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A Modern Woman’s Burden

How much does egg-freezing technology help delay reproduction?

Illustration by John Holcroft

In the fall of 2010, when I was 21, an OB/GYN gave me one of the best compliments I have ever received. In a dark exam room at the University of North Carolina’s fertility clinic, she moved an ultrasound wand over my lower abdomen and said, “Natalie, you have a lovely ovary.”

She wasn’t playing favorites—the other had been removed when I was twelve. Years later, I nearly lost my second ovary after a hemorrhagic cyst ruptured. After another emergency surgery, the surgeons recommended I consider freezing my eggs. I was at the OB/GYN in North Carolina for a second opinion.

“Egg-freezing technology is still very new and experimental,” the doctor told me. “You’re young. Your ovary is healthy—it’s lovely,” she said, smiling when I blushed. “I don’t see a need for you to take this risk right now, if ever.”

That evening, I taped the black-and-white ultrasound image to the fridge.

Four years later, I arrived in New York City to begin graduate school. I’d read about an informational cocktail party where women would be gathering to learn about egg-freezing, calming their anxieties with free drinks. I am curious by nature—and, as a graduate student, not one to turn down free cocktails—so on a warm October night, I joined 100 or so women to learn more.

That same day, news broke of Facebook and Apple’s decision to cover the costs of egg-freezing for their employees. “Not since the birth control pill has a medical technology had such potential to change family and career planning,” wrote Bloomberg Businessweek’s Emma Rosenblum. Egg-freezing touches on several fraught questions, from its health risks to its potential for undermining family-friendly policies in the workplace. There is, however, a growing market: Young, healthy women who are not necessarily experiencing reproductive issues, but who will nevertheless pay to preserve their fertility.

As a modern, 25-year-old American woman in this demographic, I am confused. I see mixed messages everywhere. We are told to lean in. We are told to recline. We are told we should want to have it all. We are told we cannot. We grow up using various forms of contraception, and then, when we’re “launched” into fledgling careers and relationships, we are besieged with warnings about our fading fertility and urged to consider freezing our eggs—yesterday.

When it comes to fertility, the United States is schizophrenic. The modern woman (ideally) uses some form of birth control as soon as she becomes sexually active; then, suddenly, she’s in her late twenties or early thirties and is encouraged to consider exchanging the pill for fertility hormones. What’s more: There isn’t any breathing room between this “prevent birth” and “preserve fertility” logic.

If ovaries could talk, I think it’s safe to say that many would be muttering in exasperation.

Last spring, fertility authority, an organization that connects women with fertility specialists, created EggBanxx (the two “x”s represent female chromosomes), a company that offers financing options for women freezing their eggs. “I call what we do ‘infertility matchmaking,’” said Jennifer Palumbo, EggBanxx’s vice president of patient care. The company throws “Let’s Chill” cocktail parties across the United States, and has become one of the most well-known egg-freezing “brokers” in the industry. After the Facebook and Apple announcements, EggBanxx’s phones were “ringing off the hook,” Palumbo said. They received hundreds of inquiries: from women in high-powered careers to worried mothers of teenage girls.

EggBanxx’s slogan? “Lean in. But freeze first.”

A woman freezing her eggs undergoes ten to 14 days of self-administered hormone injections (to hyperstimulate her ovaries) and a series of vaginal ultrasounds. She’s then put under sedation for the retrieval procedure. Including hormones, one cycle costs around $12,000. Annual egg-storage costs are approximately $500. Years later, the thaw, fertilization, and embryo transfer procedure is around $5,000. Twenty thousand dollars is the price of an American woman’s fertility. “Because we’re so queasy about talking about babies and commerce in the same breath, the commercial dynamics that are often at play escape our notice,” said Marcy Darnovsky, executive director at the Center for Genetics and Society.

The conversation around egg-freezing shifted in 2012, when the American Society for Reproductive Medicine (ASRM) removed its experimental designation. But neither the ASRM nor the American College of Obstetricians and Gynecologists have wavered in discouraging egg-freezing for nonmedical reasons. “Marketing this technology for the purpose of deferring childbearing may give women false hope and encourage women to delay childbearing,” the ASRM report cautioned.

I think about that warning every time I see the ad on the subway that reads: “To Emma (Age 42). Love Emma (Age 30). If you are not ready to have a baby, freeze your eggs now and give yourself the gift of time.”

It is frustrating that the most salient data about egg-freezing—namely, whether it works—are few, and not widely available. The U.S. Centers for Disease Control and Prevention began collecting statistics in 2012, but have not yet made their findings public. According to the ASRM, the chance that one frozen egg will lead to a baby is between 2 and 12 percent. The most comprehensive study to date, published in Fertility and Sterility, suggests live-birth failure rates run as high as 75 percent in 30-year-old women who used frozen eggs to try to conceive. At 40, failure rates reach 85 percent and higher.

The health concerns associated with egg-freezing include pelvic infection; injury to the bladder, bowel, or blood vessels; and damage to the ovaries. One of the more alarming risks is ovarian hyperstimulation syndrome: In some cases, injected hormones swell ovaries to the point of a life-threatening rupture. Moreover, no one knows how the chemicals used in the freezing process affect eggs over time, or whether the injected hormones have long-term health risks.

“There is this notion that you can get pregnant whenever you want—the technology is here, we’ve got the answers, it’s in your control,” said Arthur Caplan, a bioethicist at NYU Langone Medical Center. “But spending your twenties thinking just about not getting pregnant is not consistent with how your eggs work.”

Before I ever seriously discussed egg-freezing with my current doctor, I learned about its costs and potential benefits from a company eager for my business. It was so easy to drink the Kool-Aid at the two informational cocktail parties I attended, and that shouldn’t be what ignites conversations about a woman’s fertility.

For his part, Caplan argues that market forces are distorting our ideas about fertility in troubling ways. “The consumer doesn’t know what’s going on, and the provider has every reason to sell it to you and make a lot of money,” he said. Fertility treatments are largely elective, so patients pay out of pocket. In addition, reproductive technology in the United States is not well regulated. Unlike most of Europe, U.S. fertility clinics need not be licensed, and so there are no uniform standards for freezing and maintaining eggs. “It’s not a good market—the consumer is disadvantaged and often desperate to do something,” said Caplan. “And there doesn’t seem to be any inclination to regulate any of this.”

Those who stand to profit the most from this technology are fertility clinics and egg-brokering companies, like EggBanxx, whose direct-to-consumer marketing resonates with women anxious about their fertility. “They want customers, and they’ll advertise accordingly. But that’s not necessarily appropriate for a sensitive, medical area like infertility,” said Caplan. “They make me nervous.”

Should I freeze my eggs? While my ovary is currently healthy, I know I have a higher risk of experiencing fertility issues. I’m scared by the very real health risks I will face if I freeze my eggs, but I’m also scared of not being able to have biological children. Rationally speaking, the current science and cost make it clear that, for most women, elective egg-freezing is probably not worth it. But for me, it might be.

Middlemen may provide education about reproductive health, but they also frighten women into thinking that if we don’t freeze our eggs, our declining fertility will make it difficult or impossible to get pregnant when we feel prepared to. How do we reconcile our ambitions with our biology? Technology won’t change society’s mixed messages, expectations, or pressures. That’s a job for the next generation.

This story was updated to reflect the version that appeared in the May 2015 issue of our magazine.