I had just turned 35 when I started thinking about freezing my eggs. I'd always thought I'd have a husband and a kid or two by 35—that's the ominous year when doctors start stamping women's medical charts with the words "advanced maternal age" if they are pregnant, and some warn that fertility starts to drop off a cliff if they are not. But instead I was single, with an adventurous career, and concerned about my eggs. So in 2005, when I heard about a free seminar offered by a company called Extend Fertility, I thought this was exactly what I needed: a way to safeguard my eggs so I can relax until I meet Mr. Right. Extend had just begun marketing egg freezing as the newest choice among women's options: preserve your fertility and wait to have a child.
Egg freezing is more technically known as oocyte cryopreservation, a technology by which a woman's eggs are surgically removed from her ovaries and frozen until she is ready to use them. It's still considered an experimental technology by the American Society for Reproductive Medicine, but as the success rates rise, an increasing number of doctors and women are betting that this reproductive tool could help both women with cancer and healthy women who are not yet in a position to have a baby to preserve their fertility. Egg freezing, I believe, could be as revolutionary as the birth-control pill. And the timing for its takeoff couldn't be better. The age of first-time motherhood is rising. In the United States, the number of women becoming pregnant between the ages of 35 and 44 has nearly doubled since 1980. As education, advanced degrees and higher salaries become priorities, we are trading in our years of procreative power to gain economic power.
But this societal change is out of sync with women's biology. Fertility declines in our 30s, and this is not going to change naturally. As a result, technology and feminism are leading us to make choices that we couldn't a generation ago. Since its invention in the 1980s, the science has steadily improved. A 2009 study completed by doctors at the NYU School of Medicine and the University of Bologna, in Italy, revealed that 936 babies have now been born from frozen eggs worldwide—and genetic anomalies were no different from those occurring in naturally conceived babies. Feminism and capitalism, however, form an uneasy alliance in this new world. While egg freezing has become a real option that could help resolve the serious contradictions between career advancement and family planning, it also costs upwards of $15,000, making the profit motive very real. Besides the (usually minor) health risks women may face from the process itself, there's another possible drawback: freezing your eggs does not guarantee you will one day have a baby.
At the Extend Fertility event, I walked into an apartment packed with 30-something women. A doctor explained the realities of our fertility, and the head of marketing for the company pitched egg freezing as a source of empowerment. All the potential customers were asking the same questions: What's the best age to do it? (The younger, the better.) How well does it work? (Unclear.) Does health insurance cover it? (Usually not.) I wondered if this new company was too aggressively trying to cash in on well-heeled women's anxiety by turning them into guinea pigs and, more broadly, whether women should rely on technology to postpone motherhood.
Still, I was intrigued. A few weeks later, I met with Dr. Nicole Noyes, an endocrinologist and ob-gyn at NYU, in order to learn about my own fertility so I could make an informed choice. Noyes questioned the egg-freezing technology as well, and advised me to wait until the results improved. And since the blood tests I later took to check my hormone levels pointed to years more of fertility, I decided not to freeze and hoped I would meet Mr. Right. I did meet someone, but the relationship didn't work out and, two years later, I was once again single and worried about losing my chance to have a child.
I felt stuck. So in the fall of 2007, I decide to once again investigate egg freezing. I had unexpectedly inherited some money from my grandmother and thought if the technology had improved, freezing my eggs would be a good use of it.
This time, when I go back to see Noyes, she tells me that since we last talked she had done 17 egg-freezing cycles in women up to age 38. Her patients have had 11 babies, including three sets of twins. "Now I feel very comfortable. I wouldn't think twice about it," she says. "I think you need eight mature eggs to achieve a pregnancy."
I'm still skeptical, however, because I know the marketing machine is strong and the technology is still experimental. In October, I fly to Bologna to meet with Dr. Raffaella Fabbri and Dr. Eleanora Porcu, the biologist and clinician who invented the technology at the Department of Obstetrics and Gynecology at the University of Bologna. When the two started working together in the 1980s, they never envisioned egg freezing as a way to fulfill women's desires to "have it all." They saw the possibility of freezing unfertilized eggs as a way to sidestep a ban on freezing embryos, which the Roman Catholic Church deemed immoral. As the technique improved, so did the success rates. The clinic has achieved a 28 percent pregnancy rate from frozen eggs compared with the 18 percent rate it reported two years earlier.
Fabbri and Porcu, however, are at odds with one another. Their debate goes straight to the heart of the issues that surround egg freezing and my own intensely emotional decision over whether to do it. Fabbri supports its commercial use to extend fertility. Porcu tells me that she believes that many U.S. statistics are exaggerated in order to lure customers. She thinks that women who have no alternatives, such as patients with cancer or patients who want to store eggs instead of embryos for moral reasons, should be free to use it. Giving healthy women the opportunity to freeze their eggs to postpone childbearing with an experimental technology, she believes, is harmful for feminism. "It means that we're accepting a mentality of efficiency in which pregnancy and motherhood are marginalized," she says. "We've demonstrated that we are able to do everything like men," she continues. "Now we have to do the second revolution, which is not to become dependent on a technology that involves surgical intervention. We have to be free to be pregnant when we are fertile and young."
I find myself torn by Porcu's argument. I agree that companies and society need to better adapt to the needs of working mothers. I can see how, on a broad social level, egg freezing allows working women to deny our biological nature. But her moralizing also puts me off. She's not advocating government regulation of egg freezing; she just believes that women shouldn't use the technology as a crutch. I think that like birth control or abortion, egg freezing could also change society. It is a choice, another tool by which women are able to assert control over their bodies. The decision to freeze eggs should be a matter of personal conscience rather than a political statement.
"What about the case of a woman who is divorced and still wants a child, or someone like me who hasn't yet found Mr. Right?" I ask.
"I understand circumstances like yours," she says. "In your case, it is an additional tool to fight against unfair nature. You want to survive as a fertile woman." She then explains that if I do go through with it, I must pay attention to my own biology. "The possibility of freezing and thawing eggs in your late 30s and 40s is low because many of a woman's eggs are damaged," she explains.
"Of course," she adds, "many women over 35 still have a large-enough ovarian reserve and are therefore younger from a biological perspective."
I tell her that I recently learned that I had eight antral follicles. Antral follicles produce eggs, and the number declines as a woman ages. "That means you're biologically young," she says. This is the vital piece of information I've been looking for. I leave Italy feeling more convinced that egg freezing is the right choice for me now.
On Dec. 17 I attend my first egg-freezing class at NYU. A nurse at the clinic explains that I will begin by shooting myself up with a hormone called a gonadotropin that is used to stimulate egg production. In a natural menstrual cycle, it takes two weeks for an antral follicle to grow one egg. "Gonadotropins stimulate a larger number of follicles to grow so you get more than one egg," she says.
During a normal menstrual cycle, estrogen typically peaks shortly before the point of ovulation. When stimulated with the drug, my estrogen level should reach 10 times the level of a normal cycle. The nurse uses the analogy of cooking. The key to getting a good number of eggs is to take my levels up slowly, like thickening a sauce on a low heat. If my estrogen gets high too quickly, then I run the risk of ovarian hyperstimulation syndrome—burning the sauce. It happens in only 2 percent of cycles, but if it does, I could get really sick.
I'll go into the clinic every few days for a blood test to check my estrogen levels and have my follicles measured to know if my eggs are ready for retrieval. Just before the retrieval, I will take what the nurse refers to as the "trigger shot" to induce ovulation. Then, using an ultrasound needle, Noyes will remove the eggs from my follicles. I will be under a light anesthesia, and the procedure will take about 25 minutes.
I tell the nurse I'm concerned about the long-term effects of the drugs because every time I tell someone what I'm doing, they say, "Doesn't that cause cancer?" She says I shouldn't worry. Later that day, I read a number of studies that conclude that no direct correlation has been found between IVF drugs and breast or ovarian cancer.
On Jan. 4 I start giving myself the shots, which blend into my morning ritual. Make coffee. Wash face. Brush teeth. Shoot hormones cloned from Chinese hamster ovaries into my belly. After three days of shots, I have an enormous amount of energy. It turns out, however, that my doctors have given me too high a dose. On the third night, I wake up dizzy and nauseated, and it turns out my estrogen has gotten too high. I've overheated—and the doctors have to cancel the cycle.
I've run into one of the pitfalls and feel discouraged. For a moment, I even wonder if I'm acting out of desperation. But my strong reaction to the drug is ultimately good news. It means that I'm really fertile for my age and will probably produce a lot of eggs. So I toughen up to start a new cycle. And this time it works.
The night before my retrieval, my good girlfriend gives me the trigger shot of human chorionic gonadotropin, a hormone that tells my ovaries to prepare my developing eggs for release. On Good Friday morning, I take a cab to NYU. A nurse takes my vital signs, and then leads me to lie down on the surgery table where I talk briefly with the doctor who will perform the retrieval. The anesthesiologist tells me to sleep well. In what seems like three seconds, I'm awake in the recovery room.
The anesthetic has made me feel jittery, so I drink some apple juice while I wait to hear the results. In the meantime, the freezing process is beginning behind the scenes in a lab. My eggs are placed in a portable incubator. An embryologist hunts for the most mature ones, puts them in a petri dish filled with cryoprotectant and then places them in liquid nitrogen.
I'm still drinking apple juice when the embryologist comes into the recovery room to report that they have retrieved 35 eggs. Eight are mature. I go home feeling tired, a little sore and not sure whether my choice is a success.
Later, Noyes calls to say that eight mature eggs is good, though she wishes I had a few more just in case I end up wanting a second baby. She suggests I go through another cycle. I tell her I can't afford that, and anyway, I feel as if I should just accept what I have. "Do you feel less anxious now?" she asks.
I do feel more at peace knowing my younger eggs are preserved in a little test tube in a big metal tank. NYU has offered me free storage for the first year and then charges $400 every year after that. It seems surreal, but I also feel like I've done everything within my control. Even though the odds are uncertain that I'll produce a child from my frozen eggs, I've taken a step forward. I won't stop thinking about my fertility entirely, but I think I'll feel a bit calmer the next time love comes my way.