—Zadie Smith, Lenny Letter interview, December 2017

We are all yeses. We are worthy enough, we passed inspection, we survived the great fetal oocyte extinctions. In that sense, at least—call it a mechanospiritual sense—we are meant to be. We are good eggs, every one of us.

—Natalie Angier, Woman: An Intimate Geography

List of Abbreviations

ACOG: American College of Obstetricians and Gynecologists

AFC: antral follicle count

AMH: anti-Müllerian hormone

ART: assisted reproductive technology

ASRM: American Society for Reproductive Medicine

BBT: basal body temperature

BIPOC: Black, indigenous, (and) people of color

BMI: body mass index

BRCA: breast cancer gene

CAP: College of American Pathologists

CDC: U.S. Centers for Disease Control and Prevention

CLIA: Clinical Laboratory Improvement Amendments

CMS: Centers for Medicare and Medicaid Services

D&C: dilation and curettage

DOR: diminished ovarian reserve

FAMs: fertility awareness-based methods

FDA: U.S. Food and Drug Administration

FLE: Family Life Education

FSH: follicle-stimulating hormone

hCG: human chorionic gonadotropin

HPV: human papillomavirus

ICSI: intracytoplasmic sperm injection

IM: intramuscular

IUD: intrauterine device

IUI: intrauterine insemination

IVF: in vitro fertilization

IVG: in vitro gametogenesis

IVM: in vitro maturation

LGBTQ+: lesbian, gay, bisexual, transgender, queer, or questioning

LH: luteinizing hormone

NYU: New York University

OB/GYN: obstetrician and gynecologist

OHSS: ovarian hyperstimulation syndrome

PCOS: polycystic ovary syndrome

PGT: preimplantation genetic testing

RFID: radio frequency identification

SART: Society for Assisted Reproductive Technology

STI: sexually transmitted infection

TSH: thyroid-stimulating hormone

WHO: World Health Organization

Author’s Note

About the Reporting

This is a work of nonfiction. All names are real except when noted otherwise. I have indicated these instances in the footnotes and provided explanations in the Notes section at the back of the book. There are no composite characters or events, though I had to omit some people and details in the interest of book length; I did so only when an omission had no impact on either the veracity or the substance of the story.

This book relies predominantly on interviews and research I conducted. Most scenes and dialogue draw from what I saw and heard firsthand. I occasionally describe events for which I was not present and in so doing consulted with others and relied on extensive documentation. To write this book, I set out on an immersive first-person quest, and to that end, I also relied upon my journals and my medical records, as well as my own memory and the memories of others. Memory, of course, can be fallible; I have done my best.

The Notes section is intended to offer more detail on certain studies, statistics, and topic areas, as well as to guide readers to publicly available resources.

On Limited Language and Perspectives