Kira Bindrim: As a single, childless 36-year-old, there is one thing I have been told many times: My fertility is declining by the second. My eggs are dropping like flies, and every year that passes will make it harder for me to have a child naturally. As of right now, that’s fine with me. I like my independence and I love my peace and quiet. But what if I don’t feel that way in five years?
For people like me, and people a good deal younger than me, egg freezing is becoming a popular option. Between 2009 and 2016, the number of women in the US who froze their eggs rose by more than 1,000%. These days, I even come across ads for egg freezing on Instagram, right between photos of my friends’ babies. As more women become more ambivalent about having kids, egg freezing is becoming borderline mainstream. Celebrities like Chrissy Teigen, Khloé Kardashian, and Rebel Wilson have all spoken publicly about freezing their eggs.
But freezing your eggs isn’t as simple as it sounds. The procedure is far from a sure thing. And it requires time, support and money. In the US, the total cost can easily top $15,000. That price point has attracted a lot of startups and a lot of investment dollars. But it leaves women in a tricky situation. How do you truly and effectively take control of your reproductive health without breaking the bank?
This is the Quartz Obsession, a podcast that explores the fascinating backstories behind everyday ideas and what they tell us about the global economy. I’m your host, Kira Bindrim. Today: egg freezing, the next big offspring insurance policy.
I’m joined now by Courtney Vinopal, who is a breaking news reporter at Quartz based in Washington, DC and who is also starting to have conversations with her friends about egg freezing. Courtney, when we first started talking about this topic, I was really struck by how new egg freezing is, relatively speaking. So maybe we could start with you walking me through how we got here. When did egg freezing begin? And how has its popularity evolved over the last few decades?
Courtney Vinopal: Yeah, so egg freezing has been around since the 1980s. And I think it’s important to note that we really wouldn’t be talking about egg freezing without in vitro fertilization. And egg freezing really just refers to the first half of that process. So the first baby from IVF was born in 1978. That’s a so-called test tube baby, you might remember. Then the first baby born from a frozen egg didn’t come along till 1986. And it’s interesting—when you read the news reports of the baby that was born in 1986 from a frozen egg, it was like the technology was sort of unheard of at the time. It seemed almost taboo, the woman who got pregnant with having her eggs frozen, she didn’t even want to give her name. But anyways, that’s sort of when egg freezing came about. And from there you kind of see the science evolve throughout the 1990s into the early 2000s when it finally starts being recommended widely to women.
Kira Bindrim: So how do we get from there to here? So in 1986, we have the first baby born this way, which makes them a millennial, which I kind of love. And then today, you know, we’re seeing ads for egg freezing, and maybe more important, we’re seeing a lot more conversation about it among young women. What is the path to take us from then to now?
Courtney Vinopal: Yeah, absolutely. So throughout the 1990s, egg freezing was still very, very experimental. The reason for that is that eggs are quite fragile. They’re more fragile than sperm. So sperm freezing has been around since, I believe, like the 1950s. We’ve been freezing sperm for a long time, safely. But eggs are much more fragile, and they can get damaged during the freezing process. So the procedure was really just considered too risky to recommend to women throughout the 1990s. And then in the late 90s, you have a new freezing technique called vitrification that allows for safer egg freezing, essentially. It’s a freezing technique where there’s less risk that ice crystals will form on the eggs. Some studies were done that showed it was just a safer way to freeze eggs. It was less risky, the success rates were higher their survival rates of the eggs were higher. And so in the early 2000s, you have egg freezing sort of recommended for what they called medical reasons. So it was primarily recommended for women who had diseases that threatened their fertility. So maybe they were receiving chemotherapy treatment for a cancer diagnosis. Maybe they had a disease where they had to get their ovaries removed. So it was really just recommended for medical reasons. And then finally, in 2012, the American Society for Reproductive Medicine basically said, ‘Okay, we’ve seen enough studies now that suggest the technology and the science here is improving. So we are going to remove the experimental label off of egg freezing.’ And so that’s where you see it become more of an option for a wider swath of women, I guess.
Kira Bindrim: So it’s really only in like the last 10 years that this has become something that women who don’t have a health consideration would be considering?
Courtney Vinopal: Yeah, it’s really only in the last decade that this has become a consideration for women my age. So it’s very new in that sense.
Kira Bindrim: It is so tempting for me to make a chicken or egg joke right now, but I will not. But it does seem like egg freezing becoming more mainstream, or at least more common, has coincided pretty neatly with a shift in the age at which women are having children, versus that women are waiting to have children because egg freezing is a more viable option. Is that right? Why would you say that egg freezing is becoming more popular these days?
Courtney Vinopal: I think there are a number of factors. One, definitely, is that women are waiting later to have children. Women are also waiting later to get married. The median age at which women get married is around 28 now. And basically I think women want to devote more time maybe to their careers, or they realize that having a child is a really significant investment, at least in the US., so they don’t feel financially ready to have a kid but maybe they can put some money toward egg freezing. And then, of course, I think one reason that a lot of people give for freezing their eggs is just that they don’t have a suitable partner. They don’t have someone in their lives that they want to have a kid with yet. You know, there are a number of different studies and data suggesting that women are having more trouble finding partners in the US now. I think that is a major factor contributing to the popularity of egg freezing now.
Kira Bindrim: Two other things I could see being a factor here. One, I imagine this is a good option for members of the LGBTQ community. And then the other is that, you know, obviously, the last two years has really thrown off a lot of people’s life timelines. So if you were thinking like, ‘Oh, I you know, I kind of want to settle down and have a kid,’ and then the pandemic hits, you might have just been forced into a position where you’re waiting. Is there evidence or data to back up either? both of those?
Courtney Vinopal: Yeah, absolutely. So it’s definitely an option for the LGBTQ community. You definitely have people who are thinking, ‘Okay, I don’t know if I want to have a kid. But maybe I want to freeze my eggs in case I want to use them at some point.’ It’s also seen as an option for transgender men. So some transgender men will freeze their eggs before they transition, before they take start taking hormones for transitioning. So it can just be a good option, I think, for people who are in non-hetero relationships. And I think more companies are starting to realize that as well. And then, yes, you’ve definitely seen a spike in interest from people during the pandemic as they’re sort of sitting at home in lockdown, not going out dating, not getting any closer to finding a partner they would want to have a kid with, but at the same time, they know their fertility is declining. So you have clinics that have said they’ve seen definitely an uptick in clients over the past year and a half. NYU Langone, I believe, said that they saw an uptick in patients of 41% last summer compared to the previous year. So I think the pandemic is definitely changing people’s perspectives on having families and maybe a little bit of panic set in for some people. So you have more and more clinics that are seeing, you know, an uptick in patients during this time.
Kira Bindrim: Can you give me a sense of, and I don’t know that this has to be in a number format, but how popular egg freezing is now? I think, especially for the listener who is not a woman between the ages of 25 and 40, they might not be encountering it in quite the same way you or I are. So what are some indicators of sort of how ubiquitous this is becoming as an option for some people?
Courtney Vinopal: So, well, you referred to a few celebrities at the beginning who have frozen their eggs. So I would say that can serve as somewhat of an indicator at least to show that people know what egg freezing is now and are conscious of it. So Kourtney Kardashian spoke about freezing her eggs on an episode of Keeping Up With The Kardashians. I think she actually revealed recently that she did it, so we can we can hold out for a Kourtney-Travis Barker baby. And then there were two contestants on The Bachelorette who’ve spoken about freezing their eggs, one when she was with a partner, one when she had just broken up with a partner. So you do see these things in the news and on social media, definitely, you see prominent figures. Then, I think, as you mentioned again, just looking on your social media feeds, you get a sense of its popularity now. So you read stories of women who will see like 25 to 30 ads for egg freezing or other fertility services on their Instagram feeds in a week. So I think social media companies, yes, they definitely have a way of tracking our data and knowing what we’re likely to click on and be interested in. But I think fertility services and egg freezing in general has figured out how to sort of use social media to make their services known. So I think that can kind of speak to its popularity as well.
Kira Bindrim: I’m almost offended now by how infrequently I see these ads. Like, has social media given up on me? I’m getting a lot of like couches and Allbirds and stuff. But they’re like, ‘She’s, she’s not having a kid. We don’t need to serve those to her anymore.’ So let’s just talk about the basics. How much does egg freezing cost, on average?
Courtney Vinopal: Yes. So according to the website FertilityIQ, which is it’s almost like a Yelp for fertility—they have reviews of clinics and a lot of information about the procedure and things like that. So they say a single cycle on average costs between $8,000 and $15,000. And that’s not including the money that you have to pay for the drugs that you have to take before the cycle, that can be up to $5,000. And that’s also not including storage fees. So once you freeze your eggs, you have to pay each year to store them. And in the US that can average $500 to $1,000. So once you freeze your eggs, if you paid $15,000 for one cycle, for example, and then you freeze them for five years, you’re looking at upwards of $20,000.
Kira Bindrim: That’s pretty, pretty hefty. Are there ways to offset the cost?
Courtney Vinopal: Yeah, so there are definitely companies now that are trying to find ways to offset the cost. There are programs where you can actually donate half of your eggs and do a cycle for free. The other thing I would say is that some companies do cover it now, but that’s very dependent on where you work. So a lot of tech companies will cover at least part of the cost of egg freezing. Apple and Facebook are some of the first to do it. Many more companies are doing it now. But it’s certainly not the norm yet.
Kira Bindrim: So it sounds like, basically, unless you are in a financial position to just pay for this out of pocket, or you work for a company that supports it as a perk or pays for it entirely, or you are willing to give away half of your eggs in the interest of getting the egg freezing for free, that’s kind of it, those are the options.
Courtney Vinopal: Yeah, I mean, it’s not the norm that a regular insurance plan is going to really cover egg freezing here in the US. So you are looking at a pretty hefty cost unless you fall into one of those categories.
Kira Bindrim: What do we know at this point about how effective egg freezing is once you’re on the other side of that and now you’re ready to try and get pregnant?
Courtney Vinopal: Yeah, so I will say this was maybe the most frustrating part of my research here, is that it really, really varies in terms of how effective egg freezing is once you’ve chosen your egg. Part of that is because most women who freeze their eggs still never unfreeze them, still never use them. So there’s not a whole lot of data on how likely eggs are to produce successful pregnancies. But what the science says, and the data that we have indicates, is that it’s really dependent on how young you are when you freeze your eggs and how many eggs you freeze at the time. So I’ve looked at studies that put success rates as low as 4%—like an egg would have a 4% chance of turning into a viable pregnancy once you freeze it—or as high as 90%. But the data is going to look a lot more promising if you freeze your eggs when you’re 29 and you’re able to freeze 15 of them., versus if you freeze them when you’re 40 and are only able to freeze five, for example. And you really don’t know how fertile your eggs are going to be until you unfreeze them. So you won’t know until you until you actually use them.
Kira Bindrim: After the break, what are the implications of a world with more egg freezing?
Kira Bindrim: Listening to all of this, like, what strikes me is the complexity of this decision. There’s a lot of factors that go into it, there’s a lot of science, for better or worse. There’s a lot of nuance to it. And that’s one thing when the primary place you’re going to get answers or to make the decision is your doctor. You kind of expect that they’re walking you through really nuanced, complex decisions about your body. But we have talked a little bit about the marketing of egg freezing, and what underlies that is the idea that this is also an industry, that there are companies getting involved in this space. So tell me a little bit about how egg freezing became a big business.
Courtney Vinopal: So I think companies started to see a lot of promise in the IVF industry when they realized it’s growing at a pretty rapid pace, and it’s pretty fragmented. So there’s opportunities to buy up clinics and form networks, essentially. So that’s how you see more startups sort of come on the scene and offering egg freezing in recent years.
Kira Bindrim: What are some of the big players in the egg freezing space in the private sector?
Courtney Vinopal: A few that I would point out. One is Prelude fertility. So this is a startup that was founded in 2016. It was founded by an entrepreneur named Martin Varsavsky. And he actually says he was inspired to start this company after he and his wife had trouble conceiving, and were helped with IVF technologies. So I think what is sort of interesting about Prelude, and sort of indicative of the direction a lot of newer startups are going with egg freezing is they really encourage women to freeze their eggs in their 20s and early 30s, so at quite a young age. And I think the idea there is that they want to offer services in a bundle. So they want to offer not only egg freezing, but also combine it with sperm, and make the embryo once you’re ready. They will implant the embryo. They do genetic testing on the embryos. So they’re not just offering egg freezing, they’re offering this whole bundle of services. And the idea is that the sooner you do it, the better chance of success you have. So that is one company that I think is kind of leading the charge and really encouraging women to do it at a young, a younger age.
Another is a company called Kindbody. So this company was just founded in 2018. And I think what’s interesting about Kindbody is the way they sort of market their services. I think at one point one of their marketing directors told The Atlantic that they want to seem like a lifestyle brand, not so much like a fertility clinic, even though that means the services they’re offering are probably not so different than any other clinic that offers egg freezing. So you look at pictures of their clinics, and they look so nice. It looks like a combination of like SoulCycle and that women’s workspace The Wing—it’s like a lot of millennial pink, just a really nice place. And I think they’ve sort of recognized what an unkind or sort of scary place doctors offices can be for women and they’re trying to make their services seem different from that and, you know, set themselves apart from that.
Kira Bindrim: I want to talk a little bit more about marketing because we’ve touched on that a few times in terms of where it’s showing up and how it’s showing up in more places. But what are we seeing in terms of how these companies are trying to recruit customers, as it were, for egg freezing?
Courtney Vinopal: Yeah, so I would say that they’re trying to market to a certain type of client, right? They want to mark it to sort of go-getter, career-minded person who is thinking about their future and wants to make a smart decision about their future, but wants to focus on things other than pregnancy right now. So Prelude, actually, their advertising, it encourages you to find that right person, focus on your career, finish your education, and then use our services so that you can do that and have the option to get pregnant with your good eggs later. They also stress in their advertising that the age of your eggs (not you) is the number one cause of infertility. So it’s interesting, I think, with this advertising, you see they try to make it empowering and give you a way of taking control of your fertility in a world where you really don’t have much control of it.
But also there are messages that are a little bit anxiety-inducing, where they want to convey the message that you’re born with as many eggs as you’ll ever have, and you know, it’s best to make to do this now rather than later. One other interesting way that I think some of these companies market their brands as they do want them to see more accessible and more cost effective, right? So a few years ago, you had this company called Extend Fertility that had an ad circulating that had a picture of an açaí bowl pictured next to a frozen egg. And it just said, ‘Frozen açaí and frozen eggs’ and then it marketed its services as ‘Egg freezing for the price of a healthy snack.’ So to me that says, ‘Okay, we have customers that are likely to buy açaí bowls, maybe there’s a way to market this to them.’ I think that it’s pretty obvious an açaí bowl is probably going to run you less than freezing your eggs, but that’s just sort of an interesting way that they’re trying to market their services. I do think this marketing has a way of sort of glossing over just how complex the process is, and just how much the success rates vary. Maybe some of that is because the marketing seems to be really focused on the present. Like they want to emphasize that they want you to focus on your career and your education and finding a good partner and everything but pregnancy. So I think sort of what they’re promising is that if you freeze your eggs, you can put anxieties surrounding pregnancy and your declining fertility out of your head for a little bit. It’s like a peace-of-mind promise, almost.
Kira Bindrim: It’s like the 401(k) of your fertility.
Courtney Vinopal: Yeah.
Kira Bindrim: You’re doing what you need to do to handle this thing later in life. I have very mixed feelings hearing all of this, honestly. Like, on the one hand, it feels very of a part of, at least in the US, like our weird medical system, where you’re being asked to make this complicated, expensive decision, often, like, through advertising, instead of through a conversation with your doctor. And that feels a little fraught, and it isn’t low-key, it’s a pretty intense procedure. On the other hand, there is a lot of silence and stigma, at least in my perception, around fertility and pregnancy, and that it is a lot harder to get pregnant than people talk about, and that’s something you don’t realize, I think, until you until you’re starting to think about it yourself, until you get to that age. What do you see as maybe the larger questions, you know, if we take the last 10 years and see how much more common egg freezing has become, and let’s assume we keep going on that trajectory, and the trends we’re seeing today continue into the next 10 years, next 50 years. What do you see as some of the larger questions that progression raises?
Courtney Vinopal: I think as you mentioned, there is a lot of stigma surrounding pregnancy and infertility in the US. And I think another question that the popularity of egg freezing and some of these startups raises is just sort of what the flaws in our healthcare system are, and why some women just don’t feel comfortable going to a traditional fertility clinic maybe to freeze their eggs. I think some companies are kind of starting to recognize that the medical system has been unfriendly to women traditionally. And so they’re trying to find ways maybe to make this process more comfortable, I suppose, for women. So I think those are going to be some of the questions that come up from the growth of this industry in the coming years, is: Are traditional fertility clinics going to feel like they have to make some changes to adapt, in light of maybe some of the positive aspects of these newer startups? Things that women appreciate about them that they don’t get at a traditional, you know, doctor’s office. And then also, I think, there’s just going to be questions about how comfortable we are putting a lot of money into egg freezing. Because I think some in the medical community have expressed concern a bit about all the money that’s pouring into it right now, and about companies that have a financial incentive to get more and more women to freeze their eggs. So I think there’s a question of, if we’re getting more and more women to freeze their eggs and profiting off of that, but then they never use them, and we have all these thousands of eggs piling up in the bank, to whose benefit is that? And, you know, is that really, you know, ethical, I suppose? So I think there’s gonna be ethical questions that arise with that.
Kira Bindrim: I feel like, at this point in an episode, I’ve always meant to have like a very poignant, large, 30,000-foot-view thought, and this is probably the first episode we’ve done where my final thought is personal. Where it’s like, wow, I have learned so much, and more than I think I’ve actually learned in any setting where I probably should be learning about my fertility and reproductive health, which is to say, this is not something we talk about enough. And as I get older, and as this becomes a decision that I’m going to need to make, that’s interesting. That it’s not something I’ve been, you know, taught about a lot through the course of my life. So if and when I have kids, Courtney, know it will be because of this conversation. I will name them Courtney, which is gender-agnostic name, so that works.
Courtney Vinopal: Love that.
Kira Bindrim: Thank you so much, Courtney, for everything you’ve done in this episode in helping me make my life choices. I appreciate it
Courtney Vinopal: Thanks Kira.
Kira Bindrim: That’s our Obsession for the week. This episode was produced by Katie Jane Fernelius. Our sound engineer is George Drake and our executive producer is Alex Ossola. The theme music is by Taka Yasuzawa and Alex Suguira. Special thanks to Courtney Vinopal in Washington DC.
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