In the early 2000s reproductive medicine doctors in the United States, using methods developed in Italy, started offering to freeze their patients’ eggs. The far simpler process of cryopreserving human spermatozoa had been explored as early as 1776 (by an Italian priest-scientist who found that sperm, of unstated origin, became motionless when cooled by snow and then started swimming again when warmed), but it wasn’t until 1965 that oocytes, which are water-laden and comparatively huge, were successfully preserved, and not until the 1990s that the technology really caught on. When early egg-freezing trials showed promising results, the procedure was extended to cancer patients who were about to start chemotherapy, which can permanently impair fertility, and then to women who for personal, nonmedical reasons wanted to prolong their ability to have children.
Elective egg freezing soon attracted attention as a way for women to take control of their fertility during the stage of life when biological countdowns purportedly compete with other metaphorical clocks—those of building a career and finding a mate. A 2005 New York magazine article described the women availing themselves of this new service as “the aspiring law-firm partners, the ambitious actresses, the medical-school residents.” A 2014 issue of Bloomberg Businessweek featured the cover line “Freeze Your Eggs, Free Your Career”; the article imagined that “if a 25-year-old banks her eggs and, at 35, is up for a promotion, she can go for it wholeheartedly without worrying about missing out on having a baby.” (Incongruously, the writer focused on a divorced marketing executive who enthusiastically froze her eggs at the age of thirty-nine.) Around that time Facebook and Apple announced they would pay for workers to freeze their eggs, and newspapers reported on the trend of baby boomers footing the bill for their daughters as an investment in their own future grandparenthood.
In 2012 the American Society for Reproductive Medicine (ASRM) declared that egg freezing was no longer “experimental.” Vitrification, a late-1990s innovation in which oocytes are flash frozen in liquid nitrogen (and become glass-like), had significantly improved the survival rates of thawed eggs over the older slow freezing method. Frozen eggs were now just as likely as fresh ones extracted during an IVF cycle to result in the birth of a healthy baby. The procedure became a standard offering at established fertility centers that had been serving patients who were having difficulty conceiving.
A typical egg-freezing cycle takes about two weeks. The patient injects herself daily with subcutaneous shots of hormones to stimulate her ovaries to produce multiple mature oocytes. (This is in contrast to the single oocyte, released by a single ovary, in a normal menstrual cycle.) She goes to the clinic every few days, for ultrasounds of the ovaries to measure the growth of the follicles that contain the oocytes, and for blood work to measure hormone levels. Once enough of the follicles (around 70 to 80 percent) are big enough, the patient gives herself a precisely timed intramuscular hormone injection called a “trigger shot,” which sets off the final maturation of the oocytes.
About thirty-six hours later she goes to the clinic for the egg retrieval: doctors insert an ultrasound-guided needle through the vaginal wall and into the ovaries, puncturing the follicular sacs and aspirating the oocytes into a vial. When the patient wakes up from her sedation she is told how many eggs were retrieved, and a few hours later she is told how many will be frozen; only mature ones make the cut. (At this point the eggs of a patient immediately trying to get pregnant would be fertilized and allowed to develop for several days into embryos that would then be either transferred to the uterus or frozen for later use.) The average egg-freezing patient has to undergo two to three cycles to reach the target of about twenty eggs, the recommendation for fair odds of a live birth.
Beyond the physical demands on patients, there is the high cost for the substantial majority who don’t have employer coverage. In the past decade start-ups focused on egg freezing, backed by venture capital and targeting millennials, have pushed down prices. An Instagram ad for Extend Fertility, a New York City–based egg-freezing company, showed a manicured hand next to an anthropomorphic egg, with the caption “If you can afford this” (the nails) “you can afford this” (the gamete). The cost of one egg-freezing cycle in the US is around $12,000, or about ten years of fortnightly manicures.
Despite the burdens, the number of elective egg-freezing cycles completed in the United States has climbed steadily, from around five thousand cycles, undertaken by around four thousand patients, in 2014 to nearly 40,000 cycles in 2023. For her book Motherhood on Ice: The Mating Gap and Why Women Freeze Their Eggs, Marcia Inhorn, a medical anthropologist at Yale, interviewed 150 women who froze their eggs. Almost all said they did it because they lacked a suitable reproductive partner.
The women Inhorn interviewed tended to be in their late thirties, highly educated, professionally successful, financially stable, heterosexual, and single. The average age at which Inhorn’s subjects froze their eggs was 36.6, which is consistent with average ages not just in the US but worldwide. Some of the women she spoke to had never been partnered; others had been in marriages or in long-term relationships that ended because the men were not ready for fatherhood. Nine percent of the women were, at the time of freezing, in “a tenuous relationship” with a man. The remaining women, roughly 10 percent, were in stable relationships and had undertaken egg freezing—tellingly, not embryo freezing—while waiting for their male partners to agree to have a child. All of Inhorn’s subjects found themselves in what she calls “reproductive waithood,” a phrase that captures the involuntariness of their position.1
Inhorn’s findings, which are consistent with those of smaller studies over the past decade (including one conducted in 2018 by Inhorn herself), plainly contradict the pervasive cliché that women freeze their eggs for career reasons. Only one of Inhorn’s subjects cited career planning as her main motivation. “I’m not doing it because I want to spend more time on my career,” Inhorn was told by Kayla, who worked at a tech start-up, was single for much of her thirties, and completed two egg-freezing cycles at the age of thirty-eight. “Like, I’m pretty sick of my career.”
The women Inhorn interviewed talk with analytic clarity about their romantic histories, their jobs, how they came to freeze their eggs, and how they feel about it now. Aziza, an academic physician who had dated very little (one boyfriend for one year, long ago), found herself in her mid-thirties with no real prospects:
The only reason why I did this egg freezing is because I hadn’t found someone…. So, even though I’m 1,000 percent happy I did it, it felt somewhat like a defeat. I felt like I gave up, because I couldn’t find a man.
Tiffany, a project manager at an engineering firm, never got close to marriage over the course of several relationships: “I have never been ‘their person,’ you know what I mean?” When she was thirty-nine she froze two eggs. Lily, a curator in Manhattan, spent her thirties in a relationship with Jack, a humanities professor. When, at the age of thirty-eight, she told Jack that she was going off the Pill, he refused to have sex with her for over a year. As she approached forty, she left him. At forty-three she froze sixteen eggs, and the following year she tried to use them. She was single, and even though she blamed Jack for “fucking up” her ability to have children, she asked him to provide sperm. He agreed, but she did not get pregnant. “These men over forty who have never been married,” she told Inhorn, “there is a reason why, and there is something wrong with them…. There is something wrong.”
I know about a dozen women who have frozen their eggs, and all of them did it because they were single. They had considered it for years and finally got around to it, between the ages of thirty-five and forty, because they didn’t see their romantic prospects changing quickly enough. They are, as far as I am aware, happy that they did it, but they are also sad about the circumstances (for most of them ongoing) that brought them to the decision. Some wish they had frozen earlier, but that would have required a certain pessimism about their future at an age—say, thirty-two to thirty-five—when it’s entirely reasonable to hope to find a serious partner. “Wishful thinking” is a retrospective construct. None of them—most are in their forties now—has gone back for her eggs yet.
Inhorn’s main revelation is that egg freezing is less a paradigm-changing technology than the bellwether of a much broader trend, that of a “mating gap” in which American women from the upper socioeconomic echelons are struggling to find similarly situated men with whom to have children. The most comprehensive book on the subject of egg freezing, The Big Freeze by the journalist Natalie Lampert, misses this startling and fundamental quandary. Lampert argues that most women, including herself before she started writing the book, aren’t well informed about their reproductive health in general and about age-related fertility decline specifically, and she implies that this is why some women wait so long to try to get pregnant or freeze their eggs. She blames various cultural factors, including school sex education that’s entirely focused on preventing pregnancy, and tabloid tales of celebrities getting pregnant in their late forties or fifties that create unrealistic expectations among common folk without access to weapons-grade fertility care.
For women in their early-to-mid-thirties, she observes, the pressure rapidly shifts from pregnancy prevention to fertility preservation, and single women who feel fabulous (or just normal) one day can feel like spinsters the next. Inadequate knowledge of age-related fertility decline is indeed common, including among populations who ought to know better (e.g., OB–GYN residents!); both egg quantity and quality drop slightly in the early thirties and steeply in the mid-to-late-thirties, when some women mistakenly assume they’ll easily get pregnant. But the women in Lampert’s book, and in Inhorn’s too, are sophisticated consumers whose dilatoriness seems to be driven less by ignorance than by something like a psychological block related to mating problems.
Lampert profiles three women who froze their eggs, but these stories are mostly procedural, focused on the minutiae of the freezing experience rather than on the biographies that would explain how these women got here. Two of Lampert’s subjects do fit something like a typical profile: Remy, a thirty-three-year-old anesthesiology resident in Nashville, is recently divorced, and Lauren, a thirty-eight-year-old “entrepreneur” in Houston, has been single for some years.
The third subject, Mandy, is a thirty-year-old “professional” who is far from typical. She is married and is freezing embryos, not eggs, mainly for medical reasons; recurring cysts led to partial excision of her ovaries, and she and her husband are not quite ready to have kids. Lampert herself has a similar medical history: she lost one ovary at age twelve, after a spontaneous torsion, and when she was twenty and briefly went off hormonal birth control, the remaining ovary twisted but was saved in an emergency surgery. She started looking into egg freezing as a twenty-five-year-old graduate student in journalism at New York University. (Only around 6 percent of egg freezers have a medical reason, and that reason is usually cancer.)
Despite acknowledging Inhorn’s findings, Lampert writes of “aspiring mothers delay[ing] childbirth to climb the career ladder or find the right partner,” treating the lack of a partner as just one possible reason rather than the reason. Perhaps Lampert’s own experience didn’t bring her close enough to the mating crisis Inhorn describes. Her wavering about freezing takes the form of endless lists of pros and cons. Whether to freeze is presented accordingly, as a deliberative process rather than a decision made while feeling, dreadfully, that time is running out.
While still in J-school, she attended an informational cocktail hour in Manhattan hosted by a start-up called EggBanxx. Of the guests, “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.” But it’s the absence of diamond rings that is the problem, and she seems to have been shielded from it. In Lampert’s own love life, about which we hear a good deal, there’s no stringing along, no man-child weirdness, and by the end of the book she is engaged to be married, still in her early thirties, with a decent number of years left to get pregnant naturally—a good thing, since she decides (surprisingly, to me) not to freeze.
These blind spots in an otherwise well-researched primer suggest just how effective the hype is. With the more representative subjects, Remy and Lauren, Lampert falls into further clichés and euphemisms. Of Remy she writes:
Thirty-three had long felt symbolic to her. Unabashedly superstitious, Remy had always imagined having kids at this age. This year of medical residency was going to be her year for children. But things in the love department hadn’t exactly gone as planned, and so now thirty-three was her year for egg freezing.
A broken engagement when she was twenty-five and in medical school. Then: a new flame, a whirlwind romance, a hasty wedding, a brief marriage, and divorce—all before she finished residency.
We learn nothing of Remy’s brief marriage. Were she and her ex-husband planning to have kids? Why did they break up? We learn even less of Lauren’s history—just that she had been single for a while and that she decided, at thirty-eight, that she wanted kids someday: “Not now, but when she wasn’t too old, either.” Why “not now”? Is she waiting for a partner? How old is “too old”?
Lampert’s approach, earnestly feminist and dutifully proffering a bad guy in the form of the for-profit fertility industry, can never go deep because asking questions about these women’s predicaments might seem politically untenable, built on an assumption that they have done something wrong. As Motherhood on Ice shows, detailed histories tend to vindicate such women: it’s not that they are particularly poor decision makers, but that they’ve found themselves casualties of profound changes in mating trends.
For decades both marriage and fertility rates in the US, as in the rest of the developed world, have been dropping, and the ages at which Americans get married and have children have been rising. (The reasons for both are many and frustratingly hard to pin down.) Two thirds of Americans under the age of thirty-five live without a spouse or partner, and nearly half of childless adults under fifty say they aren’t likely to have children.
Women who freeze their eggs occupy an ill-defined spot in the culture in relation to these trends. Their predicament is inevitably shaped by the broad global decline in the total fertility rate: with fewer people having children at all, there’s going to be a smaller mating pool for those who are affirmatively interested in doing so. The crisis for these women is thus partly sampling bias. There are also sociological factors specific to egg freezers as a subpopulation, including the fact that the smartest, best-educated Americans have tended—following the expansion of higher education and white-collar professions in the postwar era—to seek spouses of comparable credentials. During the past three decades American men have fallen behind women in high school and college completion and in employment, which means that across the socioeconomic spectrum there are fewer men of comparable attainment for women to pair up with.
Changing male attitudes toward marriage and children are beyond Inhorn’s remit, but the stories she includes suggest that delayed maturity in men is a determinant of women’s delayed childbearing. The men in the background of her book are successful professionals (doctors, lawyers, professors), and most of them are ruinously indecisive. She writes, “Many men in the US no longer face a masculine marriage imperative, or any kind of social mandate requiring them to become a father.” One group that has actually followed a pronatalist cultural imperative is conservatives, who are now outbreeding others in the US and Europe.
The majority of Inhorn’s academic output has been on gender and family life in the Middle East; in her 2012 study The New Arab Man she argues that Arab men tend to regard marriage and children as fundamental, eagerly sought facets of their masculine identities, and often feel frustrated by any delays (caused by economic hardship, for example). She does not see any such alacrity in the West.
Surveys show that childless American men are less likely than their female counterparts to say they intend to have children. They also tend to wait longer before trying, and report less worry about disappointment if they weren’t to succeed. The one metric where gendered enthusiasm reverses is in the realm of misty abstraction—men’s numbers are higher if the question is whether they would like to have children one day. The average college-educated American father has his first child at thirty-three.
It would be absurd to suggest that men are entirely responsible for delays in childbearing. Women’s unprecedented levels of education and workforce participation have changed their attitudes and expectations about the shape of their lives. For those with at least a master’s degree, the median age at marriage and first baby is around thirty (which in some circles is young: being pregnant in New York City at thirty has been called a “teen pregnancy”; in medical parlance, “geriatric pregnancy” begins at thirty-five). The error in the tenacious clichés about egg freezers may be the assumption that the delay is part of a grand plan or ambitious calculation rather than an effect of women having other sources of validation and satisfaction that include education and career, along with less cultural pressure to get married or have kids. “Children are foundational not capstone,” went a cautionary tweet directed at the “over-educated, over-anxious types.”
Inhorn predicts that Gen Z women will marry men of lower socioeconomic backgrounds who are ready to have kids. She tells the story of Hannah, a management consultant with a JD from an Ivy League law school who, finding herself single at thirty-six, did three freezing cycles, banking thirty-two eggs. She then quit her job and went on a bike tour, during which she met Lucas, a firefighter with a state college degree. They began dating, and at thirty-nine Hannah got pregnant spontaneously. Three years later they had another child, this one a “frozen-egg baby.” If the mating crisis Inhorn describes tracks with the broader fertility collapse, then it’s not going away anytime soon, and egg freezing “will remain educated thirty-something women’s single best reproductive option.”2
Lampert’s journalistic investigation, and her personal dithering, are organized around a single question: Is it worth it? Lampert is generally optimistic about the ability of egg and embryo freezing, like the Pill and legalized abortion, to give women a further degree of control over when they become mothers. But she gets preoccupied with the notion that egg freezing’s popularity is “predicated almost entirely on providing a kind of insurance,” yet it “carries no guarantees” and, she asserts, comes with a variety of risks.
The immediate risk to patients’ health is that the hormone injections may overstimulate their ovaries, causing uncomfortable swelling and, in rare cases, leakage of follicular fluid into the abdominal cavity and even the chest—complications that require hospitalization. Whether there are long-term health risks is a question that, Lampert argues, deserves more attention, though she underplays how much has been done to answer that question. Scientists have hypothesized that the high doses of hormones used during ovarian stimulation could increase the risk of hormone-sensitive cancers, such as breast, ovarian, and uterine cancers. Estrogenic cancer risk is tied to lifetime estrogen exposure; ovarian stimulation dramatically if briefly increases estrogen levels, commonly ten times the levels in a natural menstrual cycle. Current evidence does not show a significant increase in cancer risk for most women who undergo stimulation, though these studies have limited follow-up periods and do not clearly address whether repeated cycles might change the risk.
When most critics of egg freezing talk about risk, they mean the prosaic risk that it will not “work.” Patients’ eggs don’t always survive thawing, or don’t fertilize, or their embryos stop growing or don’t implant. (Such attrition was taken into account when the ASRM declared frozen eggs to be as promising as fresh ones extracted during IVF; even in natural conception, about half of embryos fail to implant.) A 2017 Business Insider article titled, millennially, “There’s a Dark Side to Egg Freezing That No One Is Talking About” revealed that when Brigitte Adams, the woman from the 2014 Bloomberg Businessweek article, returned to claim her eggs, at the age of forty-four, using donor sperm, only one of eleven eggs became an embryo, and that embryo stopped developing soon after it was transferred to her uterus. She was too old to try again.
In 2022 the NYU Langone Fertility Center published the largest study to date on success rates. The study found that, overall, 39 percent of patients who returned for their frozen eggs had at least one child. Not surprisingly, the odds were better the younger the patient was at the time of freezing and the more eggs she froze.3 The president of the ASRM said the NYU data was “sobering” and “should give women pause,” but this warning assumes a degree of choice that many women don’t have—paradoxically, given the “elective” label attached to the service. In the NYU study, the average age at freezing was 38.3, well beyond the optimal age with respect to egg quantity and quality. The medical problems largely have to do with age; they are downstream of the social problems.
Despite the perception that women who freeze in their late thirties or early forties are delusional or being deceived—and bringing down the success rates—it can be argued that it’s these older women who are best served by egg freezing. Older women are more likely than younger women (who have more time to get pregnant on their own) to use their expensively obtained eggs, and they have decent odds of success when they do. One in three women who froze between the ages of thirty-eight and forty, and one in four women who froze at forty-one or older, will take home a baby that probably would not exist otherwise; the odds of spontaneous pregnancy at these ages are low.
And the value of the service is not solely in the return on investment. Lampert reports that only between 12 and 15 percent of patients have used their frozen eggs; the vast majority of women who haven’t do not regret freezing. All three of Lampert’s subjects got pregnant naturally, the oldest of them at thirty-nine, and none has regrets. Regardless of age, the psychological relief of feeling less time pressure may be the benefit—not glossy self-care or the ironclad insurance Lampert wishes existed but a different kind of backstop. Several of the women I know who have frozen their eggs—along with those I know who, like myself, have gone through IVF—have come out of the experience set on imparting lessons to younger women. A friend who recently froze at thirty-seven found herself, a few weeks after her retrieval, interrupting two twenty-something strangers on the subway who were talking about guys ghosting them. “Freeze your eggs,” she told them.
At a population level, her admonition is being heeded. According to data from the Society for Assisted Reproductive Technology, a growing number of egg-freezing patients are under thirty-five: roughly 35 percent in 2020, compared with 25 percent in 2012. The director of the NYU Langone Fertility Center recently reported that the average age of patients there has dropped in the past few years, from thirty-eight to “the lower 30s,” a change he “applauds” but for which he provides no explanation. “For Gen Z, fertility anxiety is trending,” Women’s Health reported in 2024. Perhaps the bleakness of contemporary mating is behind the change. Perhaps the new generation has learned to be more clear-eyed, more calculating about motherhood. All it took was becoming a little less hopeful.
English (US) · 