It started when Alix Greenberg was in her early 30s. She was single and wanted kids, but, she says, “I had this weird feeling, an intuitive feeling, that something was wrong, that I wouldn’t be able to get pregnant easily.”
She did have a problem — a low ovarian reserve, meaning she had fewer eggs in her ovaries than is typical. Greenberg doesn’t remember her gynecologist’s exact words, but she remembers what she took away from their conversation: I have to freeze my eggs right now, or I will never be able to have kids.
“I was totally freaked out,” says Greenberg, who lives in New York City and owns an art ecommerce business.
She underwent three rounds of egg freezing, which only gave her eight eggs, far fewer than the number her doctors said she would need to have a high chance of a live birth. “The last egg freezing I did, I got one egg,” she says. “I was like, Great, I just had the most expensive period ever.”
Her health insurance also didn’t cover the procedures—egg freezing is usually considered elective unless the patient has major health problems. She spent $60,000 out of pocket.
Just after her first round of egg freezing, Greenberg met her now-husband. When they were ready to have a child, she used the eight frozen eggs, one of which was used to successfully create an embryo for in-vitro fertilization. That’s how she had their son, who is now 15 weeks old.
Greenberg is a part of a growing wave of women choosing to freeze their eggs. There was a 400 percent increase in procedures from 2012 to 2020, according to the Society of Assisted Reproductive Technology. From 2020 to 2021, the number of egg-freezing cycles increased by more than 31 percent. Companies such as Google and Apple even started covering part or all of the cost of the procedure as an employee benefit.
The increase in egg freezing is the result of “a combination of things: improvement in technology, in the way we freeze eggs and the survival rates; increased patient awareness; and decreased financial barriers,” says Dr. Denis Vaughan, a reproductive endocrinologist and the director of clinical research at Boston IVF, a fertility clinic with locations in Brookline, Lexington, and Waltham among other places. Vaughan says that, each year for the past three, the clinic has seen a 50 percent jump in egg freezing cycles.
Greenberg may be part of a trend, but in one notable way, she is very much an anomaly. In January, the American Medical Association published a startling finding in its monthly open access medical journal, using data collected from fertility clinics across the country. Despite the procedure’s surge in popularity, only 2½ percent to 3 percent of women who froze their eggs were actually returning to use them.
The promise of elective egg freezing can be alluring: A woman doesn’t have to interrupt her career at a key point. She doesn’t need to settle for a less-than-ideal partner. If she can afford it, she can buy herself time to — in the familiar, dreaded phrase — have it all. And for some women, egg freezing is an essential tool in building the lives they want. But for many others, that promise proves more elusive than they might have imagined.
When more effective egg freezing technology became widely available for elective procedures over a decade ago, it was hailed as a “reproductive revolution,” not unlike the birth-control pill in its ability to give women more control over their reproductive choices. “A technique that allows some women to extend their fertility is making progress,” science journalist Rachel Nowak wrote in a 2007 New Scientist article. “That technique is egg-freezing, and in theory it could allow a woman to stop her biological clock for a decade or more. When she finds a partner, say, or is in a position to take a career break.”
And as egg freezing has become more common, its reputation as a symbol of freedom for women has only solidified. “The pill was the revolutionary event of the late 20th century, and now it’s freezing our eggs,” Nation columnist Alexis Grenell wrote in 2022, arguing that it “should become standard for women to freeze their eggs at 25.”
But egg freezing’s popularity belies a more complex reality. While more women than ever are freezing their eggs, a vanishingly small number of them return to retrieve them.
There are several reasons for this. Some women rush to freeze their eggs only to happily discover they can have kids naturally or to later decide they don’t want kids at all. Other women who want to use their eggs sometimes find the decision taken out of their hands. Even with improvements in technology, eggs sometimes don’t dethaw properly, or women find out they have other medical problems that affect their fertility (meaning they can’t get pregnant even with healthy eggs), or would make pregnancy unsafe.
Marcia Inhorn believes there’s another reason, too. She’s a medical anthropologist at Yale University whose 2023 book, Motherhood on Ice, explores why healthy women freeze their eggs, based on interviews with 150 women, most of them heterosexual. Her overwhelming finding was that women were not doing it for medical or career reasons, but because they couldn’t find a partner.
The narrative of a career woman “deferring being a mom isn’t the right rhetoric,” Inhorn says. “It’s about women who find themselves without the thing they wanted, which is a stable reproductive partner, somebody to build a family with.”
For the women she interviewed, “egg freezing was like a suspension bridge,” Inhorn continues. “They were bridging this gap in their lives until they found a reproductive partner.”
She suggests that one reason so few women return to use their eggs may be that they still can’t find someone. Some women, of course, decide to have babies on their own. But for the majority who want to raise kids with a partner, egg freezing is useless to them until they find their person. And that is a completely different problem that needs to be solved, she says.
“Something is going on with men, including educated ones, where they have no intention of really settling down,” she says. “We need somebody to do a study of men and their reproductive aspirations.” In other words, men still have an outsized role in a process often thought of as putting more control in the hands of women.
“I loathe the rhetoric that this is a ‘reproductive revolution.’ It’s not,” Inhorn says. “Egg freezing can’t solve the social and relationship problems that are at the heart of why most women are doing it.”
Kit Myers, a medical sociologist at the University of Southern California who has collected and analyzed about a hundred hours of interview data from elective egg freezers, suggests that egg freezing may also be about something other than wanting children. “I thought when I went into this that if you were willing to pay thousands of dollars out of pocket, give yourselves hormonal shots, go through surgery, you must really want to have kids,” says Myers, who uses they/them pronouns. “You must be so sure and so passionate about having children you will do anything to make this happen.”
But Myers found that egg freezing served a different function for most of the women they interviewed. These women “were less concerned about whether or not those eggs were going to turn into babies for them. Many of them still weren’t certain they were going to have babies,” Myers says. “It gave them this personal, psychological resource for those moments of panic, when they were like, ‘Do I need to jump on the next guy because I am getting older?’ It allowed them to stay calm and trust they still had options,” they say. “Egg freezing functioned as an emotional security blanket more than anything else.”
Myers also found that women were using egg freezing as a way to alleviate social pressure. “When people said to them, ‘What is wrong with you, that you are this age and not yet married and a mother?’ . . . It lets them say, ‘I am a good woman, I have done what I can to have children. I can’t make the other person show up, but I can do this.’”
That invites the question: Should healthy women pay five figures for an invasive procedure that might not be able to do what it was intended for, for reasons often outside their control?
“As long as everybody understands this is mostly a security blanket,” Myers says.
Erin Berger was 30 when she froze her eggs. “I didn’t even know many people who had done it, but there was just something inside of me that felt it was necessary,” says Berger, a publicist who splits her time between New York City and Los Angeles. “I felt like I needed to take charge of something.”
She asked her parents to pay for the procedure, which ended up costing $11,000. The cost of a single cycle of egg freezing in the United States, including the related medication and storage, ranges from $7,000 to $20,000, according to Freeze Health, a company that helps women decide where to freeze their eggs. One cycle of egg freezing takes about two weeks, though patients often go through multiple cycles.
Berger went through the required preliminary tests to determine her egg and follicle supply and interviewed doctors and clinics to decide where to have the procedure.
When it was time, she spent a two-week period injecting herself with daily hormone shots. Generally, a woman does this for about 10 to 12 days to stimulate the ovaries to produce multiple eggs. (The long-term health effects of these hormone injections have not been well-studied.)
Berger frequented the fertility clinic before work, alongside other women on their way into the office. “I just remember feeling like cattle,” she says. “I was with all these other women, and we would take turns going into one room and get our blood taken and then into the next room to do the ultrasound.”
The process was fraught, and emotional. “I had a million thoughts running through my head the whole time,” Berger says. Will I ever use these eggs? Who will I use them with? Will I have a baby alone one day? And she was in pain physically. “The last three days is when I started becoming really uncomfortable,” she says. “I had so many follicles, and they had so many eggs, and I was so big.” (“It’s PMS from hell,” is how Myers describes the feeling.)
During egg retrieval surgery, the patient receives anesthesia, and doctors pass a needle through the vaginal wall into the ovary to drain the follicles and remove the eggs.
Berger secured 25 eggs, safely above the number generally recommended to have a good chance of a live birth (not all eggs make it through genetic testing and the dethawing process). So at the time, she decided it was worth it.
“The second I did it and got all these eggs, I felt like this anxiety went out of my mind,” she says. “I felt grateful that I had them.”
Two years on, however, Berger no longer knows if she wants kids. “I had this strange awakening that kids are forever, and there is a lot more that goes into them than wanting to have kids,” she says. “There are finances, there is your emotional capacity.”
Berger is now in a serious relationship with a woman who also doesn’t know if she wants children. “Things would need to line up in a variety of ways,” she says.
Looking back, Berger has no idea why she felt so strongly about doing this procedure, especially since all the tests came back showing she was in excellent shape from a fertility perspective. “If I could do it again I probably would check my vitals and then wait a few years to see how I felt,” she says. “I think the most important thing is to know yourself and be mindful.”
Of course, many women see egg freezing as a godsend.
They know that these options weren’t available to the women who came before them, says Dr. Alison Zimon, cofounder and co-medical director of the fertility clinic CCRM Boston. “This is a pretty modern development in reproductive medicine,” she says. “The ability to freeze eggs and do it successfully with good results has only happened in the last decade.”
Still, “I am very careful when I counsel patients to tell them this is a Plan B, a backup plan,” Zimon says. “You can never guarantee how well eggs will do regardless of how strong the lab is or how good the success rates are. It is variable.”
One of those grateful women is Katie Murphy, a 36-year-old who lives in Greenwich, Connecticut. She left her job in finance and is working on starting her own financial consulting firm.
Her egg freezing journey was not an easy one. She had just turned 30 and ended a serious long-term relationship. “I had a friend whom I was leaning on quite a bit during the breakup and she suggested egg freezing,” Murphy says. “My boss also mentioned it to me, and I was like, Maybe this is the universe telling me I should make an appointment.”
With a low ovarian reserve, she went through four rounds of egg freezing, which took a year and gave her 15 eggs. She spent $80,000 out of pocket.
Murphy married her husband in May 2020 and couldn’t conceive naturally. She was thrilled, then, to combine one of her eggs with her husband’s sperm for IVF. She had their son in December 2021.
Wanting more children, she tried to use her frozen eggs two additional times, both of which failed. “Of course I was disappointed, but I knew the risks,” she says.
Since then, Murphy has undergone four more rounds of egg freezing—these have been covered by her husband’s company’s health insurance—and is currently undergoing her ninth round total.
“I am so grateful that I have fertility issues, and there is a solve, a way for me to have children,” she says. “There have been so many shots and blood tests and ultrasounds, but I would not have had my son if it wasn’t for egg freezing.”
That is why Ellen S. Glazer, a clinical social worker whose practice focuses on infertility and who is a guest contributor to Harvard Health Publishing, recommends all her patients take a good look at egg freezing, even if they know the chances of ultimately having a baby from their eggs is low. “Let’s say it’s a fairly low percentage that you are actually going to use your eggs,” Glazer says. “If you are in that small percentage, those eggs could really matter.”
Glazer understands that women sometimes feel pressure to make this choice, but she encourages them to view it in a pragmatic light. “It’s a tool in one’s tool kit,” she says. “It isn’t pleasant but it is an added asset that she can use that women couldn’t before.”
Regardless of which path her clients choose, Glazer does see these decisions weighing heavily on them. “It used to be when I would meet 40-year-old women who couldn’t have children, it was a gift to tell them they couldn’t have frozen their eggs because the technology wasn’t there,” she says. “I’d see them having a sigh of relief for not blaming themselves.”
But the emergence of better technology has come with the emergence of a new kind of guilt. “Now,” Glazer says, “we have a generation of women who have to confront the possibility of regret if they could have frozen their eggs and didn’t.”
Alix Greenberg, the e-commerce entrepreneur who recently had her baby with the help of IVF, is now confronting that choice again. “I had my six-week checkup after having my son, and my OB was like, ‘You better go get your eggs frozen right away if you want another kid,’” she recalls. “I’m like, ‘What is this cycle? Why don’t you let us try naturally?’”
Now 37, she is grateful for the process that gave her a son. But Greenberg can’t help wondering if it was actually as necessary as she thought. What if nobody had told me about my levels? she sometimes thinks. Would she get pregnant naturally?
Greenberg feels the decision weighing on her. She dreads going through the process again. But she says she doesn’t know if she can resist the pressure to have a backup plan. “I don’t know what I’m going to do.”
Alyson Krueger is a lifestyle journalist based in New York City. Send comments to firstname.lastname@example.org.
Correction: Due to a reporting error, the frequency of hormone injections was misstated in an earlier version of this article. The injection was administered daily. The Globe regrets the error.