Few studies have focused on outcomes beyond pregnancy. One, from a while ago, that has—the study reviewed reports published between 1986 and 2008 of more than nine hundred babies born from frozen eggs—found no difference in the rate of congenital anomalies compared to the rate for babies born with fresh eggs, meaning researchers didn’t see a rise in chromosomal abnormalities or birth defects in children born from frozen eggs. A 2013 study found similar outcomes. Also, there’s currently no evidence to suggest that eggs become less viable in storage, so, as far as we know, they can be frozen indefinitely. While most patients make disposition decisions about their embryos or eggs within five to ten years of freezing them, technically, in the United States, there’s no limit on how long you can store frozen reproductive tissue.[*16]
While it was reassuring to learn that, for now at least, there doesn’t seem to be any compelling reason to worry about the safety of eggs on ice and potential health risks to children born from frozen eggs, it wasn’t lost on me that—once again—there isn’t enough data yet to be fully confident.[*17] Research with larger sample sizes is needed to reinforce this conclusion—and all of egg freezing studies’ other conclusions. Experts have been saying so for years. The authors of the study on nine hundred frozen-egg-babies I just mentioned outlined the need for a systematic outcome reporting system, writing at the time: “A working knowledge of the actual number of babies born as a result of transferred cryopreserved, thawed-warmed fertilized oocytes, including fetal wellbeing, is an important step towards adequately judging the merits of this highly sought after technology.” A worldwide egg freezing registry, they stated, “would help to assure the safest, most expeditious development of this technology.” And yet, all these years later, no such registry exists, and there remains little information or follow-up from years of women having given birth using their frozen eggs. In time and with more robust data, we’ll better understand possible risks of birth defects—if any—for children born from frozen eggs and how years of storage in liquid nitrogen may impact eggs.
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In Ohio, I had witnessed the kind of permanent repercussion associated with ART that the public is rarely privy to. The tank failures were a distressing counterpoint to Remy’s optimism and some of the rosier aspects of egg freezing I’d been immersed in. As I considered more seriously what happens after the thaw, as women return to use their frozen eggs, I found myself still wondering about individual cases of frozen eggs failing, and if women for whom egg freezing didn’t work had been prepared for that difficult outcome.
In his book When Breath Becomes Air, Paul Kalanithi considers whether it is the medical expert’s job to suggest what their patients should do or whether to simply provide information and sit back while patients and families figure out how to decide among their options. He writes that nowadays the second model is the norm, and so the proliferation of choices and medical possibilities just adds to stress and confusion. When it comes to fertility treatment, it’s clear that walking patients through informed consent—the various disposition options, the reality of the success rates, the potential risks—is so important. Some doctors do a thorough job of this; others don’t. I wasn’t surprised to learn that there isn’t enforced standardization of consent forms across fertility clinics; the several forms I reviewed varied greatly. SART has a detailed consent form on its website that SART-member clinics can use (and probably more should). Other limited guidance comes from ASRM’s Ethics Committee, but their directives, as we’ve learned, exist merely in the realm of self-regulation. Proper informed consent entails collaborative discussions between physicians and patients about the technology’s risks along with the limited outcome data, although as we’ll see, such conversations are the exception, not the rule.
But the importance of fertility doctors helping to manage egg freezing patients’ expectations, I was about to learn, was not something to gloss over.
All in One Basket
As I’ve said, more than 85 percent of women who have frozen their eggs have not attempted to use them. But some have, and their ordeals shed light on the precarious nature of the tightrope we walk with this new technology.
In the years since egg freezing became mainstream, accounts of it not working have increasingly been covered in major media outlets. Actor and writer Lena Dunham was a famous case. After nearly two decades of chronic pain from endometriosis, Dunham underwent surgery to have her uterus removed, and, eleven months later, her left ovary. In 2020, she froze eggs that her remaining ovary was still producing, in hopes that a gestational carrier could carry one of her fertilized eggs to term. But none of her eggs successfully fertilized. Reckoning with the end of her fertility in an essay for Harper’s Magazine, Dunham writes: “I tried to have a child. Along the way, my body broke…. I had lost my way, and a half-dozen eggs sitting in Midtown promised to lead me home. Instead, each step took the process further from my body, my family, my reality. Each move was more expensive, more desperate, more lonely.”
The rare instance of a cryotank failing is, obviously, one way in which frozen eggs don’t lead to a baby. More common, though, are issues with safekeeping while eggs are being stored, as well as with the thawing and fertilization process when using eggs to make embryos. As we’ve seen, the problems can be mechanical, science-related, or the result of human error. Sometimes fertility doctors and embryologists ascertain why eggs aren’t viable; sometimes they can’t. Regardless, if a woman’s frozen eggs or embryos are compromised and don’t survive the thaw, patients are almost never given an explanation as to why. When Dayna,[*18] a thirty-nine-year-old attorney who froze her eggs in New York City and later shipped them to Colorado after moving there, learned that her eggs had gone missing—only one egg arrived at the receiving clinic; both clinics claim not to know what happened to the rest—she hired lawyers and spent years trying to figure out what happened, to no avail. “When eggs die, there isn’t a debrief,” Dayna told me. It can be incredibly frustrating and dismaying paying thousands of dollars to undergo an intense procedure only to hear, “Sorry, it didn’t work out. Maybe try again?” But that’s usually all that’s said.
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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.
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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.
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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.”
