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
Cerviva or Bust
It didn’t start out as a quest to give cervical fluid a more palatable name. It started, as so many things do, because of love. And sex.
“ ‘Cerviva,’ ” said Will Sacks, seated in a coffee shop near his home in Boulder, Colorado. He wore a blue T-shirt that matched his eyes; behind his trim beard was a warm smile. “We wanted to start calling cervical fluid ‘cerviva.’ Cer-VEE-va. Pretty good, right?”
It was a brisk fall morning, and Will, an entrepreneur in his late thirties, was telling me about the connection between cervical fluid—also called cervical mucus—and Kindara, a company he co-founded that develops apps and products for fertility tracking. And cervical mucus, a fluid secreted by the cervix, changes in texture, color, and amount during a woman’s menstrual cycle, especially around ovulation. Until recently, most of what I knew about cervical mucus involved words like “sticky” and “egg-white.” But I’d done my homework before meeting with Will, because I realized that in order to grasp what Kindara did for its hundreds of thousands of users, I would need to understand cervical mucus and ovulation. And to talk about ovulation, I quickly learned, requires a working knowledge of the cervix.
A woman’s cervix acts as the gatekeeper to her uterus. The cervix—the “neck” of the uterus, about one inch long, positioned at the top of the vaginal canal—decides what and when things go in and come out. Tampons, sex toys, fingers, and penises can all get to the cervix, but they don’t get past it. And things like menstrual blood and perhaps a baby need to get out. The cervix’s job is to safeguard the uterus—like a bouncer poised outside a fancy, VIP-only hotel—and keep this crucial part of a woman’s reproductive system happy and healthy. Outside the cervix, sperm are lining up and competing to get in. Cervical mucus, acting as a protective barrier to the uterus, has two jobs depending on where a woman is in her cycle. Either it prevents sperm from entering the cervix or it nourishes and protects the sperm as they move through the cervix and reproductive tract to fertilize an egg. So at this particular party, if a woman is nearing ovulation, cervical mucus keeps the sperm alive, sweaty and dancing, while inside the uterus an egg makes its way down to the lobby. Once the cervix determines which lucky sperm are worthy enough to enter, the fun really begins.
I had asked Will to coffee to learn more about Kindara, and about fertility- and period-tracking apps in general. Most women I know—whether trying to conceive, actively avoiding pregnancy, or falling somewhere in between—use an app to track their menstrual cycle. And each swears by the one she uses. Kindara, in particular, intrigued me because of what it’s based on: fertility awareness-based methods of birth control, also called FAMs or FABMs. “Fertility awareness” is a general term for the set of practices used to determine the fertile and infertile phases of a woman’s menstrual cycle. A woman is fertile only a handful of days each month—around ovulation, when the egg is released. Fertility awareness-based methods are essentially about answering one question: Am I fertile today? People using FAMs identify and track fertile days and draw upon that information to avoid or achieve pregnancy. A woman does this by tracking the hormonal fluctuations that occur during her menstrual cycle, paying close attention to signs of ovulation in particular. Two primary ones are her basal body temperature and the consistency of her cervical mucus. Taken together, these physiological indicators can help her monitor her ovulation patterns and reliably identify the days when pregnancy is possible.
—
One August, more than a decade ago, Will was twenty-nine and in need of a change. Originally from Quebec, he was living in Toronto and had recently quit his job as an energy efficiency consultant. He dreamed of being an entrepreneur, using his engineering background to create companies that would have a net-positive impact on society and the environment. Companies that did things that mattered. He decided to attend his first Burning Man festival, which he was pretty sure was a thing people his age did when they were having a quasi-existential crisis. He booked a plane ticket to the desert and, upon arriving at the Reno airport, posted a message on Craigslist saying he was headed to Burning Man, had a rental car, did anyone need a ride? Kati Bicknell, a young woman from Brooklyn, answered. Petite and fair-skinned, with wavy brown hair and dark blue eyes, Kati worked for TED Conferences. They talked the entire drive into the desert.
After Burning Man, they started dating. “We got along like a house on fire,” Kati told me. It was a long-distance relationship from the start, maintained with overnight buses between New York and Toronto. One weekend night in November, a few months later, the couple had a conversation about birth control. For Kati, fertility was a familiar topic. Her mother was one of the two million women who had been fitted with the Dalkon Shield, the defective IUD. Kati’s mother struggled to conceive her. And Kati had had an IUD earlier that year, but it was so painful she’d had it removed. That, along with a bad experience on the Pill—she’d reluctantly taken it in her late teens and early twenties to “correct” her irregular periods—led her to swear off hormonal birth control.
