The failed promise of egg freezing

“For me, it was almost like a message from the universe,” says MeiMei Fox. It was 2009, and Fox was a 36-year-old divorced writer and editor when she sat down to interview a fertility specialist for an upcoming book. He pulled out a chart showing female fertility after age 35 — in her memory, a curve swooping exponentially downward. “I was like, holy moly, this is not a pretty picture,” Fox recalled. She’d always wanted a family, but since her divorce, she hadn’t met the right person to share it with. That’s why she took notice when she and the doctor discussed a technology called egg freezing, still experimental, that could help preserve people’s eggs until they were ready to have kids. At about $10,000, it was expensive, and typically not covered by insurance. She started pulling the money together right away. Fox was an early adopter of a technology that was about to explode in popularity. Initially used primarily by people undergoing chemotherapy or other treatments that can harm fertility, the procedure became more mainstream after the American Society for Reproductive Medicine (ASRM) announced in 2012 that it should no longer be considered “experimental.” Since then, the number of egg-freezing cycles performed each year has skyrocketed, from around 7,600 in 2015 to 29,803 in 2022, the most recent year for which data is available, according to the Society of Assisted Reproductive Technology. --- What you’ll learn: * A brief history of egg freezing’s rise * What the research says about success rates * The reasons many people decide to freeze their eggs * What experts — and patients — say everyone should know about the procedure --- In the beginning, expectations were high. Despite the eye-popping cost of the procedure, experts predicted it would usher in a new era of gender equality and career advancement for women. A now-famous 2014 Bloomberg Businessweek cover story promised a new option for professional women: “Freeze Your Eggs, Free Your Career.” Big companies such as Facebook and Apple started covering egg-freezing expenses for employees. Startups devoted to the procedure began wooing potential customers with parties and prosecco — and attracting millions in VC funding. Egg freezing was also hailed as the next big step in reproductive health. “It was supposed to revolutionize the whole field just as much as the birth control pill did,” says Janet Takefman, a reproductive health psychologist at McGill University. For Fox and for many, many people who underwent the procedure, however, freezing their eggs was more than just a medical decision; after an increasingly frantic race against the clock to find a partner, it felt like a way to take back control over their own lives. “Oh my god, I just bought myself years,” Fox remembers thinking. “The stress level went way down.” Many patients report the same sense of relief after making the decision to freeze eggs. Marcia Inhorn, a professor of anthropology and international affairs at Yale, interviewed more than 100 women about their egg-freezing experiences for her 2023 book, Motherhood on Ice: The Mating Gap and Why Women Freeze Their Eggs. After the procedure, more than 90 percent of women had something positive to say. But in other ways, egg freezing has failed to live up to its early hype. For many years, the effectiveness of the procedure was a bit of a black box: Not enough people had tried to use their frozen eggs for scientists to pull together reliable data. Now, however, a picture is emerging. In one groundbreaking 2022 study conducted at NYU Langone Fertility Center and looking at 543 patients over 15 years, the chance of a live birth from frozen eggs was 39 percent. “There isn’t a guarantee of having a baby from egg freezing,” says Sarah Druckenmiller Cascante, a reproductive endocrinologist at NYU Langone Fertility Center and one of the study’s authors. The study made a splash because it provided numbers where little comprehensive national data exists, though experts at other clinics tell Vox that its results are in line with what they’ve found. And far from ushering in a new era of gender equality, some experts say, the procedure serves as another way for companies to make money from stoking women’s anxieties. Sales pitches about egg freezing, rather than liberating women from their biological clocks, simply became another way to put pressure on them, says Jody Madeira, a law professor at Indiana University Bloomington and author of the book Taking Baby Steps: How Patients and Fertility Clinics Collaborate in Conception. “In a capitalist society, you’re going to have that incentive to get women’s dollars by piggybacking on this guilt, shame, anxiety, whatever you want to call it, about how we’re supposed to reproduce and we haven’t done so yet.” About a decade after it shed its “experimental” label, the procedure has become ubiquitous in pop culture and ballooned in popularity, with over a million frozen eggs or embryos stored in the United States today. It has done little, however, to materially change women’s lives. The first successful births from frozen eggs were twins, born in Australia in 1986. But the procedure used in this case was difficult to replicate, and egg freezing didn’t begin to take off until the 1990s, starting at a clinic in Bologna, Italy. The Italian government had passed a law, backed by Catholic politicians, that gave embryos the same rights as citizens and restricted freezing them. Freezing eggs instead became a way to circumvent the law and still treat patients with infertility. In the early 2000s, the procedure spread to the US and around the world, gaining more interest after 2012, when the ASRM removed the “experimental” label. For patients, egg freezing can be an arduous process. It starts with 10–14 days of hormone injections, often two or three per day, to stimulate the ovaries to produce large numbers of eggs at once, Cascante said. On top of that, the patient also has to visit a clinic two or three times a week for ultrasounds and bloodwork. Finally, when the eggs are the right size, another injection known as a “trigger shot” gets the eggs ready for collection. “Physically, you go through a lot,” says Fawziah Qadir, a 38-year-old education professor at Barnard College who froze her eggs in 2022. If all goes well, patients under 38 can expect to retrieve between 10 and 20 eggs, which are frozen using liquid nitrogen and stored in a lab until they’re ready to be used. If it doesn’t, more cycles may be necessary — meaning more shots, and more money. When egg freezing first became widely available, there wasn’t a lot of long-term data on its effectiveness. But there was buzz — lots of it — especially around the idea that it would give women more time to focus on their careers. “Imagine a world in which life isn’t dictated by a biological clock,” Emma Rosenblum wrote in the 2014 Bloomberg Businessweek story. “If a 25-year-old banks her eggs and, at 35, is up for a huge promotion, she can go for it wholeheartedly without worrying about missing out on having a baby.” --- Related: Alabama’s IVF warning to the country [Image: https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/25420283/1953816133.jpeg?quality=90&strip=all] --- In the next few years, new companies sprang up to market the procedure to women, often with a millennial-pink, girlboss sheen. Extend Fertility, launched in 2016 in New York City, offered Instagram influencers reduced rates in exchange for posts. Trellis, a “fertility studio” in Manhattan’s fancy Flatiron district that opened in 2018, offered Turkish-cotton bathrobes and called itself “the Equinox of egg freezing,” a reference to the upscale gym chain. One wall bore the slogan, “It’s up to each of us to invent our own future.” The startup Kindbody, also launched in 2018, hosted parties with drinks and scented candles and peppered its social media ads with taglines like “Plan your path.” “Egg freezing has become like a mantra for how to be an independent woman,” Rebecca Silver, director of marketing for Kindbody, told NBC in 2018. “The people who have frozen their eggs are doing the cool new thing.” That cool new thing, however, was pricey. It took Fox a year to save up the money. Today, with the process still coming in at $10,000 to $15,000 per cycle, several companies offer loans specifically for egg freezing. Qadir’s procedure in 2022 cost about $14,000, which her mom paid as a gift to her, Qadir says. That included storage fees, which are rising rapidly and can run to $800 a year or more. The costs of egg freezing and storage usually aren’t covered by insurance, although more large companies are beginning to offer fertility benefits that include them. The price tag of the procedure limits who can access it; the majority of egg-freezing patients are white women with professional jobs. For Black women like herself, “sometimes it’s unattainable just because it’s so expensive, or we don’t have the jobs that would cover it,” Qadir said. Some experts say stigma and stereotypes, dating back to the history of slavery in America, also contribute to lower rates of fertility treatment among Black women. Startups have attracted enough customers to draw interest from deep-pocketed backers, with fertility companies gaining more than $150 million in investment in 2019, according to the New York Times. “It is an attractive investment for venture capitalists who are looking to make money because it’s an almost unlimited market, potentially, of people who think they need to extend their fertility,” says Karey Harwood, a professor of women’s, gender, and sexuality studies at North Carolina State University and the author of The Infertility Treadmill: Feminist Ethics, Personal Choice, and the Use of Reproductive Technologies. It’s no surprise that people will pay tens of thousands of dollars, or even go into debt, for the chance to build the family they’ve always imagined. But that key word — chance — can fall by the wayside in an industry built on selling optimism. [Image: https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/25420287/GettyImages_1471033757__1_.jpg?quality=90&strip=all] The year after she froze her eggs, Fox got together with her now-husband. After about a year of trying to get pregnant and one miscarriage, the couple had Fox’s frozen eggs shipped from the San Francisco Bay Area, where they were stored, to Los Angeles, where Fox and her husband lived. “Here’s where the story goes rotten,” Fox says. The Bay Area clinic had failed to pack the vials properly, and when they arrived in LA, all the eggs were destroyed. It was “one of the worst days of my life,” Fox recalls. She’s not the only patient to fall victim to storage or transportation mistakes. One 2022 study found at least nine storage tank failures over 15 years, affecting 1,800 patients. Egg-freezing patients also have had to contend with the unpredictable nature of the human body. The process can fail at many points, Cascante said. The ovaries may not produce enough eggs, the eggs may not survive the freezing process, they may not fertilize properly, or the fertilized embryos may not implant in the uterus. One UK-based woman, who asked to remain anonymous because she was concerned about professional ramifications, told Vox she froze 14 eggs, beginning about 10 years ago when she was 36. At the equivalent of about $1,200 per egg, the process wasn’t cheap. But by the end, she says, “I felt really proud that I was doing something proactive, and something that gave me options.” When she decided to use the frozen eggs to conceive on her own at 40, however, none of them fertilized. “I felt really angry at the universe,” she says. She later married and had a child using a donor egg. “In a single cycle of egg collection and fertilization, our donor produced more eggs and created more embryos than I had done in seven cycles.” Despite her experience, “I never felt like I was mis-sold,” the woman says. “I’m a nerd; I did my research.” At the same time, when she was freezing her eggs a decade ago, there wasn’t much research to do. “There weren’t a lot of people who had frozen their eggs, and there were even fewer who had gone back to try and conceive.” Today, there’s more data available, and mainstream fertility clinics are likely to be frank with patients about success rates, says Madeira, the author of Taking Baby Steps. Findings at other clinics have been in line with the NYU study, with another study finding that about a third of patients who returned to use their eggs ended up having a live birth. “Clinics have an actual ethical imperative to give accurate information.” But egg-freezing parties hosted by for-profit companies may be another story. There’s also a difference between listing success rates in fine print and really emphasizing the uncertainty of a procedure. Even Brigitte Adams, the woman featured on the 2014 Bloomberg cover after freezing her eggs, eventually told the Washington Post that she was unable to conceive using her frozen eggs. “They’re going to tell you, in all the paperwork you sign, that this is no guarantee, but you’re still going to have a sense of, oh, this works,” Fox says. Some of that feeling may stem from a kind of relentless optimism in American culture — or, perhaps, a Protestant work ethic — around the idea of having biological children, the message that if people simply try hard enough and long enough, they will eventually be rewarded with a child. This messaging has led some women to open up in recent years about their unsuccessful infertility treatments, to destigmatize their experiences. “For those of us who close our infertility chapters without a baby, we’re often met with unsolicited advice, reinforcing the narrative that we obviously gave up too early,” one woman, Katy Seppi, told CNN. For their part, fertility companies and practices say they work hard to make patients aware of the possibility of failure. At Extend Fertility, every prospective egg-freezing patient gets a free consultation session that includes information on their odds of a live birth from frozen eggs, based on their age and initial test results, says Joshua Klein, the company’s chief clinical officer. After that, “we try to trust women” to make an informed decision, he said. Kindbody also provides every prospective client with “expected outcomes based on their individual hormones and sonograms,” and offers a fertility calculator that estimates a patient’s chance of a live birth based on test results and number of eggs retrieved, Margaret Ryan, the company’s VP of communications, said in an email. For some people, egg freezing isn’t the only option on the table. Another path is freezing embryos, which are denser and have a lower water content, making them “less sensitive to the freeze-thaw process,” said Amanda Adeleye, a reproductive endocrinologist and the medical director of CCRM Fertility of Chicago. Doctors also are able to screen embryos to help give patients a better sense of how likely they are to have a successful pregnancy. The process has even found its way into the American cultural imagination, with Succession’s Shiv Roy suggesting to her beleaguered husband Tom that they freeze embryos because they “survive way longer than eggs.” Embryos, however, require sperm. The majority of people freezing eggs are single, and they’re often hoping to have biological children with a partner one day. Using donor sperm would defeat that purpose. Fox, for example, was told that freezing embryos might be more effective but “I had zero interest,” she says. “I did not want to be a single mom.” If a patient has a partner or is comfortable using a donor, doctors may recommend embryo freezing. But “if you’re doing all of this to expand your flexibility and time to build your family, to prematurely close the door on part of that by fertilizing the eggs doesn’t necessarily help you,” Adeleye said. Eggs, embryos, freezing, thawing, shots, ultrasounds, thousands of dollars — it’s a lot for patients to navigate, often without much guidance. For example, there’s no single regulatory agency overseeing fertility centers in the US, as NBC has reported. That means no one is ensuring that patients are given a clear picture of the effectiveness of procedures. A lack of oversight also allows companies to use sales pitches that experts say are misleading, like an Instagram ad for Extend Fertility that claimed, “When you freeze your eggs, you #freezetime.” Klein calls that message “oversimplified,” but says it contains a kernel of truth because the procedure gives patients a chance to get pregnant with younger, more viable eggs. Advertising egg freezing is always a difficult balance, he tells Vox. The company doesn’t want to be too aggressive, but at the same time, to keep silent about a technology that can be “life-changingly impactful” risks doing a disservice to all the people who could benefit, Klein says. Others, however, argue that egg-freezing companies are being too aggressive, not just about the effectiveness of the procedure but about its necessity. Companies can “scare women into freezing their own eggs when they might not really need to,” Madeira says. In recent years, fertility startups have reached out to younger and younger groups of women. “We are now targeting women in their 20s and early 30s,” Susan Herzberg, the president of Prelude Fertility, told the New York Times in 2018. “Fertility declines at 22,” Jennifer Lannon, founder of the website Freeze.Health, told the publication. It’s true that egg quality declines with age and that younger patients have better luck with egg freezing. But the American College of Obstetricians and Gynecologists puts the age of significant fertility decline at 32, not 22 (the chance of conceiving drops more precipitously after 37). In the NYU study, the success rate rose to 51 percent for patients who froze their eggs when they were under 38. But the idea that large numbers of people should be freezing eggs in their 20s to guard against future infertility is misguided, some experts say. People in their 20s and early 30s often have time to conceive naturally, without the need for a lengthy, expensive medical procedure. Indeed, only about 12 percent of patients worldwide actually go back for their frozen eggs. Many patients conceive without assistance, Takefman says, while others decide not to become parents. Patients who froze eggs when they were younger than 34 are especially unlikely to use them, Madeira says. Those numbers don’t capture people who froze eggs only a few years ago and might still return, Klein says. And it’s not necessarily a problem that not everyone uses frozen eggs — after all, the process is meant as a “proactive investment,” he says. “You don’t know if you’ll need it.” To some, that investment comes at too high a cost. “More women are freezing eggs, and paying a lot to freeze eggs, than are actually ever going to need [them],” Madeira says. Ten years ago, egg freezing was seen as a path to economic and social empowerment for women. But most people aren’t freezing their eggs so they can work; they’re freezing their eggs so they can date. Eliza Brown, now a sociology professor at the University of California Berkeley, and her team interviewed 52 women who had frozen or were considering freezing their eggs in 2016 and 2017. None of them cited a desire to climb the corporate ladder. Instead, almost all were interested in egg freezing because they lacked a romantic partner. “Most of our participants understood egg freezing as a way to actually temporarily disentangle romantic and reproductive trajectories,” Brown tells Vox. However, in many cases, egg freezing was a bandage on a bigger problem. The women Inhorn interviewed for her book Motherhood on Ice were largely educated professionals who could afford a five-figure elective medical procedure. “They wanted an eligible, educated, equal partner,” Inhorn said, and “they were having trouble finding that.” --- Related: How millennials learned to dread motherhood [Image: https://platform.vox.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/25420318/EleanorDavis_VOX_Motherhood.jpeg?quality=90&strip=all] --- Both Brown and Inhorn spoke with some egg-freezing patients who were seeking female partners. However, the majority were dating or seeking men, and struggling with the process. Some had tried dating men with less education or career success, but found “there was a lot of intimidation,” Inhorn said. “Men were not comfortable with who they were.” Others were frustrated with “men who will just wine you and dine you, but really have no intention of committing.” MeiMei Fox describes the sense of rush and pressure that can be attached to dating for women in their late 30s: “You go on the first date and you’re like, well, do you want to have kids? No? Okay, bye.” Egg freezing doesn’t change the fact that women are outpacing men in educational attainment, nor that social norms still fetishize the male-breadwinner family, pressuring women and men alike to look for something that may no longer fit them or the times they live in. It also doesn’t change the fact that many women find dating men to be a frustrating and demoralizing experience, as Anna Louie Sussman writes in the New York Times. Daniel Cox, a senior fellow at the American Enterprise Institute who has surveyed more than 5,000 Americans about dating, told the Times that many men were “limited in their ability and willingness to be fully emotionally present and available” and that dating today “requires a level of emotional sensitivity that I think some men probably just lack.” To actually fix straight women’s dating problems, you would need to “fix men,” one of Inhorn’s study participants told her. Until then, Inhorn writes in her book, “egg freezing will remain educated thirty-something women’s single best reproductive option — a techno-medical solution to a fundamental gender inequality that provides them with some hope and allows them to retain their motherhood dreams.” For Fox, freezing her eggs indeed took the feeling of time pressure away. She felt more relaxed and confident. “It was really positive for me,” she says. “Until I tried to use them.” After Fox’s frozen eggs were destroyed, she and her husband went through three rounds of IVF. It cost about $100,000, but she eventually got pregnant and gave birth to twin sons. Today, she’s not against egg freezing but says, “I tell people it is no guarantee.” Fertility centers don’t always “present that to their clients in an honest way,” she adds. Better regulation would help, experts say. Creating a single regulatory agency to oversee fertility centers — as the Human Fertilisation and Embryology Authority does in the UK — could make it easier to require those centers to educate patients on the risks and effectiveness of egg freezing and to follow accuracy guidelines in their advertising, Rachel Strodel argues in an NBC op-ed. “I still certainly respect people’s freedom to make the decision that’s best for them, but they’ve got to be armed with the facts and realize that it’s a gamble,” says Harwood, the Infertility Treadmill author. Federal lawmakers should also require that egg storage facilities follow proper freezing protocol and report any failures, legal scholars Naomi Cahn and Dena Sharp write at the Conversation. Meanwhile, helping women with the relationship problems that push many to freeze eggs in the first place may require bigger social changes. “Maybe men are going to need to get more comfortable marrying women who are more educated than they are and make more money than they do,” Harwood said. “Maybe the change happens there, in our gender ideologies and how we think of family.” Greater support for single parents and other family forms beyond the heterosexual two-parent household could also take the pressure off of women to bank eggs in hopes of meeting a male partner. So, too, could a greater social acceptance of the value of a child-free life, especially since more and more people are choosing not to have children. While many people who freeze eggs have a deep and personal desire for children, it’s also the case that women, especially, experience enormous social and even political pressure to reproduce — and reducing that pressure could free some people to pursue other shapes for their lives. Patients and scholars alike are clear that they don’t want to see egg freezing disappear as an option. “Reproductive choices are being eclipsed in this country,” Inhorn said. “This is a technology that does give women some help with difficult situations they find themselves in.” The process could take on added importance now that an Alabama court ruling has cast doubt on the future of IVF using frozen embryos. Federal oversight of and research into fertility technology and treatment in general have been hampered by opposition to abortion in the US, which has made it difficult to form nationwide policies around reproductive health. Egg freezing also remains an especially important option for people dealing with cancer or other conditions or treatments that can damage ovarian function, and it can be a useful tool for trans people who want to remove their ovaries or who are taking hormones that affect them, Adeleye said. For many patients, however, experts say that the sense of control that egg freezing offers — at a high price — turns out to be illusory. If anything, Fox’s experience with the procedure was an exercise in letting go. “It’s taught me some more patience with life and the universe,” she says. “There are many different pathways to getting what you dream of.”