Seven hours and a handful of bus transfers later, we arrived in Prestea. I interviewed local men who had scrambled to dig for gold in their communities before the big companies took over, as well as some of their family members whose backyards—their source of food and livelihood—were being destroyed by the bulldozing and mining processes. I jotted down notes, photographed streams degraded by mercury pollution, and awkwardly presented gifts to village elders as a thank-you for allowing me to pepper their community members with questions.

It was my first taste of reporting, dusty and demanding. I had no idea what the rules of journalism were, and yet was fairly certain I was breaking several of them. But at the end of each long day, my brain abuzz and my limbs streaked with dirt, I felt gripped by something I couldn’t quite articulate. After an interview, a bare-chested miner asked me, “Are you going to help tell my story?” And that was it; I was hooked. A breathless eagerness took hold—to probe and uncover, to tell stories that mattered. And to do justice in the retelling, as best I could.

After college, I received a Fulbright scholarship and went to live and teach in Sri Lanka. Two years later, I arrived in New York City to begin graduate school: a master’s program in journalism at NYU. I dreamed of being a foreign correspondent or an investigative reporter, filing pieces from conflict zones or finding a key fact buried in a stack of newly declassified documents. That was where, I was sure, I would find the stories containing truths that were being glossed over or ignored, the narratives that transform how people understand the world.

—

It was during my first month of journalism school that I heard about the EggBanxx party. I had put the idea of egg freezing on the back burner since my doctors’ initial urging that I consider it. But I remained curious. Here was an opportunity to learn more, enjoy a free glass of something bubbly, and maybe meet a source or two I could interview for my introductory reporting class.

It would also be the moment when my reproductive reality began to sink in.

After the swelling on my wound faded away, I kept thinking about how in the eight years between losing one ovary and almost losing the other, I had learned nearly nothing about my body, let alone my chances of giving birth. But as I got older, I found myself worrying about these things more and more. The sense I had about my fertility was that it was clearly fragile, definitely confusing, and probably something I ought to know more about. My surgeries had left me both reeling and vigilant, like a person after a car accident who no longer takes seatbelts for granted. What I’d almost lost mattered—I just wasn’t exactly sure why.

By age twenty, I knew something about ovaries, condoms, and sexually transmitted infections. Add to that the rudiments of menstruation (although I still have questions) and birth control pills (I take mine in the morning). But in fact I possessed a savvy twelve-year-old’s understanding of my reproductive system. As I was growing up, my parents didn’t hide information about bodies or sexuality from my siblings and me, per se, but we sure never sat down to talk about how it all worked. What I learned about sexual anatomy and reproduction in school boiled down to simply this: Do not let sperm get near your egg. That was the message, the most important point. Until I started having sex, I understood the act to be purely mechanical. I do not remember being part of any discussions about sexual pleasure, masturbation, or firmly saying no.

In lieu of straightforward basic anatomy lessons or frank conversations about gender identity and sexual orientation, I took my cues from the media, culture, and my own experience. I learned—and learn still—about my body and sex from my friends; from glossy women’s magazines; from apps on my iPhone; from porn; from movies; and, most fundamentally when I was younger, from my childhood copy of The Care and Keeping of You, the American Girl book about changing bodies. (My copy is inscribed: Easter, 2000. To Natalie, as your body grows and changes. Love, Mom.) In my teens and twenties, I never learned about endometriosis, uterine fibroids, or polycystic ovary syndrome, despite how prevalent these conditions are. No one educated me about hormones or the quality of my eggs. No one explained that a woman’s ability to become pregnant declines considerably in her mid- to late thirties, and that by the time she’s forty-five, fertility is close to zero. No one talked to me about how a woman can ask a doctor to perform diagnostic tests—to check things like her ovarian reserve, the number and quality of her eggs—that may offer a snapshot of her current fertility and possibly a preview of what may or may not be coming down the pipeline.

Maybe it’s silly of me to think that the adults in my life—parents, teachers, others—would have had some idea about these things. Maybe most of us are pretty much in the dark. It was only because of my emergency surgery at age twenty that I was forced to confront reproductive health issues earlier than most of my peers did. And while my sole ovary makes me physiologically different from them, I am otherwise quite similar; the unrelated ovarian cysts I developed at age twelve and age twenty can happen to anyone. I have one healthy ovary with eggs inside it, and that’s all I should need. Ovaries and kidneys are similar in this way: You can get by with just one. Now, my twenties barely behind me, I’ve learned so much at this point in my research that I only now realize how much there is to know.

What has finally dawned on me is that until I started investigating fertility—my own and everyone else’s—I had been living in a vast bubble of ignorance and silence. So had almost all of my friends; so had millions of young women in the United States and across the world. It’s a bubble in which too many women simply deal with their bodies instead of understanding them. This is true regardless of race, class, or education level. We lack essential information regarding our inner workings. We take our reproductive health and fertility for granted—because no one has taught us that we shouldn’t. Putting off getting pregnant is an article of faith, a badge of honor for nearly all the young, ambitious women I know. For many of us, from when our periods first begin until our thirties or even forties, pregnancy is something to avoid. We will not be solely defined by our ability to bear children, we declare. As women of a certain generation, we grew up knowing we can have careers and families. We can marry our true loves. We can play just as hard as the boys. To do so means many of us decide we won’t get pregnant and settle down at twenty-five, or thirty-two, or thirty-eight. Children can wait—until we’re ready.

Control on Ice

I became a journalist thinking I would find the stories that most needed telling in remote, shadowy corners of the world. Instead, much to my surprise, I realized there was a big story right under my nose—and inside me, as well as many other women. Turns out eggs have stories that need to be told, too.

The more I realized how ignorant I was about my fertility, the more determined I became to investigate it. In the days following the EggBanxx party, I kept thinking about all those women a decade or two older than me who were still seeking answers to fundamental questions. I kept thinking about my remaining ovary, too, and it dawned on me that almost losing it was a wake-up call I didn’t know I needed. It set me on a path to educate myself about the particulars of my body and the basics, and to get real about my possibly diminished odds of having biological children. That I wanted kids—had always known I did, cannot remember not having this fierce desire—was another reason I became so invested in learning more about fertility. As a young woman with one ovary, and all this on my mind, I came to realize that I had a monumental personal decision to make: Should I freeze my eggs? How did it work—and did it always work? Was it safe, not just for me but for women around the world, allowing us to give birth later than we’d ever imagined? Or was it a half-assured medical treatment, marketed like a cosmetic surgery or the newest fancy tech product, shiny with ease and convenience but with little regard to potential downsides?

As a journalist, I was intrigued by egg freezing’s rapid growth. By all accounts, official and empirical, more women than ever are freezing their eggs. In 2009, a mere 482 healthy women in the United States froze their eggs. In 2022,[*1] 22,967 did. That’s more than a 4,000 percent increase in just over a decade.[*2] Today, the International Federation of Fertility Societies calls cryopreservation “one of the most significant recent advancements in assisted reproduction technology.” And yet, ten years ago, it was a phrase about which most people furrowed their brows, maybe for sounding like a dystopian movie; if it was talked about at all, it was in a doctor’s office or in low murmurs with a friend over coffee, not at happy hour with co-workers or across the internet, as it’s being discussed today. Now, having shed almost all of the stigma it once had, egg freezing has exploded into our vernacular.

Across social media, in magazines, on the subway, it’s difficult to escape the feminist-friendly, direct-to-consumer marketing of the fertility tech industry, from Instagram ads recruiting egg donors to group discounts encouraging “freezing with friends” to the wildly popular #EggFreezing on TikTok, where many young users extol the virtues of freezing their eggs while in their biological “prime.” Fertility technology has provided plot points for television shows, documentaries, podcast episodes, and special reports from nearly every major streaming service and media outlet. And it’s next to impossible these days to read the news or scroll a screen without seeing a headline or post related to reproduction, parenthood, or babies.

Celebrities like Rebel Wilson, Priyanka Chopra, and Chrissy Teigen have spoken openly, and enthusiastically, about their decisions to freeze eggs. Others, such as Jennifer Aniston, lament not doing so: “I would’ve given anything if someone had said to me, ‘Freeze your eggs. Do yourself a favor,’ ” the actor told Allure, speaking publicly for the first time about her fertility struggles and years spent trying to get pregnant. Teigen and husband, John Legend, have four children who were conceived with her frozen eggs, one of whom was born from a surrogate pregnancy. Barbara Bush, daughter of George W. Bush and Laura Bush, froze her eggs and was prepared to become a single mother before meeting and marrying her husband. Amy Schumer shared a picture of her bruised stomach as she took hormone shots before freezing her eggs. Kourtney Kardashian went so far as to film her egg freezing preparation on Keeping Up with the Kardashians. The singer Halsey froze her eggs at age twenty-three after undergoing multiple surgeries to treat endometriosis. Actor Olivia Munn revealed on Anna Faris’s podcast that she’d frozen her eggs before she turned thirty-five. “Every girl should do it,” she said confidently. When Céline Dion was forty-two, she gave birth to twin sons using embryos she had kept frozen for eight years.

Advances in reproductive medicine have fundamentally altered how people approach partnership and if, when, and how to start families. The changed way of thinking is at once personal—young women today use our phone apps to date, to track our periods, to order our birth control—and cultural. A slew of social, economic, legal, and political forces together form the larger environment within which fertility technologies such as egg freezing are developed and used. Then there are people like Stanford bioethicist Henry Greely, who predicts that in the next twenty to forty years, people with good healthcare coverage will no longer rely on sex to have babies; instead, most children will be conceived in labs. How and why that world will arrive is a broader and different conversation, but the technological innovations—particularly concerning stem cell therapies—matter in consequential ways, too. They may not dictate our behavior, but they do influence it. Like egg freezing, they can’t be ignored.

To talk about egg freezing, I learned, is to talk about a woman’s place in the world, her hopes and values, her grappling with her body, age, relationships. When it comes down to it, egg freezing is an incredibly personal decision. You have your own perspectives, goals, and limited timeframe. Your fertility is affected by so many variables, a few of which are unique to you, others not. And so it is for the scores of individuals who graciously shared their stories with me about their fertility, sexual health, and reproductive lives, who most inform these pages. Among them were dozens of women—three of whom I’ll focus on in detail—struggling to make important decisions about their fertility. Their experiences, along with my own, I discovered, are the best way to tell this story.

Remy,[*3] in her mid-thirties, is an anesthesia resident in Nashville. Remy is determined to take charge of her fertility, despite having considerable medical school loans, credit card debt, and a love life that’s not gone according to plan. Egg freezing is her answer to ensure that nothing gets in the way of her carefully designed future.

Mandy, in her early thirties, is a recently married young professional in the San Francisco Bay Area who, like me, is considering freezing her eggs for medical reasons. She’s frustrated by the lack of quality information she can find on the topic. This big, costly decision is beginning to feel to her like a ticking time bomb, and while she isn’t sure if she wants to be a mother someday, she knows she wants to preserve the option of having biological kids if she can.

And Lauren, an entrepreneur living in Houston, froze her eggs two days before her thirty-ninth birthday. After her efforts to preserve her fertility take a scary turn, freezing her eggs ends up changing her life in a way she never could have imagined.

—

What I did not expect: that my quest to decide whether or not to freeze my own eggs would grow into a reckoning about trying to control virtually every component of my life. I realize now that the constant pressure to manage my body and my potential to have babies is deeply intertwined with society’s expectations, and my experience, of being a woman. So is the inclination to worry and try to have it all figured out. As I contended with big decisions about love and work, about my body and my reproductive future, I considered the fact that my generation has many opportunities that our parents and older generations didn’t have. That’s a blessing and a curse. For all the choices many of us are so fortunate to have, we are overwhelmed by too much information, often of the wrong sort. Our lack of basic knowledge about our reproductive health and the realities of fertility is just one example, but it’s a big one. It doesn’t help that most of the quality information out there is reserved for older women struggling with infertility and couples having trouble conceiving naturally.

The problem here is the overwhelming absence of resources for the young woman who has no known fertility issues—at least, not yet—but who, as we’ll see, is part of a global trend of women having children later in life and, as a result, increasingly struggling with age-related fertility decline; for the young woman who wants to understand the options, technologies, and paths available to her before her long-term partner informs her they never want kids, or a preexisting medical issue compromises her fecundity, or she’s (all of a sudden, it feels like) in her mid-thirties, when doctors start applying terms like “geriatric pregnancy” and “advanced maternal age”; for the young woman who realizes that the rudimentary education she’s received about her reproductive system isn’t going to cut it. I set out to write a book for that young woman—in part because I was that young woman. I wanted to write the book I wish I’d had when that scar was still fresh, back when I was twenty.

If I was going to face tough choices concerning my fertility and potential parenthood, I’d better try to understand what lay in my future, as best I could. If I was to be informed about my body, I needed to figure out what essentials I’d missed en route. If I was to be prepared to make smart decisions about the fundamentals, I had to identify the gatekeepers who were coming between me and my uterus. And along the way, I wanted to get to the bottom of why I had learned so little—and how to make up for it.

To start, though: What to do about my eggs? If my doctors suggested I think about freezing them, then the first thing I needed to do was get the image of a carton of brown, farm-fresh eggs out of my mind.

Skip Notes

*1 This is the latest year for which official data is available as of this writing. Preliminary 2022 egg freezing data came out in 2024. There’s typically a two-year lag when it comes to compiling assisted reproductive technology statistics. For further explanation, see the Notes section at the back of this book.

*2 And that’s just in the United States. The United Kingdom has also seen record numbers of women freezing their eggs in recent years.

*3 Name has been changed.

2 An Intimate Geography

“What’s a Cervix?”

Vera Lloyd stood before several dozen ninth-graders in a small high school gymnasium in northern Virginia. A petite woman with gray-streaked short black hair, Vera, a public health nurse, was wearing a pastel-colored blouse and summery sandals. She’d be turning sixty soon, and had worked in and around Stafford County for almost twenty years. A few feet away, Vera’s longtime colleague Vanessa Akin arranged condoms and packs of birth control pills on a folding table.

A Monday morning in May. First period. In the wrestling room next to the gymnasium at a high school about forty miles south of Washington, D.C., boys and girls sprawled across blue mats. Under the fluorescent lights, several of the teenagers stifled yawns, still waking up; one boy, wearing athletic shorts and bright white sneakers, was fully asleep, his limbs stretched out on the ground not far from where Vera stood. The students sat in small clumps or alone; a few had their backs against the walls and arms crossed over their chests, cool-kid style. I was sitting in on Vera and Vanessa’s presentations because I’d wanted to observe a modern-day sex ed class, theoretically one of the places we begin to learn about our bodies. Today was the first day of the school’s two-week curriculum on the subject. At the moment, Vera was holding a plastic speculum and talking about pap smears. There was a click, click as the speculum widened. Several girls gasped, horrified that the object in Vera’s hands—or any object, for that matter—functioned to hold open a vagina. “Oh my God,” a girl with French braids whispered, covering her face with a lime-green folder. Raising her voice over the sound of bouncing basketballs from gym class next door, Vera asked if there were any questions. A student wearing a yellow shirt that read Girls do it better raised her hand. “What should you do if you think a tampon has gotten lost in your cervix?” Several students giggled. A girl sitting near me turned to her friend and murmured, “What’s a cervix?”

The nurses delivered their presentation in two parts, as they had for every year they’d taught together. Vanessa kicked things off with methods of birth control; Vera followed with a graphic slide presentation about sexually transmitted infections, or STIs. They’d brought their usual props, which were always a hit. When Vera described bacterial vaginosis, a condition that occurs when there is too much of certain bacteria in the vagina, she held up a pink thong—“Ladies,” she said, in a well-practiced presentation voice, “this is not underwear”—and explained how its narrow piece of fabric acts as a connector of microbes, making it easy for bacteria to travel from the wearer’s rear to her vagina. During her bit about the vagina being more or less a self-cleaning oven, Vera motioned disapprovingly to a pack of scented Summer’s Eve feminine cleansing wipes on the nearby table, emphasizing that vaginas should not smell like peaches and cream. She sounded a bit exasperated, and I wondered if all her presentations began this way, with subtle myth-busting about thongs, fragrant wipes, and other items familiar to high school girls.

Vanessa’s visual aids were funny-looking—a few looked like products one might find at Target, others not—and almost all pink. Students craned their necks to see better. “Sperm poison,” Vanessa announced, holding up tubes and containers of foams, creams, and jellies. Next, a female diaphragm and a pack of birth control pills. When Vanessa held up a female condom, no one—including me—seemed to know what it was.

“Now, guys,” Vanessa said, picking up a familiar-looking box of Durex male condoms, “what’s your complaint about wearing one of these?” Several students snickered. Vanessa didn’t wait for an answer before addressing the girls. “Don’t listen to any boy who tells you the condom won’t fit,” she said. She removed a condom from its wrapper and, arms above her head, stretched the latex between her hands until it was longer than a ruler. The students roared with laughter. “If he wants to feel better about himself and go buy a big-man giant-size condom, he can,” she said, stretching the condom wider, “but regular ones like this will fit him, I promise.”

Vera, sitting on a folding chair next to me, looked up from the Getting Ready to Retire pamphlet she was reading. “The things you have to say,” she sighed, shaking her head.

—

The way sex education is taught in schools in modern-day America is, in short, a mess. The reasons for this are more or less the same as they were a century ago, when sex ed started: Whose values are the right ones to teach to adolescents, and who should make that decision? In his book Too Hot to Handle: A Global History of Sex Education, Jonathan Zimmerman, an NYU history and education professor, explains that since sex ed was introduced in schools in the first few decades of the twentieth century, critics have condemned it for fostering the same promiscuity it purported to control. Predictably, the debate rages on in an ideologically divided America, where fights about parental, local, and federal control over education dominate public discourse. Across the country, local politics and beliefs dictate the substance and style of a school district’s sex ed curriculum. The vast majority of such programs in the United States are abstinence-based or abstinence-only, as opposed to evidence-based and comprehensive. Abstinence-based programs, sometimes called “sexual risk avoidance” programs, promote abstinence until marriage and belabor contraception failure rates—if they cover contraception at all. In more than half the country, school districts aren’t required to go over methods of birth control. But the fact is, there is little evidence that providing accurate information in an appropriate context increases sexual activity. On the contrary: Research shows that comprehensive sex education reduces rates of teen births and risky sexual behaviors, as well as a child’s risk of being sexually abused.

After my first surgery at age twelve, I partially listened when a doctor explained why he had removed my ovary and fallopian tube, body parts I vaguely remembered from fifth-grade health class. (It was sex ed but had an innocuous name: Family Life Education, or FLE.) Later, after the doctor left the room, I asked my mother what those organs did. It was out of embarrassment, and not because I already knew, that I didn’t ask her the same question when I almost lost my second ovary at the age of twenty. Was I exceptionally ignorant? Young women are generally expected to know how to handle menstruation, prevent pregnancy, perform breast self-exams—but do they actually know anything about fertility? If they, like me, hadn’t received much or adequate sex ed in the many more school years that followed fifth-grade FLE class, the answer was probably not. As it turns out, my experience was completely typical. As of 2023, only twenty-five states and the District of Columbia mandate that schools teach both sex education and HIV education. Most states allow parents to opt out on behalf of their children. And I was shocked to learn that only seventeen states require information presented in sex education classes to be medically accurate.

So, what does sex ed cover in the states where it is taught? Many of the classes taught in middle and high schools limit discussions of puberty to the bare-bones basics: periods and unwanted pregnancy, erections and ejaculation. The classes require students to identify the parts of the female and male reproductive systems, but they tend to stick with a woman’s internal parts—uterus, ovaries, vagina—while skipping the external parts, as if the vulva,[*1] labia,[*2] and clitoris[*3] don’t exist. Important topics such as fertility fundamentals and how to resist unwanted sexual pressure are rarely covered. Female pleasure or any indication of it is almost always a taboo subject. And when it comes to birth control, well, the research shows that young people are less likely to receive information about birth control now than they were twenty-five years ago. This should have shocked me, but by that point I’d already learned too much about the dismal state of sex ed in the United States for it to be surprising.

“It was as if we were being given documents about our bodies but with all the important info redacted,” writes Katie Wheeler, reflecting on her sex ed experiences in The Lily, a publication for millennial women put out by The Washington Post. States differ when it comes to mandating what is to be taught in public school sex ed classes and when, and many high schools and middle schools don’t teach the sexual health topics that the U.S. Centers for Disease Control and Prevention (CDC) considers essential for healthy young people. Fewer than half of adolescents receive sex education that meets the minimum standards articulated by national standards.

It’s worse for teens in rural areas than for those in more urban communities. For example, sex ed teachers at schools in Mississippi are barred from demonstrating the proper use of condoms and other contraceptives. Texas requires that education materials for students under the age of eighteen must state that “homosexual conduct is not an acceptable lifestyle and is a criminal offense.” In Tennessee, a bill known as the “Gateway Law”—added years ago to the state’s abstinence-only curriculum—prohibits sex ed courses from including instruction on “gateway sexual activity” that encourages youth to engage in “non-abstinent behavior”; educators who fail to comply can face punitive measures. “Kissing and hugging are the last stop before reaching Groin Central Station, so it’s important to ban all the things that lead to the things that lead to sex,” former Tennessee governor Bill Haslam, who signed the bill, said on the TV show The Colbert Report.

The kicker is that in most states, school districts have the power to adopt and censor aspects of sex ed as they see fit. Only ten states require that sex ed curricula provide instruction that isn’t biased against any race, sex, or ethnicity, while a handful of states explicitly require instruction that discriminates against LGBTQ+ people. In many states, such as Virginia, local control over sex education makes it easy for schools to demand that nurses like Vera stick to a restrictive and harmful sex ed curriculum—which is particularly detrimental to sexual and gender minority youth. “They won’t let us talk about homosexuality,” Vera told me. “They won’t let us talk about abortion.” If the students bring up these topics in a group setting, she added, “we have to deflect.”

Back in the high school wrestling room, Vera’s STI curriculum amounted to a slide show consisting of pictures of diseased genitals. I reacted the same way the students did—the images were horrifying. Upon seeing a chlamydia-infected penis on the screen, one boy yelped and yanked the hood of his sweatshirt over his face. “Pushing pus out of a penis is very painful,” Vera said matter-of-factly, clicking to the next slide, a picture of a baby born with gonorrhea-infected eyes. The entire room, including the P.E. teachers sitting against the back wall, gasped. I waited for Vera to pair some of the graphic photos with a few of the equally alarming statistics about STIs in the United States—that people ages fifteen to twenty-four account for nearly half of the twenty-six million new cases of STIs each year, for example, or that on any given day one in five people in the United States has an STI—but they went unmentioned.

“When you have sex,” Vera said at one point, “you either get a baby, a disease, or both.” Several students giggled, but I raised my eyebrows. It didn’t sound as if she were making a joke. I thought of Coach Carr’s infamous line in the movie Mean Girls: “Don’t have sex. Because you will get pregnant. AND DIE.” As in the movie, the shock-and-awe effect aimed at the students around me was clearly intentional. While Vera and Vanessa at times quite rightly leaned on humor to communicate their sex ed points effectively, their message was heavy on warnings and scare tactics. The terrified looks on the students’ faces spoke volumes. I couldn’t help but feel that that morning’s presentation, despite Vera and Vanessa’s best intentions—and the maddening fact that they weren’t allowed to say more on certain topics—might leave these teenagers feeling insecure and confused about their bodies and sex instead of informed and empowered.

“There still seems to be a combination of prudishness and ignorance around the unique, and sometimes idiosyncratic, functions of the female body—which is shocking, considering half the world is born with one,” writes Jenna Wortham in The New York Times Magazine. The opacity surrounding women’s health is not a modern malady. Nor is the prudishness. The history of neglecting to teach women the basic scientific principles of their reproductive biology and sex anatomy is a problem rooted in earlier times and still hanging on. In most sex ed lessons decades ago, and still today, young women are taught that their bodies can and will create life. “Your body is a miracle,” the refrain goes, a comforting platitude offered as a balm to the scary STI stories and rushed reproduction overview. It sounds nice, but the fact is that our collective, modern-day ignorance is partly due to the religious underpinnings of sex ed policies. The two seemingly can’t be untangled. And appropriate separation between church and state as it applies to sex ed is definitely not around the corner.