—

Another headlines-making case was that of Brigitte Adams, who froze her eggs when she was thirty-nine. A marketing consultant living in San Francisco at the time, Adams was single and divorced when she froze her eggs. She’d learned about egg freezing from a friend who had done IVF using a sperm donor and figured with all the yoga she did and green juice she drank, her fertility was probably fine. But then Adams watched that same friend undergo multiple rounds of IVF, and the comments her friend made—if you want to be a mom someday, you’d better get going now—shook her. So she came up with a plan: freeze eggs now, meet and marry Mr. Right, have a baby before she turned forty (using her frozen eggs if need be), and never be a single mom.

Brigitte Adams would become egg freezing’s de facto poster child. The 2014 Bloomberg Businessweek story about egg freezing and its exciting promises featured her on the cover. At the time, she felt somewhat excited about undergoing a new fertility procedure that was giving women more choices in, as the magazine noted provocatively, “the quest to have it all”—although she was also frustrated by the lack of resources on the procedure; neither doctors nor fertility clinic websites had much information to offer. That was why, while undergoing egg freezing, she had founded Eggsurance, a blog that grew into a robust community—the first of its kind—where people shared tips about the whole process. After the Bloomberg story ran, Adams was interviewed by major media outlets and appeared on morning talk shows, telling the world about the sense of freedom she felt after freezing her eggs. Many young women considering the procedure saw in Adams’s story a road map for a happy ending. Her life had not followed the perfectly linear path she assumed it would, and theirs hadn’t either. Egg freezing was a way to alter the course before the road disappeared entirely.

In late 2016, Adams was nearing forty-five and still hadn’t met The Guy. Having abandoned her “don’t ever be a single mom” thoughts from years earlier, she decided to start a family on her own. She excitedly unfroze the eleven eggs she’d put on ice five years earlier and selected a sperm donor. Then the horrific news started rolling in. Two eggs didn’t survive the thawing process. Three more failed to fertilize. That left six embryos, of which five appeared to be abnormal. The last one, the single chromosomally normal embryo resulting from her frozen eggs, was implanted in her uterus. But, as we’ve learned, not all embryos that are transferred go on to develop. Then she got the devastating news that this embryo, too, had failed.

I met Brigitte in the fall of 2019. A few hours before our meeting, I listened to her speak to a ballroom full of fertility experts—the same ones who gather year after year at ASRM’s annual conference. This year it was held in Philadelphia, and egg freezing was as hot a topic as ever.

“When I froze my eggs, I knew there were no guarantees,” Brigitte told the audience. She wore a simple cardigan, black slacks, and low heels. “I’d researched the odds. But over the years my eggs were on ice, I began to think the rules didn’t apply to me. I thought, ‘Of course they’re going to work for me.’ ” She clicked to the next slide on the movie-theater-sized screen behind her, then paused, looking up at it. The slide explained the path from frozen eggs to baby and showed the inverted pyramid, the one fertility doctors sometimes use to describe egg freezing’s attrition rates—and the slide Dr. Zore showed me when she described how she counsels her patients. “This is the chart I wish I’d seen,” Brigitte said, turning back to the audience, her voice sad but firm. “This slide should be laminated and given to every egg freezing patient.” She’d been invited to speak at the large conference to offer a patient’s perspective on egg freezing and explicitly address the doctors—and that’s exactly what she did.

We met in an atrium on the top floor of the convention center. Brigitte had been immersed in the world of egg freezing for a decade and today, at least, it showed. “I’m tired,” she said apologetically, looking deflated. She tucked a strand of her shoulder-length blond hair behind her ear. In a low voice, she told me what she now knows she would’ve asked about and perhaps tried to have done differently.

Freeze more eggs, for one. When a physician recently reviewed Brigitte’s tests, they showed that her fertility was in more severe decline than expected for a woman her age, indicating that, based on her age and test results, she would have needed a lot of frozen eggs—many more than she’d had retrieved—to conceive. But no one had told her that. In addition to doing at least one more cycle, Brigitte would have frozen embryos instead of eggs. “And I would’ve stopped waiting for the perfect time in my career to become a mom. I would have embraced motherhood sooner,” she said. When she described being told her eggs didn’t work and the implanted embryo didn’t result in a pregnancy, Brigitte’s eyes filled with tears. I wanted to reach across the table and hug her. Instead, I thanked her for sharing her story. She didn’t have to be at this reproductive medicine conference, onstage in front of thousands of fertility doctors explaining how their science and technology did not work for her. But here she was, talking about the cruel irony: how, for egg freezing’s poster child, her frozen eggs ultimately failed. Brigitte didn’t ask to be a character in the technology’s saga, but she is willing to share what happened—how, egg by egg, all of it went wrong—because as the number of women freezing and thawing eggs continues to rise, Brigitte said, “I know more women are going to have my same story.”

Brigitte’s case is a quagmire of many of the possible flaws in this process. Much of what happened to her was not preventable—not yet, at least. But her story is one we can learn from. She insists we do.[*19] Today, Brigitte continues to give talks and interviews about egg freezing, but her message has changed. Now she talks about the marketing hype and overpromises surrounding the procedure. And she encourages women to educate themselves about fertility basics because she knows that many who undergo egg freezing don’t have a clear idea of the myriad components of the process, especially the reality of the success rates.[*20]

Science can go only so far. Brigitte learned that when the crushing blow came that her frozen eggs had failed, which to some degree felt as if her clinic had failed her, too. It’s frustrating to reflect on: Had more information been available at the time, had she known what to ask and then been diligent in asking more questions—she’d be thinking about all this quite differently. While she is still a proponent of egg freezing, Brigitte firmly believes women need to be better educated about the possibility of bad outcomes and that the industry needs to be more transparent. She remains frustrated about how egg freezing patients typically only see one-half of the story—the optimistic half. They need to be seeing both.[*21]

It was the bit about how important it is to figure out, as best we can, what questions to ask in the first place that resonated with me so deeply when I heard Brigitte’s story. Also: how one of the worst things that happened to her ultimately led to the best thing that’s happened to her. Brigitte remained determined to become a mom. After a dark period of mourning and soul-searching, she began IVF again, this time with a donor egg that had been fertilized with donor sperm to create an embryo that was then implanted in her uterus. In May 2018, when she was forty-five, she gave birth to her daughter, Georgie.

—

Ruthie Ackerman froze her eggs when she was thirty-five. She’d recently gotten married, but she and her husband had gone back and forth for years about having kids. Having eggs on ice felt like permission to take her time—to sit with the ambivalence she occasionally felt about motherhood, to figure out what to do about her marriage. She fully bought into egg freezing’s oft-repeated marketing message: Take your time. Your eggs will be here when you need them. Fast-forward a few years: Ruthie, now divorced, met her current partner, Rob. They discussed the possibility of children, but because of her frozen eggs, she still felt no rush. Six years after undergoing egg freezing, Ruthie returned to thaw her eggs and learned that eight of the fourteen she’d frozen had survived. She and Rob used Rob’s sperm to attempt to fertilize all eight eggs. Three eggs did fertilize, but none developed into viable embryos.

When I asked Ruthie what it felt like to go through egg freezing to no avail, she reflected on how her fertility doctor, in her view, didn’t walk her through the informed consent piece thoroughly. “I wish somebody had said to me, ‘Just so you know, I’m glad the science and the technology is here for you to be able to use it—but it may or may not work,’ ” she said, her tone a mix of remorse and anger. “And so I waited. And I was willing to wait for Rob because I thought we had those eggs.” I asked her about a line from an essay she’d published about her experience: I felt less that my eggs had failed me than I had failed them. She explained how she’d spent her twenties not doing the things her friends had been doing: taking certain jobs, meeting a certain kind of man, making a certain amount of money. “I felt like I was being punished for not being strategic enough,” she told me. Punishment for not hustling to secure all she was “supposed” to as a woman, she explained. And the consequence—the price it felt like she paid for buying into the fantasy that she could have it all, on her own schedule, and for relying on a technology with no guarantees—was her eggs not working.

—

By this point in my journey, I’d met dozens of older women who had struggled with infertility. Most had gone through IVF, using their own or donor eggs; many ended up with a baby or two. When I told these women I was considering freezing my eggs, almost all emphatically expressed (unsolicited) advice: If I was your age, I would run, not walk, to the nearest place to get eggs frozen. They meant well, I knew, and spoke from a place of wishing they’d known about egg freezing or had had the opportunity to freeze their eggs years before trying to have children. But Brigitte’s and Ruthie’s experiences illustrated another part of egg freezing’s story that’s rarely acknowledged: its power to disappoint. Their frozen eggs hadn’t led to babies, and by the time they learned their eggs weren’t viable, their natural fertility was gone. In a stark contrast to what we often hear from our doctors, our social media feeds, and our friends at happy hour, their eggs are a chilling reminder that this far-from-perfect procedure remains riddled with mystery and heartbreak and unmet expectations.

Their stories also offer concrete bits of practical advice for anyone thinking of freezing eggs in order to have a baby later:

Don’t wait too long to thaw your frozen eggs, since you won’t know if they will work until you attempt to use them.

Make sure you freeze a lot of them, since most frozen eggs won’t develop into chromosomally normal embryos.

Do your homework, ask educated questions of your fertility doctor and clinic before you freeze, and insist on a thorough informed consent discussion.

On this last point: There are numerous factors to consider when a potential egg freezing patient is choosing a fertility clinic, but the two most important ones are a clinic’s success rates and its embryology lab.[*22] Inquire about rates of embryo formation and live birth, as well as success rates specific to your age group—and proceed with caution if the clinic isn’t forthcoming about its outcomes or has few results to speak of. Ask about lab safety protocols. Embryology labs aren’t created equal; almost every aspect of a fertility clinic’s lab can be different from the one across the street. “You can take a brilliant reproductive endocrinologist and put him or her in a poorly functioning lab, and that fertility doctor is going to have very poor results,” said Dr. Timothy Hickman, then president of SART, when I asked him about this often overlooked component. “The lab is really the key part of this whole enterprise.” Also, look into credentials: You want your fertility doctor to be fellowship-trained and board-certified in obstetrics and gynecology as well as reproductive endocrinology and infertility. Finally, ask where, exactly, your frozen eggs will be stored.

Two years after the tank failures and a few months after the ASRM conference where I’d met Brigitte, a different sort of reckoning was about to occur—a catastrophe that would have a major impact on egg freezing, and, well, everything else.

Skip Notes

*1 The nitrogen in cryotanks continuously evaporates at a slow rate, requiring it to be replenished on a daily basis. “It’s standard in the egg and embryo storage industry for facilities to equip their tanks with auto-filling mechanisms to refill the liquid nitrogen when the system detects that levels are low,” lab director Cindee Khabani told me.

*2 Ultimately, hundreds of affected patients settled claims with University Hospitals Fertility Center. The lawsuits included nondisclosure agreements and did not disclose settlement amounts, but it’s likely the payout for those who sued was in the millions.

*3 Hundreds of plaintiffs filed claims against the tank manufacturer, Pacific Fertility, and Prelude.

*4 An article about the 2021 Pacific Fertility jury trial noted: “After the March 2018 mishap, Pacific Fertility Center made several changes to its protocols. The facility now has backup monitors and alarm systems for each storage tank. The lab also stores patients’ eggs and embryos in separate vessels to ensure that one tank failure won’t wipe out a patient’s entire stock of reproductive tissue.”

*5 One recent example: a New York Times story titled “ ‘We Had Their Baby, and They Had Our Baby’: Couple Sues Over Embryo ‘Mix-Up’ ” in which a couple spent months raising a child who wasn’t theirs and endured a painful custody exchange after DNA testing.

*6 I gleaned what these statistics looked like in practice when I learned of a 2019 Accenture study that gathered data over two weeks in four IVF labs. The fifteen hours of recorded footage showed injuries (an embryologist was even sent to the hospital for a severe liquid nitrogen burn); a cane (a long piece of plastic, you’ll recall) containing several embryos dropped on the floor; alarms repeatedly ignored; and liquid nitrogen spilled and mishandled. The footage also showed that about one in twenty-five specimens (embryos/eggs/sperm) were not where the inventory indicated they were stored.

*7 “It was absolutely devastating,” a senior Prelude executive with direct knowledge of the tank failure told me. “We did everything we could to deal with the situation in the best possible way for the patients.” As for the timing of Prelude’s acquisition of Pacific Fertility, he likened it to “buying an airline, and then one of its aircrafts falls out of the sky.”

*8 In contrast, several other countries have national ART regulatory agencies. The best known is the Human Fertilisation and Embryology Authority, the United Kingdom’s independent regulator overseeing the use of sperm, eggs, and embryos in fertility treatment and research.

*9 There’s also a murky third: the Clinical Laboratory Improvement Amendments (CLIA), passed by Congress in 1988 and administered by the Centers for Medicare and Medicaid Services (CMS). CMS, FDA, and the CDC have joint responsibility for the law, which requires that all diagnostic lab work performed on humans (in a fertility patient’s case, semen and blood testing) adhere to quality standards. But CLIA doesn’t extend to embryology, which involves the retrieval of eggs, their fertilization, and the transfer and storage of eggs and embryos. These procedures do not fall under CLIA’s mandate.

*10 The tanks are considered medical devices, which the FDA does regulate—but it doesn’t regulate the use of the tanks. The agency does not, for example, ask clinics to disclose how often tanks malfunction or how many specimens have been accidentally destroyed.

*11 ASRM acknowledges that if fertility clinics and doctors were required to follow ASRM guidelines, it “might improve the uniformity of practice nationwide.” Even so, ASRM maintains that ART is highly regulated in the United States. But the examples it points to supporting this assertion all have caveats—the ones I’ve dug into here.

*12 Save for their patients, which nearly all of the fertility doctors I spoke to in the course of reporting this book consider an important responsibility.

*13 Most clinics require that couples sign a contract prior to creating embryos that states their agreement about the fate of any remaining embryos after undergoing IVF.

*14 Reflecting on how Arizona’s law gives the court guidance on how to award frozen embryos when there’s a dispute during divorce proceedings, Cathi Herrod, president of the Center for Arizona Policy, said: “Just like a judge will decide when there are disputes over property, disputes over who gets the family dog—now, who gets the family embryos—will also be decided by a judge according to the law.”

*15 The party/spouse who’s against the reproductive use of the embryos is usually absolved of legal parental responsibility for any resulting children. But they’re still being forced by the state to become a genetic parent against their will.

*16 Most clinics require patients to sign a contract stipulating their frozen specimens be stored for a set number of years, and after that period of time patients can renew their contract.

*17 Especially when I zoomed out from frozen eggs and considered that there are studies showing that children born with the help of fertility treatments face various increased health risks. See the Notes section for examples.

*18 Name has been changed.

*19 Especially because, as she noted, the women freezing their eggs now are much younger than the first wave of egg freezers, of which she was part; they’re also waiting longer before attempting to use their frozen eggs.

*20 Freezing eggs at an older age, it bears repeating, increases the likelihood of their being chromosomally abnormal, which is a reality of age and genetics. And, again, the freezing and thawing processes carry their own risks.

*21 A different and more pragmatic half that’s also important to see: Brigitte pointed out the importance of considering and learning about actually using the eggs you’ve frozen. It’s quite involved, as we’ve seen, and as she said, “If you’re going to spend all that money on the first part—the freezing—you also have to know what goes along with that, especially cost-wise, to make a baby from those frozen eggs.”

*22 For more on choosing a fertility doctor and the importance of the lab, I recommend FertilityIQ’s five-module course on the subject (there’s a fee, but it’s worth it): fertilityiq.com/​the-ivf-laboratory/​introduction-to-the-ivf-laboratory-and-course-plan.

15 Reproduction Reimagined

Inconceivable

The beginning of the pandemic fell at the blurry line between late winter and early spring in Colorado. We didn’t know anything about the coronavirus or how long we’d be hunkered down for. All we really knew, in those first months of 2020, was that a plague was upending the world. Covid-19 deaths mounted, the numbers unfathomable. New normals rearranged themselves in our homes, our grocery stores, our lives. We began wearing masks everywhere. We grew more afraid. We doom-scrolled. We settled in. I waited to feel anxious about spending so much time alone in my apartment. I thought I would resist the stillness, find ways to distract myself from quieting down. I’m good at drumming up noise when I fear solitude. Instead, as the weight of the days changed, as I felt time slow, I slowed with it. I learned the sounds of my neighborhood, the small slice of downtown Boulder I call home. I felt both opened up and tucked in; tender parts were exposed, but I wanted to keep them nestled. I walked the streets at dusk, struck by the hush, the empty sidewalks. I lay on the living room floor and hugged my legs to my chest, marveling at what it felt like to not be doing and going every minute of every day. I spent days with only myself and enjoyed it. I remember how that felt like a small miracle.

One thing I did not do during the pandemic that scores of other women did was freeze my eggs. In the context of a global pandemic, fertility preservation took on a new, urgent meaning. The number of women freezing their eggs had already been increasing year over year at fertility clinics across the country, and the uptick continued during Covid—despite the fact that most clinics were forced to shut down and suspend fertility treatments during the pandemic’s early months. There was an overall 39 percent increase in egg retrievals compared to pre-pandemic levels and, interestingly, a notable increase in egg freezers under age thirty-five, as well as a significant decrease in time between patients’ initial consultation and their egg retrieval. Between August 2020 and October 2021, Shady Grove Fertility, which has more than forty locations across the country, saw a 95 percent increase in women freezing their eggs compared to the same fifteen-month period pre-Covid. Kindbody quadrupled its revenue and tripled its number of clinics in 2021. NYU Langone Fertility Center saw almost three times the number of women—overall younger patients—starting egg freezing cycles in 2022 compared to 2019. And in the United Kingdom, where egg and embryo freezing cycles are the fastest-growing form of fertility treatments, clinics saw a 60 percent increase in egg freezing from 2019 to 2021, which experts said was in part prompted by the pandemic.