N° 24 – No, Freezing My Eggs Isn’t Selfish — It’s the Best Decision I’ve Made
Posted by Leila Janah on
For most of my life, I never wanted to get married or have kids. I had adventure in my bones and dreamed of being a humanitarian Lara Croft — adrenaline-addicted and willing to go to dangerous, desperately poor places to help people in need. My parents had a bad divorce while I was in my teens, and the constant fighting at home made me skeptical of the whole idea of having a nuclear family. White picket fences and adorable toddlers never factored into my ambitions.
That is, until I hit 31. After my best friend Angie made me her son Isaac’s godmother, my ovaries began interfering with my dreams, making me pine for FaceTime dates with Isaac and hunt for baby-sized handmade socks in Dharamsala. And it wasn’t just Isaac’s adorable fault. Facebook has flooded my consciousness with babies and weddings, as it does to everyone between 27 and 35. My feed is a constant stream of powerful, carefully edited images connecting happiness with partnership and family. This has profound effects on the brain, literally rewiring neural pathways based on the “filter bubble” I inhabit. (My friends in their 40s chuckle at this and tell me that their feeds are filled with divorce announcements and remarriages, and to ignore Facebook.)
Between Facebook and my ovaries, I didn’t stand a chance. At some point in the last three years, I came around and realized that building a family is one of life’s great projects. My internal dialogue went something like this: “How am I at this point in my life? Why have I failed at something so basic and obvious as reproduction?” And then seconds later, “wait a minute, I haven’t failed at reproduction — I just haven’t wanted to reproduce yet.” I’ve loved traveling the world, building Sama and LXMI, social impact businesses that give work to women, scuba diving, performing in dance shows, learning to kitesurf and paraglide. Adventure is in my DNA. I always imagined I’d get a lot of this out of my system, and find a partner who understands my crazy life, before deciding to settle down.
But then I had a bit of a crisis. Friends clued me into the fact of my aging eggs. In two years, I’ll be 35, considered “advanced maternal age” by fertility experts. I felt stuck: how could I build the kind of life I’d be proud of, with enough time to do good work in the world and also devote myself fully to having kids when the time was right, if I had to do it all before 35?
Let’s get something out of the way first. “Having it all” — an emotionally supportive, financially secure partnership to someone you still like having sex with, children, a mega-successful career, and enough time to stay healthy in mind and body, all while in your 20s and 30s — is a bullshit idea that has caused me and most women I know immense and unnecessary suffering. But while having it all in a given period of time is bullshit, you can quite well have each of these things over the arc of a long lifetime. This, I realized, would only be possible if I extended my window of fertility.
When you’re considering freezing your eggs, you hear a lot of objections. Some of them (“but you’re attractive enough to get pregnant now if you want to!”), I dismissed outright. But others had a shadow of truth to them, and came from people who seemed genuinely concerned about the implications of this technology for me and for society. Here are some thoughts on the most common issues:
“It costs too much — it’s elitist!” The average cost of egg freezing is $10,000,slightly more than the average American spends on driving a car annually. And if you wait to have a baby until you’re 40, you will have spent an average of $15,000 more than if you’d frozen your eggs at 35 and used those. The cost is prohibitive for many low-income women, which is true for women’s healthcare in general and needs to be addressed via policy. But I don’t believe that the procedure itself is elitist.
“What if I’m not sure I want to have a baby?” Let me ask you this: Have you ever changed your mind about something important — your job? Your relationship? Obviously you have. Frozen eggs are an insurance policy — the ability for your older self, if she changes her mind, to carry her younger self’s babies. Is insurance ever bad?
“I think it’s weird and unnatural.” This makes no sense to me. It could also be seen as “unnatural” to take antibiotics, receive a life-saving vaccine, or preserve the life of a prematurely born baby — would we ever think twice about that? To me, any option that increases the ability for people to have loving, healthy families is a good one. Also, why are these people spending so much time thinking about my follicles? Remember that saying you learned in grade school — “You can pick your nose and you can pick your friends, but you can’t pick your friend’s nose”? Ditto her fertility choices.
“You’re playing God.” As far as I can tell, the Catholic church and mainstream Jewish and Islamic leaders are supportive of egg freezing as long as it doesn’t involve destroying or otherwise endangering embryos. This seems possible. You could freeze your eggs and only create embryos for implantation one at a time. Or you could donate your unused embryos rather than destroy them, the equivalent of embryo adoption.
“Aren’t you too young?” I really hate this one, because many women I know followed this advice, waited too long, and then had a disaster of a time extracting eggs. You are “too young” according to many doctors until the precise moment when you switch to being too old. Here’s what the data tell us: women’s eggs are healthiest between the time they mature sexually and roughly age 30. At 35, there is a major cliff in egg quality, and after 40, any pregnancy is considered “high risk” because of the quality of the egg. And this doesn’t account for the fact that some women develop conditions, like ovarian cancer, that dramatically diminish the health of their eggs before they turn 30. Basically this means that the younger you freeze after puberty, the higher the probability you will obtain healthy eggs. A friend of mine was told by her ob-gyn at 32 that she was too young, only to learn at 35 that she had a fertility problem. She’s now been through several painful freezing cycles, which could easily have been avoided.
“It’s selfish, because of all the unwanted kids out there.” I think adopting a child is one of the most wonderful things you can do for another human and fully support people who choose this option. But it’s not mutually exclusive — you might want to have one of your own kids via IVF and adopt another, Shonda Rhimes–style. We have a moral duty to support adoption, egg freezing and all options that give women and their partners greater agency to build healthy, loving families.
Once I overcame the objections, I decided it was the right choice for me. Still, I kept finding reasons to put off the procedure. I learned that I’d gain weight, feel nauseous, lose emotional control, and be unable to travel for a solid two to three weeks during the process (I’m on a plane pretty much every week.) I’d have to administer injections nightly in my abdomen. I’d have to show up for early-morning ultrasounds. It sounded like the absolute worst. Last year in December I got invited to Sweden for the Nobel ceremony and, having cleared my calendar for months beforehand in order to freeze, accepted the invitation and went anyway. I accepted too many speaking opportunities in the spring, subconsciously avoiding this scary subject. Finally, as my 34th birthday loomed, I found the courage to just do it in June of this year.
There are several steps in freezing your eggs. You choose a facility, go in for an ultrasound to test your hormone levels and count your follicles, begin administering hormones, and go for regular check ups ultrasounds while your ovaries are swelling. Finally, you take a trigger shot and go in for the egg retrieval 36 hours later.
My doctor told me I had the “ovaries of a 16-year-old” after the initial evaluation and ultrasound. This meant that I could go for a “low-stimulation” option — because I’m pretty young to freeze and had a high follicle count (meaning that I can release many eggs), I could order and take less of the follicle-stimulating medications. The downside of being fertile is that the process can be more painful — even at very low doses, the drugs can make your ovaries swell to uncomfortable proportions. The first night, I went home and did the injections easily. I’d draw up the right dosage of liquid with a syringe and inject the tiny needle (the same size used for insulin injections) into the fat under my belly button. One of the medications requires mixing saline solution with a powder using a larger mixing needle, but that’s the upper limit of complexity. There’s even a website with video instructions for each injection. Many people asked me if the injections were painful. I love getting acupuncture and I have a tattoo, so needles don’t freak me out. The shots were a 0.5 on the pain scale for me, if 5 is biking up the Marin Headlands and 10 is breaking your femur. I’m told I have a high pain tolerance — it started when I ran a marathon in high school (an athletic pursuit I recommend only for what it does for your confidence in tolerating discomfort). So this wasn’t so bad, but for other friends of mine the hormones were pretty tough. The injections take less than five minutes and make you grateful for the conveniences of modern medicine. After the first few nights, I felt no change in my body other than a bit of nausea. As my body absorbed more of the drugs and my stomach swelled, it was a bit tougher to find a spot to give myself a shot that wasn’t already tender. Luckily, I gave myself a break during this period even though I’m obsessed with ultra-healthy food — the body fat really helps for injections.
At the peak, I had well over 30 times the normal amount of estrogen in my body, and the space under my belly button swelled to give me a pseudo-pregnant pooch. My boobs pulled an Incredible Hulk, going from a 32C to a 34DD (one of the few body-shape upsides of this process). I felt like a waterbed full of estrogen. Initially I freaked out, but the nurse reassured me that this water weight would go away within one or two months. The hormones themselves had the overall effect of increased calm and a Zen-master focus on my home and body — I started reading a ton. It also made me talk about babies a whole lot, which wasn’t great for my relationship. But none of these things were so terrible. One of the biggest upsides of the shift in my hormones was bonding with other women who’d been pregnant, gone through IVF, or were curious about egg freezing. I decided to use the opportunity to talk about something that’s still inexplicably taboo — the scientific breakthrough that allows us to preserve our life-giving gifts.
Going in for ultrasounds every other day to have my follicles measured and counted made me feel special. I suppose this is how pregnant women feel — proud that their bodies are capable of perpetuating the species. It’s incredibly beautiful to see your reproductive machinery in real time on a screen above your head. The large dark circles on the screen, my follicles, grew daily, following the same path as my estrogen levels — by the time my eggs were ready, my follicles had more than doubled in size and my estrogen levels were off the charts. I took home a print-out of the last ultrasound and taped it to my wall to remind me of my body’s profound capabilities.Whenever I’m stressed out, I look at that picture and think how lucky I was to be born a woman with the awesome powers of nurturing life.
Towards the end of the cycle, as my belly grew and I switched to wearing more forgiving pants, the checkups happened every morning before work. I’d speak to a nurse about what was going on in my body, remind her what medication I’d administered the night before, and receive changes to the dosages based on my blood test results. Toward the end, I learned that only the larger follicles would release an egg, and the daily follicle counts gave us some idea of what to expect — at least 20 good eggs. On the last night when I had to administer the trigger shot (a high dose of hormones that prepares your eggs for the retrieval), I brought it in my purse to a client dinner and quickly did the injection in the ladies’ room between entrees and desserts.
The morning after the trigger shot, I showed up at 7 A.M. to the clinic and they put me on a drip. My patient boyfriend (the same one who had to listen to me talk about babies for a week and watch me inject myself), drove me to the clinic and waited there during the procedure. The retrieval, performed by another doctor at the clinic, took 40 minutes, twice as long as it usually does because of the number of eggs — they retrieved 32 in the end, of which 30 were viable and frozen. Luckily, the procedure doesn’t require general anesthesia, making the recovery quick and painless. I emerged feeling happy and somewhat high, sipping grape juice.
When my doctor called to tell me I’d frozen 30 eggs, I was ecstatic. This means I could have two healthy babies from my 33-year-old self’s eggs, at any time in the next decade (possibly longer). It means I no longer have to worry about having kids in the next two years, putting premature pressure on my relationship and finances. It means I can donate eggs to friends or family members who might need them. It’s a tremendous gift.
Some of my friends have had a much harder time. Some only retrieved 5 or 6 eggs, far less than the recommended 16 — sadly, only a fraction of frozen eggs will become viable embryos, and an even smaller fraction will become babies. I can’t imagine going through this procedure 5 times in a row, and can’t comment on how shitty it would feel to go through all of this and not harvest enough eggs for a future baby. But even among my friends with lower rates of retrieval, a similar feeling persists: freedom to be female to the fullest. We feel liberated from the tyranny of the biological clock, better able to make smart decisions about our partnerships and future families, and happy that we chose to be pioneers in the new world of later-stage baby-making.
I now tell every woman I meet who’s on the fence to go for it. At worst, it’s an insurance policy. And at best, egg freezing gives us the capacity to extend women’s life-giving window another decade or more. It offers us the chance to sequence our work and personal lives if we so choose. Choice — isn’t that what feminism is all about?