Egg freezing is, by and large, a numbers game.

One of the few indisputable certainties is that the younger you are when you freeze eggs and the more eggs you retrieve when you do, the better your shot at producing a chromosomally normal embryo(s) and having a healthy baby.

Egg freezing success rates are described as general rules and broad averages. New useful tools like online egg freezing calculators help on an individual level, but to more accurately predict personal fertility health, you need to get the facts about your egg quality and quantity.

While many thousands of women have had their eggs frozen, the vast majority have not had their eggs thawed.

As for what I’d learned about the lack of reliable data—honestly, all that left me feeling pretty disheartened. Remy, Mandy, and thousands of other millennial and Gen Z women are intent on securing their reproductive futures. But considering how tricky it is to get a handle on egg freezing success rates, it’s easy to see how they pin their hopes on limited data. How tempting it is to fall prey to a false sense of security. This really frustrated me. The more I learned about egg freezing, the more I understood that it was an expensive and intense process. Now I was learning that it was riddled with uncertainty. One doctor puts egg freezing this way: “I always tell patients, ‘There’s not a baby in the freezer. There’s a chance to get pregnant.’ ”

Except that’s not how we think about egg freezing. Its popularity is predicated almost entirely on providing a kind of insurance—saving viable eggs now in hopes of using them later. But egg freezing carries no guarantees. “If you buy insurance, you’re guaranteed a benefit if you need it,” said Dr. Julie Lamb, director of fertility preservation at Pacific Northwest Fertility in Seattle. “Egg freezing isn’t an insurance policy, because it doesn’t pay out all the time.” This was so counter to how I was used to hearing it talked about that I wrote the doctor’s words on a Post-it note and taped it to my bathroom mirror. Egg freezing is not an insurance policy. Brushing my teeth, I’d read the note and shake my head. How many articles had I read, how many doctors had I heard say the exact opposite? But I got it now, especially after all the time I’d spent sifting through the success rates (or lack thereof): Egg freezing isn’t a dependable safeguard against age-related infertility.

“The message about egg freezing’s benefits is much stronger than the message about its uncertainties,” said Dr. Karin Hammarberg, the lead author of the first Human Reproduction study I mentioned, when I called her up to ask about all those women not coming back to use their frozen eggs. And then she reminded me of something else that really threw a wrench into my thinking about all this: that while women who bank their eggs at younger ages are more likely to have those eggs work, they’re also far less likely to have to rely on them. Dr. Lamb had said something similar during one of our conversations: “The fear-based advertising is a huge ethical dilemma because a lot of those patients are never going to need those eggs.”

Egg freezing, then, is a possibility, not a promise. And therein lies the enormous question mark when we talk about its role in the reproductive medicine revolution. The Catch-22 of egg freezing is that its effectiveness will remain unknown until more women return to use their frozen eggs. But even though its efficacy remains somewhat shrouded in mystery, that’s not stopping the growing numbers of women who are doing it.

FertilityIQ

Somewhere between trying to analyze egg freezing’s success rates and getting bogged down by acronyms, I heard about a fertility education start-up that reviewed fertility clinics and doctors. It had a name that particularly appealed to me: FertilityIQ. On a warm weekday morning back in Brooklyn, I opened my notebook and dialed the company’s founders, Jake and Deborah Anderson-Bialis, a married couple living in San Francisco. Their company was relatively new, but from what I’d learned up to this point about the lack of data surrounding assisted reproductive technologies, it was clear that what they were doing was unique—and desperately needed.

FertilityIQ’s mission is to provide the latest research on every kind of fertility treatment, including outcomes and costs. It does this through a robust online platform, a website chock-full of educational courses and guides on every ART subject. This, along with FertilityIQ’s verified assessments of reproductive endocrinologists and clinics, make it one of the only in-depth resources for a person pursuing fertility treatment in the United States. It offers the comprehensiveness of Google business reviews paired with the intelligence sorting of Amazon and the old-school veracity of Consumer Reports.

When I talked with them for the first time over video, I was struck by their genuine and down-to-earth demeanor. Our follow-up conversations were just as invigorating. Jake and Deborah’s enthusiasm—for the company they’d created, for speaking with someone also personally invested in the fertility field—was apparent in every sentence. After one of our conversations, I read through some of the witty and irreverent “Founder’s Notes” blog posts on FertilityIQ’s website. One read: “Maybe we’re all masochists, but according to a Gallup poll, 90% of us want to have a child…. Normally, conceiving a child involves a steamy shower, a bottle of rosé, and Enya’s greatest hits. But when you are infertile, or sub-fertile, the majesty of conception is supplanted by teeth-gnashing anxiety (on-par with developing cancer, according to a Harvard study), skyrocketing expenses (one round of IVF depletes two years of household savings) and mating acts so unnatural even Seaworld would boycott in protest.”

I soon realized that what FertilityIQ did was totally novel in the ART world—offering dispassionate facts, extensive assessments of fertility specialists, and straightforward explanations about treatment plans and protocols. I often saw their data cited in The New York Times and other major news outlets. In our initial phone and video calls, Deborah and Jake explained their goal to me: get patients the best information during the most trying process of their lives. Now, FertilityIQ has a far reach—the company, which is growing and profitable, helps 85 percent of all fertility patients in the United States—but the founders started out just trying to solve their own needs. They met when they were both pursuing advanced degrees: Jake at Harvard Business School and Deborah at Georgetown Law. The couple married in 2012 and planned to start a family. They wanted biological children but faced a potential complication: Deborah had a history of ruptured ovarian cysts, and she risked losing an ovary if it happened again. Even so, there was no reason at the beginning to think this wasn’t an issue they couldn’t overcome. But they didn’t want to waste time finding out. “I don’t know if we made an appointment from our ‘Just Married’ car, but if not, it was by the time we got to the hotel,” Jake told me, smiling.

They were in their late twenties and could count on one hand the number of people they knew who had ever been to a fertility clinic. Of those, only a few had positive things to say about the experience. Like so many other couples, they knew they wanted a family—even if they didn’t know exactly how or when that family might take shape. But they had no idea what fertility treatment entailed and, try as they might, couldn’t find helpful information, online or off. With the sense of urgency and spunk she was born with, Deborah led the charge, doing her best to balance their foray into the fertility world with their demanding schedules. Jake was a partner at Sequoia Capital, a Silicon Valley venture capital firm. Deborah worked as an attorney for a start-up called Rise, a mobile nutrition app. Over the next two years, the couple traveled coast-to-coast and spent $75,000 pursuing IVF—to no avail. The timeline and costs are typical, although most people undergoing fertility treatment don’t travel to multiple states. Deborah and Jake grew increasingly frustrated and exhausted in their efforts to have a baby. After miscarriages and three unsuccessful rounds of IVF, they gave up.

The silver lining of their arduous journey was that it inspired them to start FertilityIQ. Not in a hurry to monetize it, Deborah and Jake turned away potential investors when they were launching their company. At first, FertilityIQ was self-financed, and it was entirely free until it added pay-to-access courses. Unlike other companies that act as an intermediary between patients and fertility clinics, FertilityIQ doesn’t get any referral fees; it has no affiliations or partnerships with doctors or clinics.

There are a number of ways patients can use and interact with the site. Prospective patients use FertilityIQ’s assessment data when they are trying to find a fertility specialist who would be a good fit (the site’s find-a-doctor database is free to use). This is a huge benefit, since one of the most important things a woman considering fertility treatment can do is to find the best doctor for her particular situation, as quickly and as accurately as possible. But finding one who matches your needs and won’t abscond with your time, money, or hope is easier said than done. “For most of us, picking a fertility doctor looks a lot like how a first-time entrepreneur chooses a venture capitalist,” said Jake, the former venture capitalist. “Decisions are made on a short fuse, fraught with emotion, swayed by unsubstantiated claims of success, insensitive to economic implication, and clinched on brand cachet alone. Ninety percent of patients we talk to don’t bother to interview a second doctor—and yet most run out of patience with their first doctor well before they run out of hope or money.” The anecdotal doctor recommendation from a friend or colleague is usually unhelpful, since it represents a tiny percentage of all the patients that a fertility specialist or clinic sees at any given time. “You simply don’t know what you’re getting,” said Deborah. “That may suffice for picking a sandwich shop. Not when lives, budgets, and relationships are on the line.”

Click “Find a Doctor” on FertilityIQ’s home page and a quick guide about their doctor rankings pops up, followed by an easy-to-navigate list of physicians, including their specialty, proximity, and photo. Most of the physicians have at least a dozen detailed assessments—provided by unsolicited fertility patients—and several have more than one hundred. I’ve looked up my own fertility doctors on the site—their reviews felt accurate to me—and have directed friends to FertilityIQ’s database to compare clinics and specialists before booking appointments. Unlike sites like Yelp or Zocdoc, FertilityIQ is ad-free and has protections in place to ensure that assessments are vetted and written by real patients. The fertility industry is plagued by paid referrals, which makes FertilityIQ’s efforts to connect women with patient-reviewed physicians and reliable data on procedures such as egg freezing all the more valuable.

I was most impressed, though, with FertilityIQ’s nearly three hundred courses.[*10] They’re taught by reputable doctors and leading fertility experts—names I recognized and individuals I’d come across in my reporting, even—and are geared toward current or prospective fertility patients wanting to learn more about specific treatments and preparing them for decisions that they’ll be making along the way. “Once you’re in treatment with a doctor, there are myriad hard decisions you still need to make,” Deborah explained. “Each has trade-offs.” With IVF, it’s things like how the eggs are fertilized, whether to do preimplantation genetic testing (PGT), and how many embryos to transfer. If you’re an egg freezer, it’s how many rounds to do, whether to freeze eggs or embryos, if you want to store all your frozen eggs at the same place, and more. “Most doctors don’t have time to give patients the balanced details each of these life-changing decisions warrants,” she said. In lieu of that, she continued, FertilityIQ offers full courses on a wide variety of fertility-related subjects, “so that the degree to which patients are educated is not a function of how busy a doctor might be that morning.” A few examples of course titles: Fertility for Lesbian Women Becoming Moms. IVF with Donor Eggs. Fertility 101. Endometriosis. Mental Health and Fertility.

Zeynep Gurtin, a sociologist of women’s health at University College London, told MIT Technology Review that “when it comes to making a decision on egg freezing, it’s vital that people be fully informed on four issues: the success rates, the risks, the side effects, and the costs.” FertilityIQ is a solid resource in this regard, and a great place to start. Now that I was mulling over the incongruities between the realities of egg freezing and its promises, there was still a lot I didn’t understand. What does having this option actually afford women? Who are the doctors putting all these millions of eggs and embryos on ice? Who owns the clinics? And what accounts for the many-thousands-of-dollars price tag? I fell back on my comfort zone as a journalist. I needed more information. And reassurance. That’s what I really wanted. It was time to find more resources—individuals, companies, doctors—to help me feel confident, before I went through with it, that freezing my eggs was the right decision.

Skip Notes

*1 Name has been changed.

*2 In most areas of medicine, nurses and pharmacists administer medications, but in anesthesia, doctors directly dilute and administer meds. Remy and Leah were pros.

*3 In this statistic, “healthy” means patients freezing eggs to preserve fertility, versus patients undergoing egg freezing for medical reasons. The data do differentiate, and today, the vast majority of women who freeze their eggs do so to preserve their fertility.

*4 For all patients who underwent the procedure after 2011, their eggs were cryopreserved using vitrification, making this study relatively robust in terms of data on eggs frozen with the more modern, non-slow-freezing method.

*5 After fertilization, the embryos are grown in a nourishing liquid nutrient solution—the kind I mentioned in chapter 7 when I visited Extend Fertility’s lab—that mimics the internal environment of the reproductive tract.

*6 It’s only possible to assess whether a woman’s thawed eggs are chromosomally normal after they are fertilized and the resulting embryos are tested; more on this when we get into the pros and cons of freezing embryos versus freezing eggs in chapter 11.

*7 Increasingly, patients across all age groups choose to transfer a single embryo. Transferring more than one embryo increases the likelihood of multiple-fetus pregnancies, like twins or triplets, which in turn increases the probability of premature births and related health problems (lower average birth weight for the offspring, higher risk of gestational diabetes for the mother, and more).

*8 The figures in this example are general averages; a lot of attrition data is clinic-dependent, so the numbers vary.

*9 The researchers involved in the 2021 study, on the other hand, plainly stated that the available data “clearly suggest that age is the main factor that dictates success rates, and even with the most optimistic predictions, a live birth cannot be guaranteed.” The point is, both a woman’s age at the time of freezing and the number of eggs she has retrieved significantly impact her chances of having a baby with her frozen eggs.

*10 In fifty-five countries, taught by regional experts in the native tongue.

9 The Femtech Revolution

Egg Freezing, Commodified

It was just after 6 p.m. on a Monday at Kindbody, a women-led fertility start-up headquartered in Manhattan. Specifically, it was the company’s flagship clinic in the Flatiron District, but “clinic” brings to mind a doctor’s office, and the chic, welcoming space I’d just entered felt more like a West Elm—which is exactly how Kindbody wants it to feel for anyone walking through the doors. I was there for Fertility 101, one of Kindbody’s educational events. As soon as I arrived, I had a flashback to the EggBanxx cocktail parties, which made sense: The same woman was behind both.

When Gina Bartasi, founder and executive chairperson of Kindbody, launched the venture-capital-backed company in 2018, it wasn’t her first rodeo. Back in 2008, Bartasi had started FertilityAuthority, an IVF referral network. FertilityAuthority’s spin-off egg freezing company, EggBanxx, contracted with physicians to offer lower egg freezing prices for patients and focused heavily on marketing. Then she founded Progyny, which manages fertility benefits on behalf of employers and operates similarly to a health insurance company.[*1] From there, she set her sights on building a national network of boutique fertility clinics that offered services without the premium price tag. With Kindbody, Bartasi removes the intermediary entirely, by selling directly to consumers and employers. Valued at nearly $2 billion just five years after it launched, Kindbody is her most ambitious vision and among her biggest successes yet.

It was the first day of spring, and the fresh faces and youthful energy of the fifty or so female—and two male—attendees gathered in the lobby reflected it. That evening, at least, walking into the future of fertility felt like walking into the living room of a friend who had a lot more money than me. Also better taste. Light wood floors, perky succulents, a gray couch with a soft blanket draped over one arm. Soft music played overhead. Books with their jackets removed sat on coffee tables. Period Power. The Kinfolk Table. Ask Me About My Uterus. Quiet chatter filled the room, punctuated by the occasional pop of a prosecco bottle being opened.

The event was led by OB/GYN Dr. Fahimeh Sasan, founding physician and Kindbody’s chief innovation officer, who’s been at the company’s helm since day one. Two wool-hatted camera operators from CNN were there, filming a segment for National Infertility Awareness Week. Dr. Sasan stood at the front of the room, a mic clipped to her collar for the camera crew. The company’s slogan, “Own Your Future,” hung in whimsical cursive lettering on the white brick wall behind her. Splashes of Kindbody’s signature yellow—“We call it ‘optimistic’ yellow,” Bartasi told me later—were everywhere: the napkins, the fresh flowers, even Dr. Sasan’s fitted sleeveless dress. It was a fireside fertility chat without the fireplace. The crowd was younger and more diverse than the EggBanxx parties, a reflection of egg freezing’s changing clientele. Fewer wedding rings, too.

After briefly explaining the basics of male and female fertility, Dr. Sasan gave a rundown of egg freezing and IVF with Kindbody—what’s involved physically, logistically, and financially. At this, I watched several women in the room smile and nod, as if to say, Yes, this is why we came. The sun was beginning to set, and I noticed the fluorescent yellow Kindbody sign in the window, facing bustling Fifth Avenue, shining brighter. Dr. Sasan answered questions from several attendees before ending her presentation with an ask—“talk about this with your friends, share some of the empowering information you learned tonight”—and an offer (“good for twenty-four hours”): $500 off any IVF or egg freezing cycle when you book an assessment with Kindbody.

Kindbody’s reach in the femtech world is unparalleled. Along with its fleet of pop-up van clinics and retail products, the company owns and operates more than thirty brick-and-mortar fertility clinics across the United States, mostly in metropolitan areas. Kindbody also contracts directly with employers to provide fertility and family-building benefits to their employees, including companies such as Walmart, Lyft, BuzzFeed, Princeton University, even Disney and SpaceX.

Bartasi, now in her mid-fifties, is queen of the castle. She doesn’t have a medical degree but has taken executive education courses at Harvard and went on to become a major player in the increasingly big-business fertility industry. What EggBanxx set out to do—sell the idea of egg freezing to women—is what Kindbody, the fastest-growing egg freezing provider in the country, now does better than anyone. With EggBanxx, Bartasi marketed egg freezing and connected women to fertility clinics where they could do it; with Kindbody, women fall in love with the idea and freeze right there. Scroll through Bartasi’s Instagram account and you’ll quickly get a sense of the company’s reach and influence. There are posts announcing millions in venture capital dollars raised, babies garbed in yellow Kindbody onesies, and even a photo of Bartasi speaking on a panel with Gwyneth Paltrow, one of Kindbody’s celebrity investors. (Two others: Chelsea Clinton and Gabrielle Union.) “The SoulCycle of Fertility Sells Egg-Freezing and ‘Empowerment’ to 25-Year-Olds,” read one headline about the company. An article in The Verge began: “How do you build a cult following for an egg-freezing clinic?” For one, make an app. Use social media to announce signature boutique openings and where the next pop-up event will land. And launch an influencer program and provide egg freezing discounts to content creators.

Kindbody is predominantly run by women, and more than 50 percent of both the clinic and corporate teams are BIPOC, which is notable, considering the fertility industry has historically been white and male. The company’s doctors don’t wear white coats or hang their medical degrees on their office walls. They don’t have offices at all, in fact; they meet with patients in exam rooms that have the same cozy, living-room vibe as the clinic’s lobby. When Bartasi and her team designed the flagship New York City clinic, they purposely sought to avoid the cold and sterile feel of traditional medical exam rooms and instead took design cues from Soho House, the global chain of private members’ clubs, and branding inspiration from Drybar and SoulCycle. Months from now, I’d step into Kindbody’s Denver clinic and have déjà vu from my Manhattan visit; all Kindbody clinics, like all Starbucks stores, look and feel the same.

The day after the Fertility 101 gathering, I sat down with Bartasi in one of Kindbody’s conference rooms, with floor-to-ceiling glass walls. She wore a blue sheer blouse and small silver hoops; glasses were perched atop her chestnut hair; her nails were unpolished, and she had on a hint of red lipstick. A can of seltzer and a rose-gold MacBook sat on the large glass table, where a few signature-yellow Kindbody pens lay scattered. I recalled that she’d had children via IVF and asked her if she wished she had frozen her eggs when she was younger. “I should’ve, could’ve, would’ve,” she replied in her southern accent, lamenting that when she was in her thirties vitrification had yet to be developed and egg freezing technology was not yet reliable. “I’m an eternal optimist,” she went on. “I think most entrepreneurs have to be. I try to always look forward and think, ‘Okay, what train do I have to catch to be home for taco Tuesday with my kids tonight?’ So I always think about the future instead of the past. No regrets.” It’s a mindset Bartasi has centered Kindbody around: help women live a life free of regret by helping them have children in their own time frame. Doing so means building brand loyalty with women in their mid-twenties who will come back at age thirty-five and forty-two and even fifty, offering a continuum of care from their first OB/GYN visit to the birth of their last child.

—

Elizabeth Holmes’s Theranos was in Walgreens. Modern Fertility is in Target. Kindbody is near enough to your office building for you to pop by on your lunch break. The Kindbody educational session I attended may have moved on from the EggBanxx event I went to years earlier, but the hors d’oeuvres and low-grade anxiety filling the room sure felt similar. And the fanfare around eggs and fertility testing had skyrocketed.

By now, I’d spoken with several experts who expressed concern about women seeing egg freezing as a commodity. I’d learned about the new business models cropping up in the femtech sector. I’d taken in the alarming language being used in features written about the industry in general (aggressively expand; target women; it’s an insurance policy; it’s control) and the breezier verbiage of egg freezing articles in particular (break free from your fertility; empowering, efficient, cutting-edge; it’s like freezing time). The headlines I read were eyebrow-raising: “Femtech Shows the Way to Billion-Dollar Opportunities” (Forbes), “The Race to Hack Your Period Is On” (Elle), “The Women Who Empty Their Savings to Freeze Their Eggs” (BBC), “Can Silicon Valley Get You Pregnant?” (Fast Company), “The Dawn of the Femtech Revolution” (McKinsey & Company).

The media hype reflects a new phenomenon: Egg freezing is a booming sector of the multibillion-dollar femtech industry. The influx of private equity and slew of venture-capital-backed start-ups have pumped a ton of money into what was not very long ago a niche area of ART. There are egg freezing concierge services, acupuncturists, egg hormone experts, and nurses who moonlight as on-call fertility coaches, going to people’s homes to walk egg freezing patients through the injections. The target demographic of new companies specializing in egg freezing is women in their late twenties and early-to-mid thirties. In lieu of the typical medical experience, these companies offer sleek décor and top-notch customer service to help brand the procedure as a logical, savvy choice, not unlike researching mutual funds or charting a path from renting to mortgage. “Just like Uber, Seamless, Spotify, and Tinder,” an article in The Cut read, the new egg freezing companies “cater to the millennial desire for infinite options and a user experience that’s more stylish and efficient than the traditional clinic.”

Dr. Joshua Klein worked at Reproductive Medicine Associates (RMA) of New York, one of the country’s most prominent fertility centers, before co-founding Extend Fertility, the boutique clinic I visited to see egg freezing in action. His move follows a trend wherein the few big prestigious institutions that dominated the fertility industry have splintered into small, nimble clinics able to operate—and flourish—without the associated overhead. Extend Fertility was innovative because when it opened in 2016, it was the first medical practice in the world to focus exclusively on egg freezing.[*2] Until then, a woman could freeze her eggs only at one of the country’s large fertility centers. At these bustling IVF-focused facilities, where egg freezing is certainly not the priority and often an afterthought, waiting rooms are typically full of couples there because they need medical help to have a baby. It is not a particularly welcoming environment for, say, a woman in her early thirties who is curious about the possibility of delayed childbearing or a transgender man interested in fertility preservation before beginning gender-affirming medical care. In terms of marketing, IVF patients want to see pictures of happy babies on the walls, diapered and smiling. Egg freezers, by contrast, are typically women sitting alone in those same waiting rooms, and they don’t particularly want to see images of babies—not then. This subtle but important difference between consumers—one seeking a baby now, one seeking to preserve her ability to have a baby later—is the raison d’être for the popular egg-freezing-first clinics. These sleek facilities often tout the procedure as breezy and accessible, an investment in one’s reproductive future, the fertility equivalent of a 401(k). But what egg freezing patients gain at these spa-like, picturesque clinics can sometimes, as we’ll see, come at a cost.

“A Baby or Your Money Back”: Paying for Egg Freezing

Speaking of which, fertility treatment of any kind is expensive, and financing it is beyond the realm of possibility for most Americans. So when it comes to egg freezing, cost can be a major barrier. For many women, it’s the most significant obstacle by far. I mentioned earlier that egg freezing in the United States costs an average of roughly $16,000 per cycle. The two major components: the cost of treatment and the cost of hormone medications. Each cost varies, by clinic and by patient. The clinic will likely charge the patient around $7,000 to $10,000 for treatment—including monitoring, the egg retrieval (with anesthesia), and vitrification—and the fertility meds, which she buys separately from a specialty pharmacy and injects herself, will cost around $3,000 to $6,000 or more.[*3] Egg storage costs about $500 to $1,000 per year.[*4] Keep in mind that these are rough estimates for one cycle of egg freezing. A fact that many fertility clinics and articles about egg freezing rarely mention: Most women undergo more than one cycle—on average, 2.1 cycles—so of course these costs increase if a patient does multiple cycles. The typical egg freezing patient in the United States is therefore looking at a total price tag of upward of $30,000. And that doesn’t include the cost of using her frozen eggs down the road—which entails thawing and fertilizing the eggs, developing embryos in the lab and testing them for genetic abnormalities, then transferring them to the woman’s uterus. All that’s another $15,000 to $20,000, at least.

“Welcome to the fertility casino,” The New York Times said in an article about the latest trends in fertility clinics’ package deals. As more and more women want to freeze their eggs but balk at the prohibitive price tag, various business models have sprung up to help them afford the procedure, offering financing options and helping them coordinate coverage. I’ll talk more in a moment about how insurance coverage, employer benefits, and self-pay options help people afford egg freezing, but first, let me set the scene of fertility financing’s contemporary landscape.