“Oh my God,” Mandy said. “I’m so sorry.”
My throat felt thick, as if the feelings I’d been trying to shove down for weeks were clawing to come out. “He was always so supportive of me possibly freezing my eggs,” I heard myself say. Hearing Mandy talk about her relationship with Quincy reminded me of that. When their teaching program in China had ended, Mandy moved back to Los Angeles and Quincy back to Boston. They were in their early twenties. Did they want to move for each other? They broke up, then got back together, then broke up again. The cycle continued until they realized they kept coming back to each other for a reason. Quincy moved to the Bay Area and the two of them started fresh, beginning a committed relationship that led to their getting married.
I expected Mandy’s next question, and sure enough, she asked it. “So, are you going to do it now? Freeze your eggs? Or are you still torn?”
I hesitated. “Well,” I said, “I’m grateful I’m still relatively young. It’s not weighing on me in that way quite so much. But in some ways I feel like I’m back at square one.” The truth was, I had no idea how to think about egg freezing in personal terms anymore. With Ben no longer in the equation, my thoughts reverted to my sole ovary. It felt almost harder to decide yes or no because my ovary was fine—for now. But I didn’t know for certain that I was fertile. No matter what doctors predicted for me, there’d be no certainty until I became or tried to become pregnant. And now that seemed further off than ever. “I don’t want anything to happen to my ovary,” I said. “But a part of me wishes that something would happen that would make the decision easier for me.” Mandy nodded. She understood that, in a way most people couldn’t.
Mandy had been forced to make a decision about egg freezing because of reproductive surgeries that had left her with partial ovaries. She’d decided to do it, but her next step, a consultation at a fertility clinic, had not exactly been comforting. A reproductive endocrinologist told her he agreed she should freeze her eggs, but that it wasn’t very likely she’d be able to freeze a good number of them. Don’t get your hopes up, he told her. One of her ovaries was virtually inactive, meaning it very likely wouldn’t produce any eggs; the other one looked okay, but not great. The doctor predicted Mandy would freeze ten eggs at most. So she’d sped home and opened her laptop. Chance of having a baby from ten frozen eggs, she typed into Google. Then she remembered the doctor recommended she freeze embryos, since she and Quincy were married. Chances of ten eggs becoming embryos, she typed. The answers she found were all different, and dozens of clicked links and opened tabs later, Mandy felt dizzy. The ins and outs of embryo freezing and success rates were a lot to digest. She’d been keeping a list of questions to ask at her next appointment at the fertility clinic, and every day, it seemed, the list grew longer.
For Mandy, the egg freezing orientation had been one of the most difficult parts of the entire process. Injecting a cocktail of synthetic hormones, in particular, made her feel as if she was doing a science experiment. That she was a science experiment. She had gone alone; Quincy was working. A young nurse ran the training, showing Mandy and several couples how to prepare and inject the shots. The room was stuffy. Most of the couples held hands. A sense of sadness hung in the air; Mandy looked around and realized most people looked miserable. They looked older, too, and she felt a mix of sympathy and awkwardness, imagining they were there because they were having trouble conceiving and so were going through IVF. Mandy had felt so out of place. She wasn’t even sure she wanted kids. What was she doing there, learning how to pump herself full of fertility drugs? Did she really want to be doing all this instead of just trying to get pregnant now? Quincy, who hated needles, still managed to administer all of Mandy’s shots in the days leading up to her egg retrieval. He’d been stunned by how complicated it all was. She had watched hours of YouTube videos to make sure she understood how to unbox the thousands of dollars’ worth of meds that arrived on her doorstep, check the inventory, and prepare the injections, carefully calculating how much liquid she needed for each shot.
“It was the longest month of my life,” Mandy told me. She cried during every injection and never got used to the pain.[*4] After the first few shots, she told her doctor they felt like torture. “Is that normal?” she asked. “Yeah, I’ve heard it stings,” he replied. She returned to the internet and took comfort in online forums where other women shared about how much the injections hurt for them, too. Even Mandy’s mother, who was thrilled that Mandy was taking action with regard to possibly having children someday, grew concerned during Mandy’s several days of injections.
“We didn’t know it was going to be like this,” she told her daughter.
“Like what?” Mandy asked.
“Very…unnatural,” her mother replied.
In darker moments, Mandy vacillated between wishing she would accidentally get pregnant and wishing she’d just discover she was infertile. She wanted to be free from worrying she was making the wrong decision—or would, or already had. An accidental pregnancy or infertility diagnosis would mean the decision had been made for her: She would accept the reality and that would be that. No more “figure out my fertility” as an item on her someday to-do list.
Finally, after all the visits to the clinic and the days of shots, it was time to harvest her eggs. Mandy’s egg retrieval resulted in twenty eggs extracted from her ovaries, which were then fertilized with Quincy’s sperm. They had successfully frozen eight embryos—which was a lot. The doctor told them that the chances of having one healthy child from their frozen embryos was extremely high.
Mandy accepted that being forced to consider her fertility at an early age meant always knowing that having biological children might not be possible for her. Most of her friends who knew they someday wanted children hadn’t given their fertility much thought. Mandy, at least, felt somewhat mentally prepared. The cyst her doctors had discovered that changed everything for her now felt like a blessing in disguise. Even so, despite having a medical reason for freezing, Mandy never really felt solid about her decision. Shouldn’t we just get pregnant now? a voice in her head kept murmuring. But she and Quincy hadn’t felt ready to be parents. It wasn’t until the day she got the final results that the voice quieted down.
With the experience behind her, Mandy focused her thoughts on what it had all led to: her and Quincy’s eight embryos on ice and the peace of mind that gave her. “It was really hard, and really expensive,” she tells her friends when they ask. “And it’s going to be more involved than you think. But I’m really glad I did it.” Going back to regular life felt strange at first. For a while, it had felt as if fertility was all Mandy thought about. Just freezing my eggs had unexpectedly turned into months of contemplating motherhood and starting a family with her partner. Unaccustomed to dwelling on the future, she used to cringe when the subject of having kids was brought up. All those years she spent actively protecting against pregnancy meant that almost by default she had put off all thoughts of possible parenthood. But all that shifted while she was going through the many steps of egg freezing. She began to imagine what it would be like to have a family, how many kids she and Quincy might have, what he’d be like as a dad. Getting pregnant had, for so long, been the worst thing that could happen. Egg freezing changed all that. Having frozen embryos made motherhood seem more manageable; now, she felt she had more of a choice of when it would happen.
And if it didn’t? She’d at least know she had done everything she could.
—
Our ovary sagas brushed up against each other in small but striking ways. It was almost as if where mine left off Mandy’s began, and where mine lulled hers returned. We both had had two surgeries for ovarian cysts eight years apart: mine at ages twelve and twenty, Mandy’s at twenty and twenty-eight. We both had fewer than the normal two healthy ovaries most women have, and before we met each other we’d never known someone with an ovary situation like ours. We both grew paranoid anytime we felt cramps or a sharp pain in our lower abdomens, thinking it was an ovary dangerously twisting on itself again.
I saw myself in Mandy’s experience: her fragile ovaries and history of painful operations, the confused guilt she felt about the cyst that threatened her fertility, the ache in her voice when she said, “I should have known better. How did I let this happen again?” I empathized with how, for so long, she’d had low expectations about her ovaries’ capabilities. Did they work? Would they one day help her conceive? She had harbored little hope over the years. Mandy was the sort of person who thought twice about a lot of things and often felt anxious about the future, quick to spiral into a thick fog of what if and what then. I understood this deeply. My doctors had painted a rosier picture for my one ovary, but no matter what any doctor ever said, I always wondered—and always knew the wondering would stop only if and when I became pregnant. For Mandy, freezing her eggs turned the wondering down to a low hum. I envied her that.
As we sat in the fading light of her kitchen, I realized I had been subconsciously hoping Mandy’s journey would inform my decision. This truth had been simmering inside me for a while, and in that moment it welled up like a confession: A part of me wanted to let Mandy and the other women I had spent hours talking with over the past many months make my egg freezing choice for me. I had done my homework, but they had done the actual thing itself. I had uncovered some answers—some illuminating, others inconvenient—but they had decided, they had experienced it, and what truths, what answers, are more powerful than that? I could make my egg freezing experience look like theirs, couldn’t I?
As I was getting ready to leave, Mandy repeated in almost an offhand way a comment one of her doctors had made at one of her early egg freezing appointments: “Ovaries are really resilient, you know.”
Heartbreak, Hormone Shots, and a Change of Plans
My last night in California, I holed up in the basement of a friend’s apartment in Oakland. My half-open suitcase sat wedged between two large racks of Burning Man garb. During the week’s meetings and interviews, I had compartmentalized my grief, cosplaying a put-together reporter instead of being a person with no idea how to start over.
My decision to freeze my eggs no longer felt sturdy. I wanted to Velcro myself to the facts. I was a reporter; facts were the bricks of gold paving the path to Knowing, to the Right Decision. I was nearing thirty and fresh out of a breakup. Egg freezing made more sense now than ever, at least on paper. But I still had questions about the fertility drugs and about the fact that I was a “cyst-former” with a history of my body overreacting to just natural hormones. The journalist in me had concluded that egg freezing was a striking, if presently overhyped, technology with powerful potential—but I wasn’t sure I could live with the risks. As for the woman in me: My research into freezing eggs versus embryos, plus my recent visit with Mandy and hearing about her frozen embryos, had me close to convinced that freezing embryos was smarter than freezing just eggs. But now Ben—and his sperm—were gone.
I lay back on the bed, feeling weary. I closed my eyes and pictured going through with it by myself, injecting drugs into my abdomen late at night until the skin came to resemble a dartboard. It was getting more and more difficult to imagine putting myself through the hormone shots unless a doctor told me I was infertile and couldn’t get pregnant without them. Harder to admit was that for now, at least, it was difficult to imagine going through any major life event without Ben.
As more time passed, I realized that I had been using my relationship with Ben to distract myself from actually making a choice. In both cases, to some degree, I’d been hedging, brushing aside many of the doubts and hard questions. I worried that I’d wanted things with Ben to work out so badly that I had lost the ability to tell if I was still happy. Now it sometimes seemed I’d begun looking at egg freezing with the same rose-colored glasses. As if the more I wanted it to be right for me, the less able I was to tell if it was a smart choice. But whether or not to freeze my eggs had been my decision to make before I met Ben, and it was mine to recommit to now that I was once again single. It was—still—just me and my ovary. That thought used to bring me comfort; now it made me feel profoundly alone.
I had wanted a straight line to what had felt like the right decision: to freeze my eggs. I wanted to be sold on egg freezing. I longed for the wave of relief I had been assured it would bring me if I went through with it. I’d already been counting on how sensible it was for me, the woman who’d always been certain about having biological children, the woman with one ovary who knew she wanted kids later but not now. Instead, on top of my achy heart, I was angry about how ending my relationship with Ben had thrown a wrench into my egg freezing plans. I worried Dr. Noyes had been right all along: The problem was that I knew too much. And that made it nearly impossible to stop vacillating, stop researching, stop chasing more data. Mostly I was afraid that I had no idea about anything anymore: where to live, how to write and do my job, how to move on.
“Freezing my eggs seemed like the best decision I could make with the information I had at the time,” writes Sarah Elizabeth Richards, who spent $50,000 on several rounds of egg freezing more than fifteen years ago, in her memoir Motherhood, Rescheduled. Money aside—I’d never spent so much on anything—her statement made complete sense to me. But, unable to distinguish what I knew, or couldn’t know, about the drugs’ risks and shaky success rates from how I felt, which was lost and heartbroken, I had arrived at a fraught in-between place with egg freezing: I was afraid to do it and afraid to not do it.
I didn’t know where to begin with confronting all this personal fear. I could, however, continue to channel my reporter energy in pursuit of more balanced answers and perspectives. Dr. Noyes was wrong, I decided: I didn’t know too much. Not yet, at least. To recommit to freezing my eggs, I concluded, I needed to reassure myself I could live with the risks attached to the hormone injections—risks to my ovary as well as to my long-term health. And I wanted to learn more about the powerful peace of mind that Mandy, and many other egg freezers I’d interviewed, had gushed about.
That night, I fell asleep with Mandy’s words echoing in my head: Ovaries are resilient.
Skip Notes
*1 These percentages can vary among labs, which is one reason why choosing a fertility clinic that has a reputable laboratory and well-trained embryology staff is important—really important. More on this in chapter 14.
*2 Frozen eggs and sperm, on the other hand, do not independently have the potential to initiate a pregnancy, which makes the choices surrounding the disposition of stored gametes less fraught. More on egg and embryo disposition decisions in chapter 14.
*3 A major benefit: By fertilizing half of my retrieved eggs and hopefully getting a few high-quality embryos, I’d have a sense of how good my remaining unfertilized eggs were likely to be.
*4 Icing the area before can make the shots more bearable; ice globe roller balls, the kind some people use to depuff their eye areas, work well.
12 Fertility-Industrial Complex
The Lovely Louise
It was just after eight on a Monday at the convention center in San Antonio, Texas, the site of the American Society of Reproductive Medicine’s annual meeting. Every year, the ASRM—the governing body that oversees most reproductive medicine and technology in the United States—holds a large conference for the industry’s doctors and researchers. I wanted to see the world of fertility technology in action and put faces to names of the physicians at the forefront. So I reached out to the ASRM press office and obtained a media pass for the four-day event. Then I packed a bag and flew to Texas.
I stood there in the convention center, marveling at how huge it was. Thousands of fertility experts attend ASRM each year, with nearly one-third of them coming from outside the United States. The large hall echoed with the click-clack of women’s heels and deep male voices. I shuffled around in a black dress and shoes that gave me blisters, getting the lay of the land before I made my way to one of the ballrooms for the conference’s opening plenary. It was going to be a long day, and I was glad; being back in Texas just a couple of months after leaving Houston and Ben was painful, a dull ache and sharp sting all at once. The buzz of the conference, I hoped, would take the edge off.
“It is every woman’s right to decide when, how, and with whom she wants to have a baby,” ASRM’s president at the time, Dr. Richard Paulson, said in the opening keynote address. He looked a lot like Tom Selleck. “This includes the ability to access not only family planning services, but also fertility promoting services.”
