The Big Freeze, page 1
The Big Freeze is a work of nonfiction. Some names and identifying details have been changed.
Copyright © 2024 by Natalie Lampert
All rights reserved.
Published in the United States by Ballantine Books, an imprint of Random House, a division of Penguin Random House LLC, New York.
Ballantine Books and colophon are registered trademarks of Penguin Random House LLC.
Hardback ISBN 9781524799380
Ebook ISBN 9781524799397
randomhousebooks.com
Book design by Jessica Shatan Heslin/Studio Shatan, Inc., adapted for ebook
Cover design: Rachel Ake
ep_prh_7.0_147498688_c0_r0
Contents
Dedication
Epigraph
List of Abbreviations
Author’s Note
Introduction
Part I: The Consultation
1. Young, Fertile, and Fabulous
2. An Intimate Geography
3. Egg Freezing’s Rise
Part II: The Orientation
4. Hacking Our Hormones
5. Why Women Freeze
6. Optimizing Fertility
7. Not Our Bodies, Not Ourselves
Part III: The Stimulation
8. Ready, Set, Trigger Shot
9. The Femtech Revolution
10. Ovaries in Overdrive
Part IV: The Retrieval
11. Scar Tissue
12. Fertility-Industrial Complex
13. Great Eggspectations
Part V: The Freeze
14. Unviable
15. Reproduction Reimagined
16. A Journalist and Her Ovary
Acknowledgments
Notes
Index
About the Author
_147498688_
For all the people with ovaries
confronting uncertainty and the
consequential questions
I used to think, as a young woman, that life was something I was controlling and directing. Now I only think: What a mess we all are, with so many contradictory impulses, so many things about ourselves we’ll never entirely understand.
—Zadie Smith, Lenny Letter interview, December 2017
We are all yeses. We are worthy enough, we passed inspection, we survived the great fetal oocyte extinctions. In that sense, at least—call it a mechanospiritual sense—we are meant to be. We are good eggs, every one of us.
—Natalie Angier, Woman: An Intimate Geography
List of Abbreviations
ACOG: American College of Obstetricians and Gynecologists
AFC: antral follicle count
AMH: anti-Müllerian hormone
ART: assisted reproductive technology
ASRM: American Society for Reproductive Medicine
BBT: basal body temperature
BIPOC: Black, indigenous, (and) people of color
BMI: body mass index
BRCA: breast cancer gene
CAP: College of American Pathologists
CDC: U.S. Centers for Disease Control and Prevention
CLIA: Clinical Laboratory Improvement Amendments
CMS: Centers for Medicare and Medicaid Services
D&C: dilation and curettage
DOR: diminished ovarian reserve
FAMs: fertility awareness-based methods
FDA: U.S. Food and Drug Administration
FLE: Family Life Education
FSH: follicle-stimulating hormone
hCG: human chorionic gonadotropin
HPV: human papillomavirus
ICSI: intracytoplasmic sperm injection
IM: intramuscular
IUD: intrauterine device
IUI: intrauterine insemination
IVF: in vitro fertilization
IVG: in vitro gametogenesis
IVM: in vitro maturation
LGBTQ+: lesbian, gay, bisexual, transgender, queer, or questioning
LH: luteinizing hormone
NYU: New York University
OB/GYN: obstetrician and gynecologist
OHSS: ovarian hyperstimulation syndrome
PCOS: polycystic ovary syndrome
PGT: preimplantation genetic testing
RFID: radio frequency identification
SART: Society for Assisted Reproductive Technology
STI: sexually transmitted infection
TSH: thyroid-stimulating hormone
WHO: World Health Organization
Author’s Note
About the Reporting
This is a work of nonfiction. All names are real except when noted otherwise. I have indicated these instances in the footnotes and provided explanations in the Notes section at the back of the book. There are no composite characters or events, though I had to omit some people and details in the interest of book length; I did so only when an omission had no impact on either the veracity or the substance of the story.
This book relies predominantly on interviews and research I conducted. Most scenes and dialogue draw from what I saw and heard firsthand. I occasionally describe events for which I was not present and in so doing consulted with others and relied on extensive documentation. To write this book, I set out on an immersive first-person quest, and to that end, I also relied upon my journals and my medical records, as well as my own memory and the memories of others. Memory, of course, can be fallible; I have done my best.
The Notes section is intended to offer more detail on certain studies, statistics, and topic areas, as well as to guide readers to publicly available resources.
On Limited Language and Perspectives
It was my goal to present a character-driven narrative of the contemporary landscape of egg freezing. Most of the research I discuss in this book focuses on the experiences of heterosexual, white, cisgender women, because they are the people who, for now, predominantly constitute that landscape—although they are by no means the only people who use and/or require assisted reproductive technologies. LGBTQ+ people, same-sex couples, solo parents, and a wide spectrum of others plan their family-making outside the traditional male-female partnership, often relying on fertility treatment to do so.
In this book, I use the terms “female” and “woman” to refer to people with ovaries, although not everyone with internal reproductive organs identifies as a woman or a female; likewise with “man” and “male.” Sex and gender exist on a spectrum, and people with ovaries include those who are transgender, nonbinary, intersex, gender-nonconforming, genderqueer, agender, and genderless.
All too often, BIPOC women struggle to access fertility treatment and technologies—a reflection of the broader, unjust ways in which reproductive healthcare’s racial and ethnic inequities play out in the United States. One of the book’s primary characters, Mandy, is Asian American, and I hope readers who are women of color, in particular, will see themselves in her egg freezing experience.
I recognize some of the limitations in my reporting and in the research and findings I describe here. More so, I acknowledge the fact that this book cannot capture all the complexities of the experiences of people with ovaries. However you identify, and regardless of whether you have ovaries and eggs, I hope you will find something of value here.
Introduction
This isn’t the book I set out to write.
I began writing this book in my late twenties. I’m in my early thirties now, and I couldn’t have imagined all that would happen in the years between. The second half of one’s twenties and beginning of one’s thirties is a tumultuous and tender time for many people even under normal circumstances, and this was certainly true for me, though at times the circumstances were decidedly not normal.
One unusual and unique-to-me circumstance that did not change during these years was the fact that I have one ovary, for reasons I’ll soon explain. But I mention it now because it was my doctors’ urging that I freeze my eggs and protect my ability to have biological children that turned out to dominate this roughly five-year period. And it was this dilemma that became the main impetus behind the deep dive that resulted in this book.
As I wrote, my life kept changing. And that, in turn, changed what this book was becoming. What began as a straightforward investigation into egg freezing and reproductive technologies morphed into a book about control. About what we—women, humans, all of us—try to control, why we do that, and how we ultimately have much less control than we think we do. Even as we attempt to buy it or freeze it or otherwise procure it.
Nearly half a century after the birth of the first “test-tube baby” conceived via in vitro fertilization, a third of American adults say that they or someone they know has used fertility treatment to try to have a baby. The ability to successfully freeze eggs has been among reproductive medicine’s biggest achievements, resulting in the first two decades of the twenty-first century having seen egg freezing secure its place among the full range of processes by which conception begins outside the human body. What was once science fiction is now simply science: Fertility can be frozen in time. Along with in vitro fertilization, or IVF, egg freezing is on its way to becoming part of a vast demographic shift—a global tr
For most of U.S. history, many women didn’t have legal rights over their bodies, and we’re still experiencing the horrible hangover. The conflict in America today over abortion is proof of how many people still believe that a woman’s uterus should belong to the government. At the same time, we live in an age that prizes optimization and taking charge, and the notion that a woman should command every aspect of her future fertility—even if her reproductive rights are at present on shaky ground—has become, for many, a pillar of modern womanhood.
The pressure to take charge of one’s fertility helps to explain egg freezing’s rapid growth and why it has become, for a certain group of women, a mainstream, viable option, viewed as one of the best technological solutions available for women hoping to “have it all.” From boardrooms to bedrooms, egg freezing is touted as an obvious and immediate way to conquer the biological clock. More and more employers cover the cost of the procedure as a workplace benefit. Celebrities sing its praises. Many of us know someone who has done it, or have seen targeted ads for it on our social media feeds, or have watched it unfold as a plotline on one of our favorite TV shows. Even if we’ve only heard of egg freezing in passing, we know what it purportedly offers women: More agency over their reproductive lives. More flexibility in planning a family. More options. More control.
My quest to decide whether to freeze my eggs took me to the front lines of fertility—tomorrow’s final frontier for women’s reproductive autonomy. I set out to learn all I could about the latest developments in assisted reproductive technology and how they affected my own future choices. I was a young journalist on a personal mission, determined to unearth information that I and so many other women were shockingly ignorant about. Along the way, I visited world-famous fertility clinics, sat in on high school sex ed classes, and peered into petri dishes inside laboratories. I attended egg freezing parties and medical conferences. I interviewed dozens of reproductive endocrinologists and fertility experts. I followed the experiences of young women who froze their eggs and a few who chose not to. I met with scientists and start-up founders, embryologists and ethicists, clinicians and corporate executives. I spoke to therapists specializing in reproductive trauma and lawyers specializing in reproductive rights. I even sat down with Louise Brown, the world’s first IVF baby, who showed me every one of her twelve tattoos as we chatted about menstrual cramps, fish and chips, and giving birth.
When I decided to look into the science of egg freezing myself, I had hoped what I found would determine my choice. It did—but not in the ways I had expected. It took years to arrive at the conclusions I make in these pages. Some are clear-cut and satisfying. Others are murkier because of what we still do not know about egg freezing and won’t for some time. I wrote this book to put all the information we do have about egg freezing in one place and to make it easy to understand.
I turned over many stones to get here, to stand up with dirt smeared across my face, brush off my hands, and say, “Okay, here’s the deal.” I learned what questions to ask and to whom to direct those questions. I spent a long while holding my breath, waiting to see if egg freezing—the incredible technology and the lucrative industry behind it—could and would deliver on its promises. I searched long and hard for answers. For myself. For you. My mission, I came to realize, had two objectives that were inextricably tied. I couldn’t decide whether or not to freeze my eggs without first learning all the facts. And I couldn’t help women identify and ask the right questions about egg freezing unless I put my skin in the game and was transparent about why making this choice—which at first I thought would be easy—became as difficult as it did. The shape of my search became a double helix, weaving journalistic objectivity with personal interest as I set about learning the truth for you and trying to make a decision for me. Ultimately, the answers I uncovered caused me to consider my questions, and all that informed them, from completely different vantage points and in an entirely new light. And that, it turns out, is often par for the course, both in journalism and in life.
The further afield I went, the deeper my reporting led into a little-understood world where medicine, politics, commerce, technology, and sex intersect in convoluted ways. It’s a world that women, and those who care about them, ought to understand. And so this book is more than the result of my search for answers. It is also a tale about my journey into the future of fertility, as it unfolded against a backdrop of reproductive rights being dismantled and liberties pertaining to women being stripped away. Of all I learned, as a woman and as a journalist, the single most important truth was this: It has never been so important for a person with ovaries to understand their body, their options, and their reproductive autonomy—and the forces that threaten them.
Before all that, though, in the beginning, I set out with simple intentions, notebook in pocket and pen tucked behind one ear, a metaphorical hat labeled Journalist in one hand and a hat labeled Woman in the other. Off I went, just me and my one ovary, giving this all we’ve got.
1
Young, Fertile, and Fabulous
Walking into the Future
My official introduction to the future of fertility was courtesy of EggBanxx, a start-up company offering financing options to potential customers to freeze their eggs. One afternoon in early September, I read on Twitter about an informational “Let’s Chill” event in Lower Manhattan, hosted by EggBanxx, where women would be gathering to learn about egg freezing while liquoring their anxieties with cute cocktails. I wasn’t sure what to expect, but I registered for the event online and promptly received a confirmation email: Forget sweating in the hot summer sun looking for Mr. Right!, the invitation read. It’s fall now and smart women will be staying cool at the EggBanxx party tomorrow night! We hope you’re as excited as we are to sip our Banxxtinis while talking about the three F’s: Fun, Fertility, and Freezing! It wasn’t just idle curiosity. Fertility—and my eggs and sole ovary, in particular—had lately been very much on my mind.
The following night, I headed down to the Crosby Street Hotel to learn more.
“Ladies, you are young and fertile and fabulous!” chirped Dr. Serena Chen, a reproductive endocrinologist at the event. Her white coat and smooth dark hair emanated authority as she smiled at the attractive group of attendees. The hundred or so women around me pecked at popcorn and sipped raspberry-filled flutes of champagne. Several women sat on the edge of their seats in anticipation of…of what? I wasn’t sure. Most appeared to be in their thirties or forties, fashionably dressed, with tan faces and flowing blow-dried hair. I noticed many sparkling diamond rings and designer handbags. It felt like a scene from a Sex and the City episode. I, meanwhile, wore a backpack—I’d just started graduate school at New York University—and was probably the youngest in the room by at least five years.
It was 2014, and EggBanxx, which had launched a couple of years earlier, was now attracting major attention in New York for its series of swanky cocktail parties. The company acted as a matchmaker between doctors and patients in the market for state-of-the-art fertility treatments. “We will be like Uber, but for egg freezing,” said Gina Bartasi, EggBanxx’s founder, in a Washington Post article. An early pioneer in the fertility marketing space, EggBanxx—the two x’s represent female chromosomes—negotiated with fertility doctors to provide lower treatment prices for patients and offered discounts and low-interest loans to women wanting to freeze their eggs. “We’ve learned that millennials don’t like paying retail,” Jennifer Palumbo, who was then director of patient care at EggBanxx, told me in an interview. Palumbo, who had struggled with infertility in her thirties, froze her eggs before taking a job at EggBanxx. Bartasi also had faced difficulties conceiving naturally; she now has twin boys, courtesy of IVF, which is when a sperm and egg are merged to become an embryo in a lab and then implanted in a woman’s uterus.
