In this episode of The Egg Whisperer Show, Dr. Aimee interviews Natalie Lampert, award-winning journalist and author of ‘The Big Freeze: A Reporter’s Personal Journey Into The World of Egg Freezing and The Quest to Control Our Fertility.’
Natalie shares her personal journey and professional insights into egg freezing, highlighting the psychological, ethical, and practical aspects. She emphasizes that egg freezing is a backup option that offers assurance but not insurance. They discuss the broader implications of fertility preservation, societal pressures, and the importance of thorough education on the subject. Natalie also touches upon the landscape shifts in fertility preservation over the past decade and how fem tech and regulatory changes have impacted the industry.
Resources:
Purchase Natalie Lampert’s book, “The Big Freeze: A Reporter’s Personal Journey Into The World of Egg Freezing and The Quest to Control Our Fertility.”
Visit Natalie Lampert’s website.
Watch and subscribe on YouTube.
Full Transcript:
Joining me today is Natalie Lampert, an award-winning journalist whose reporting focus is primarily on women’s health and the fertility industry. She’s the author of The Big Freeze: Everything You Need to Know About Egg Freezing, a book that follows her seven-year-long experience with learning about egg freezing and freezing her own eggs.
A former Full Bright Scholar, she has written for The New York Times, The New York Times Magazine, The Washington Post, The Atlantic, and The Guardian, among other publications. She lives in Boulder, Colorado.
The Big Freeze is a great book for anyone who wants to know about the experience of egg freezing. Natalie has done an amazing job of weaving together her personal experience with the science behind what’s going on and pulling it all together with the eye of a journalist.
Dr. Aimee: I’m so excited to have Natalie Lampert on today. She’s the author of The Big Freeze: Everything You Need to Know About Egg Freezing. Welcome, Natalie.
Natalie Lampert: Thank you for having me.
Dr. Aimee: Can you share how this book took shape?
Natalie: Definitely. I had professional reasons and unique personal reasons for wanting to deeply investigate egg freezing.
The book of course gets more into this, but the personal reasons in a nutshell, when I was 12, I had an emergency surgery that removed my right ovary and fallopian tube. Then eight years later, for unrelated reasons, I almost lost my remaining ovary in a different surgery. So, there was no connective tissue there. My one ovary that I have now is fine, but with one ovary and after these two major surgeries, doctors strongly encouraged me to freeze my eggs. So, I needed to make a decision about if and how to preserve my fertility because having biological children was something I had always wanted, just sometime in the future.
Then the professional reasons happened when I was 25 years old and starting graduate school in New York City. I remember seeing ads for egg freezing on the subway and on Twitter, and I needed something to write about for my introductory reporting class. I thought I would kill two birds with one stone and go to this egg freezing cocktail party at The Harvard Club. It sounded very fancy. I would learn a bit about egg freezing for this reporting class and maybe get a good story to write, and I’d also learn more about this thing that five years earlier doctors had told me to do, and now I was a bit older and thought I should look into it.
That’s kind of the first 15 pages of this book. From the very beginning, I was on this personal and professional quest. But in terms of the book taking shape, as I reported and researched, I very quickly learned that you can’t talk about egg freezing without talking about so much more, as you know, Dr. Aimee. Hormones and birth control, sex ed and how women learn or don’t learn about their bodies, ethical issues with regard to reproductive technologies, reproductive rights and systemic inequities in our healthcare system, money, marketing, existential angst, it’s so much.
So, I set about reporting. I visited world-famous fertility clinics. I talked to all kinds of reproductive endocrinologists. I sat in on high school sex ed classes. I interviewed executives, lawyers, interviewed the doctors who invented egg freezing, the world’s first IVF baby, etcetera… So, the book’s shape very much expanded.
While the book unpacks the pros and cons and the many facets of egg freezing through the lens of my journey, as well as the journeys of three other women who are confronting their fertility through all sorts of challenges and triumphs and unexpected realizations, while all that is true, it also became a book about this larger quest to control fertility, what that means and how people with ovaries do or do not do that.
Dr. Aimee: Wow.
Natalie: It’s a lot.
Dr. Aimee: I feel like everyone who is freezing their eggs should read your book first just to get more educated about it. What advice do you have for women who are considering this option?
Natalie: I think my first bit of advice, and a bit of shameless plug, is buy my book.
Here’s the thing. Having a way to know what questions to ask your doctor, how to advocate for yourself throughout the process, knowing how the medications work, knowing ways to get the costs down, knowing what you need to know about safely storing your eggs and the chances of using them to have a baby in the future, all of that is very important to have some knowledge about when you’re considering egg freezing.
That’s why I wrote this book. I wrote the book that I needed that didn’t exist when I was trying to make a decision about egg freezing. I wanted to put all the information that we do have about egg freezing in one place and make it easy to understand. I think that rather than going down all kinds of Google and Reddit rabbit holes, starting with a book like mine is a good way to figure out that you don’t know what you don’t know, and that’s a good place to start.
Other advice is I would encourage women to shop around until they find a doctor that they’re comfortable with and a clinic that has proven success rates of thawing and using frozen eggs. I think this is a good indication that the clinic’s embryology lab is high quality. That’s a really important aspect of egg freezing that women often don’t think or ask about, but clinic reputation and lab protocols are very important.
I guess a couple of other things would be affording it. If your employer is paying for it or you have a lot of disposable income, I’d argue that’s a strong reason to freeze. The financial aspect can be crippling otherwise. I think the stress of going into a lot of debt to freeze your eggs can in a way counteract the other kinds of stress that egg freezing might alleviate.
Then I think my biggest piece of advice I’d offer is not to mistake freezing eggs for freezing time. Egg freezing is a backup option. It offers some assurance, but it is not insurance. It’s wonderful that for so many women freezing their eggs sparks a very positive and powerful psychological shift. The research is very clear on this. But it doesn’t guarantee a woman more control over her life, necessarily, and accepting that makes all of the difference.
Dr. Aimee: I think all of the marketing should be exactly what you just said. It should be: egg freezing is all about assurance, not insurance. I think a lot of women think that when you do IVF it’s going to work, when you freeze your eggs it’s going to work, and you can have it all, it’s just a matter of when, you can freeze your eggs and have it all. So, I love that you said that.
What are some of the most surprising things you learned about your body and fertility through this process?
Natalie: I knew next to nothing about hormones and how they work and how much they impact. I feel like I had to get a PhD in hormones just to write a chapter of my book that gets into this. It was a lot.
In a larger sense, I grew up, like so many women, terrified about accidentally getting pregnant. I postponed ever learning about eggs and ovaries – or ovary – and what goes into conceiving a baby beyond just having sex. Having the excuse to learn about my menstrual cycle and my fertility was very empowering.
There’s a chapter in my book that opens with me sitting down to interview a fem-tech founder, a man, and he and his partner invented one of the first fertility trackers and period tracking apps, and things that go along with it. It was so incredible how refreshing it was to have this very in depth and knowledgeable conversation about fertility and periods and cervical fluid with a man, first of all.
This is a bit beyond learning about my body and fertility, but that prompted me to sit down with my boyfriend at the time and flip through books together, like Taking Charge of Your Fertility and other great books out there. It was so fun and freeing to discuss sex-related things with him, my boyfriend, and tell him about what it feels like to have a speculum hold open my vagina once a year at the gynecologist’s office and explain to him, because now I understood, how the birth control pill that I took every day worked, things like that.
It really broadened my knowledge about myself, but also how I talked about these things as a young progressive woman who thinks we all should be talking about these things more and normalizing not just egg freezing, but truly what it is to have your vagina held open with a speculum, things like that, things we go through and don’t talk about enough. That was really great.
Dr. Aimee: That is great. I started egg freezing parties about ten years ago, the cocktail parties you mentioned that you had gone to. I only threw them just to educate people about their fertility. I said to myself if people understood egg freezing, they would understand their fertility, they would understand their bodies. I think that it should not be a mystery. It should be something that we’re teaching early on.
How has the landscape of fertility preservation changed for women in recent years, what have you found?
Natalie: I’ve been reporting on egg freezing for a little over a decade, and in that decade I feel like a lot changed. Before that, it was things that you know a lot about, like vitrification and the technology aspect of freezing. One of the biggest shifts has been the number of women freezing. I have memorized this stat because I’ve thought about it so much over the years. In 2009, 482 healthy women in the United States froze their eggs. In 2022, nearly 23,000 women did. That’s more than a 4,000% increase in just over a decade. That’s very significant.
A few things contributed to this, which I think just speaks to the two shifts within that changed the landscape of egg freezing. In 2012, as you know, the ASRM removed the experimental label from egg freezing, so that was a very big deal. Then in 2014, Apple and Facebook announced that they would help cover the cost of egg freezing for female employees. They were offering, I think, up to $20,000 per person. This kicked off a huge increase in companies offering fertility benefits. Not just egg freezing, but with regard to egg freezing, fertility preservation, specifically, it’s now, I think, 19% of large US employers that offer egg freezing, compared to just 6% in 2015. That has been a very big development.
I think that’s the biggest in terms of the landscape shifting.
Dr. Aimee: Wow. That’s a huge percentage rise in women who are freezing their eggs now. I think in the Bay Area, if you take a group of 35-year-olds, over 50% of them in the San Francisco area will have frozen their eggs. So, yeah.
What role do you believe education and awareness play in women’s fertility decisions, and how can we improve this?
Natalie: The misinformation with regard to egg freezing is a big issue, I think. There have been studies in the US, the UK, and Australia that have shown that many fertility clinic websites tend to be more persuasive rather than informative in their language. They emphasize the benefits of egg freezing while minimizing the risks and the costs. Some clinics even fudge the numbers somewhat when it comes to success rates.
I say in the book that the good doctors and clinics do counsel women well about egg freezing success rates and associated risks. But the fact that still so many women are in the dark about this makes it clear that many of us are not being counseled well enough by our doctors, and we don’t have enough baseline knowledge going, because this education is not all on our doctors.
It can be hard for an egg freezing patient to distinguish the marketing from the medical advice. This comes up a lot in my reporting, especially with one of my book’s main characters who scoured the internet looking for reliable information about egg freezing and found it very difficult to find. She literally found me on Twitter saying, “What did you decide to do about egg freezing? Did you freeze? I need to know everything you went through, tell me it all. I know your book is not coming out for a while,” etcetera. Now the book is out, and that’s great and she is a main character. But it was really a wake-up call. Women are hungry for this info and it’s not out there.
With regard to how I think doctors can help with this, I think it’s imperative that fertility doctors help bridge this knowledge gap when it comes to egg freezing. I think thorough, informed consent is huge, talking about embryo attrition rates, managing expectations about the likelihood of a woman’s frozen eggs (1) being used at all and (2) leading to a pregnancy. I think those things are important.
I don’t hear a lot of doctors talk about the fact that as of right now more than 85% of women worldwide who have frozen their eggs haven’t returned to use them. That will change as more women go back to use the eggs that they’ve only recently frozen, because it has exploded in popularity. But what that means is while we have a ton of good research and data on egg freezing, we still lack a lot.
I think when it comes to egg freezing’s efficacy, we’re not talking about the fact that there’s still just not a lot of numbers out there and data on women who have frozen their eggs. Women can make what they want to with that, but it’s something that’s not talked about enough.
Dr. Aimee: Yes. Because I started egg freezing parties and I feel like so many people already know about egg freezing, I don’t need to do those parties anymore, I’ve now started egg thawing parties. I’m just kidding. But I have a guide on my website, The Egg Thawing Party: Everything You Need to Know Before Your Thaw. I share that with all of my egg freezers up front so that they know everything that they need to know about the thaw when they’re freezing, so they don’t feel like they were misled or misguided.
I think one of the things people don’t know is the cost, how much it’s going to cost once you’re ready to thaw your eggs, and that’s something that is important. Also, you’ve worked so hard at freezing your eggs–do all of the tests on the sperm before you thaw your precious eggs.
Natalie: Yes.
Dr. Aimee: The other thing I tell patients is let’s say you’ve frozen eggs and you’re not going to use them until you’re a certain age, and that age is an age where you’ve basically aged out of freezing more eggs, I encourage women to freeze more or make embryos with some of their eggs so they can even see if the eggs that they froze are good enough. I’ve seen so many patients who froze at 37, they’re ready to use them at 44, and none of them survived. It’s just heartbreaking for me to hear those stories because I feel like if they had known before they were 40, they might have had a chance to freeze more.
Natalie: Totally.
Dr. Aimee: In your experience, do societal pressures and expectations impact a woman’s decision to pursue egg freezing, and how so?
Natalie: There is certainly debate around the trend of employers subsidizing egg freezing for women with no known fertility issues. One argument is that employers paying for nonmedical egg freezing applies even more pressure on women to keep working while putting their fertility on hold, if you will. On the flip side, the argument goes that this levels the playing field for women.
I think women face a lot of pressure, period. I think this pressure skyrockets in the rather short window that is our late-20s into our early-to-mid-30s. This is when we are kicking ass in our careers. We are starting or ending serious relationships. We’re trying to date. We’re coming to terms with our fertility and thinking about if and when we want to have kids. Maybe we’re also paying off student loans or dealing with chronic health issues or we’re extremely worried about climate change or the political division in our country, etcetera. It’s a lot.
While researching my book, I also learned about the motherhood penalty. I don’t know if you’ve heard of that. It’s when women lose professional and economic power after they have kids. I think that’s one reason why egg freezing looks like an empowering solution, because the ability to do something to hopefully protect your ability to have biological kids in the future but not now is really enticing. That could be a great reason for any woman listening to this to freeze her eggs.
The deeper issue here, to me, is how we are collectively in many ways rapidly embracing egg freezing without pausing to consider how society is changing as more and more people postpone childbearing, or what that means, what it says about us and our modern culture that so many women don’t feel free to be pregnant when we’re fertile and young. There’s a lot of other systemic issues going on that make it pretty hard to think about having kids and bringing a kid into this world. I think that’s a larger issue that’s not talked about a lot.
Yes, to answer your question, the pressures are very real.
Dr. Aimee: How would you fix that? If you were in charge, how would you fix the problems that we’re seeing today?
Natalie: I think we need an overhaul of our healthcare system. I think we need an overhaul of how we support young parents and mothers in this country. We need to make it more affordable to have a kid and less incredibly scary.
I’m a Millennial and I talk to my parents about this a lot. They had three kids, no problem, they both worked, okay. We were pretty privileged, but it was just easier it seems. I’m like, maybe I want three kids, and then I’m like, I cannot afford that, my husband and I, that’s going to be very hard. Maybe one, maybe two. My parents are like, “It’s fine, you can do it.” It’s just changed a lot.
Making it easier not just to have a kid in this country, but supporting that kid and parents, especially young parents, is very important. Policy wise, I’d start with an overhaul of the healthcare system, the childcare system. That’s where I’d start.
Dr. Aimee: Yes. I imagine you’re ready to get pregnant, we’ll send you healthy foods, we’ll send you out prenatals and we’ll give you first trimester leave. I feel like the focus on maternity leave is not where the focus should be. I feel like to set people up with a healthy pregnancy, they need to have first trimester leave when you’re feeling the worst.
Then, companies supporting women during the first trimester and not making them feel bad. If you’re really sick and you need to stay home, you stay home, you’re not going to lose your job. That should be built into our culture where we just wrap women around in bubble wrap, just honor them and take really good care of them from the very beginning.
Natalie: That’s a good point.
Dr. Aimee: I hope I’ll be in charge one day of some of these policies.
Natalie: For sure.
Dr. Aimee: What are some of the pros and cons of the changes in the reproductive health landscape over the past few years?
Natalie: That’s a very big question. I think I can speak a bit more specifically maybe to the fertility landscape, if that’s okay. Especially because my mind just goes then to politics and reproductive health in general.
In terms of egg freezing and fertility technology, I’ll start with cons. I think one of the cons – and I’d be curious of your thoughts on this, because I think I know how you run your practice, Dr. Aimee – I think that private equity and venture-backed firms owning so many clinics is a con. Private equity is pouring so much money into the for-profit fertility industry. That’s a trend that’s in line with a lot of what’s been happening in medicine since the 1990s, so that’s not specific just to egg freezing and the fertility industry.
In some ways, this has helped spread the word about egg freezing and other fertility care, both in the media and in the employer market, and that’s a good thing. But I worry about the marketing driving women to especially the newer clinics, which in many ways offer more inclusive and kind of feel-good patient experience, and they tend to charge less for things like egg freezing, but those clinics lack solid records in thawing and using those eggs. I believe this should be a red flag to women considering egg freezing, but it is tough to care about cost and quality equally, and I get that, so a lower price tag often trumps an established reputation. I don’t think that private equity is totally a con, but there are things to worry about there.
A big pro, I’d say, is that there is less stigma with regard to infertility and fertility treatment. Women know a lot more and are talking more about infertility, fertility treatment, etcetera. So, another pro with that is that there has definitely been increased access in terms of the number of women who know about egg freezing and have the ability to do it if they choose to. That’s very good, but we still have a long way to go when it comes to who is actually able to access fertility treatment.
Going back to healthcare system issues, the systemic barriers in place there are a huge issue. There are so many hurdles to receiving insurance coverage and affording fertility treatment that make it difficult for LGBTQ+ couples and solo parents by choice to access IVF and egg freezing. BIPOC women struggle to access reproductive technologies in particular, and it’s not acknowledged enough.
You probably know about this study, Dr. Aimee. A few years ago, The Society of Assistive Reproductive Technology analyzed nearly 30,000 egg retrievals and they found that only 4% of women who undergo the procedure identify as Hispanic and 7% identify as Black. So, as it stands now, egg freezing is available to only the relatively few people who are aware enough to seek it out and can afford it. That’s a big problem, especially as reproductive freedoms continue to get chipped-away at in this country.
Dr. Aimee: Those are some staggering statistics. Thank you for sharing that.
How has fem-tech impacted these changes?
Natalie: One egg freezing specific example that comes to mind, but I do think it’s a very positive impact of fem-tech, is fem-tech’s role in changing the landscape when it comes to improved technology for things like egg and embryo storage.
In 2018, there was a big tank failure at a fertility clinic, as I’m sure you remember. There was a tank failure in California. I flew to Ohio to report a story for The Guardian about this and I was kind of on the frontlines of watching that unfold. It was something that nobody in the industry had ever seen happen. It was just heartbreaking and awful. That was the first time I woke up to how egg and embryo storage works, what happens when it doesn’t work, what happens when there are catastrophic errors, etcetera. I have a whole chapter in the book about that.
One example of fem-tech doing great work in the landscape is companies like TMRW. I’m a big fan of them because I think they’ve changed the game with regard to the safety of egg and embryo storage. That’s huge. That’s not a very fun thing to talk about, and I think a lot of egg freezers are not actually thinking down the road about how their eggs are being stored. We just assume it’s going to be fine. It’s actually very important to look into, and I feel pretty strongly about it.
I go into more detail about this in the book, but I think while the fertility industry does benefit from a good degree of self-regulation, I still see huge room for much needed improvement when it comes to regulation and transparency.
Dr. Aimee: There are clinics out there that don’t even have working generators.
Natalie: Right.
Dr. Aimee: Patients don’t know to ask about their monitoring system, and the clinics haven’t invested in that. I know that for a fact.
Natalie: Right. Or they have lab directors that are in charge of overseeing labs in five different clinics across the country, so they’re not usually there if something goes wrong. Maybe this is an area where fem-tech and the government and the industry itself can just do better. I’d like to see enforced rules governing how fertility clinics operate and consequences for those that don’t comply, so that when huge errors like tank failures, or a ton of embryo mix-ups, or accidental egg or embryo destruction happen, we hear about it at least and we know what recourse there is or should be.
I think with the industry rapidly growing, it’s past time that we have more of that.
Dr. Aimee: Yes. I have patients move their eggs and embryos to CryoFuture and ReproTech. CryoFuture is local and they do basically white-glove service pickup of your eggs or embryos in a tank. You can watch them leave the clinic, and then they’ll deliver them to the center where they’re going to be frozen. You can even watch your tank, that’s how cool it is. They have all sorts of security measures. I think the only time your eggs or embryos would not survive is if there’s an atomic bomb. Basically, through fire, earthquake, flooding, your embryos will be fine if they’re on-site. So, that’s what I recommend to my patients.
Natalie: That’s great. Do you know if those both have automated systems also?
Dr. Aimee: Absolutely. It’s all automated at CryoFuture. I’m sure ReproTech has similar systems, too, but I can’t say for sure.
Natalie: That’s great.
Dr. Aimee: What do you hope readers will take away from The Big Freeze about fertility and women’s health?
Natalie: Something that I took away only at the end of this journey of reporting and researching this book, which is that it’s okay to not have all the answers. That’s a big one for somebody like me who is a Type-A control freak, in a good way, but takes matters into my own hands, etcetera. It is okay to not know and not to have all of the answers. Giving ourselves permission for that is, I think, really important.
I hope readers take that away from reading the book, that they feel empowered with the knowledge that they’ve gained, and also are okay not having it all figured out in this very short timeline. I hope readers take away that you don’t have to buy into the notion that your fertility is something to be conquered. I hope readers take away that if you freeze your eggs, don’t let them be a band-aid that postpones confronting the difficult questions that otherwise come up in your life and in your relationships and in your desire to have kids or not have kids, etcetera. Letting egg freezing be the powerful technology that it is and the powerful backup option that it is, but not letting it make you postpone confronting those important difficult questions.
Dr. Aimee: That’s so true. Because I see so many patients, I hear so many stories, I see the patient who froze her eggs at 33 and she was with her partner, and he still doesn’t want to have kids, but she really wants to have kids. She feels like she can still be with him, but they’re not having that tough conversation and she’s not willing to confront it, but somehow freezing her eggs makes it okay for her. That is so true.
Looking back, is there anything that you would have done differently in your egg freezing journey?
Natalie: Again, I have a funny answer to this one. I would not have taken seven years to make a decision about egg freezing. However, because I wrote a book about it and that was the point, I’m glad I did that. So, I wouldn’t change that necessarily. I don’t think any woman needs to or should, or that’s just not a good thought. I couldn’t have done that if I had started the journey a bit later, but I started that in my mid-20s.
Dr. Aimee: That’s great. I do have patients that were doing so much research and all of a sudden three years have passed.
Natalie: Yes.
Dr. Aimee: It’s like you’ve done the research for everyone. Just read The Big Freeze.
Natalie: I will say that’s where in some ways I had to put my personal journey into egg freezing on the back burner at times to keep being a journalist and be objective about this going throughout. That was very hard. It’s very hard to write about your life as it’s happening. As I’m going in and out of relationships, and as I have lots of doctors telling me, “You really should freeze your eggs,” and I’m like, “but I still don’t know enough, I still have questions about this thing, and also I have one ovary and that’s a weird medical factor that a lot of women don’t have to think about,” etcetera.
Again, I’ll just make another plug for The Big Freeze here. I truly wrote this book so that women do not have to spend three years or maybe even three months deciding, especially if they’re older and need to make a fast decision. I really would say buy my book and then go talk to Dr. Aimee for more.
Dr. Aimee: Where can people find your book or your website?
Natalie: PenguinRandomHouse.com or Amazon.com. Anyplace you buy books, really. Buying from your local bookstore would be great. You can find me at NatalieLampert.com, and all of my social handles are on there.
Dr. Aimee: Awesome. Thank you, Natalie, for joining us. Thank you for pouring your heart and soul into the research that you did for this book. It’s going to help the next 29,000 women that freeze their eggs.
Natalie: Thank you, Dr. Aimee.
