A new podcast from the award-winning body hair and care brand Flamingo, hosted by author, curator, and critic Kimberly Drew. Each week on Unruly, we unpack the quiet ways women’s bodies are commodified, defined, and regulated by social media, the medical profession, the beauty industry, and more. Then we name them, out loud — because information is power, and your body is your business. New episodes drop on Wednesdays.
Episode 4 Transcript | To Freeze or Not to Freeze: High-Tech Fertility
[MUSIC IN]
Marcia Inhorn: I feel like women are the ones who get blamed. They get blamed and shamed for their fertility, like being too fertile, being not fertile enough, making choices that are judged. You know, women are just judged for reproduction in ways that men aren't. And I, and I feel like there is still the stigma about egg freezing, like, oh, she went up to freeze her eggs instead of, you know, finding a partner. And like, I really want to remove that judgment.”
Kimberly Drew: When you’re born with a body that has a uterus, you’re faced with the potential promise and peril of getting pregnant. It’s a tension we carry with us the second we start menstruating. In those early years, it’s about how to avoid pregnancy at all costs. Later, for some of us, we begin to ask ourselves: Do I want to get pregnant? Am I ready? Am I able to now that I want to? They’re all tough decisions.. There are a ton of financial, social and emotional things to consider. Plus…hanging over everything… is the big old “the biological clock.” In today’s episode, we’re talking about reproduction in the age of egg-freezing, and how much we don’t know about our own fertility.
I’m your host Kimberly Drew. I’m an author, curator, and all around cultural enthusiast.
And from Flamingo, this is Unruly. Where we take the quiet ways women’s bodies are commodified, defined, regulated and we name them – out loud. We want to educate and support each other. Because your body is your business.
This is Episode 4: To Freeze or Not to Freeze: High-Tech Fertility
Today, I’m joined by Marcia Inhorn, an anthropologist and professor at Yale whose book “Motherhood on Ice: The Mating Gap and Why Women Freeze Their Eggs,” explores the misconceptions, struggles, and triumphs of women delaying motherhood.
Kimberly: So, welcome to Unruly
Marcia: Oh, thank you, I’m so happy to be here.
Kimberly: We are truly so honored. So let's get right into it. What is the history of egg freezing? When was it invented? What were the intentions? Let's just start with a briefer for anybody who might not be familiar.
Marcia: Yeah. So interestingly, since the beginning of in-vitro fertilization back in 1978, there was a lot of interest in freezing the eggs and sperm and embryos. And sperm freezing was easily achieved. Actually, since about the 1950s or 1960s, embryo freezing has been possible since the 1980s, almost since the beginning of IVF. But it was really difficult to freeze the human egg. And why is that? The human egg is the largest cell in the body and it is watery and in the sort of old slow process of freezing, it didn't freeze well, it would sort of crystallize, there was chromosomal damage, so it was difficult to achieve. And then a new form of fast freezing called vitrification came about in the aughts, basically since the new millennium. And it worked. It worked to finally freeze eggs with this very fast, flash freezing method. And sort of the original intention, I guess, clinically was for young women facing dire medical issues, especially young women with cancer, who were going to have to go through chemotherapy and radiation and so on, which has the potential to really make a person sterile. I mean, it can damage a young person's fertility. And so the first kind of application was really for what's now called medical egg freezing. But it was realized that there was a wider potential application for healthy women who didn't need to do this medically but were concerned about their own fertility and perhaps were getting into their thirties and worried about what we would call age-related fertility decline. So by the year 2012, the American Society for Reproductive Medicine lifted the experimental, you know, label and really allowed it to be used for both medical and what's now called non-medical or elective egg freezing. So we're ten years on, you know, it's been sort of a decade of egg freezing for, you know, otherwise healthy women. And it's been a burgeoning – I mean, really, every year more and more people are going to have this procedure, this new technology undertaken not only in the United States, but really increasingly around the world.
Kimberly: You mentioned the term medical freezing, and there was this important transition that happened. And of course, there comes all of these other classifications of how people accessed it. But I wonder if you could talk about this turning point with a bit more depth. How and when did this reach the larger market? What were some of the things that happened as this dispersal happened?
Marcia: Right. So it was October 19th, 2012. The American Society for Reproductive Medicine, which is basically the professional society for clinicians in the world of IVF, lifted the experimental label saying that it is okay for egg freezing now to be practiced in IVF clinics around the country at this point in time. In the first year that it was clinically available, in 2013, there were already 5,000 egg freezing cycles undertaken in the United States. So that was sort of the first year. And then every year since then, the numbers have just gone up and up and up, you know. So now there are thousands of American women who have frozen their eggs. I did a major study with the U.S. National Science Foundation, and I recruited women mostly from the East Coast and the West Coast, just, you know, asked for volunteers for the study, people who wanted to talk with me. But about a quarter of the women that I interviewed were in other parts of America, you know, sort of doing it wherever there are IVF clinics that are offering it.
Kimberly: How common are IVF clinics on a scale of one to accessible, where would you rate it in terms of – at least in the U.S.?
Marcia: Yeah, there are more than 400 IVF clinics in the United States, but all of these assisted reproductive technologies are not very accessible, to be quite frank. They're expensive technologies. And, you know, in the United States, we don't have universal health care. So you have access to health care if you have a good insurance policy and in vitro fertilization and all of the other technologies, including egg freezing, are mostly not covered by health insurance. I mean, it depends if you work for like a Fortune 500 company or a tech company, you know, you may have assistive reproductive technology coverage, but because most people don't, you know, it's elective and you have to pay for it. And I'm going to say egg freezing is very expensive.
Kimberly: I was going to say let's, let’s throw some figures out.
Marcia: Let’s talk about it right.
Kimberly: How penny pinching are we going? How expensive is this process?
Marcia: It is minimally about 10,000 U.S. dollars for one cycle of egg freezing. And egg freezing is really half of an IVF cycle. You're doing the first half of an IVF cycle. When you freeze your eggs. You, you basically have to pay for the procedure itself. And then added to that is the hormonal medication. You have to basically inject – self-inject usually – hormonal medications to stimulate the production of eggs in your ovaries. And that can be an additional, you know, thousands of dollars. So some women spend more like $15,000 on a round of egg freezing or even more. And ideally, women are encouraged to freeze about 20 eggs. And for many women, that's difficult because of age-related ovarian issues. And so women sometimes undertake two cycles or three cycles. So we're talking a lot of money. You know, when I say $15,000 for a cycle of egg freezing, we're just talking about going through the procedure that I just described. But then the eggs are stored. and you have to pay an annual storage fee, which could vary from $500 to $1,500 dollars. Let's say it's $1,000. You stored your eggs for eight years. That's an additional $8,000 between the ages of 32 and 40. And then, when you go back to use your eggs, on average it's about $6,000 to do the next part, which is to have them rewarmed, have them fertilized. If you have to purchase donor sperm, that's an additional cost. So in the long duree of the whole process, we're talking thousands of dollars.
Kimberly: Okay, so what you’re saying is, not only is this is an incredibly complicated process that does a number on your body and your bank account.
Marcia: When I asked women, do you have any recommendations about egg freezing, the number one recommendation is, you know, something needs to be done about the cost of this or there needs to be health insurance coverage for this, as there often is for IVF – if you're married, which was another issue, women, single women felt that there was a certain level of discrimination that, you know, they worked for a company that covered infertility diagnosis and treatment for married employees. But as a single woman employee, there was no coverage for the egg freezing. And, actually also they said it's not only just single women, it's lesbian single women or lesbian partnered women who can't say that they've had one year of unprotected intercourse, you know, trying to conceive with a man.
Kimberly: Which could you talk about that specific year? Because I read about this in the book, but people might not be familiar.
Marcia: Right, so to have an infertility diagnosis, according to the criteria from the World Health Organization, you have to demonstrate at least one year of unprotected sexual intercourse to show that you're trying to have a child, you're trying to conceive, and it's not working. And that's sort of how infertility is defined, right, that you've tried for at least a year and nothing's happened. You haven't been able to conceive and therefore you then have an infertility diagnosis that then allows you to, you know, go forward with whatever the technology, the most common one being in vitro fertilization. So I interviewed some women in tech who were working for the sort of Silicon Valley based tech firms who realized this, that their married friends in the company were getting the benefits of IVF for their infertility diagnoses. But these were single women who were very concerned in their mid-thirties about their own declining fertility. And so egg freezing was there. This is sort of before the companies were paying for it. And they went to their, you know, human resources people and said, you know, I am worried about age-related fertility decline. I don't want to be infertile. I want to prevent my own future infertility by freezing my eggs. Can I get it covered? And they were shocked to learn that, no, you know, you're single. They were asked questions like, ‘well, are you having sex, unprotected sex with your partner?’ And it felt very bad, right? Like, this isn't really fair. Just because I'm not married, I don't get the same benefits. So I learned a lot about, in the sense, women felt there were these injustices and, you know, something needs to be done about the cost, or at least to have some at least partial insurance coverage for this procedure, because it is about sort of protecting or trying to protect one's fertility and one's reproduction.
Kimberly: And one's autonomy. Right. Like you are not able to make these decisions if these restrictions exist and especially under these very clear double standards.
Marcia: Yes, exactly. And there were some really powerful feminist voices, women that I talked to in my study, who were saying, you know, this is about reproductive choice, this is about reproductive justice, this is about reproductive rights, this is about reproductive autonomy, all the things that women in this country should have. But we see often these, these things being eclipsed in all sorts of ways. And I guess we could say that this is one of them. And some clinics, you know, realizing that not everyone can pay a lump sum of $15,000 cash, have different schemes to help put people on payment plans or to give discounts. Some clinics do give income based discounts to women. So there are certain ways that clinics are trying to help in some cases. But, you know, this is a real inequity that really prevents a lot of women who might want to use this technology from ever attempting to access it. And that's really unjust and unfair.
Kimberly: I mean, because these questions always come as part of a larger ecosystem. They're not in a container. They're all part of the ways in which women feel judged. Feel limited in their options and in many ways how our bodies are viewed both socially and medically. Right.
Marcia: Yeah, I agree with you. Can I just say like, I feel like women are the ones who get blamed. They get blamed and shamed for their fertility, like being too fertile, being not fertile enough, making choices that are judged. You know, women are just judged for reproduction in ways that men aren't. And I, and I feel like there is still the stigma about egg freezing, like, oh, she went up to freezer eggs instead of, you know, finding a partner. And like, I really want to remove the judgment and say, you know, instead this is a reproductive justice issue. The right to have children is a reproductive justice issue. It's one of the UN human rights, the ability to found a family. And that's what women hope to do by using this technology.
Kimberly: I wonder, in your research or in your opinion, there is this association between egg freezing and time. And this idea of maybe buying time. Did you find that people in your study or are you finding in general that it's, that buying quote unquote more time is helpful?
Marcia: Yeah, no, it's an excellent question. And I think it is about time. Basically, just to be really clear, when you freeze your eggs at, say, age 32, those are your biological 32 year old eggs. They get literally suspended in time at the age that you froze them. And let's say that you then get stuck in what I call reproductive wait-hood. You're waiting to find a partner who maybe isn't emerging in the way that you'd hoped. And so let's say you become age 40. It's, you know, eight years on, you haven't found your partner. And let's just say maybe you decided you wanted to use your eggs and become a so-called single mother by choice or by circumstance. Right? So, you can then go back and get those eggs. They will be rewarmed in the IVF lab and using sperm, either a partner sperm or donor sperm, the embryos are created and you are using your 32 year old eggs. And so it is actually a way to preserve fertility in time and then to extend it, let's say by the time you reached 40, your own eggs in your body may no longer be viable for conception, but using your 32 year old eggs, you may end up creating very excellent, high quality embryos. So it is about time. I asked women at the end in, you know just my conversations with them, ‘Ultimately, after you've done this, how do you feel about having done that egg freezing?’ And it was overwhelmingly positive. I mean, more than 90% of women had at least one positive thing to say about their egg freezing experience. And for a lot of women, it was really actually kind of wildly empowering. In fact, the word power, empowering, empowered came up just over and over without any kind of prompting, women feeling like, you know, this is the one thing I could do for myself. It's the one thing I could take charge of. It gives me a little bit of a safety net. It's a tremendous release of pressure. I was feeling so psychically burdened about my fertility and, you know, I feel like I can just breathe a little bit. It gave me optimism that I might become a mom. So the timing aspect of it is, is really important and it's real in some sense.
Kimberly Drew: We're gonna hear about the reasons why women are choosing to freeze their eggs in just a moment. Normally, this is where you’d hear an ad – and honestly, maybe you’d skip through it. But instead, we’ve got a story from a nonprofit that supports women's bodily autonomy and mental health. It’s one of the organizations that Flamingo donates to as part of its mission to “keep your body in mind.”
Kimberly: So, Marcia, before fertility and egg freezing technology had become available, you were already studying other forms of reproduction. Could you say more about that?
Marcia: Yeah, so I had done literally three decades of research in the Middle East and an Arab America looking at, you know, infertility, IVF and then emerging technologies, because a number of variants of IVF have sort of come down the pike. And so I have been studying this phenomenon for really a very long time in the Middle East and in Arab America. But at Yale, in the year 2012, when the new technology egg freezing was coming about, my very good colleague at the time who was directing the Yale Fertility Center said, you know, there is this new technology and we should figure out who's going to use it, who are the kinds of people who are going to turn to egg freezing. It was his suggestion, you know, So he launched this big study, interviewed 150 women. I would say 36 of them were women who were medically egg freezing, but the majority volunteered because they were doing it for elective reasons, they were healthy women. And it was simply because the technology emerged, and the problem that I discovered, the reason why these educated American professional women of all backgrounds were freezing their eggs is because they were straight – they were heterosexual – but they were single, single, single. I mean women said, ‘Why am I freezing my eggs? I’m single, single, single.’ And this is not something I necessarily expected. Actually, when I wrote the grant proposal for this study, the main theory or sort of assumption about why women would be freezing their eggs is about educational and career planning. You know, this is about women in their maybe twenties who are going to take charge of their careers or climb the corporate ladder, and they're going to be using egg freezing as sort of this tool to promote their professional lives. And that is still actually an image out there very much in the world that this is all about selfish, career-climbing women. And that is so not what I discovered. I mean, the main finding of my study is something I'm calling the mating gap: the lack of eligible, educated, equal male partners who are enthusiastic to be partnered and become parents with these women. I mean, women who freeze their eggs are successful, professional, educated women who want to be moms. They want a partner, they want to be pregnant with their own eggs, and they want to be parents. Always hoping to be a mom, I never assumed I wouldn’t be a mom. And the issue is just finding a partner, a man who wanted to be part of this journey. And, you know, I wasn't expecting that because that wasn't what was sort of suggested out there in the literature, in the media.
Kimberly: I would like to zoom out just a bit as well, and I wonder if we could talk on a more macro level about what the promises are that are being sold to people who take up this option and how likely is it that some of these promises will come to fruition for them?
Marcia: Yeah, I think the biggest false promise that is out there in the media and it's, you know, through advertisement by some of the more, how shall we say, profit-oriented sorts of IVF centers. It is not a promise that you're going to get what's often called a take-home baby from egg freezing. There's no guarantee. And the term ‘insurance policy’ has often been used to describe egg freezing. And that is the wrong terminology. It is not an insurance policy. You could freeze twenty eggs, which is sort of what people hope to get at least twenty eggs. And when they're rewarmed and embryos are tried to be created, there's no guarantee that you're going to be able to get viable embryos or that they're going to end up in a pregnancy. So it's not a guarantee. So that's one thing that really needs to be made clear. And it's difficult to do. You have to learn how to self inject these hormonal medications, which for a lot of women is daunting. Many people have a fear of needles, and so you really have to overcome that. You have to do that on a daily basis, including one toward the end called the trigger shot, which is a very large needle. And you have to get it into your gluteal muscle in your buttock. And it's hard to do on your own. And then sometimes they're real disappointments, just the number of eggs, you know, the hope that you're going to end up with a good number of eggs from one cycle often doesn't happen for women. So especially women in the latter part of their thirties, they have to take another cycle or another cycle just to try to build up a good store of eggs.
Kimberly: I know that your research focuses on a lot of the world and that you've done extensive research in the Middle East. How do conversations around fertility and fertility and egg freezing vary across cultures?
Marcia: Yes. So honestly, most of my career, I'm an anthropologist and I'm a specialist in the Middle East, I've worked in a number of different Middle Eastern countries. And I really started there focusing on the sort of social suffering of women facing infertility in a part of the world where 90% of people will marry. And it is a very pronatalist part of the world where people really want to have children. It's just expected, it's almost like mandatory to become a mother and a father. So that's a lot of pressure and it has its own issues. When you're in a place where you're really expected to be fertile and if you can't, it's very difficult. Having said that, people in the Middle East really want to have children, including men. Men really want to become fathers. Most men want to be married. And if they're not married, it's often because of economic and political economic conditions. But men value marriage and family life and really want to be dads to children, and it's just a very different cultural vibe.
Kimberly: I am a person who is in network with many people who are on their childbearing, caregiving journeys, and I wonder if we could talk a bit about how people in the universe of those people might best support them. What are some of the solutions that you've found or that you might have heard or things that worked well for people as they were considering egg freezing or also in the process of doing this work?
Marcia: Yeah. So first of all, I have to say, I found that egg freezing involved this network of support, just doing the egg freezing itself. And there were these wonderful sort of friend groups where often like one woman decided to do it, and then she became like, I called her the egg-freezing bellwether for the rest of her group. And so you got these little communities of women, friends who were sort of doing it – one started it and then they kind of did it, sometimes did it together, and decided, look, if we don't find partners, we're just going to support each other. And so I had some very good examples of women who were basically living close to each other in proximity and being the support group. And a couple of those women, actually three women in one group, all had children, you know, without a partner but were helping each other. And so I think, you know, people can help women on that journey, especially if they need some support. Women in friend groups. Sisters often were a huge factor for women who had sisters. They were often very lucky and feeling close to their sisters and talking about sharing eggs with each other. So yeah, there was a lot of different kinds of support from different kinds of people.
Kimberly: I spend so much time having fertility conversations, child bearing conversations. I am brave to say I'm 33 years old and it is the constant hum of my life. What kinds of conversations should we be having in relationship to these options made available?
Marcia: What I learned is that women in this country are routinely put on hormonal contraceptives, often in their adolescence, for reasons that don't have to do with pregnancy prevention, but menstrual regulation or dermatological issues, you know, preventing acne and so on. And women often just stay on contraceptives and they go to their well women visits, you know, on an annual basis, and they have pap smears and they do what they're supposed to do, staying on those contraceptives and never having a conversation with a physician, a gynecologist about fertility – when it starts to decline, whether fertility is something that they're considering. Women said, ‘Gosh, I've really been, you know, very routine. I've tried to be good. I go annually. I try to be a very good gynecological patient. And now I'm 33 years old. I never had a single conversation with a doctor about whether I wanted to have children, whether I should go off contraception.’ So there was this feeling that clinicians weren't having these conversations with women, and there was also this feeling that women had, that they'd had a lot of sex education since actually sometimes elementary school, often about pregnancy prevention and STIs, but the fertility conversations about like, when does fertility start to decline? Women had never had those conversations, including women who had gone to women's colleges. They said, you know, ‘we talked about everything. We were like, so open and nothing was, you know, taboo. We talked about everything, but we never talked about fertility, like, should we think about our fertility?’ So I called this “fertility benightedness,” people just in the dark about their fertility, you know, very educated women who felt that they just didn't have enough information. And I think a lot of American women really don't know when fertility starts to decline, which is around age 32. But there's something called the fertility cliff, a real decline in fertility at around age 37. And so most women don't know that.
Kimberly: It is funny, I am a proud Smithy and can also confirm that I learned how to build my own credit. I learned how to do all of these other tools of empowerment. But I cannot think of a single time where I talked about fertility, fertility windows. There have been so many cautionary tales about what it means to take these next steps in your life, or even the overall divestment from men. But the conversation about fertility and these, and the like, not so much.
Marcia: People should have the right not to have children. People should have the right not to partner. You know, there are people who are just single at heart. You know, I have a niece who's that way and people have the right to make these decisions and choices about parenting, as you're saying. But when you know that you want to do that, you know that you want to be a parent, you do need to know about your own biology and you need to know about your fertility. And fertility testing is not routine. It's not routinely done in the sort of, well woman gynecological visit. So it's just something that we need to be thinking a lot more about and we need to have ways to convey that information in ways that don't scare women but inform them. Better education on fertility is needed.
Kimberly: I think that that's the perfect place to wrap this. I appreciate the generosity of this information and the accessibility of how you described it.
Marcia: Oh, well, great. Thank you. It's been my pleasure. And lovely to meet you this way.
Kimberly Drew: The looming pressure of a “biological clock” is just a fact of the body. We can’t escape it. In a perfect world, technologies like egg-freezing could help everyone achieve a certain reproductive freedom from that clock.
But even that is no guarantee. And it’s a big risk– both to the body and the wallet. What we can do is make conversations about fertility an on-going practice with our physicians.
And while we’re at it, we can push for a culture where definitions of family, and family planning are redefined. Where the decision to become a parent doesn’t just rest on the availability of a PARTNER. Then, maybe, we’d have a generation of parents that are a bit, well…Unruly.
I’m Kimberly Drew… for a transcript of the episode and more resources visit shopflamingo.com/unrulypodcast.
Unruly is a podcast created by Anna Wesche and produced by Pineapple Street Studios in collaboration with Flamingo. Our associate producer is Marialexa Kavanaugh. Our lead producer is Natalie Brennan. Our mid-episode profiles are produced by Sophie Bridges. Our managing producer is Kamilah Kashanie. Our editor is Darby Maloney. Our Head of Sound & Engineering is Raj Makhija. Our Senior Audio Engineers are Pedro Alvira and Marina Paiz. This episode was Mixed by Davy Sumner. This episode was mixed by Marina Paiz. Our Assistant Audio Engineers are Jade Brooks and Sharon Bardales who also gave scoring assistance. Our Executive Producers are Je-Anne Berry and Aggi Ashagre. Our Music is from Epidemic Sounds.
