The idea of women freezing their eggs no longer seems futile or dangerous, yet in truth a lot of the enthusiasm around the procedure is still premature. The marketing is ahead of the reality, and in some cases it’s just plain deceptive, like calling egg freezing an insurance policy—which I’d like to say a final word about, in an effort to put this all-too-common comparison to rest. A 2020 Fertility and Sterility study stated plainly: “Data suggest that to virtually guarantee one live birth (97 percent likelihood), a woman would need to freeze about forty oocytes.” That would require about three or four cycles, which is both incredibly expensive and would necessitate a lot of fertility drugs. The paper continues: “If a woman younger than 35 years were to undergo one cycle and retrieve an average number of mature oocytes, she would have a 75 to 80 percent chance at one live birth. Although these odds are relatively favorable, they do not provide the kind of guarantee that the word ‘insurance’ brings to mind.”

The fact remains that egg freezing is still a technologically advanced process riddled with risks. And yet, even though more data on the risks and success rates has been slow to emerge, and concerns about the aggressive sales culture and operations at some of the glitzy, newer fertility clinics seem to be well-founded, the medical community—especially the thousands of fertility doctors at this conference—acts as confident as ever.

—

I left the convention center around eight in the evening. A long day. I walked on faux-cobblestone streets to the Tower of the Americas, the sounds of late summer in Texas washing over me: chirping crickets, a large fountain, big cars starting in a nearby parking lot, children still outdoors playing. I looked up at the lights on the tower and remembered hearing that the observation deck was closed for a private cocktail hour hosted by Progyny. I recalled something a man from a digital marketing company had told me after a session earlier that day: “If you knew how hard these doctors partied at conferences like this, you’d never want them doing things to your ovaries.” He was half-joking, but the underlying bit of truth pointed to the confluence of forces—money, medicine, marketing, motherhood—at play here. And it worried me.

Plot Twists and Tangled Webs

One evening, a month after the ASRM conference, I received an email from my cousin Bridget, who was living in Washington, D.C. Subject line: “Some bummer news.” Breast cancer. She’d just found out. There was no history of it in our family. She was twenty-nine years old.

She’d discovered a lump, had a biopsy, and was diagnosed with an aggressive form of breast cancer, stage III. She would undergo chemotherapy, have surgeries, and dutifully do as her doctors said. She might also freeze eggs or embryos—she and her husband, Chris, newly married, wanted children. That’s in part why she wrote to me, to ask about egg freezing and urgent fertility preservation. Her email concluded: “Please make a calendar reminder to do a monthly self-exam.”

Then, an excruciating plot twist: Bridget was pregnant. When she went in for the biopsy, there were signs all over blaring Tell your doctor if you’re pregnant. She and Chris had recently started trying, and she hadn’t gotten her period that month—she was expecting it later that week—so she informed the doctor doing the biopsy she might be pregnant. The doctor called the next day to tell Bridget she had cancer, and then said, “You really don’t want to be pregnant right now.” Bridget took three at-home pregnancy tests—all immediately positive—then confirmed it with a test at her OB/GYN’s office. That night, after she hosted her book club—the shock propelled her into a discombobulating autopilot mode—she and Chris googled “pregnancy + cancer treatment” and cried. Theirs was a pregnancy that was planned and very much wanted.

I closed my computer screen. Elbows on desk. Head in hands. I was in upstate New York, about halfway through a ten-week writing residency. Most days, I wrote in the mornings, sifted through research and reporting in the afternoons, and spent the evenings trying not to think about Ben. My belongings were in Colorado, part of my heart was still in Houston, and every day I wrestled with concentrating on my work. The residency was an incredible opportunity, one I didn’t want to squander with the nagging anxiety I felt about returning west to live with my parents until I figured out my next move. But all that felt trivial compared to what Bridget was going through: learning that she had breast cancer and that she was pregnant on the same day. Forty-eight hours after being diagnosed, Bridget was thinking not about her body but about her future babies. Babies she had always been sure she’d have. Cancer means chemotherapy and chemo threatens fertility. We take it for granted, all of it, until one day there’s a lump and a biopsy and suddenly you are a recently married woman on the cusp of thirty, with a job you love and a cat named Nancy Drew and a pregnancy you’re longing for, and cancer growing in your chest.

After getting the okay from Bridget, I called my mother and told her about Bridget’s diagnosis. We talked about breast exams and how radiation can damage ovaries and scar the uterus. I felt a newfound personal appreciation for ART and the scientific capability that existed and that would, I so deeply hoped, preserve my cousin’s fertility, her ability to have biological children, the family she had always wanted.

Bridget’s oncologist recommended she start chemotherapy as soon as possible; triple-negative breast cancer grows fast. Bridget and Chris met with a surgeon, who explained that options for breast cancer treatment in the first trimester are limited. If Bridget’s health was the top priority, she couldn’t be pregnant when she started chemo. Then they visited a reputable fertility center and learned Bridget couldn’t start the process of an egg retrieval until at least six weeks after ending a pregnancy, because it would take time for the pregnancy hormones still in her body to normalize. She and Chris made the devastating decision to terminate the pregnancy, and a week before starting chemotherapy, she had a D&C.[*6]

Ultimately, Bridget wasn’t able to harvest eggs from her ovaries before starting chemotherapy. Her tumor had already grown quickly; there wasn’t time to delay treatment for several weeks. The awful irony is that if she hadn’t been pregnant, she most likely would have been able to do an egg retrieval. But needing chemo right away meant she couldn’t safely stay pregnant, and terminating the pregnancy meant she didn’t have time to undergo fertility preservation before starting treatment.

—

A month after starting chemotherapy, Bridget’s genetic testing results came back: She was BRCA1 positive, which made her more susceptible to getting certain types of cancer. Our family later learned that Bridget’s father—my mother’s brother—also had the gene mutation. He’d never had cancer, and neither had his siblings, but he urged them to get tested. The child of a parent with the BRCA1 mutation has a 50 percent chance of inheriting the variant, and having a mutated BRCA gene greatly increases a woman’s chance of developing breast and ovarian cancer and a man’s chance of developing prostate and male breast cancer. Our family was worried: If my mother tested positive for BRCA1, it would mean my siblings and I each had a 50 percent chance of having inherited the mutation, too, as Bridget had.

During those long weeks of waiting and worrying, I did another egg freezing one-eighty. There was no question that I would freeze my eggs as quickly as possible if I learned I was BRCA1 positive. I was so relieved when my mother learned she didn’t have the mutation. But the waves that Bridget’s cancer sent reverberating through our family—the females, in particular—lingered, and in my case they forced me to think anew about egg freezing in the face of yet another potential threat to my fertility. Life went on, but a new realization crystallized: Fertility-related decisions do not exist in a vacuum. The journey to figure out and make decisions about my fertility was, it turns out, inextricably tied up with my love life, career, physical and mental health—areas of my life that, often despite my best intentions, cannot be neatly compartmentalized.

I remembered something Lesley, the nurse who was diagnosed with breast cancer not long after freezing her eggs, told me: how she wished she had dedicated more time to understanding the procedure in detail. “I didn’t have any questions,” she told me, “so I just went for it.” But, barring an urgent medical need like Bridget’s, egg freezing isn’t always an easy or simple decision. That, at least, I now knew with certainty. I also understood that most potential egg freezers had neither the time nor the desire to spend months or years studying the nuances and underlying questions. For better or for worse, though, that’s what I’d decided to do, and by now I had researched the whole process long enough to go well beyond its shiny surface. At the core of my analysis paralysis was the realization that the decision to freeze was wrapped up in a tangled web: motherhood, marketing, medicine, money, and, now, even mortality. I couldn’t know what might happen in the future. Cancer. Infertility. More romantic disappointments. A career that sputtered and fizzled out. Never feeling financially secure. But I knew I wanted to have a say about a lot of it. I wanted to control what I could.

Skip Notes

*1 The hefty profits are in part because many patients pay for treatment out of pocket. So clinics often receive cash directly, rather than seeking reimbursement from health insurance companies, which tend to negotiate down the costs of services.

*2 When I asked Kindbody about this in April 2022, a spokeswoman for the company relayed: “We’ve had ten oocyte thaw cycles from eggs that were frozen at Kindbody. Only one patient has had a transfer as of now and she is pregnant.” (When I reached out in October 2023 for an update, the company’s response was that the ten oocyte thaw cycles was the most current figure they could offer.) This doesn’t mean that Kindbody, or any newer clinic, is less adept at freezing eggs, necessarily; it just means they don’t yet have the pregnancy rates from women who’ve frozen eggs with them to point to as a proven measure of success.

*3 One ironic example of this: Last Valentine’s Day, I received an email from a prominent national chain of fertility clinics with a discount code for 20 percent off an egg freezing cycle. The subject line read: “Here’s a special gift in honor of self-love.”

*4 I was reminded of one of the reasons why ASRM was so reluctant to remove egg freezing’s experimental label a decade ago—that it’s quite challenging to freeze an egg.

*5 Kindbody told Bloomberg that it reports, investigates, and takes corrective action if incidents occur, including in each example the article detailed.

*6 A dilation and curettage, a procedure to remove tissue from inside the uterus, is one method of ending a pregnancy.

13 Great Eggspectations

Remy: A Sleepless Night and Seventeen Eggs

At five-thirty the morning of her egg retrieval, Remy pulled into her driveway. It was Monday, close to thirty-six hours after she’d taken the trigger shot. She was coming off an overnight shift at the hospital and had been awake for almost an entire day. She needed to be at the fertility center in an hour. She threw the Tupperware from her night shift dinner in the dishwasher, fed Sophie the cat, and gazed longingly at her Peloton, which she hadn’t been able to use for several days. She couldn’t recall the last time she’d neglected her exercise bike for this long.

In the bathroom, Remy shed her scrubs and showered, rinsing off her shift. She remembered to remove her belly button ring but forgot to wash her hair. She dressed in clothes easy to pull off and on: leggings, a loose denim button-down shirt, the brown boots she wore when she wasn’t at the hospital. She pushed her long blond hair out of her face, yawning. On a table off the kitchen sat boxes of leftover meds surrounded by crystals. Glancing at the table while she changed Sophie’s litter box, she felt relieved there’d be no more shots.

She pulled out her phone to call an Uber. The clinic’s instructions were clear: She wasn’t allowed to drive herself home from the egg retrieval, and a responsible driver had to pick her up. The clinic wanted to know ahead of time who this person would be. This had been the only hiccup so far; with no family nearby and most of her friends working at the hospital, she didn’t have someone to ask to accompany her to the retrieval and wait until it was over to drive her home. It was the only part of the egg freezing process impossible to do alone. Remy could’ve done all the injections herself if she’d had to, though she was glad she’d had Leah’s help for the trigger shot. She’d gone to all the appointments solo. She was doing this on her own, freezing her eggs for her future self. But the responsible driver requirement, at the very end of the whole ordeal, dampened her spirits a bit.

Her phone buzzed. She gasped. The driver was eighteen minutes away. “This is not going to work,” she groaned, then checked her phone again. “Come on, dude.” Prickles of anxiety fluttered in her stomach. This was why she didn’t like relying on people. She checked her watch. Then she canceled the Uber, grabbed her purse and car keys, and flew out the door.

It was a cool morning and the streets were quiet. In the car, she plugged her phone in and balanced the sheet of paper with driving and parking instructions on her lap. The sky was dark blue, the sun just beginning to come up. She raced through yellow lights. Braking hard for a red, she winced: Her breasts felt huge, and slamming on the brakes hurt. For days, she’d felt like she’d been swimming in estrogen. She’d experienced some mittelschmerz on her left side while on call the day before; she grimaced a bit at the thought of a long needle going into her vagina today. A wave of tiredness came over her. Fatigue felt different to her now; she realized she’d been masking it with coffee for years. Learning she could survive a twenty-four-hour shift at the hospital without coffee was a nice side benefit of all this. Remy held the steering wheel with one hand, her phone and the crumpled paper directions in the other. She’d followed the instructions the clinic had provided her carefully: nothing to eat or drink after midnight the night before; arrive at the clinic an hour before her scheduled procedure time; park in the indicated garage.

Inside the building, Remy was momentarily confused by the signs on the doors. She sighed, recalling how it’d never been easy to remember all the different names of the offices, labs, and companies involved in her egg freezing process.[*1] She found the door for Ovation Fertility Nashville, greeted the receptionist, and followed a nurse into a small room with bland tan walls and closed blinds. She slipped off her tall brown boots and changed into a teal hospital gown. She tied it expertly, thinking about how strange it felt to be the patient today. Her legs and bare feet dangled from the end of the exam table. She shivered, then pulled on the thick blue socks she’d been told she might want to wear during the procedure. She sat and waited. Now that she was there, the stress of the morning behind her, she wanted to get it over with.

A nurse came in to take her vitals. “Tell me you haven’t been googling ‘egg retrievals’ and reading what all the crazy people on the internet say about it.”

“I haven’t,” said Remy.

“Good girl!” the nurse replied. “People come in scared to death about the crap they read online.” She went over the post-op basics and explained that Remy would still be at risk for ovarian torsion for several days, until all the swelling went away. When the nurse got to explaining how Remy might feel later in the day after the anesthesia wore off, Remy nodded, as if she weren’t already an expert on anesthesia and its possible side effects.

The nurse left. Remy reached for her phone to check her texts and send a quick message to her parents. A few minutes later, Dr. Lewis knocked and opened the door. Gray scrubs, same glasses and blond straightened hair. Remy put down her phone and sat up straighter on the table. “Hi!” she said brightly, relief in her voice. She trusted Dr. Lewis and always felt better in her presence.

“Alrighty,” said Dr. Lewis. “Here we go—you ready?”

“Ready,” Remy replied. “But it’s so weird being on the other side of all this.”

The reason I can tell you all this word for word is not because Remy remembers it all so clearly—which she doesn’t; she was nervous, and the anesthesia meant she didn’t remember much once it was all over—but because I was with her during every part except for the retrieval itself, during which I sat in the waiting room. When Remy’s retrieval was over—it lasted thirty minutes—a nurse led me back to Remy’s room. I opened the door and Remy looked over at me from her gurney, where she was waking up. I crossed the room to talk to her. “Thank you, Natalie,” she said groggily, reaching for my hand and squeezing it. She was crying, tears streaming down her temples. “It really means a lot that you’re here.”

“Thank you for letting me be here,” I said, looking down at our hands. It was a powerful moment, the slow-motion kind that you realize as it’s happening you likely won’t ever forget. I looked at Remy and didn’t know which part of me was doing the looking: the journalist, the potential egg freezer, the woman. “I’m so happy,” Remy murmured groggily. “Relief. I feel such relief.” Her voice was raspy and low, thick with emotion. “I really want to know how many eggs I got. How many do you think? A lot. I hope it’s a lot.” She closed her eyes and sank back into the pillow, pulling the blanket up to her chin.

Several minutes later, the embryologist came in and introduced herself. When she told Remy seventeen eggs had been extracted, Remy gasped. “Awesome.” Remy was instructed to call a phone number, a voice mailbox, later in the day to find out how many of her retrieved eggs were in suitable condition to be frozen. When the embryologist left, a nurse popped her head into the room. “Ready to try to pee?” Afterward, she gave Remy more sheets of paper. Discharge instructions, prescriptions, more phone numbers. Then she was cleared to go home.

Remy had asked Rachel, a fellow anesthesia resident, to drive her home after the retrieval. She knew Rachel had been on call all night and might not be able to. But then Rachel, who was nursing her second kid, texted: On my way! Sorry if you get flashed. I’m pumping and have no shame…The valet guys might be concerned. Remy hated having to bother a colleague, especially one coming off a long overnight shift. She was tempted to break the rules and drive herself home; her car was already in the clinic’s parking garage, after all. But Rachel insisted. Two young doctors, very little sleep between them; one lactating, one post–egg harvest. In the car, Remy talked excitedly, telling Rachel about the morning and getting lots of eggs. They stopped at a gas station so Remy could get Gatorade, though what she really wanted was a smoked rosemary latte. Also, a long nap. She took a deep breath and let her shoulders sink back against the passenger seat. Except for the logistics stress and last-minute change of transportation plans the morning of her retrieval, her egg freezing process couldn’t have gone more smoothly.

Relief: palpable, overwhelming relief. Remy had felt only nervous anticipation in the days leading up to the retrieval, but as soon as she woke up from the procedure, it rolled over her in a euphoric wave. Of the many emotions she felt today, in the days and months to come it would be this feeling of relief she’d remember most.

Later that day, she called the voice mailbox to learn the fate of her eggs. All seventeen of them ended up being mature and frozen.

Peace of Mind and the Illusion of Control

Remy had been single for the past seven months and had learned to love her alone time, to relish arriving home to her bohemian sanctuary, where it was just her and Sophie. No drama, no tiptoeing, no fights. She’d made many concessions with the partners she had dated long-term, and now she was no longer willing to give up who she was for the sake of connection. Which, she figured, meant it was going to be harder to meet the right person—and finding the right person was already hard enough. Still, she was excited to start dating again, and even more excited that egg freezing had freed her from the pressure she usually felt to be hyperfocused on finding a partner.

The statistics and current data, as we’ve seen, lead to the conclusion that you can’t count on having kids with your frozen eggs. Nevertheless, many women see egg freezing as insurance for the future. Mandy, Remy, and Lauren certainly did. But frozen eggs are not an insurance policy. So if egg freezers aren’t getting that guarantee, what exactly are they getting?

As an egg freezing patient, Remy was more in the know than most. But even she was confused about what happened when her eggs left her body and embarked on their tenuous journey. She hadn’t been counseled on attrition rates or the inverted pyramid detailing the multistep process involved in turning thawed eggs into viable embryos and then a healthy baby. Yet she wasn’t concerned. Remy may not have been clear on the scientific intricacies behind egg freezing, but she was quite clear about what egg freezing would give her. “I just don’t want to settle,” she’d said to me more than once, referring to dating. “And now I don’t feel like I have to.” That’s what egg freezing was really about, I realized. Not the guarantee of frozen eggs producing healthy children in the future. Not actual insurance, but assurance.

I considered Remy’s certainty. I hadn’t heard her express doubt, not even once, about her seventeen eggs on ice becoming babies.[*2] Just as strong was the sense of relief—which she’d felt immediately after her egg retrieval—at being able to step away from her romantic future as a project she had to actively work on. I wanted to know if Remy’s experience, particularly her strong emotions post-freeze, were in line with those of other women freezing eggs for non-medical reasons. I asked Jake and Deborah if FertilityIQ had this sort of data. They didn’t, but they agreed to conduct a survey to help me learn more.

Nearly half of the survey’s seventy respondents said the decision to freeze eggs caused them to change their timeline and delay childbearing. In other words, they were giving themselves more and better options moving forward. When asked if they’d still be glad they froze eggs even if those eggs never led to a baby, nearly three-quarters of respondents said yes. Later, I found more data on the psychological benefits—which felt like a small win after my slog with the paltry data on success rates. In one survey of 224 egg freezing patients, 60 percent reported feeling less time pressure while dating after they’d frozen their eggs, with many patients saying they felt “more relaxed, focused, less desperate and with more time to find the right partner.” A whopping 96 percent said they would recommend egg freezing to others. A study published in 2020 that surveyed women who underwent egg freezing between 2008 and 2018 found that 91 percent of egg freezers reported no regret, even if they got pregnant without having to use their frozen eggs.[*3]