*9 Placebo pills—part of some but not all regimens—are placeholders; the idea is that if a woman stays in the habit of taking a pill every day, she’ll be less likely to forget when she needs to take the real thing. Even though she’s taking placebo pills, she’s still protected against pregnancy as long as she’s been taking the active pills as prescribed. Some women opt to go on a continuous-cycle birth control pill and skip placebo pills and having a light, fake period altogether.
*10 I was surprised to learn that female sterilization is the most popular birth control method for women—more popular than the Pill, even—both in the United States and worldwide. For most women who opt to have their fallopian tubes tied to prevent pregnancy, they’ve had all the children they want to have.
*11 There’s a lot of room for error with “coitus interruptus,” aka the withdrawal method, when a man withdraws his penis before ejaculating. It is not as effective at preventing pregnancy as most other forms of birth control; about one in five people who rely on the withdrawal method for birth control becomes pregnant. It also doesn’t protect against STIs.
*12 Researchers have created a birth control pill for male mice, which proved 99 percent effective in preventing pregnancy, but experts say male birth control pills won’t be available anytime soon. An injectable hydrogel that’s marketed as “the IUD for men” recently completed clinical trials.
*13 But we do know that many women struggle to find any form of hormonal birth control that they’re happy with and often stay on hormonal birth control despite the way it makes them feel.
5 Why Women Freeze
Egg Freezing Appointment #2
Like many people, I’ve spent much of my adult life trying not to get pregnant. And like a lot of people with uteruses, I’ve long been nervous about it happening accidentally. But at the same time, I’ve been anxious about the fact that I’m not certain I can have biological children, since I’ve never been or tried to become pregnant—and the only true test of fertility is conceiving a baby. I’m aware of this continual contradiction: I want to protect my ovary, but I do not want to let it do what it was made for. Not now, anyway. These connected yet contrary worries have troubled me for more than a decade.
A memory: It’s the middle of the night, the summer after college. I wake suddenly and sit up in bed, clutching my side, the cramp sharp and hot. I’m twenty-two and halfway across the world, traveling through Sri Lanka with my boyfriend of six months. We’re in a house on the outskirts of Colombo. He’s asleep next to me, his feet pushing against the mosquito net. I sit up, reach around for my headlamp, then slip out of bed and walk barefoot into the bathroom, where I swallow a couple of over-the-counter pain pills. In the kitchen, I put the kettle on for tea and boot up our laptop. My surgeries have left me hypersensitive and somewhat distrusting of my body; for me, pain is often indicative of a deeper problem. I’ve had cramps for the past two days but don’t know if they are related to my cycle on the Pill or if they are the less frequent but more painful cramps caused by the scar tissue that has built up since my first surgery.
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.
