Late one October evening in my Brooklyn apartment, I sat cross-legged in bed, eating salad out of a Tupperware container. It was my third semester of graduate school. A string of delicate paper-lantern lights bordered shelves brimming with books. On my bedside table, a scented candle burned. My journal lay open in my lap. I needed to clarify some basics; lists are good for that. I flipped to a blank page and scribbled: What egg freezing is:

A back-up plan

Hope and peace of mind—I think?

Promising technology; keeps getting better over time

Supported by lots of big companies

A very good option for many women What egg freezing is not:

An insurance policy—right?

Risk-free

Inexpensive

A guaranteed way to prevent my fertility from fading

A very good option for many women

I studied the lists. I finished my salad. On my desk lay a faded, two-pocket folder labeled “Surgeries.” Tucked inside were medical records, copies of doctor’s notes, pamphlets on egg freezing, and a handful of Polaroid-sized pictures of my ovary. From my perch in bed, I reached for the folder and lifted a recent ultrasound image from one of the pockets. I held it up to the light. In the narrow white space beneath the fuzzy picture, I had written: Just me and my ovary, giving this all we’ve got.

I sat wrapped in a patchwork quilt I had made out of T-shirts I’d collected as a child and teenager. Running my hand across the soft cotton squares, I smiled, recalling nicknames and jersey numbers, celebrations and milestones. When it comes to having children and being a parent, I am drawn to the ineffable mystery of motherhood, the seductive veneer that nothing has been able to penetrate—at least for me, and, I believe, for many women—despite how much and how fervently motherhood and all it entails is discussed and picked apart in our culture. My mother’s experiences being pregnant and giving birth have a lot to do with my romanticizing early motherhood. She talks about it in a way she doesn’t talk about anything else—not her decorated career as a U.S. Army officer and government lawyer; not the few dozen countries she’s visited; not even her forty-five-year-long marriage to my father. She has also made giving birth sound easy and joyful (yes, really). My mother is not a martyr, nor does she have an unusually high tolerance for pain. But she did birth three babies, all without epidurals, IVs, or pain meds—not even Tylenol. (She wasn’t opposed to medical intervention had something gone wrong; she just hadn’t needed it.) And when she talks of nursing my siblings and me, her normally rapid-fire voice slows and she sighs in satisfaction, in reverence, as if she’s sharing a secret about some magical land she once visited. “Breastfeeding my babies is the single most satisfying and wonderful experience of my life,” my mother has told me more than once. She says it triumphantly and I believe her completely.

Perhaps the in-my-heart certainty is a seed watered by my mother’s stories. I am her firstborn daughter. It would not be until years later, when my friends began having kids, that I would come to realize that, for many women, pregnancy is not easy or joyful, epidurals are a polarizing topic, and breastfeeding is not something that all women love or even want to do. Even so, where my mother’s tales of pregnancy and childbirth left off, I want mine to begin. Of course, I have no way of knowing if I will one day have the unmedicated, low-intervention birth experiences she did, but I can’t help but imagine I might. And, also like her, I want to have children with a person I love and am committed to. I have always wanted this. I have always planned on it.

A few weeks before that list-making night in my apartment, I’d returned home after being out of town for my brother’s wedding. I took the subway from the airport and by the time I arrived at my street it was quite late. I pulled my purple suitcase along the sidewalk and wondered how many times I’d done this exact thing, returning home alone after a trip. A fierce loneliness took hold. As I walked, I felt as if a hole in my heart was growing bigger, block by block. Inside my empty apartment, I unpacked, made a ham sandwich, stood at the kitchen island, and cried. Then I shook my head hard, as if to fling off the sobs. Stop it, I berated myself. You’ve lived on four continents and traveled all over the world. You’re close with your family. You’re earning a master’s degree from one of the top journalism programs in the country. My life was full—but I felt deeply alone. I wanted to lug my suitcase next to someone else lugging theirs, then climb the stairs to my fifth-floor walk-up together. I wanted to make this ham sandwich for someone else.

My last serious relationship had ended two years earlier. I hadn’t had much time or energy to devote to thinking about a new one since moving to New York, but now that I was feeling settled, I was ready to not be single anymore. I wasn’t yet facing the intense time pressures I knew single women in their thirties often feel, and I wasn’t old enough to worry about the expiration of my fertility. But my missing ovary was beginning to haunt me, saying otherwise. It used to remind me of painful surgeries and hospital stays; now it reminded me of too-close calls and the quiet ticking of my biological clock, of egg freezing and my forever desire to have a family.

A few months before the Apple and Facebook news broke, Bloomberg Businessweek reported: “Not since the birth control pill has a medical technology had such potential to change family and career planning.” The questions were coming faster now: Was egg freezing really the next revolution for women’s reproductive lives? Did it give women real agency, or just the illusion of it? Would I be among a generation of women buying into a grand experiment? As I sat on my bed that night, I realized I was almost certain I wanted to freeze my eggs. But I needed to do something about all these questions and figure out why egg freezing was being so readily and widely embraced and if in fact it was, or could be, as good as it sounded. To better understand the nuts and bolts of egg freezing, I decided, I needed to go back to the science, and lay out all the facts and implications as best I could.

That sounded like a lot of work. And many more lists.

Maybe there was a better place to start.

Maybe I could find someone who had decided to do it.

Skip Notes

*1 Before I tell you more about this part of Sanger’s story, it must be acknowledged that Sanger believed in eugenics—an inherently racist and ableist ideology that labeled certain people unfit to have children—which undermined her movement for reproductive freedom and caused harm to many people. It’s one of many awful examples of how the fight for reproductive rights in the United States has also been marked by an ugly alliance with the eugenics movement.

*2 Prior to FDA approval, when promoting birth control was still illegal in many states, oral contraceptives were prescribed to treat menstrual issues.

*3 In the mid-1950s, Enovid clinical trials were conducted on more than two hundred women living in a housing project in Puerto Rico. The women were not told that the Pill was experimental or that there was a chance of potentially dangerous side effects. Nor were they told that they were taking part in a clinical trial, which was being run by biologist Gregory Pincus and gynecologist John Rock. Three women died, and their deaths were not investigated.

*4 I was glad to see that the Pew report notes that its use of the term “mother” “refers to any woman who has ever given birth, even though many women who do not bear their own children are indeed mothers.”

*5 As a 2023 CDC report noted, “Having a first child at older ages has been associated with a positive impact on women’s wages and career paths, in addition to having a positive impact on their children because they are more likely to have parents with greater family and economic stability.”

*6 The New York Times noted that the rise “subsided in 2020 with the pandemic, when the overall birth rate in the U.S. dipped, but the rate among women in their late forties grew.”

*7 Also, though, increasing numbers of young women under the age of twenty-five—Gen Z women—are opting to freeze their eggs. “The average age of my egg freezing patients is rapidly declining every year,” Dr. Serena Chen, the fertility doctor who spoke at the first EggBanxx party I attended, told Vice in 2023.

*8 As of this writing, the actual number to date of women in the United States who have electively undergone egg freezing is likely closer to 150,000. More on this in chapter 8.

*9 These newer, more upbeat ads have replaced those plastered on buses in major U.S. cities since the early 2000s, like the one featuring an image of a baby bottle shaped like an hourglass, running out of milk.

*10 This is a huge health equity issue. More on this in chapter 9.

4 Hacking Our Hormones

Remy: Egg Freezing Orientation

A little after eight o’clock on a cool Nashville morning, Remy opened the door to her apartment and headed straight to the bedroom. She fell face-first onto her bed, too tired to peel off her scrubs. Sophie, her cat, padded in to greet her. Remy lay on the soft white duvet for a few minutes, eyes closed, hoping to nap. But her racing mind wouldn’t let her. Get up and get it together, she told herself. Her appointment at the fertility clinic was in a couple of hours; she needed to be alert. Just wash your face, brush your teeth, let’s go, let’s go. She took a deep breath and pushed her tall, lean frame to a seated position on the bed.

An anesthesia resident at Vanderbilt University Medical Center, Remy was used to crawling into bed when most people were beginning their days. Night shifts bled into days spent sleeping; weekends were indistinguishable from the Monday-to-Friday hustle. She didn’t mind the relentless routine, really—life was busy, and good—but she found she especially looked forward to her appointments at the fertility clinic, where she would soon be freezing her eggs. The visits reminded her of the future—of her future, and what it held. There’s so much more to come, she thought often.

Remy had made the decision to freeze her eggs a couple of months earlier, shortly after her birthday. Thirty-three had long felt symbolic to her. Unabashedly superstitious, Remy had always imagined having kids at this age. This year of medical residency was going to be her year for children. But things in the love department hadn’t exactly gone as planned, and so now thirty-three was her year for egg freezing.

A broken engagement when she was twenty-five and in medical school. Then: a new flame, a whirlwind romance, a hasty wedding, a brief marriage, and divorce—all before she finished residency. When Remy’s personal life got derailed, she couldn’t help but feel she had somehow fallen behind. She hadn’t thought she’d be single at thirty-three, and she definitely hadn’t expected to have a broken engagement and a divorce under her belt by then—or ever. What she did have was the career of her dreams and an unshakable belief in doing whatever she could to secure the future children—future family—that felt more important to her than anything else.

And egg freezing was the way to do it.

Remy exchanged her scrubs for a long-sleeved denim shirt and faded tan jeans. She looked around for her tall leather lace-up boots, tucked in a corner next to a stuffed brown bear she’d had since childhood. She glanced at her Apple watch. Just enough time to stop for a smoked rosemary latte at her favorite coffee shop before driving south to the clinic.

It was a damp morning in February, the sky a deep gray. Nashville traffic was a pain, and Remy arrived with hardly any time to spare. The clinic’s waiting room was drab. Beige walls, beige carpet, fluorescent lights. Monochrome portraits of babies hung on the wall. Two couples sat waiting to be seen. Remy walked purposefully to the receptionist’s desk and offered a warm hello. The woman smiled brightly, remembering her, and presented a clipboard of forms in exchange for Remy’s credit card.

Checked in, Remy settled into one of the stiff chairs. She rubbed her eyes, feeling tired but calm. She had been too busy at work to overthink today’s appointment, a two-hour session about the hormone shots that were the prelude to her egg retrieval and freezing. For the past month, Remy had been treating pregnant women, her schedule a whirlwind of epidurals and C-sections. Some overnight shifts were so busy she didn’t stop to eat or rest. But she was thrilled to be on OB/GYN clinical rotation this month, of all months; her workdays felt rich with meaning and connectedness. She prepped patients who were about to give birth while her brain buzzed with egg freezing plans and the babies she hoped—she knew—her frozen eggs would someday yield. She closed her eyes and concentrated on turning off her doctor brain and switching to the patient mindset. Here at the clinic, most of the staff didn’t know she was an anesthesiologist, and Remy preferred it that way. She could sit back and be the one taken care of. Here, she was just another woman preserving her fertility.

At her first egg freezing appointment a few weeks earlier, Remy had met the reproductive endocrinologist who would do her egg retrieval. Dr. Ruth Lewis[*1] had walked Remy through the process, the research, some of the risks. She wasn’t particularly warm and fuzzy, but Remy trusted her no-nonsense demeanor immediately. Dr. Lewis explained that she typically didn’t see women having difficulties with fertility until after age thirty-six. Remy was three years shy of that, but she already felt she was losing precious time while she waited to develop the relationship she wanted, to be able to have children with the right person. Or to decide to become a solo parent, a possibility she’d been considering. All her clocks were ticking.

In an exam room, Dr. Lewis had Remy’s blood drawn to test her hormone levels and looked at Remy’s ovaries via transvaginal ultrasound. When her follicles, the fluid-filled sacs containing egg cells, appeared on the monitor, Dr. Lewis counted them: eight follicles on the right ovary, thirteen on the left. Dr. Lewis told Remy she was remarkably healthy, with a good supply of eggs. She was unlikely to face issues conceiving if she tried to get pregnant in the next few years. She understood Remy’s desire for the peace of mind that can come with preserving eggs at an optimal age. But having found no red flags in terms of Remy’s current fertility, Dr. Lewis had told her she might want to reconsider egg freezing, save her money instead. Remy appreciated the doctor’s straightforward way of laying it all out. But she was already committed to freezing her eggs and told Dr. Lewis she wanted to start as soon as possible.

Now she was back for her second appointment. A nurse called Remy’s name and led her to a small exam room. More fluorescent lights and beige. The nurse, nodding toward a chair, instructed Remy to make herself comfortable and left. A few minutes later, there were two curt knocks and the door opened. Dr. Lewis—straightened blond hair, long white coat over a blue floral top, black ballet flats—sat down on a stool, clipboard in hand. She and Remy exchanged hellos, and then Remy introduced me as a friend who was interested in egg freezing and was also writing about it. Dr. Lewis nodded and shook my hand before turning her attention back to Remy.

“Got a lot to cover today,” Dr. Lewis began. “We’ll review the ovarian stimulation process, go over some risks and consent forms, then talk about the egg retrieval. Sound good?”

She launched into explaining the different types of medications that stimulate a woman’s ovaries: carefully timed, self-injected hormone shots phased over about two weeks. During the first phase, the shots would kick Remy’s ovaries into overdrive to produce more eggs. The second phase of shots would prevent immature ovulation, instructing her ovaries not to release the eggs too soon. The final injection, known as the “trigger shot,” finishes off the eggs’ maturation so that they’re ready to be retrieved.

Remy leaned forward, chin in hand and elbow resting on her crossed leg. Her blond hair sat in a messy bun on the top of her head, and silver feather earrings dangled from her ears.

“Now, the trigger shot,” said Dr. Lewis, resting her back against the exam table. “It’s a powder, so you have to mix it. And then, don’t shake it, you just—”