’s name on the form, later adding both her parents’ phone numbers, which felt a bit strange. Her mom, Remy knew, would have a strong opinion about where her eggs should go in the event of Remy’s death. But would anyone else? If signing the blizzard of forms and making rushed decisions about what would happen to her frozen eggs and who would care were supposed to make her, as an egg freezing patient, feel better, she didn’t.

That night, Remy felt uneasy. When she sat down to meditate, she couldn’t find her moonstone ovary crystal anywhere. She rummaged through her apartment, checking the same spots over and over. She found it, finally, tucked deep inside the plastic rim of the door of the washing machine. She had forgotten to remove the stone from the pocket of the denim shirt she’d worn to the appointment the other day. The moonstone lay soaked in water, glistening. It reminded Remy of what an ovary looks like under a laparoscopic view.

Later, after getting into bed, she texted her father to let him know that he and Remy’s mom would be in charge of her eggs if something happened to her before she could use them. He texted back that he’d take care of her “twins,” joking about raising them in Arizona, where they’d live in a trailer and fish off the dock. Remy read the text and giggled. She texted back: Just as long as you raise them humble. As in, with a sense of humility—a virtue she couldn’t imagine her children not having, no matter who raised them.

—

Since emphatically deciding Yes! at my last appointment with Dr. Noyes, I was beginning to see how egg freezing might be the long-lost key to the Have-It-All Castle. Like Remy, I feared waiting until too late. I was wary of being part of an older couple, or being a single woman, who wanted a family. Like Mandy, I worried about my ovaries, or lack thereof, and felt pressure to protect against possible future regret by grabbing whatever my ovary could yield now. The facts were adding up: I wanted biological children in the future. I was single, and in a demanding graduate school program that consumed most of my time and energy. My eggs were not getting any younger. Egg freezing technology had vastly improved since its early days. Underlying the facts was a bit of subliminal messaging that resonated with me: Smart women think ahead. Smart women are uncompromising about what they want—and have a backup option in case life does not go according to plan. Smart women are proactive and in control. There was that idea again: control. There was a part of me that found it incredibly appealing.

—

Twelve days after my second egg freezing appointment, I met Ben.

We “met” on a dating app. After a bit of flirtatious banter over the app’s messaging platform, we arranged to meet in person at Brooklyn Public House, a bar a few minutes’ walk from my apartment. He was late and I was cranky—great start!—but what I thought would be a casual drink turned into four hours of conversation. A few of the coincidences were striking. We each had a parent who was a retired U.S. Army colonel (his father, my mother). His sister and my sister-in-law shared a name. He and my brother had the same name, too.

Ben spoke passionately about his work in the renewable energy industry. He wore glasses and a red Patagonia pullover over a wrinkled button-down. He was the first person I’d ever met from Wisconsin. Sometime after midnight, we stepped out onto the sidewalk and kissed under the bright moon. He pulled me into his chest and I felt a quick shiver of pleasure as his hands moved down my jeans and gripped my hips. “Where have you been all this time?” he said softly, his arms wrapped around my waist.

Our next date found us ducking inside a pizza shop for 99-cent slices and two bottles of Snapple after a concert at Madison Square Garden. We ate on a dirty street corner outside the entrance to the subway. I was exhausted, anxious to get home. Ben had pizza crust crumbs all over his collar. “You still haven’t told me what you write about,” he said.

For the most part, the men I dated never wanted to hear about any of this. They’d ask me what kind of journalist I was, what sorts of subjects I covered. “Lately, fertility and egg freezing,” I’d reply, and they’d cock their heads or reach for their beers. “Like, chicken eggs?” a guy once asked me. I took a big bite of pizza, stalling. Here we go, I thought. When I was twelve…I always began. I was used to telling friends, or anyone who knew me well enough to ask, the story of my surgeries for years. I had never felt reluctant to talk about why I only had one ovary. Until now. I didn’t know how to begin explaining my possibly uncertain fertility future—especially since that future suddenly seemed close to the present. Two weeks had passed since my last appointment at the clinic, where I’d excitedly announced I was going to freeze my eggs. The man standing in front of me with crumbs in his beard could someday have a vested interest in my fertility, my ability to have children. It was only our second date—in fact, he was the first guy from the dating apps I’d gone on a second date with. But I had that knowing feeling, deep in my gut.

I looked at Ben, my mouth suddenly dry. The thought was so clear in my mind: I cannot fall in love with you and freeze my eggs at the same time. It wasn’t a logical thought—women freeze their eggs while dating and starting relationships all the time—but I felt a creeping sense of overwhelm. I took a swig of iced tea and shook my shoulders, as if to clear away the dramatics looping in my mind. A taxi blared its horn. “Well,” I began. I couldn’t think of another way to answer the question. “When I was twelve…”

I could almost hear my ovary mutter in exasperation.

I don’t remember all of what I said. I do remember his rambling reply. “Yeah, fertility, yeah,” he said eagerly. “I read this article the other week, about free IUDs in Colorado? Some sort of program for low-income teens and women, have you heard about it?” he continued, explaining the program. While he’d been talking, we had walked down the stairs leading to the train platform. “So, are you still considering egg freezing?” he asked. His tone, unlike my brain at the moment, was very matter-of-fact. I searched for what to say. “I think so, yeah.”

Ben opened his arms to hug me. “It sounds like what you’re doing and writing about is important,” he said. My face pressed into his chest and he kissed the top of my head. I felt exposed, vulnerable. He looked behind me and squinted at a Metro-North sign. I wanted to keep talking, but he had a train to catch.

“Can we do this all the time?” he asked.

I stared. He wanted to talk about my missing ovary all the time?

“Can we hang out all the time?” he clarified, smiling.

“Well, no,” I replied, smiling back.

That weekend, Ben slept over for the first time. Before he arrived, I removed the four-by-six ultrasound image of my ovary from its prominent spot on the fridge.

—

As a reporter, I had a lot of questions about egg freezing technology and the money and medicine behind it. But on the personal side, things were looking up. The optimism I had felt leaving Dr. Noyes’s office lingered. And: I had a plan. When the clinic called me with the results of my blood work, I’d get a clearer picture of the current state of my fertility and learn whatever the tests—what did the tests actually test, again?—said about my ovary and my eggs. Then I would move forward with the next steps of egg freezing. I wasn’t actually sure what the next steps were, but I’d figure it out.

And in the meantime, I would keep seeing charming, easygoing Ben.

Skip Notes

*1 While ovarian dermoid cysts themselves are relatively common, it’s extremely rare for one to rupture. The recurrence of bilateral dermoid cysts, a condition Mandy has, is also rare.

*2 The degree to which a woman’s ovaries enlarge during the process depends on her starting follicle count—that is, how many follicles she has when she begins fertility medications.

*3 Mandy learned later this wasn’t a universal experience, and that many other egg freezers don’t find the shots quite this painful.

*4 Ovaries enlarge during an egg freezing cycle, and the larger they become, the more vulnerable they are to ovarian torsion. Certain types of exercise heighten that risk. So, while taking the injectable egg freezing medications and for several days post egg retrieval, low-impact physical activities—walking, lifting light weights, gentle yoga—is okay. Strenuous exercise—CrossFit, running, any activity that requires jumping, twisting, or flipping the body—is not. As for caffeine, which is a stimulant that narrows the blood vessels and increases heart rate and blood pressure: The data on its effect on fertility is limited, but similar to how women trying to get pregnant are advised to stop or limit their caffeine consumption, women undergoing egg freezing and IVF are, too.

*5 Often, multiple cycles are needed to get “enough” eggs. We’ll get into the nitty-gritty of what “enough” means, as well as egg freezing success rates, shortly.

*6 An estimated one in six adults globally—17.5 percent of the population—are affected by infertility. Being diagnosed as infertile doesn’t mean a woman can’t get pregnant; it just means something is preventing her body from getting pregnant on its own. Another fact worth noting—and this is important, so let it sink in for a moment—is that infertility affects women and men equally. About a third of infertility cases are the result of issues in the woman, a third can be attributed to men, and the remaining 33 percent or so either are a combination of both or can’t be explained.

6 Optimizing Fertility