It was my goal to present a character-driven narrative of the contemporary landscape of egg freezing. Most of the research I discuss in this book focuses on the experiences of heterosexual, white, cisgender women, because they are the people who, for now, predominantly constitute that landscape—although they are by no means the only people who use and/or require assisted reproductive technologies. LGBTQ+ people, same-sex couples, solo parents, and a wide spectrum of others plan their family-making outside the traditional male-female partnership, often relying on fertility treatment to do so.

In this book, I use the terms “female” and “woman” to refer to people with ovaries, although not everyone with internal reproductive organs identifies as a woman or a female; likewise with “man” and “male.” Sex and gender exist on a spectrum, and people with ovaries include those who are transgender, nonbinary, intersex, gender-nonconforming, genderqueer, agender, and genderless.

All too often, BIPOC women struggle to access fertility treatment and technologies—a reflection of the broader, unjust ways in which reproductive healthcare’s racial and ethnic inequities play out in the United States. One of the book’s primary characters, Mandy, is Asian American, and I hope readers who are women of color, in particular, will see themselves in her egg freezing experience.

I recognize some of the limitations in my reporting and in the research and findings I describe here. More so, I acknowledge the fact that this book cannot capture all the complexities of the experiences of people with ovaries. However you identify, and regardless of whether you have ovaries and eggs, I hope you will find something of value here.

Introduction

This isn’t the book I set out to write.

I began writing this book in my late twenties. I’m in my early thirties now, and I couldn’t have imagined all that would happen in the years between. The second half of one’s twenties and beginning of one’s thirties is a tumultuous and tender time for many people even under normal circumstances, and this was certainly true for me, though at times the circumstances were decidedly not normal.

One unusual and unique-to-me circumstance that did not change during these years was the fact that I have one ovary, for reasons I’ll soon explain. But I mention it now because it was my doctors’ urging that I freeze my eggs and protect my ability to have biological children that turned out to dominate this roughly five-year period. And it was this dilemma that became the main impetus behind the deep dive that resulted in this book.

As I wrote, my life kept changing. And that, in turn, changed what this book was becoming. What began as a straightforward investigation into egg freezing and reproductive technologies morphed into a book about control. About what we—women, humans, all of us—try to control, why we do that, and how we ultimately have much less control than we think we do. Even as we attempt to buy it or freeze it or otherwise procure it.

Nearly half a century after the birth of the first “test-tube baby” conceived via in vitro fertilization, a third of American adults say that they or someone they know has used fertility treatment to try to have a baby. The ability to successfully freeze eggs has been among reproductive medicine’s biggest achievements, resulting in the first two decades of the twenty-first century having seen egg freezing secure its place among the full range of processes by which conception begins outside the human body. What was once science fiction is now simply science: Fertility can be frozen in time. Along with in vitro fertilization, or IVF, egg freezing is on its way to becoming part of a vast demographic shift—a global trend of delaying childbirth, particularly among the affluent. (Sperm freezing is on the rise, too, with an increasing number of men eyeing fertility preservation.) We are marrying and having babies later than ever, and egg freezing lets women have biological children on a timeline that suits them. That’s the idea, at least. And more women are buying into it than ever before.

For most of U.S. history, many women didn’t have legal rights over their bodies, and we’re still experiencing the horrible hangover. The conflict in America today over abortion is proof of how many people still believe that a woman’s uterus should belong to the government. At the same time, we live in an age that prizes optimization and taking charge, and the notion that a woman should command every aspect of her future fertility—even if her reproductive rights are at present on shaky ground—has become, for many, a pillar of modern womanhood.

The pressure to take charge of one’s fertility helps to explain egg freezing’s rapid growth and why it has become, for a certain group of women, a mainstream, viable option, viewed as one of the best technological solutions available for women hoping to “have it all.” From boardrooms to bedrooms, egg freezing is touted as an obvious and immediate way to conquer the biological clock. More and more employers cover the cost of the procedure as a workplace benefit. Celebrities sing its praises. Many of us know someone who has done it, or have seen targeted ads for it on our social media feeds, or have watched it unfold as a plotline on one of our favorite TV shows. Even if we’ve only heard of egg freezing in passing, we know what it purportedly offers women: More agency over their reproductive lives. More flexibility in planning a family. More options. More control.

My quest to decide whether to freeze my eggs took me to the front lines of fertility—tomorrow’s final frontier for women’s reproductive autonomy. I set out to learn all I could about the latest developments in assisted reproductive technology and how they affected my own future choices. I was a young journalist on a personal mission, determined to unearth information that I and so many other women were shockingly ignorant about. Along the way, I visited world-famous fertility clinics, sat in on high school sex ed classes, and peered into petri dishes inside laboratories. I attended egg freezing parties and medical conferences. I interviewed dozens of reproductive endocrinologists and fertility experts. I followed the experiences of young women who froze their eggs and a few who chose not to. I met with scientists and start-up founders, embryologists and ethicists, clinicians and corporate executives. I spoke to therapists specializing in reproductive trauma and lawyers specializing in reproductive rights. I even sat down with Louise Brown, the world’s first IVF baby, who showed me every one of her twelve tattoos as we chatted about menstrual cramps, fish and chips, and giving birth.

When I decided to look into the science of egg freezing myself, I had hoped what I found would determine my choice. It did—but not in the ways I had expected. It took years to arrive at the conclusions I make in these pages. Some are clear-cut and satisfying. Others are murkier because of what we still do not know about egg freezing and won’t for some time. I wrote this book to put all the information we do have about egg freezing in one place and to make it easy to understand.

I turned over many stones to get here, to stand up with dirt smeared across my face, brush off my hands, and say, “Okay, here’s the deal.” I learned what questions to ask and to whom to direct those questions. I spent a long while holding my breath, waiting to see if egg freezing—the incredible technology and the lucrative industry behind it—could and would deliver on its promises. I searched long and hard for answers. For myself. For you. My mission, I came to realize, had two objectives that were inextricably tied. I couldn’t decide whether or not to freeze my eggs without first learning all the facts. And I couldn’t help women identify and ask the right questions about egg freezing unless I put my skin in the game and was transparent about why making this choice—which at first I thought would be easy—became as difficult as it did. The shape of my search became a double helix, weaving journalistic objectivity with personal interest as I set about learning the truth for you and trying to make a decision for me. Ultimately, the answers I uncovered caused me to consider my questions, and all that informed them, from completely different vantage points and in an entirely new light. And that, it turns out, is often par for the course, both in journalism and in life.

The further afield I went, the deeper my reporting led into a little-understood world where medicine, politics, commerce, technology, and sex intersect in convoluted ways. It’s a world that women, and those who care about them, ought to understand. And so this book is more than the result of my search for answers. It is also a tale about my journey into the future of fertility, as it unfolded against a backdrop of reproductive rights being dismantled and liberties pertaining to women being stripped away. Of all I learned, as a woman and as a journalist, the single most important truth was this: It has never been so important for a person with ovaries to understand their body, their options, and their reproductive autonomy—and the forces that threaten them.

Before all that, though, in the beginning, I set out with simple intentions, notebook in pocket and pen tucked behind one ear, a metaphorical hat labeled Journalist in one hand and a hat labeled Woman in the other. Off I went, just me and my one ovary, giving this all we’ve got.

1 Young, Fertile, and Fabulous

Walking into the Future

My official introduction to the future of fertility was courtesy of EggBanxx, a start-up company offering financing options to potential customers to freeze their eggs. One afternoon in early September, I read on Twitter about an informational “Let’s Chill” event in Lower Manhattan, hosted by EggBanxx, where women would be gathering to learn about egg freezing while liquoring their anxieties with cute cocktails. I wasn’t sure what to expect, but I registered for the event online and promptly received a confirmation email: Forget sweating in the hot summer sun looking for Mr. Right!, the invitation read. It’s fall now and smart women will be staying cool at the EggBanxx party tomorrow night! We hope you’re as excited as we are to sip our Banxxtinis while talking about the three F’s: Fun, Fertility, and Freezing! It wasn’t just idle curiosity. Fertility—and my eggs and sole ovary, in particular—had lately been very much on my mind.

The following night, I headed down to the Crosby Street Hotel to learn more.

“Ladies, you are young and fertile and fabulous!” chirped Dr. Serena Chen, a reproductive endocrinologist at the event. Her white coat and smooth dark hair emanated authority as she smiled at the attractive group of attendees. The hundred or so women around me pecked at popcorn and sipped raspberry-filled flutes of champagne. Several women sat on the edge of their seats in anticipation of…of what? I wasn’t sure. Most appeared to be in their thirties or forties, fashionably dressed, with tan faces and flowing blow-dried hair. I noticed many sparkling diamond rings and designer handbags. It felt like a scene from a Sex and the City episode. I, meanwhile, wore a backpack—I’d just started graduate school at New York University—and was probably the youngest in the room by at least five years.

It was 2014, and EggBanxx, which had launched a couple of years earlier, was now attracting major attention in New York for its series of swanky cocktail parties. The company acted as a matchmaker between doctors and patients in the market for state-of-the-art fertility treatments. “We will be like Uber, but for egg freezing,” said Gina Bartasi, EggBanxx’s founder, in a Washington Post article. An early pioneer in the fertility marketing space, EggBanxx—the two x’s represent female chromosomes—negotiated with fertility doctors to provide lower treatment prices for patients and offered discounts and low-interest loans to women wanting to freeze their eggs. “We’ve learned that millennials don’t like paying retail,” Jennifer Palumbo, who was then director of patient care at EggBanxx, told me in an interview. Palumbo, who had struggled with infertility in her thirties, froze her eggs before taking a job at EggBanxx. Bartasi also had faced difficulties conceiving naturally; she now has twin boys, courtesy of IVF, which is when a sperm and egg are merged to become an embryo in a lab and then implanted in a woman’s uterus.

Midway through the presentation, the audience was totally attentive, cocktails forgotten. As I looked around, a part of me felt profoundly out of place. And yet my uterus made me feel as if I belonged, as if it were my ticket to some sort of ladies-only club. Here we were, a bunch of women on an early fall evening in New York City, listening to a handful of fertility doctors talk about our eggs. There was something delightfully strange about it all. I scribbled phrases in my notebook I’d never heard before: thaw data, dehydration protocols, autologous cycles. In the margins, I made notes of things to clarify later: embryo = fertilized egg, yes? In between speakers, pockets of quiet chatter filled the room. I sensed a we’re-all-in-this-together kind of camaraderie in the air that I hadn’t felt since my college orientation session for first-year students.

Dr. Chen reached the last slide of her presentation and took questions. Someone asked if there was any sort of refund policy if a woman became pregnant naturally after freezing her eggs. Dr. Chen replied that there was not. More hands shot up. “I’m not quite sure how to put this,” a woman in the back began. “What happens if your eggs become…poached?” The crowd erupted in cathartic laughter. I smiled, too, but the quip gave me pause. Were we really using cooking metaphors to describe our potential future children?

I raised my hand. A few minutes later—it was a big room, and a bunch of questions got answered before it was my turn—someone handed me a microphone. “Hi,” I said. “I’m Natalie, I’m twenty-five, and I’m wondering what happens if I’m living in, say, the South Pacific in five or ten years and want to start a family but my frozen eggs are here in New York.”

“Once you figure out where you are and what you want to do, we can ship the eggs to you,” Dr. Chen replied. “They’ll get sent in a container of liquid nitrogen, and, well, hopefully no one leaves them on the shipping dock alone….” A few women around me giggled. Dr. Chen went on: “But if people are transporting precious things like eggs, we usually recommend you buy the eggs a ticket to take them to wherever you’re going.” Several women in the room nodded, seeming to find Dr. Chen’s response sensible. Speechless, I sat down and passed off the microphone. As if getting shot up with thousands of dollars’ worth of hormones wasn’t financially crippling enough, now I had to factor in airfare for my own eggs?

I had hoped my logistical query would prompt an easy answer, something reassuring and straightforward amid all the talk of viscosity and thaw data. No wonder our questions—sometimes flippant, if well-intentioned—were laced with awkward metaphors: We didn’t fully understand the slides or what these doctors were telling us. We were trying to mask our ignorance and discomfort with laughter, the same way we’d giggled at enlarged pictures of penises in elementary sex ed. Back then, we’d sat on hard classroom chairs or cross-legged on cold gymnasium floors; now, it was plush seats, high heels, and one leg crossed dutifully over the other. Being older and sophisticated didn’t change the fact that many of us were as unaware of the facts now as we were then—and just as eager to hide it. The only thing separating me from these women, I realized, was a decade and a backpack. Like them, I felt dazzled by this exciting technology and the thought of taking matters of reproductive biology into my own hands. But there was a sense of unease, too, a gnawing feeling that I—and these women—had missed the boat at some point, as if we’d ducked out of a movie and missed crucial plot information.

The PowerPoint resumed; other fertility specialists took the stage. One asked us to follow her on Twitter. (“A bit of shameless self-promotion,” she said. “I’m trying to get more followers.”) The presentations concluded with a “reality check” from Dr. Chen. “With the exception of the twenty-five-year-old in the back of the room,” she said, wagging her finger admonishingly at the crowd, “all of your eggs are old, ladies.”

Not so fertile and fabulous after all.

Afterward, audience members and doctors mingled in the lobby, fresh drinks in hand. I retreated to a corner of the bar, my brain buzzing. In the days to come, with my doctor’s years-earlier recommendation that I freeze my eggs at top of mind and my questions about reproductive basics mounting, I would see this night as the official beginning of my quest for information. Near the end of the evening, I met a fertility doctor who, after hearing my story and asking my age, pushed a business card into my hand and told me to call her office to schedule an appointment. On my way out, an EggBanxx rep handed me a goodie bag. Inside, wedged between a lime-green mug and a handful of chocolate candy eggs, was a $1,000 voucher to put toward a cycle of egg freezing.

I was on my way.

Surgeries, Gold Mines, and Why I’m Telling This Story

Four years before I walked into the EggBanxx soiree, two significant events set me on a path to begin facing my fertility.

In the breezy-hot weeks of early summer, when I was twenty and home from college, my lower left abdomen began to ache one morning after breakfast. By midafternoon I was curled in the fetal position on the bathroom floor, dizzy with nausea. The pain spread from my pelvis to below my breast, sharpening and deepening. My father sat on the side of the bathtub and held a cool washcloth against my forehead. In a gentle voice, he said, “We need to go to the hospital.” I braced against the tub and hoisted myself off the floor. An ambulance ride and two emergency rooms later, I lay on my back in an exam room, feet propped in metal stirrups. I was alone, except for two male doctors peering between my legs with flashlights. A gloved hand held my knees apart. The doctors took turns putting their hands inside me, trying to figure out what was wrong. Tears fell from the edges of my eyes into my ears and my hair. As the doctors dug for answers, I stared up at the harsh fluorescent lights, trying not to cry out from the excruciating ache in my side and the doctors’ jabbing fingers.

Around three in the morning, they had a diagnosis: left ovary, hemorrhagic 5 cm corpus luteum cyst, double pedicle torsion of the whole appendage. A benign mass on my left ovary was bleeding into itself. Worse, the weight of the membranous sac had caused my ovary to become twisted around the tissues that support it. The fallopian tube twisted, too, like a kinked garden hose, blocking blood flow to nearby organs and causing severe pain. The doctors would try to untwist my ovary. If they couldn’t, I would lose it.

Ovaries release eggs; eggs make babies. Normal female anatomy entails two ovaries, but I wasn’t normal. Years earlier, when I was twelve, doctors had performed emergency surgery to remove my right ovary and fallopian tube: Multiple overgrown cysts—of a kind different from the one causing problems now—had caused my ovary to swell to double its size, causing it to do a full twist around the ovarian ligament, which cut off its blood supply, strangling my ovary. Nearly a decade later, for unrelated reasons, I stood to lose the left one, and with it, the remaining half of my eggs—and my ability to ever have biological children. To a twelve-year-old girl, that threat hadn’t meant much. To a twenty-year-old woman lying half-naked on an operating table while a nurse shaved her pubic hair, it meant a good deal more.

There aren’t many things I claim to know with absolute in-my-heart certainty, but for as long as I can remember, I’ve been sure I want to experience pregnancy, give birth, and raise kids. I am under no illusion that being a mother is an uncomplicated or always blissful endeavor. I get it, insofar as a person who is not yet a mother can get it. And yet, motherhood is the only non-negotiable on my life’s to-do list. At the same time, ever since I became sexually active, my sole concern with regard to my ability to conceive has been to suppress it. “Fertility” was a word for the future. At least it had been until now.

But I wasn’t thinking about babies or biology while lying in the frigid operating room. In those minutes just before surgery, I felt exposed and helpless, utterly outside of myself. My body had only recently emerged from the post-puberty teenage years, undergoing the kinds of changes that made me pay attention to it differently, and now here it was betraying me. It was a primal, raw kind of powerlessness I’d never known.

When I opened my eyes after the operation, my mother was standing next to my hospital bed. She squeezed my hand, answering my question before my brain could summon the words to ask it: The doctors had saved my ovary and fallopian tube. I could still have children.

A week in the hospital followed. The doctor said the pain I had experienced from my ovary twisting on itself was worse than that of giving birth. At this, my mother’s eyes widened—she’d given birth three times, so she could relate. But for me, hearing my pain put into relative terms didn’t change how agonizing it had been, or how much I still hurt. I ran my fingers along the puffy red wound above my pubic bone. The skin had begun to crust and harden. It would, over time, become a pale three-inch scar, hardly noticeable to anyone but me. In the days following the surgery, I struggled to comprehend how an organ the size of a walnut could cause so much pain and trouble. But the prognosis looked good: My remaining ovary was now in excellent condition. Once the doctors learned of my deep desire to someday have biological children, though, they urged me to consider freezing my eggs. I nodded, even though I had no idea what that meant.

A few months later, I began my senior year of college. My remaining ovary had healed well, but the doctors’ recommendation that I freeze my eggs was still on my mind. I wanted a second opinion. So after class one day, I sat in the student union with my laptop and typed “egg freezing near me” into Google. A few weeks later, I skipped an economics class to go to an appointment at a fertility clinic in a nearby town. A friend who knew I didn’t have a car kindly offered to drive me. At the clinic, a nurse led me to an exam room and instructed me to change into a patterned cloth gown. I lay on the table and clutched my hands while a reproductive endocrinologist looked between my legs, moving a transvaginal ultrasound wand covered in a cold gel from left to right inside me. On a screen to my left, the doctor pointed at my ovary and smiled.

“Natalie, you have a lovely ovary,” she said. It was one of the best compliments I’d ever received. “Egg freezing technology is still very new and experimental,” the doctor went on. “You’re young. Your ovary is healthy—it’s lovely,” she said again, smiling when I blushed. “I don’t see a need for you to take this risk right now, if ever.”

Later, the clinic would send me the doctor’s notes from the appointment. They read, in part: “We discussed ovarian stimulation with oocyte cryopreservation”—that is, egg freezing—“and that it is experimental and expensive, and likely not a good option for her now. In coming years, there may be more data and pregnancy rates from frozen eggs and she may want to consider this down the road.” At the end of the exam, the doctor told me that the best thing I could do for my ovary and future fertility was to immediately go back on the Pill—I’d been on it two years earlier but no longer was—and stay on it until I was ready to become pregnant. (Abruptly stopping hormonal contraceptives was a bad move in my particular situation, as it turned out—more on this later.)

I was relieved to have a plan in place that protected my ovary. And I was glad to have been told I didn’t need to pursue preserving my eggs. For the time being, I dismissed egg freezing and happily resumed suppressing my ability to procreate.

—

The second impetus behind my desire to investigate my fertility was less personal, more professional. A few months before almost losing my second ovary, I had been living in Ghana as an exchange student on a semester abroad my junior year of college. I’d arrived in West Africa in wide-eyed wonder; I left with a fierce desire to become a journalist.

In between classes at the university in Accra, I traveled by bus to a series of gold mines hours away to conduct field research for my undergraduate thesis, which explored the impact of mining industries on underdeveloped communities in western Ghana. I had immersed myself in the literature describing the so-called resource curse that plagued many African nations. Ghana’s mineral-fueled growth was an important driver of the country’s development, boosting its economy, and the country’s recent oil boom had led the government to grant extraction rights to several international corporations. In other words, Ghana was selling concessions—legal claims on natural resources—to foreign companies to establish mining operations throughout the country’s particularly resource-rich western region. Where oil and minerals originate in western Ghana is also where many Ghanaians in impoverished areas live—rural farmers unknowingly living on literal gold mines—but these poorer communities weren’t seeing the benefits. I asked a Ghanaian friend to come with me to Prestea, a mining town west of Accra. My friend spoke Twi, a local language, and had grown up in the region where so much mining was taking place. Years later, I’d learn the journalistic term for this—a “fixer,” a local to help arrange access and accompany a reporter—but at the time, I simply didn’t want to go alone.