I was a senior in college the first time I heard about egg freezing, formally known as oocyte cryopreservation. It was 2010, a decade ago, and I lay in a dark exam room, clutching my hands while a reproductive endocrinologist peered between my legs and moved an ultrasound wand from left to right inside me. Flimsy paper gown, cold jelly-like substance, some wincing. On a screen, the doctor pointed at my ovary (most women have two; I have only one) and smiled.
She remarked that my ovary was "healthy" and "lovely" and, later, in her notes, wrote: "We discussed ovarian stimulation with oocyte cryopreservation. We discussed that it is experimental and expensive, and is likely not a good option for her now. In coming years, there may be more data and pregnancy rates from frozen eggs and she may want to consider this down the road."
My mother’s generation made different decisions about work and motherhood because of the pill. My generation will do the same thanks to egg freezing and other assisted reproductive technologies.
Since that OB/GYN appointment 10 years ago, I've had a front-row seat to egg freezing's transformation, both as a young woman considering the procedure and as a young reporter writing about women's health. Indeed, two years after my feet-in-stirrups moment, the American Society for Reproductive Medicine, or ASRM, lifted the "experimental" label from egg freezing, just one of a host of remarkable scientific developments over the decade that have contributed to changing how women think about their fertility — and therefore their life choices.
Sixty years ago, women's liberation took off when women were finally able to (largely) prevent unwanted pregnancies, first with birth control pills and then with legalized abortion. Having some control over their fertility allowed them to pursue careers, plan their finances and take a host of other actions that gave them greater agency in the world.
But it turned out that another phrase of the movement was needed, one in which women were able to (start to) conceive when they wanted. We embraced that phase in this decade, as egg freezing, in vitro fertilization (IVF) and other advances in fertility medicine have begun to let women have biological children later in life, on a timeline that suits them.
At the dawn of 2020, technology has fundamentally altered how people approach, well, everything, but certainly partnership and if, when and how to start families. The changed mind frame is at once personal — I use apps on my iPhone to date, to track my period, to price my birth control — and larger, cultural. The power of egg freezing and related reproductive breakthroughs lies in their potential to buy time: time for a woman to find the right partner rather than "settle" for someone 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 whim of fate.
There's been a historical shift when it comes to women having children later in life, largely due to these desires. In 2016, the average age of first-time mothers in the United States was 26; in 1972, it was 21. Because fertility declines as a woman gets older — particularly in her mid-30s, as her eggs diminish in quantity and quality — finding ways to potentially extend this window has been crucial to this societal change.
IVF, by which a sperm and egg are merged to become an embryo in a lab rather than the old-fashioned way, helps people overcome many (though not all) infertility issues stemming from age and medical conditions like endometriosis. It also gives female same-sex couples and single women the opportunity to have biological children.
The first part of the process is to harvest eggs from the woman, or a donor, which involves self-administered hormone shots, blood tests and ultrasounds to maximize egg production before a doctor retrieves them. If a woman is ready to get pregnant, an embryo is implanted. But egg freezing affords a woman the option to freeze her younger, healthier eggs — ideally in her 20s or early 30s — to use if she needs to go through IVF later.
To be clear, this gives women of means such an option. Egg freezing patients spend on average roughly $35,000 on the process and storage, with each retrieval cycle costing upward of $10,000 (and most women undergo more than one cycle). Very few insurance plans cover the treatment. Still, major advances and economies of scale as the practice becomes more common are driving down the cost of fertility treatments in what is hopefully a harbinger of their pending availability across socioeconomic classes.
While IVF has been around for decades — sperm cells have been successfully frozen since the 1950s and human embryos since the early 1980s — it was in this past decade that egg freezing took off. In 2009, a mere 475 women froze their eggs. In 2017, more than 9,000 women in the United States elected to freeze their eggs, according to the Society for Assisted Reproductive Technology. That growth was spurred in part when Apple and Facebook announced in 2014 that they would subsidize egg freezing costs for female employees, a decision that at once mainstreamed the concept and conversation around it, as well as ushered in the perk at an increasing number of large companies.
Now, egg freezing has exploded into our vernacular, having shed almost all of the stigma it once had. Ten years ago, it was a phrase at which most people furrowed their brows (maybe for sounding like a "Gattaca"-like dystopian movie); if it was talked about at all, it was in a doctor's office or a bedroom, not at happy hour or across the internet, as it's discussed today.
Egg freezing can change how a woman dates — for quality instead of speed — and, perhaps most powerfully of all, can protect against regret down the line.
Despite the growing cultural fluency in the idea and its influence on women's choices, we need to remember that no assisted reproductive technology is guaranteed to result in a healthy baby. Since it emerged roughly 30 years ago, the science of egg freezing in particular remains unreliable, in part because success rates vary considerably by individual and are difficult to compile and predict. And then there's the fragility of the storage process, acutely demonstrated in 2018 when thousands of frozen embryos and eggs were destroyed following unprecedented storage tank malfunctions. Notably, the ASRM has not changed its cautionary stance on elective egg freezing from 2012, when it warned that the procedure "may give women false hope and encourage women to delay childbearing."
And yet. For a certain group of women, egg freezing has proven to be an empowering tool, transforming women's personal lives in profound ways by offering a sense of independence here and now, as well as peace of mind in terms of family in the future. Simply having a backup option — even a shaky one — shifts how a woman considers the demands of biology and time. Egg freezing can change how a woman dates — for quality instead of speed — and, perhaps most powerfully of all, can protect against regret down the line.
My mother's generation made different decisions about work and motherhood because of the pill. My generation will do the same thanks to egg freezing and other assisted reproductive technologies. The 2010s were the decade that freed women from thinking they have to settle. The decade that gave them the potential to pause their biological clocks. The decade that ushered in the second phase of trying to have it all.
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