*6 Where the ovarian tissue is reimplanted depends on the patient’s circumstances. If her entire ovary wasn’t removed, the tissue can be placed near it, where it regains blood supply, and ovarian activity—including egg production—resumes after a few months. Doctors have also transplanted ovarian tissue to the forearm, the abdominal wall, and the area just above the pubic bone—places that have several blood vessels, which help the ovarian tissue grow and produce eggs. (If ovarian tissue is transplanted someplace other than the pelvis, the patient would only be able to get pregnant via IVF.)
*7 Perhaps even more remarkable than the science is the fact that more than seventy women contacted Baylor expressing interest in donating their uterus. These women—many of whom have no relationship with a potential recipient—volunteered to have their uterus removed and transplanted not to prolong the life of the recipient (as is the case with most organ transplants) but to offer a stranger a shot at motherhood.
*8 Dina Radenkovic, a physician turned entrepreneur and Gameto’s CEO, said in a 2023 New Yorker article: “We’re really hopeful of allowing women to go through I.V.F. with much fewer side effects, less clinical time, and a lower cost—something that you could do in, like, egg freezing kiosks. I see it almost like an extension of the beauty studio, where being proactive about your reproduction and longevity just seems like an act of self-care.”
*9 I remain torn by the popular view that egg freezing, and ART in general, equals reproductive freedom. I think about this often, most recently while listening to the podcast The Retrievals, a chilling five-part narrative series from Serial Productions and The New York Times. “One of the central tensions of fertility treatment, basically since its inception, has been: Is this a patriarchal system or a feminist one?” said reporter and host Susan Burton. “On the one hand, you have a top-down system that, frankly, was designed by men, and there’s tons of drugs and doctors telling you what to do with your body. On the other hand, being able to decide when and how to have a baby—and the possibilities that fertility medicine opens up for patients in all kinds of situations—this is also reproductive freedom. If you have access to it.”
*10 PGT-A, a more generic form of preimplantation genetic testing, screens for common chromosomal abnormalities. Selective embryo transfer—the process of identifying and using an embryo with a high chance of successful pregnancy—is an option for many couples who are at risk for transmitting an inherited condition.
*11 She also spent many hours on the phone with insurance companies and doctors jumping through hoops to get approval to access ART benefits without an infertility diagnosis.
*12 To reduce the risk of ovarian cancer mortality, surgeons generally remove the ovaries as well as the fallopian tubes in women with a BRCA1 genetic mutation, typically between the ages of thirty-five and forty. Ideally, the women will have completed childbearing by then.
*13 Nineteen of their resulting embryos were tested for BRCA1 using PGT-M; five were non-BRCA1-affected and chromosomally normal.
*14 Four rounds of IVF were covered through Chris’s employer at the time; the last two rounds were covered by Bridget’s employer. Later, Bridget reflected: “I cannot overstate that if we hadn’t had insurance coverage, IVF with PGT-M would likely not have been an option for us, and a lot of my feelings on my fertility and this situation would probably be very different.”
*15 CRISPR stands for “clustered regularly interspaced short palindromic repeats.” (Quite the mouthful.)
16 A Journalist and Her Ovary
Walking into the Past
It was September, a few years ago, and I was flying to Italy for the wedding of a family friend. Before I left, I emailed Dr. Raffaella Fabbri and Dr. Eleonora Porcu—the biologist and fertility doctor who had forever altered egg freezing’s trajectory with their discoveries at the University of Bologna three decades earlier—asking to meet. I wanted to know what they thought about the technology now, decades after they’d developed it and a few years since it had become mainstream. Where were we headed?
On the train from Milan to Bologna, I reviewed my notes. When I arrived, I walked from the train station to the university, marveling at the impressive porticoes—column-lined sheltered walkways—that the city is famous for. I passed boutique clothing stores and alleys lined with parked mopeds. Statues of the Virgin Mary were scattered everywhere, the city’s Catholic roots in evidence on every corner. The University of Bologna was exactly as I had envisioned it, regal and old-looking. I walked inside the university’s hospital building and called Dr. Fabbri, the biologist, to let her know I’d arrived. (The doctors no longer work together, so I met them in their separate offices.) A few minutes later, she greeted me.
Dr. Fabbri wore a white lab coat, pens sticking out of the breast pocket, and pink glasses on a chain around her neck. Her hair was white-blond and straight, and her skin pale; her eyelashes were coated in blue mascara, and her fingernails were unpolished. I followed her through the bowels of the building to her basement office, near the laboratory she worked in. The drab-colored hallways reminded me of a 1970s locker room. It couldn’t have looked or felt more different from the bright, modern egg freezing clinics I’d visited back home, although this probably shouldn’t have come as a surprise, considering this was a research hospital.
“Sit, sit,” Dr. Fabbri said when we entered her small office. I sat in the chair across from her desk and looked around. Piles of paperwork, lanyards from several conferences, a small wall mirror. Behind her, plastic file organizers were stacked tall. Pops of personality stood out amid the clutter—there was a greeting card with an egg and sperm talking to each other, and her computer’s screensaver was a photo of a bowl of risotto.
We spoke about the worldwide patent she received in 2001 for her novel (pre-vitrification) method for successfully cryopreserving human eggs, and how she started flying to laboratories and symposiums around the world to talk about it. When we got to discussing where the industry was headed, I asked Dr. Fabbri if she thought ovary—as opposed to egg—freezing was the future of fertility preservation. “It’s not the future—it’s now,” she corrected me, then gushed excitedly about a twenty-year clinical study their department had recently published detailing more than one thousand patients who had undergone ovarian tissue cryopreservation and transfer. Ovarian tissue freezing, Dr. Fabbri explained, is the only fertility preservation technique currently available for prepubescent girls and for adult patients for whom freezing eggs isn’t possible. In her opinion, women freezing for non-medical reasons might be better off freezing ovarian tissue than eggs, in part because this isn’t just about eggs and babies, as we’ve seen; it’s also connected to restarting hormone production and postponing menopause. The logic makes sense: Why preserve a dozen cars when you could preserve the entire factory and the ability to make new cars? “If Google decided to cryopreserve the ovary,” she said, meaning if Google paid for its female employees to freeze ovarian tissue the way they do eggs, “everyone, every clinic in the world, would start doing this.”
—
Later that day, I sat on a stone wall in front of the university hospital and waited for Dr. Porcu. It began to rain lightly, a late summer drizzle. Several minutes after the time when we’d arranged to meet, a dark car sped up to the entrance, brushing against a tall stone pillar. I stood up, alarmed. Did that car just hit that pillar? And why is it on the walkway and not the road? I watched as a tall woman dressed all in black emerged from the driver’s side. She stepped around the pillar, which the car was still touching. No way is that Dr. Por—
“Natalia?” the woman half-yelled in my direction, peering over at me.
I slung my bag over my shoulder and began walking toward her. “Dr. Porcu,” I said, extending my hand. She grasped it briefly.
“The rain,” she said, motioning at her car by way of explanation. “Come,” she said, heading for the glass doors. We walked briskly and silently down the first floor’s main hallway. I wondered about her leaving the car on the walkway and touching the pillar.
Dr. Porcu’s office was spacious, with big windows, and when we walked in I was blasted with air-conditioning. “Would you like a chocolate egg?” she asked, offering me a candy wrapped in pink foil. My first thought when I saw Dr. Porcu was how much her looks contrasted with Dr. Fabbri’s. Roughly the same age as her former colleague, in her mid-sixties, Dr. Porcu was tan, with dark curly hair, and wore a long black dress and black shoes. A complete dark vision compared to Dr. Fabbri’s light and bright.
Dr. Porcu sat at her desk while we spoke. Behind her, pinned to a bulletin board, was a picture of herself on a page of a newspaper from October 1999. “It seemed like a miracle because nobody trusted the capacity of human eggs to be fertilized and give rise to a pregnancy,” she said, reflecting on her and Dr. Fabbri’s first frozen-egg birth in 1997. Dr. Fabbri was responsible for the game-changing cryoprotectant solution, and Dr. Porcu had figured out that using ICSI, the method by which doctors inject sperm directly into eggs to fertilize them, was crucial. Dr. Porcu told me about the several interviews she’d given to journalists at the annual ASRM conference shortly after their paper was published and how proud she’d been when fertility doctors from the United States came to Italy to learn the technique. When I asked about her commitment to egg freezing research, she explained it was largely due to the thousands of embryos that were being frozen and abandoned. “I believe that you can make progress in medicine without destroying and involving the root of life in this bad manner,” she said.
—
I had decided I’d take advantage of sitting down with two of the world’s leading egg freezing specialists and ask them both about my particular ovary-and-eggs conundrum. When I told Dr. Fabbri I’d gone back and forth about whether or not to freeze my eggs, she made a face—without trying to hide it—and when I asked why the concerned look, she told me I was young but warned against waiting until my mid- to late thirties to do it. “That’s closer to the dangerous period,” she said, referring to follicles decreasing month by month, “when the decline is more steep.” Dr. Porcu was more blunt. “In your case, you should freeze,” she said matter-of-factly. “Every day, every month, you risk ovarian torsion again. If you got pregnant now, that would be a good thing. But even then, if you are prone to having ovarian torsion, it can happen during pregnancy.”
I didn’t know what I wanted Dr. Porcu to say, but this wasn’t it. Before I could respond, she went on: “Do it here,” she said, in a persuasive tone that struck me as pushy but warm, very Italian. “Save your money and do the procedure in the first and still best place where you can do this.” In Italy, Dr. Porcu explained, a woman can undergo egg freezing for free if she has a medical reason to do so. The government foots the bill. When I reminded her I was not an Italian citizen, she brushed off the concern, telling me it might cost me 5,000 euros or so—a fraction of what egg freezing would cost me in the United States. “In the United States, the prices are crazy,” she said. “Where the money is the main goal, the medicine is bad. Bad for patients and bad for medicine.” She paused, craning her neck to look through the window. “Oh, good, my car is still there.” Sometimes, she explained, university staff removed it when she parked on the walkway in front of the building’s entrance, but today she’d gotten lucky.
I was relieved we’d moved on from the risk of something happening to my ovary during pregnancy—one more item to add to my growing list of ovary-related worries—until Dr. Porcu said, almost as an afterthought: “One ovary left is a risk condition. If you were my daughter, I would do it for you.” I raised my eyebrows in surprise. Without prompting, Dr. Porcu had said more or less the same thing Dr. Noyes had told me when I last saw her—at the last appointment I’d have with her, though I didn’t know it then: If you were my daughter, I’d tell you to freeze. When I mentioned this to Dr. Porcu, she said, “You know that Nicole Noyes learned the technique here.”
By this point, I probably shouldn’t have been so surprised at the way my egg freezing journey had come full circle.
—
The sun was starting to set when I stepped out of the hospital building. I ran to make the train back to Milan, my black flats slippery on the uneven cobblestones. I made it just in time, collapsing into a seat, sweaty and out of breath. I turned to the scenery flying by and pressed my nose against the window. The horizon was a bleeding line of color. It would be months before I connected the dots: that exactly four years earlier, on a similarly warm September day an ocean away, I’d walked into a buzzing room inside a Manhattan hotel and into the future of egg freezing. That was where this journey had begun. Today I had stepped into egg freezing’s beginnings—and, I’d realize a while later, a part of this journey’s end.
A few days later, I flew home. As the plane approached the Rocky Mountains and began to descend, I looked out the window and into a much larger story. I had had a front-row seat to egg freezing’s transformation, both as a young woman pursuing the procedure and as a young reporter writing about the changing landscape of fertility and revolutionary reproductive technologies. I considered the plot twists in my journey, moments that hinged on uncertainty, and the versions of me grappling with this decision. Twenty years old, in the hospital, ovary miraculously saved. Twenty-five, chuckling at the egg freezing ad on the subway, feeling smug with how ahead of the game I was from the moment I stepped into the first egg freezing cocktail party. On the cusp of thirty, single and unsure, the lens now turned inward, as I found myself shining a light on a conviction I’d held my entire life: that I am destined to be a mother.
Most journeys have stages, and this one, it dawned on me now, was no different. First there was confusion, then apprehension and fear, and now a fuzzy sort of acceptance and resolve. It wasn’t time I needed to make the decision about freezing my eggs, I realized. It wasn’t years of reporting or scrutinizing my medical records in my attempt to piece together painful surgeries and the story of what happened to my reproductive system and why. It was this: allowing myself to let the decision go, to know that I could make and unmake this choice countless times and neither answer would be fully right.
Changed Narratives
Back in Colorado, I started dating a man a few years older than I was. He was a filmmaker, clever and complex and a bit contrarian. Deeply sensitive and patient, with a wild mind and a silly irreverent side I adored. A bit self-absorbed, in the way artists can be. He taught me how to rock-climb, surf, and smoke a cigarette. He challenged me, in ways that were a mix of annoyance and frustration leading to growth. We’d talk fervently for hours, about dreams and ambitions, books and music we loved, narrative films we’d make together. The sex was so good that it left us stunned, nearly every time.
Falling in love with the filmmaker felt like traveling together to somewhere that didn’t exist yet. It was a dizzying thrill, like when we were surfing and we’d straddle our boards side by side and watch for the big waves, the ones that made us feel terribly small but the opposite of alone. Sometimes I would look at the filmmaker and know, simply and clearly, that we had something others spent their lives searching for. On a black-sand beach we stumbled upon in Hawaii, in the kitchen of my parents’ mountain house on Thanksgiving, hand in hand on a cobblestone street in Soho, from my surfboard to his out in the deep blue in Baja—a small but powerful swell would make my heart skip a beat, some cosmic force playing the strings of our connection.
Our relationship did not have a clean through line, a sensible narrative arc. He would come and go, leaving Boulder for long stretches in other places, which I didn’t mind until I did. We broke up; we got back together. He waffled about commitment while I swallowed my needs and struggled to be honest about what I wanted. The truth was, I had never felt with anyone the way I did with him. Never felt for anyone what I did for him. But I was afraid to admit that to myself—much less to him, especially when he always had one foot out the door—which made it easy for us both to go all-in with our white-hot chemistry and intellectual kinship but balk in the face of emotional intimacy and doing the real work required to make a relationship last. Despite how much I wanted it to be, feeling complicated and incredibly alive together wasn’t enough. And then there were our differing desires when it came to kids. The filmmaker would make an incredible father, I knew, but he vacillated between saying he didn’t want children and saying he wasn’t sure. A familiar story to many, but new for me, and after some time I reluctantly extricated myself from our exquisite, intense tangle. This time, each of us bolstered by our own sad but real reasons to be walking away, it felt like it was for good.
Love can make you feel both held and free; it does not have to be clamored for and clutched tight to be real. The filmmaker helped me learn that. He also taught me—showed me, rather—that questioning even the things that seem surest can be healthy and helpful. When he and I discussed a future in which we might have kids together, he would sometimes gently challenge my impenetrable “I want children and always have” stance—not because he wanted me to change my mind but because he was genuinely curious about the roots of my conviction. It was, frankly, a great question: How did my lifelong desire to have biological children become the one, and maybe only, thing I have ever known for certain? I didn’t have a thorough, cogent answer; I still don’t. But while examining this in-my-heart certainty hasn’t diminished its potency, it has helped me cling less tightly to my carefully constructed vision of babies and parenthood—and embrace the possibility that, for me, as it has for so many others, motherhood may unfold in any number of unexpected ways.
—
