*10 There are a few different terms used to describe freezing eggs for non-medical reasons: “elective egg freezing” (has insurance implications, best to avoid), “social egg freezing” (makes it sound more fun than it is), and “planned egg freezing” (better than the other two terms, the idea being you’re preserving your fertility now because you plan to have children later). The qualifier isn’t really needed, though, and most people refer to it simply as “egg freezing.”

3 Egg Freezing’s Rise

Mistress of Her Own Body

Brooklyn, 1916. On a bright mid-October day in Brownsville, then a poor and densely populated area of Brooklyn, the country’s first birth control clinic opened its doors at 46 Amboy Street. Margaret Sanger wasn’t sure what to expect and was taken aback when well over a hundred visitors came that opening day.[*1] The pamphlets advertising the clinic were printed in English, Yiddish, and Italian. They read: “Mothers! Can you afford to have a large family? Do you want any more children? If not, why do you have them? Do not kill, do not take life, but prevent. Safe, Harmless Information can be obtained of trained Nurses at 46 Amboy Street.” For the next several days, Sanger worked with her sister Ethel, a nurse, and their friend, an interpreter, distributing information about birth control to more than 450 visitors in all.

Ten days after it opened, local authorities shut the clinic down. Sanger was arrested, charged with disseminating information relating to contraception, and later served thirty days in the Queens County Penitentiary. But her mark had been made, a century-long process begun. The clinic pushed the topic of birth control into public debate, marking a seminal moment for the women’s rights movement and igniting a series of changes in how people regarded contraceptives. Sanger would go on to establish what became the precursor to today’s Planned Parenthood Federation of America.

“Woman can never call herself free until she is mistress of her own body,” Sanger wrote in an essay titled “Morality and Birth Control.” She was one of her generation’s leading female revolutionaries and activists, pushing for structural change and fighting back against repressive policies on contraception and abortion. In a deft show of marketing prowess, Sanger used the term “birth control” instead of “contraception,” to make it sound less draconian. Separating sex from reproduction was a key first step, but there was more to the movement than that. The new term didn’t invoke sexual connotations, declarations of independence, or threats. “Birth” was fine; without birth there could be no life, everyone accepted that. For Sanger, Jonathan Eig writes in his book The Birth of the Pill, “the key word was ‘control.’ If women truly got to control when and how often they gave birth, if they got to control their own bodies, they would hold a kind of power never before imagined.”

For much of history, women had very little say when it came to their bodies—especially in the bedroom. Married women were typically barred from employment, spending countless hours raising children, confined inside houses under the direction of their husbands. Saddled with childbirth and childcare, they had little power or self-determination. Sanger made it her life’s work to see to it that this changed, that women gained autonomy at least over their reproductive lives. But with no reliable methods of birth control available, many women found it difficult to free themselves from being trapped by multiple pregnancies.

They did try. One of the worst examples of the lengths women went to avoid getting pregnant was using Lysol, the harsh cleanser for mopping dirty floors and scrubbing toilets. Women would use it as a douche, and Lysol’s advertisements actually encouraged women to employ the disinfectant as birth control. At one point during the Great Depression, it was the bestselling method of contraception. (No, Lysol is not effective at preventing pregnancy; yes, it is dangerous to use Lysol in this way.) Women experimented with a few other means of contraception, but the big shift didn’t come until the late 1950s, when oral contraceptive pills were first introduced.[*2]

The U.S. Food and Drug Administration (FDA) approved Enovid, the first birth control pill, in 1960.[*3] Since then, hormonal birth control has allowed millions of women to exert control over their fecundity. Still, it was a rocky start. Even though the Pill was available, doctors in many states could not legally prescribe it. The federal government and many states had anti-birth-control laws in place. Before laws were on the books allowing for birth control services, whether or not a woman could legally take birth control was largely determined by her relationship status. In 1965, the Supreme Court deemed the Pill legal for married women. It wasn’t until 1972 that it was ruled legal for all women, regardless of their marital status. Meanwhile, companies had begun to develop and sell various types of IUDs, or intrauterine devices, inserted into the uterus; today’s IUDs are T-shaped devices about the length of a large paper clip, made from flexible plastic and sometimes copper. By the early 1970s, nearly 10 percent of women in the United States using contraception relied on the IUD.

Then came the Dalkon Shield.

During the first few years of the IUDs’ heyday, over two million American women were fitted with this particular IUD—advertised as a safer alternative to the Pill—and it quickly became the most popular one on the market. Then women started getting sick. The Dalkon Shield, it turned out, was defective in detrimental, life-changing ways. Created by a doctor and an engineer, this new IUD—called a shield because it resembled a police officer’s badge—was nearly circular, with five small plastic fins along two opposite sides that secured the device in place in the endometrium (the tissue that lines the uterus). The device’s larger surface area necessitated a more durable tail string compared to the tail strings of other IUDs. The doctor and the engineer identified a string they thought would work well called Supramid, a cable-type suture material made of hundreds of small fibers wrapped by a single sheath. It was the device’s multifilament string that caused bacteria to get trapped in the string and therefore the uterus. Thousands of patients suffered infections, miscarriages, and a host of other significant problems. More than three hundred thousand claims were filed against A. H. Robins Company, the firm that sold the device. After paying billions of dollars in damages, the company filed for bankruptcy protection, and the whole thing became one of the most famous mass personal injury cases on record.

All this resulted in the 1976 mandate that the FDA regulate and approve medical devices, including IUDs. The Dalkon Shield’s serious design flaw was corrected; modern IUDs use monofilament strings, which pose less risk of bacteria traveling into the uterus. But the Dalkon Shield dented the legitimacy and popularity of IUDs in the United States, and its legacy is one reason the Pill has remained so popular for so long. The Pill was incredibly important for women on a personal, day-to-day level, but it was also crucial in changing society. In a word, the Pill offered women agency. It had far-reaching implications for women’s social mobility, marriage choices, and economic independence. It paved the way for droves of them to enter the workforce. It helped make it possible for women to get degrees and climb the corporate ladder without getting fired because of unintended pregnancy. It was effective, it was inexpensive, and it offered women a say over their reproductive capabilities in ways they’d never had before. For that reason in particular, the Pill took the notion of controlling one’s fertility to a whole new level.

—

More and more people are attempting to have children later in life. Across the globe, women and men are increasingly waiting until their mid- to late thirties, and even forties, to start families. One reason we’re putting off having children is that we’re marrying later. From the early 1940s through the early 1970s in the United States, women’s median age at marriage was twenty. Now it’s twenty-eight. Another reason is that women are getting more education and work experience before having children. Women with college degrees are more likely to have a child at age thirty or later than women with lower levels of education. They have children roughly seven years later than women without college degrees, using those years in between to finish school and focus on career goals.

The median age of U.S. women giving birth is now thirty, the highest on record. The average age of first-time mothers has gone up considerably in the past fifty years. In 1972, it was twenty-one. Now it’s twenty-seven. This may seem young, but it’s actually not. And in part because women are waiting longer to have their first child, they’re having fewer children overall. This isn’t a new phenomenon; the number of women who are still childless after age thirty has been steadily trending up since the mid-1970s. Since 1976—around the time IUDs improved and the Pill was deemed legal for all women—the number of women ages thirty to thirty-four who have not yet had a child actually doubled, from about 15 percent to 30 percent of all women in that age group. None of this necessarily means women aren’t choosing to be mothers; in fact, 86 percent of American women are, according to a Pew Research Center analysis of U.S. Census Bureau data.[*4] What it points to is that women are simply having children later. The phenomenon of deferring motherhood has become increasingly common in the United States over the past three decades, as birth rates have declined for women in their twenties and jumped for women in their late thirties and early forties.

The takeaway from all these statistics is that these trends—marrying later and waiting longer to have children—won’t change anytime soon. Money is one reason why: Many women delay pregnancy to hold out for a higher salary. Data compiled by a Census Bureau working paper points to an interesting fact: If women have a baby between ages twenty-five and thirty-five, their earnings take a significant hit. This ten-year window is a significant chunk of a woman’s fertile years. It’s also, of course, prime time to build a career. According to the paper, giving birth during this ten-year span—when a woman’s prime window of fertility largely overlaps with her salary-building years—exacerbates the gender pay gap. American women already earn, on average, only 83 percent of what men earn, and for Black and Hispanic women, this inequity is even greater. If biology had its way, that ten-year window—ending at thirty-five—is the age when all the women who hadn’t started having babies in the previous decade would begin. Yet it makes sense that women want to avoid getting pregnant in this period of their lives, now that they have become a permanent fixture in the workforce. And so they spend this decade leaning into their careers, breaking glass ceilings rather than breaking bread with children they don’t yet want.

Women in professional careers want to delay childbearing but are no less keen to have a child than women who opted not to delay. They delay, in part, because they want a better economic platform from which to launch their families. They wait to have children because they want to avoid what’s been called the “motherhood penalty,” the decline in earnings that I’ve just described that women can expect with each child they have, often locking them into lower incomes throughout the rest of their careers.[*5] Women don’t want to have to choose between a career and children. And so, many don’t.

These overlapping—and to some degree, competing—desires are music to the fertility industry’s ears. Because while American society has been hugely changed by modern contraceptives, the number of years during which a woman’s body can reliably bear children has remained fixed for millennia. It’s all about the eggs, remember? We cannot escape the inconvenient truth: Fertility wanes as a woman gets older. And yet. In 2021, about one in five babies were born to women aged thirty-five and older, and nearly 20 percent of women in the United States today have their first child after age thirty. Also, for nearly forty years, the proportion of American women giving birth in their forties has been on a steady rise.[*6] This, as we’ve established, is not exactly when our bodies would like to be having babies.

On the one hand: a dramatic historical shift when it comes to women having children later in life, coupled with the power of contraception. On the other: the fixed window of time a woman’s body can bear children. So how do we solve this insoluble equation? By finding ways to extend the fertility window with new technology. In the face of these demographic changes, women and men are turning in increasing numbers to assisted reproductive technology (often abbreviated as ART) to help them overcome fertility issues stemming from age and medical conditions. ART is an umbrella term for techniques that involve the handling of eggs and embryos outside a woman’s body to help her become pregnant. Hence the rising demand for medical intervention and fertility treatments for more people than ever before, and the industry that has rushed to meet it, eager to capitalize on a very real biological conundrum: As more aspiring mothers delay childbirth to climb the career ladder or find the right partner, it makes a whole lot of sense that they would also be eager to buy into what egg freezing companies are offering.

For those with sufficient means, ART helps millions of people have biological children who otherwise could not. More than nine million babies have been born from IVF since 1978. The most common ART and one of those most widely available, IVF is now considered mainstream medicine in many countries; in the United States, the number of ART procedures—mostly IVF—has jumped nearly 80 percent since 2015. The technique to unite sperm and eggs outside the body and implant them directly into the womb has been heralded, for good reason, as the most remarkable achievement in fertility to date. On IVF’s heels came egg and embryo freezing, another extraordinary advance in fertility science. As a technology focused on preserving pregnancy potential and being proactive, egg freezing, in particular, is part of this same continuum, revolutionizing how women think about not just their fertility but also their agency and reproductive autonomy.

“If women had the power to control their own bodies, if they had the ability to choose when and whether they got pregnant, what would they want next?” Jonathan Eig writes. In a culture where the optimal time to advance a career and find a life partner coincides directly with the period in which the body is best suited for reproduction, the “what next” may well be the ability to not have to sacrifice one for the other. This is what makes the idea of conquering the biological clock so powerful: that doing so is what will make it possible for women to build their careers and their personal lives when they choose to—as opposed to when their biology dictates. And so as it changes the face of reproductive decision-making, ART is ushering in the second phase of trying to have it all.

I kept thinking about Eig’s provocative question. That clause, the ability to choose when and whether to get pregnant: check. We’re all good there; bless you, birth control. It was the first bit of his question I couldn’t shake: the power to control their own bodies. A sense of foreboding lurks beneath Eig’s premise. To control their own fates, women first needed to keep from getting pregnant; then they needed to be able to preserve their fertility.

Enter Egg Freezing

In medical parlance, egg freezing is known as oocyte cryopreservation. Eggs from a woman’s ovaries are extracted, frozen, and stored on ice. Once extracted, or retrieved, the eggs are exposed to cryoprotectants—a concentrated solution of chemicals that prevents damage to the eggs when they’re being frozen—and then immersed in liquid nitrogen, where they freeze almost instantly. Cryopreservation, the freezing part, halts an egg’s processes of metabolic and genetic deterioration. Using her young eggs, a woman can theoretically carry a baby to term decades beyond the traditional childbearing years. If, after her eggs are retrieved, a woman is ready to get pregnant, her eggs are fertilized with a man’s sperm to make an embryo that’s then implanted in her uterus. That’s IVF. But if she’s not ready to get pregnant, putting her extracted, unfertilized eggs on ice affords her the option to use them if she needs to go through IVF later. Ideally, she freezes in her twenties or early thirties, although most women who freeze their eggs are in their mid- to late thirties.[*7]

The power of egg freezing lies in its potential to change the temporal limits to female fertility and buy time: time for a woman to find the right partner rather than “settle” for someone in order to meet a biological deadline, to pursue a demanding career without having to rule out motherhood later on, to figure out the family structure she wants rather than being at the mercy of fate. These aren’t the only reasons people freeze eggs (more on that in chapter 5), but for the typical young, healthy woman hoping to preserve her fertility, retrieving and storing her eggs will give her some breathing room, as well as a better shot at conceiving with her own eggs—as opposed to donor eggs—when she’s older, if and when she decides to become pregnant. Buying time is the idea, at least; I’ll go into detail about egg freezing success rates in chapter 8. First, though, let’s talk briefly about how egg freezing came to be.

In 1965, after seeing promising results freezing rabbit eggs, University of Chicago gynecologist Dr. James Burks managed to cryopreserve ten human eggs in liquid nitrogen, nine of which survived when he thawed them. While this was technically (and most likely) the first time human eggs were successfully frozen, Dr. Burks is rarely mentioned in what little literature exists on egg freezing’s history. The real story begins in the 1980s, when scientists began experimenting with different methods of freezing and thawing human eggs. In 1986, in Australia, Dr. Christopher Chen reported the world’s first pregnancy—resulting in twins—that used previously frozen human eggs. The birth came on the heels of the first baby born from a frozen embryo two years earlier, in 1984. Different sources say different things about Dr. Chen and his methods, however, and most regard his two successful cases as impressive flukes. His methods were never repeated. Meanwhile, inside a laboratory at the University of Bologna, two female Italian doctors had been quietly working to develop reliable egg freezing technology.

In the late 1980s, Dr. Raffaella Fabbri, a biologist, and Dr. Eleonora Porcu, a fertility doctor, began working together at the university’s Department of Obstetrics and Gynecology. They saw the possibility of freezing eggs as a way around freezing embryos, which troubled the Italian public—and, more importantly, the Roman Catholic Church. An embryo is a fertilized egg, and when all of a woman’s harvested eggs are fertilized in a petri dish, doctors intentionally create more embryos than can be used, to maximize the chances that an embryo made this way will successfully implant in a mother’s uterus (more on embryo attrition rates later on). There are various ethical and personal concerns when it comes to freezing leftover embryos, which often end up getting destroyed. In Italy, Spain, and other parts of Europe, religious belief made many IVF patients uncomfortable about keeping their excess embryos in a freezer indefinitely. The Church had long deemed the practice of freezing embryos immoral. Searching for an alternative, fertility doctors saw egg freezing as a way to avoid flouting the Church’s denunciation of embryo freezing. If IVF patients could freeze their leftover unfertilized eggs, they wouldn’t be forced to waste them; plus, it would be easier to discard unfertilized eggs later on, if necessary.

Fertilizing and freezing gametes (sperm or egg cells) involves fragile and difficult-to-get-right practices. Egg cells, in particular, are extremely delicate. Sperm cells have been successfully frozen since the 1950s, and human embryos since the early 1980s. But eggs, which, tiny as they are, are full of water, proved far trickier. And so despite the few favorable results early on, egg freezing remained a finicky, understudied process with meager survival and fertilization rates. Another challenge in the beginning was that other researchers at the time—and Dr. Chen, specifically—had attempted to reconstruct and reproduce egg freezing experiments but had failed to repeat their initial success.

Seeing an opportunity, the chief of Dr. Porcu and Dr. Fabbri’s lab asked them to keep working on preserving eggs. With his blessing, and without defying the Church’s anti-embryo-freezing stance, the doctors continued their experiments. Vitrification (which I’ll explain in a moment) hadn’t been developed yet, so the two women were figuring out how to improve the slow-freeze method, which relies on the balance between the formation rate of ice crystals and the dehydration rate of cells to prevent ice crystals from forming. The water contained in a human egg is difficult to expel. And egg cells must be sufficiently dehydrated before they’re frozen; otherwise, too much water will cause ice crystals to form, which can rupture cell walls, thereby resulting in genetic damage and making the eggs unusable. The Italian doctors needed to figure out a way to better dehydrate the cell before freezing it. Dr. Fabbri tried adjusting the sucrose concentration in the cryoprotectant—the substance that prevents the formation of ice crystals during the freezing process—and found that increasing the sucrose, which helps draw water out of the cell, as well as exposing the eggs to the cryoprotectant for longer, meant that more frozen eggs made it through the thawing process. Incredibly, survival rates went up to 90 percent.

Another egg freezing obstacle that had stymied scientists was that sperm ordinarily cannot penetrate an egg that has been frozen and thawed. But a new method, called intracytoplasmic sperm injection, or ICSI, in which sperm is injected directly into eggs, had recently been introduced. ICSI is similar to conventional IVF insemination in that, after eggs and sperm are collected from each partner, the eggs are fertilized and, hopefully, become embryos that are transferred to a woman’s uterus and develop into a fetus. But the method of achieving fertilization is different. Conventional insemination entails placing the eggs in direct contact with sperm—mixing them in a petri dish in the laboratory—so that large numbers of sperm can swim around and ultimately one fertilizes the egg; basically the “best sperm wins” dynamic of natural conception. ICSI takes a more hands-on approach: An embryologist uses a needle to inject a single sperm into each egg. Dr. Porcu began experimenting with injecting sperm directly into frozen-then-thawed eggs. In 1997, just a few years after ICSI was developed and after the Italian doctors had been working together for a decade, Dr. Fabbri and Dr. Porcu were the first to report a baby born from a frozen egg using ICSI.

By building on the techniques of other doctors and their own discoveries, the Italian doctors had changed the destiny of egg freezing. The altered cryoprotectant solution and the use of ICSI together had made all the difference, resulting in the first pregnancy of its kind in the world. In 2001, Dr. Fabbri received a worldwide patent for her novel method and solution for cryopreserving human eggs. On the heels of her team’s breakthrough, three further significant developments would kick off the egg freezing revolution.

Game Changer #1: Vitrification

By the early 2000s, scientists managed to conquer the cryoprotectant solution problem, paving the way for bettering the method the Italians had developed that had improved frozen egg survival rates. Technological advances now gave scientists the ability to flash-freeze eggs using vitrification, which made the freezing process more reliable. Until 2003, when it was proven that vitrified eggs could successfully yield live births, the only way to freeze eggs was through slow-freezing, a method that often produced the harmful ice crystals I mentioned earlier. Vitrification, on the other hand, chills the eggs to –196 degrees Celsius in a fraction of a second. The ultra-rapid cooling technique prevents ice crystals from forming more reliably than the Italian doctors’ novel cryoprotectant discovery had. Vitrification significantly improved egg survival and pregnancy rates: Flash-frozen eggs have an 85 to 95 percent survival rate, compared to a 60 to 80 percent survival rate for slow-frozen eggs. The improved technique quickly became a firmly established technology, and is the current cryopreservation method the vast majority of fertility clinics rely on.

Initially, egg freezing was done only for reasons of medical necessity. The first women to take advantage of the Italian doctors’ promising flash-freezing method were cancer patients who froze their eggs as a way to save their fertility before undergoing treatments known to harm reproductive organs and fecundity. Some chemotherapy medications destroy eggs, and eggs are exceedingly sensitive to radiation; both treatments can leave a woman sterile. For a young woman diagnosed with an aggressive form of cancer, the ability to preserve her healthy eggs outside of her body can mean everything. But it didn’t take long for egg freezing to move beyond the “for medical reasons” realm. The possibility of extending the shelf life of one’s eggs was enticing, and before long, healthy women began raising their hands to freeze their eggs.

Game Changer #2: No Longer Experimental

In 2012, the American Society of Reproductive Medicine (ASRM), the fertility industry’s principal professional organization, lifted the “experimental” label on egg freezing. This was a big deal. A big-tent membership organization covering all areas of reproductive biology, ASRM was founded in 1944 by a small group of fertility experts to address the need for more research into infertility and more widely disseminated information on the subject. When the ASRM decided egg freezing should no longer be considered experimental—despite the lack of quality research on the procedure—their declaration raised eyebrows.

ASRM is governed by a rotating board of directors, a group of about twenty MDs and PhDs. Like other multidisciplinary professional associations, ASRM is a long-standing unified forum for debate within its field and wields a lot of influence. Fertility doctors and clinics pay close attention to what it does and does not advise when it comes to the ethics and efficacies of reproductive technologies. So when the organization changed its stance on egg freezing and issued a report to practicing clinicians across the country, the U.S. fertility industry leaned in with perked ears.

More than nine hundred babies had been born from frozen eggs by 2008, the year ASRM labeled the procedure as experimental. With that designation, ASRM approved the use of egg freezing only in clinical trials overseen by an institutional review board. Despite the society’s recommendation, many clinics offered egg freezing outside of this framework, as a clinical service for a fee, without securing informed research consent from patients, which is required for any experimental procedure. Ethically problematic, to be sure, but for at least one subset of egg freezing patients—women with cancer, desperate to preserve their fertility before undergoing chemotherapy or radiation—there wasn’t time for long clinical trials. One reason ASRM wanted to take a fresh look at the process was to make it easier for doctors to freeze the eggs of these cancer patients without the obstacles of informed research consent.

That was all well and fine, but after reviewing nearly one thousand egg freezing studies, the ASRM committee stopped short of giving egg freezing for non-medical reasons the green light. “There are not yet sufficient data to recommend oocyte cryopreservation for the sole purpose of circumventing reproductive aging in healthy women,” the report stated. While early studies on egg freezing proved reassuring—largely due to the improved freezing and thawing techniques—there wasn’t yet enough to go on for women who wanted to freeze their eggs simply to delay childbearing. So ASRM lifted the experimental label, but with a caveat, concluding there were still too many questions about the procedure to warrant its use in women beyond those with cancer and other fertility-threatening medical conditions. Other prominent associations agreed. The American College of Obstetricians and Gynecologists (ACOG) joined ASRM in discouraging egg freezing for non-medical reasons because, in addition to the lack of data and research, too little was known about its personal, social, and scientific ramifications.

When the 2012 report was published, Dr. Samantha Pfeifer, ASRM committee chair at the time, reiterated the committee’s decision: “While a careful review of the literature indicates egg freezing is a valid technique for young women for whom it is medically indicated, we cannot at this time endorse its widespread elective use to delay childbearing,” she said. “This technology may not be appropriate for the older woman who desires to postpone reproduction.” ASRM’s position was clear. But the caveat was quickly downplayed by clinics eager to market this new offering. In the end, removing the experimental label opened the door to a much wider audience.

To some degree at least, ASRM understood the impact that upgrading non-medical egg freezing from experimental to standard would likely have. It certainly knew that many women were interested in this emerging technology, because the association had actually said so in its 2008 report maintaining that egg freezing was not an established medical treatment. The 2012 report, in which ASRM reversed its stance—egg freezing was now an established medical treatment—took its cautionary tone regarding egg freezing’s potential widespread use up a notch, then up again. Scientific advancements such as egg freezing may allow women the opportunity to have biological children later in life, the report said, but “while this technology may appear to be an attractive strategy for this purpose, there are no data on the efficacy of oocyte cryopreservation in this population and for this indication.” And then the committee took it even further with a warning: “Marketing this technology for the purpose of deferring childbearing may give women false hope and encourage women to delay childbearing.”

Game Changer #3: Apple and Facebook

Yet two years after the ASRM decision, in October 2014, Apple and Facebook announced they would help cover the cost of egg freezing for female employees, offering up to $20,000 per person. The news that some of the biggest companies in Silicon Valley were now subsidizing the procedure for women with no known fertility issues as part of their benefits packages immediately set off a controversy, and debate ensued. Employers paying for non-medical egg freezing applies even more pressure on women to keep working while putting their personal lives on the back burner, went one argument. This levels the playing field for women, went another. I followed and joined the debate along with my feminist friends, and considered what such a benefit said about how companies regard young female employees and how we as a country treat mothers. That was a larger and ongoing conversation, I knew, one I was becoming increasingly attuned to as my thirties loomed. But, frankly, I was more interested in the practical, achievable aspects of this new technology, especially since now I no longer felt like such an oddball for seriously considering undergoing egg freezing myself.

While IVF has been around for decades, it was only since the mid-2010s that egg freezing really took off. Of the five hundred or so fertility clinics in the United States, almost all offer egg freezing. At these clinics, between 2009 and 2022, nearly 115,000 women opted to freeze their eggs,[*8] and the number of procedures to freeze eggs quadrupuled between 2015 and 2022. That growth was spurred in part by Apple and Facebook’s announcements, which in turn ushered in the benefit at an increasing number of large companies (more on that in chapter 9).

The night the news broke—spokespeople for both Apple and Facebook told an NBC News reporter about their companies’ new perk—I happened to be at another egg freezing event in New York City. Now that I knew more, and had learned I was a good candidate, I wanted to see how I’d feel about it when I heard the pitch again. It was a cool autumn evening, and inside the Harvard Club, the mood was light and full of intrigue. Women sipped wine and crunched on veggies they’d piled onto cocktail napkins. Again I was several years younger than most of the women in the room. Again I couldn’t help but think of Carrie Bradshaw. I wore my blue-light glasses so that I would look older and not attract as many stares as I had at that first EggBanxx event, the looks that said, You and your young eggs don’t belong here. Drinks in hand, we took our seats under a glistening glass chandelier and listened to doctors sing the praises of egg freezing.

A few days later, I saw my first egg freezing ad on the subway. “To Emma (Age 42). Love Emma (Age 30),” the blue-and-pink poster on the Q train read. “If you are not ready to have a baby, freeze your eggs now and give yourself the gift of time.”[*9] And then I began to notice targeted ads on my social media feeds. One, sponsored by a boutique fertility clinic in Manhattan, featured a pink illustration of a sperm wiggling its way into an ovum. “When you freeze your eggs, you #freezetime,” the ad read. “How often do you get to do that?” The ads, in combination with the celebrity endorsements and new employer-covered fertility preservation perk, shimmered with the illusion of control. That powerful idea: control. Until I saw egg freezing ads on the subway and my Instagram, I wasn’t aware that my fertility—present, future, or otherwise—needed to be controlled. Or that it was something I was supposed to be controlling. And control doesn’t come cheap. The answer to “How much does egg freezing cost?” requires an involved discussion we’ll get to in chapter 9, but the average cost of one egg freezing cycle in the United States is roughly $16,000, which includes the doctor visits, the medications, and the average number of years of egg storage—and most women do more than one cycle. Insurance rarely covers it. Some employers do, as I said, but most women pay for it themselves.[*10]

The Apple and Facebook announcements would prove to be a watershed moment, helping to mainstream both the concept of egg freezing and the conversation around it. Egg freezing, it seemed, was suddenly everywhere. Meanwhile, the confluence of two trends—older parents and increased insurance coverage for IVF—meant that demand for fertility services continued to rise. But questions lurked. What do fertility preservation technologies actually offer women, and what are our fantasies surrounding them? Is egg freezing a genuine help and good investment, or is it merely a bad bet laced with hope? And: how to judge whether or not the potential future upsides are worth the expense, yes, but also the consequential risks—of which there are several, I’d come to learn.

One thing I was crystal clear on after this second egg freezing event was that the pressure to procreate has a timeline and echoes warnings: “Before it’s too late” and the tick-tock, tick-tock of our uteruses. A week or so after the event, I called Barbara Collura, executive director of RESOLVE: The National Infertility Association, a nonprofit advocacy organization, to seek her advice about where to start in my quest to find objective answers about egg freezing. “I wouldn’t even know where to tell you to go to get really great, unbiased information,” she said. “There’s nothing out there for women. You want a third-party, credible source—and not to be tied to somebody who’s trying to sell you on doing this—and it doesn’t exist.” At first, I felt pretty deflated hearing that. But her declaration also stirred in me a quiet defiance to prove her at least partially wrong; surely there was some helpful, scientifically sound information about egg freezing out there for women.

Pros and Cons