When I imagine my eggs, I think of them as grey and shiny, like slippery helium balloons clustering in the thousands within organs lit up and awake. I think of eggs enfleshed in follicular cavities, folding again and again into a sponge of cells and yellow bodies, pulsing patiently with only an occasional burst: membrane breaking at the touch of engorged fimbrae, fallopian fingers brushing the ovarian skin. After stories and statistics, after computer animations and camera registrations of organs shining against surgical light, my eggs become palpable within two pulsing opals, shielded by hipbones, roused with embodied symbolism. Hypnagogic, I dream them into being—a fiction of the body.
Celebrated as empowerment and criticized as exploitation of women, egg freezing is a contested new reproductive technology that has brought the human egg into the public eye with renewed prominence. The technology, and the eggs and bodies it pertains to, have been widely featured in popular culture and public debates about whether or not women should (be allowed to) freeze their eggs and, if so, at what ages. Eggs have become some of the most culturally determined cells in the human body, represented in declining fertility statistics and referenced in tropes of the “biological clock” and “ticking ovaries.” Egg freezing has made headlines throughout the mediascape—from the Guardian to Cosmopolitan—particularly when egg freezing cocktail parties and Apple’s and Facebook’s offer of egg freezing as an employee benefit provoked international media hypes. More broadly, frozen eggs have become a familiar sight in popular culture. A giant egg floated above the dancing nurses and gynecologists of Amsterdam’s first egg bank at the Amsterdam Gay Pride, and millions watched Kim freeze her eggs in the popular reality show Keeping up with the Kardashians. As more women began freezing their eggs, they encountered them through medical imaging techniques like ultrasound or photomicrography and made new types of reproductive choices about the extracted cells in informed-consent contracts. In each of these ways, and many more, eggs are brought into discourse in ways that affect not only the women who freeze them but also the wider public.
The egg has a rich symbolic history, in which it has figured as a sign for life, death, and regeneration in many civilizations around the world. Long before human eggs were described within the tradition of European biology, creation myths across the globe identified the “cosmic” egg as the origin of the world, or humankind—from the ancient Greek cosmogonies in which the world springs from an egg, to Finnish epics that sing of an egg that broke in two and created the earth and the sky, to the numerous legends in Oceania that ascribe the birth of the first human to birds’ eggs.1 This cosmogenic significance of the figure of the egg was also referenced in the first medico-scientific postulation that all animals are conceived from eggs, described in William Harvey’s On the Generation of Animals (1651). His work opens with a frontispiece that depicts Zeus holding an egg with the famous dictum “Ex Ovo Omnia” (everything from the egg).2 Almost two centuries later, this notion was confirmed—at least where mammals were concerned—when, in 1826, Karl Ernst Von Baer killed a dog, cut open her ovaries, and became the first human to observe a mammalian egg, thereby lodging the egg more solidly in the anatomical model of the female body. In turn, the theoretical possibility of dislodging eggs from human bodies emerged with the development of tissue culturing at the fin de siècle.3 The notion that cells could live outside of the body raised popular interest in the speculative idea of human in vitro reproduction. Stories about “babies in bottles” proliferated, most famously in biofuturist Aldous Huxley’s dystopian Brave New World (1932), which opens with a technologized origin story featuring “racks upon racks of test-tubes” in which “detached and ripened eggs were kept,” from which new citizens would be created.4
Whereas tissue culturing had externalized human cells, the birth of Louise Brown (1978), the first baby conceived through in vitro fertilization (IVF), solidified the notion that the egg could also be successfully fertilized outside of the woman’s body. After that first controversial birth, a further eight million have followed, and IVF has become routine practice.5 The popularity of IVF has brought the egg into vision—first to gynecologists, many of whom, until the extraction of eggs became familiar clinical practice in the early 1980s, had never seen a living human female gamete.6 Later, the visual of an egg being fertilized in vitro, whether by a flock of sperm or by a hand-held needle inserting a single sperm in the ICSI procedure, became ubiquitous as a stock image of IVF, and reproductive technologies more broadly, in popular media.7 Much as genes became a “prominent iconic vocabulary in turn-of-the-millennium public culture because there is a rapidly expanding range of things that can be done to them,” eggs have become the subject of public awareness as their particular existence in time and space has become alterable in new ways with IVF and, more recently, with egg freezing.8
As the 20th century witnessed the advent of the extracorporeal egg’s fertilization, its cryopreservation has been hailed as the harbinger of a 21st-century “reproductive revolution” on a par with the introduction of the contraceptive pill.9 Egg freezing, or oocyte cryopreservation (OC), is effectively an IVF procedure with a prolonged period of cryostorage after the eggs’ extraction from the body, but before their fertilization. While the eggs are in the freezer, stored at −196˚C in liquid nitrogen tanks, they are thought to be unaffected by the passage of time. Those eggs that survive the freeze-thaw process may be used for fertilization when a pregnancy is desired. Initially used primarily as a technique to aid women with a cancer diagnosis who were confronted with imminent fertility loss, egg freezing may also be used to circumvent the effects of age-related infertility—and it is this application that is the focus of this study.
Freezing Fertility critically examines the technology of egg freezing, and its construction in public discourses, in relation to a notion that is relatively undertheorized in the study of culture: aging. As a reproductive technology that is employed for so-called fertility preservation rather than immediate childbearing, egg freezing both prompts the articulation of existing age normativities and reconfigures the temporal logic of reproductive aging. I investigate the implications of egg freezing for contemporary thinking on bodily temporality by analyzing a selection of cultural objects—varying from sparkly online platforms to heart-breaking court cases and intimate autobiographical accounts—that are emblematic of each stage of the procedure. Accordingly, Freezing Fertility follows the journey of the egg: starting from the initial anticipation of reproductive aging in relation to in vivo eggs and moving on to the accumulation of in vitro eggs after extraction, the selection of fertilized eggs with time-lapse embryo imaging, the novel forms of older motherhood following the implantation of fertilized frozen eggs, and, finally, the global impact of egg freezing as a condition of possibility for the transnational flows of eggs that can emerge once cryopreservation renders the egg newly mobile.
Although public discourses typically frame egg freezing as an individual reproductive choice for women who may want to have children later in life, in this book I explore how the emergence of egg freezing also reveals widespread cultural negotiations about the new norms that govern reproductive aging and the timing of childbearing when eggs become freezable. On the one hand, we are witnessing a discursive and infrastructural shift that rationalizes egg freezing by rendering fertility increasingly precarious and making women responsible for proactively managing its potential decline at specific moments in the life cycle. Multi-million-dollar investments in organizations that target young women to preserve “peak fertility,” the mainstreaming of egg freezing as a health benefit covered by Fortune 500 companies, and the rise of “Fertility MOT” tests offered by fertility clinics all evidence this development. On the other hand, the introduction of egg freezing has also elicited the reaffirmation of existing age-related normativities—whether in national regulations prohibiting fertility treatment after 45 or in popular discourses denouncing childbearing beyond “normal reproductive years”—in the face of their potential transgression with frozen eggs.10
Freezing Fertility engages the dynamic between these two developments by analyzing the changing contemporary constructions of the relation between fertility and aging—a relation that has become both more alterable and more politically charged with the emergence of the freezable egg. Oocyte cryopreservation presents a situation in which bodies age while frozen eggs, and the reproductive potential they embody, are understood to be unaffected by the passage of time. This study explores what is at stake—culturally, politically, commercially—in the encounter between lived and frozen time by following the egg as it exists inside and outside the body, in freezers or in photographs, in glass or as glass, in time or out of time. In Freezing Fertility, egg freezing functions as a prism onto a broader gender politics of aging, which both transforms and solidifies as OC practices reconfigure the ways in which reproductive cells and bodies are understood to live in time.
In order to situate the popularization of egg freezing, this introduction first considers its historical emergence and subsequently outlines the conceptual framework for rethinking notions of fertility and aging in relation to the frozen egg. This lays the foundation for Freezing Fertility’s consideration of how the clinical possibility of OC, and the concomitant emergence of frozen eggs, provide the occasion for contemporary reimaginations of reproduction and regeneration that have been associated with eggs for millennia.
The Emergence of the Frozen Egg
Described as the “holy grail of fertility medicine,” egg freezing technologies have been a long time in the making.11 Sperm and embryos have been routinely frozen for decades, but the cryopreservation of eggs has proved challenging. In the 1950s, the first woman birthed a child after being inseminated with previously frozen sperm. Three decades later, an Australian girl named Zoe was the first to be born after a frozen embryo transfer.12 Although egg freezing only gained popularity after the turn of the millennium, the first babies—they were twins—created from frozen eggs were born as early as 1986, only a couple of years after Zoe, and also in Australia.13 Notwithstanding this early achievement, egg freezing continued to be difficult, primarily because the egg—the biggest cell in the human body at 0.1 millimeters—has a relatively large liquid volume, which is sensitive to freezing damage from ice crystal formation. So while embryo and sperm freezing soon became routine clinical practice, the early successes of OC were not easily reproduced, and further clinical attempts to use frozen eggs for human reproduction were largely suspended as if “cast under a voluntary moratorium.”14
Meanwhile, IVF became increasingly popular in the 1980s and 1990s, particularly as a treatment for age-related infertility. Although IVF was originally designed as a method to avoid tubal infertility by circumventing the fallopian tubes and instead allowing fertilization to occur in vitro—indeed, Lesley Brown, who carried the first IVF baby, had been unable to conceive for nine years because her fallopian tubes were blocked—assisted reproductive technologies were increasingly used to treat age-related infertility.15 Lisa Harris describes how this focus reflects the fact that IVF was becoming a particularly market-driven sector—both in the United Kingdom, where Thatcher’s rule coincided with the rise of private, for-profit IVF clinics alongside public NHS facilities, and in the United States, where healthcare was more privatized across the board.16 The US IVF sector was also particularly affected by anti-abortion ideologies that curtailed federal funding for embryo research. As a result, US fertility research became more reliant on clinical IVF cycles, often paid for by patients themselves. Consequently, Harris argues, both IVF practice and research became organized around market rationales, reflecting the demands of patients who could afford to undergo ART (assisted reproductive technology) treatment. This group mostly consisted of relatively older women, who were “often professionals, disproportionately white, … delayed childbearing and had the best odds of affording IVF care.”17 Although low-income women with limited education, who were disproportionately women of color, had almost twice the infertility rates—often tubal infertility—compared to their affluent, highly educated white counterparts, IVF has primarily focused on the age-related infertility of the women who can afford treatment.18
Spurred on by the potential demand for female fertility preservation in the context of growing IVF markets geared towards treating age-related infertility, legal restrictions on embryo research, and demographic trends of later childbearing, new approaches to freezing eggs were developed from the 1990s onwards.19 At first, efforts focused on freezing eggs very slowly to limit cryodamage, but eventually vitrification emerged as the most promising approach. Vitrification entails freezing the eggs so rapidly that the liquid in the cells does not form ice crystals, but transforms into a glass-like state. These vitrified eggs, then, do not so much exist in vitro (in glass), but rather are vitreum (as glass) within the liquid nitrogen tanks. In fact, the vitrified egg is no longer held by the glass referenced in IVF (in vitro fertilization), but is rather stored on a thin film strip. It was the postmillennial development of this alternative container, the Japanese Cryotop system, that proved pivotal in raising the eggs’ post-thaw survival rates up to 90%.20 These high survival rates, and their reproducibility in clinics across the world, have transformed egg freezing into a technology that is used not only for women with malignant diseases but increasingly also for the purpose at the center of this study: anticipating age-related infertility.
It is important to note that nonhuman animals are also implicated in the development of human egg freezing, whether as model species for research or through the use of animal products in cell culturing—notably fetal bovine serum (FBS). This serum is commonly sourced through an unanaesthetized puncture between the ribs directly into the beating hearts of late-term fetuses taken from slaughtered cows who are pregnant (an estimated 8% of cows).21 Over 800,000 liters of serum are produced from more than 2 million fetuses annually, and it is widely used in cell and tissue culturing, including some OC studies, as a growth medium.22 Kuwayama’s abovementioned Cryotop study, for example, reported on the freezing of eggs from cows and humans and used FBS for developing the former. Although FBS is not typically used in clinical egg freezing practices, publications announcing some of the first human babies born through vitrification describe the use of this serum.23 In these “always asymmetrical” cross-species relations of oocyte cryopreservation, the frozen egg thus emerges from a broader interspecies organization of “living and dying, and nurturing and killing” and the “hierarchy of deaths” that underlie them.24
Following its improving success rates, egg freezing has become a widely popular technology. Although OC cycles only make up a small percentage (1.5% in the United Kingdom) of all IVF cycles, the number of women freezing their eggs has increased every year, and awareness of the technology is widespread among the general population, particularly as it is frequently featured in popular media.25 An increasing number of clinics across the world have introduced egg freezing, especially after the American Society for Reproductive Medicine (ASRM) lifted the “experimental” label of the procedure and the European Society for Human Reproduction and Embryology (ESHRE) considered it ethically acceptable in 2012. This study focuses primarily on the popularization of egg freezing in the Euroamerican context and draws on case studies from the United States, the United Kingdom, and the Netherlands.
Many of the novel clinical, financial, and infrastructural developments in egg freezing that are central to this study emerged first in the relatively unregulated fertility industry of the United States—whether it is fertility companies selling egg freezing insurance or cryobanks shipping frozen eggs internationally. The highly regulated national contexts of the United Kingdom, with its unique legal framework regulated by the Human Fertilisation and Embryology Authority (HFEA), and the Netherlands, where Parliament barred women’s access to egg freezing for several years, give insight into the constraints and controversies surrounding egg freezing. In the United Kingdom, egg-storing regulations were first drawn up in 1990, and the ban on using frozen eggs for fertilization was lifted at the turn of the millennium. Soon after, in 2002, Emily Perry, the UK’s first frozen egg baby, was born. In the Netherlands, elective egg freezing was not formally permitted until almost a decade later, in 2011. This was the result of a two-year political debate, which started in 2009 when the Amsterdam Medical Centre (AMC) proposed to offer OC to healthy women for age-related fertility preservation.
US IVF is characterized by a permissive regulatory regime and a largely for-profit fertility sector.26 IVF costs are significantly higher than in other countries, and assisted reproduction has become a “luxury” market, in which many people are excluded from treatment because of its cost. Those who do access IVF and egg freezing are, unsurprisingly, disproportionately wealthy, well educated, and white; perhaps more surprisingly, this trend persists even in states where treatment costs are covered by insurance.27 The US fertility sector has attracted substantial private equity and venture capital investments; particularly egg freezing start-ups have received significant capital investments and are reshaping the fertility industry through mergers and acquisitions of traditional IVF clinics, the organization of care through online platforms, and employer insurance packages for ART treatment.28
In the Netherlands, almost all IVF clinics are situated in public hospitals and egg freezing, accordingly, primarily takes place in a nonprofit context. Dutch national health insurance covers three cycles of IVF for women under 43, but egg freezing is only covered for “medical” reasons; women who wish to circumvent age-related infertility have to pay out of pocket. The Dutch egg freezing ban and both minimum and maximum age limits for OC are in keeping with the relatively restrictive regulation of ARTs in the Netherlands. For example, in Amsterdam, egg freezing is only allowed after 30 years, reflecting the Dutch tendency not to “overmedicalize” bodily problems (e.g., one third of deliveries take place at home, which is unique in the Western world).29
The United Kingdom combines both private and public reproductive healthcare systems. IVF emerged in the wake of the postwar establishment of the National Health Service (NHS) for universal healthcare. A spirit of altruistic voluntarism characterized both the large number of egg donors and the (often unpaid) medical professionals who contributed to the underfunded development of IVF for nearly a decade before Louise Brown’s birth in 1978.30 Subsequently, under Thatcher’s neoliberal rule, IVF became “a bellwether of health privatization,” and the 1980s saw the rapid rise of lucrative private IVF clinics and semiprivate fertility treatment offered alongside NHS facilities.31 Today, particularly the private fertility centers promote and specialize in egg freezing for age-related infertility; NHS-only services make up only 22% of all clinics in the United Kingdom.32
Yet the analysis does not confine itself to these particular national contexts. The cultural objects under scrutiny in this study may circulate transnationally, exemplify a broader discursive logic, or operate in the complex geographies of on/offline dynamics and data distribution. Film and news media are broadcast internationally. Online platforms may be accessed globally. The standardization of techno-clinical systems linked to egg freezing—whether automated vitrification or algorithmic embryo selection—facilitates their use in various local contexts. Practices like cross-border frozen egg donation are defined by their transnational nature and cause not only gametes but regulations, norms, and clinical practices to travel across the globe. So while I situate these cultural objects in specific sociocultural and geopolitical contexts, their locus is often more networked, distributed, and dynamic than the frame of the nation-state permits.
OC Critiques and Controversies
As is the case for most new reproductive technologies, egg freezing has been widely criticized, but also hailed as a means of improving women’s reproductive self-determination. And indeed, egg freezing may be of great benefit to people at different life stages by offering a means to (potentially) retain the reproductive capacity of one’s eggs in spite of the passage of time, allowing further possibilities for undergoing IVF with one’s own eggs later in life and establishing biogenetic relationships with the potential future children born as a result. Women who have chosen to freeze their eggs indicate that the primary motivations for undergoing the procedure are the absence of a partner with whom a family can be formed,33 avoidance of future self-blame and concern about the biological clock,34 and irreconcilable social, professional, and biological time pressures.35
Yet, notwithstanding egg freezing’s potential benefits, the choice to freeze one’s eggs also requires gauging the reproductive potential of the frozen eggs against the procedure’s health and financial risks, all of which are mediated through discourses that may themselves be contested and informed by third-party interests.36 Another downside is that the possibility of egg freezing may also entail assuming responsibility for not doing so, thereby reframing certain experiences, such as age-related infertility, as the outcome thereof. The financial and cultural capital, time investment, health status, and favorable regulatory and medical context required for undergoing the procedure moreover mean that such choices are not equally accessible, and may therefore contribute to further stratification of reproduction in general, and the timing of childbearing in particular.
In line with this concern, most studies suggest that women who freeze their eggs in anticipation of age-related infertility are relatively well-to-do. Because egg freezing is expensive and not covered by national insurance plans when used for this type of “fertility preservation,” it is unaffordable for most people. Beyond affordability, Cahn and Carbone point out that the demand for OC by childless women in their late thirties also reflects existing class- and race-specific trends in relationship formation and average age at first birth, resulting in a situation in which white, middle-class, highly educated women are overrepresented in the group for whom egg freezing becomes relevant in the first place.37
Following from this, egg freezing aligns with the critique of IVF developed by Dorothy Roberts, who describes it as a further extension of high-tech reproductive interventions that are geared towards encouraging the reproduction of the most privileged in society. Meanwhile, nonreproductive technologies and policies have been used to discourage less affluent and less privileged women from having children.38 Charis Thompson has coined the term “selective pronatalism” for this practice of differentially restricting access to reproductive or nonreproductive technologies in keeping with settler-colonial, racial, religious, or class hierarchies.39 Indeed, Bhatia and Campo-Engelstein highlight that ESHRE’s recommendation that egg freezing should be allowed because “there are demographic reasons for welcoming the birth of any extra child born to women who are socially, economically, and physically able to give it a good start in life” reflects a selectively pronatalist attitude towards egg freezing as a technology that can encourage particular groups of people to have children.40 In the private sector, fertility insurance offered for workers in high-status Fortune 500 companies likewise aligns with this selectively pronatalist frame.
Yet this pronatalist framing is complicated by the fact that, although privileged women are more likely to undergo OC, egg freezing is not a reproductive technology in the strict sense of the word. Given that currently only approximately 5% of women return to use their eggs and only 20% of those women end up having a baby conceived from the eggs, OC is hardly driving up birth rates among the privileged.41 While OC’s marketing to, and uptake among, middle-class women aligns with ideologies that selectively promote elite reproduction, egg freezing has equally been criticized as having the effect of further postponing motherhood and encouraging women in high-status jobs to focus on their careers rather than become mothers. In other words, the reproductive and nonreproductive qualities of egg freezing complicate the pronatalism and antinatalism implicit in the uptake and promotion of this technology.
Some feminist and bioethics scholars have advocated the availability of egg freezing because it benefits women in making reproductive choices and improves gender parity in timing childbearing,42 with others suggesting that egg freezing can improve reproductive autonomy by offering a way for women to “choose when to become a mother.”43 Yet academic studies of OC have more commonly raised concerns about egg freezing as an individual choice that may detract attention from the sociocultural factors that contribute to a situation in which childbearing becomes problematic and egg freezing appears as a solution, including the (temporal) organization of education, labor, relationship patterns, and their intersection with race, class, and sexuality.44 The framing of egg freezing as an individual choice suggests an expansion of women’s reproductive rights, when in fact, Lisa Ikemoto argues, its “empowerment” serves to “fuel demand” within a logic of free market individualism, while ignoring the structural factors that help determine the safety and autonomy of women’s reproductive choices, including poverty, racism, and heterosexism.45 In other words, critics have asserted that egg freezing is an “expensive and physiologically risky procedure that offers an individualist solution to social reasons for delayed childbearing” and have instead called for the need to address the structural inequalities underlying these social issues through such measures as parental leave, child care, wage equality, and comprehensive health insurance.46
These critical positions respond to two different developments in the gender politics of reproductive aging, which problematize women’s reproductive decision making in contrasting ways. On the one hand, critics like Goold and Savulescu speak out in favor of OC in response to negative news reports admonishing “career women” for “delaying” having children by freezing their eggs, moral outrage about technologically assisted older motherhood—but not older fatherhood—and calls to ban egg freezing for “social” reasons.47 They criticize the widespread affirmation of normative reproductive age limits that the introduction of egg freezing provoked in media, regulatory, and medical discourses, which have limited women’s access to the procedure or the resultant frozen eggs. On the other hand, critics who advocate social change rather than biotechnological fixes like OC typically object to the neoliberal responsibilization of women implicit in the idea that one can “extend fertility” and “stop the biological clock.” The suggested alterability of reproductive aging evades structural change and instead provides an individualized coping mechanism for social structures that do not offer supportive conditions for women to have children, or financially encourage them to reproduce later in life.48
So while egg freezing’s introduction may intensify the naturalization of reproductive aging norms in the face of their potential transgression, it has also resulted in the reconceptualization of reproductive aging as biotechnologically alterable and the concomitant institutionalization of new norms for managing the “biological clock” in keeping with the temporal logic of broader cultural and socioeconomic structures. Freezing Fertility explores the dynamics between these two developments; it positions the construction of age-related infertility as itself politically relevant and therefore requiring critical reflection.
This project does not challenge the widely observed phenomenon that women’s ability to conceive and birth children is finite and age contingent.49 I advocate the widespread availability of information on female fertility and its age-related contingencies, especially given that significant contingents of women and men remain underinformed on these matters and overestimate the success rates of technologically assisted reproduction.50 However, my main interest lies with how the relation between fertility and aging becomes legible as bodily truth in public discourses of egg freezing. In Gayatri Spivak’s words, the aim is “not the exposure of error. It is constantly and persistently looking into how truths are produced.”51 By following their public manifestation in popular culture, online platforms, technological systems, and reproductive infrastructures, I examine egg freezing, associated models of female reproductive embodiment, and the figure of the frozen egg as material-discursive phenomena that both reflect and transform contemporary notions of what it means to age, and to be (in)fertile.
Fertility and the Frozen Egg
Egg freezing has introduced new ways in which we can become fertile throughout the life course. While late-20th-century technologies of IVF and egg donation have created possibilities of bearing children after the onset of age-related infertility, the 21st-century introduction of egg freezing offers a chance of not only birthing but also conceiving later in life with frozen eggs. Conversely, as a technology that is used to bypass reproductive aging, OC also uniquely implicates younger fertile women, who are confronted with the option of freezing eggs to anticipate future infertility at increasingly early ages. The possibility of egg freezing thus produces emergent modes of being fertile—beyond the fertile/infertile binary—now that age-related infertility may be lived prior to its arrival and its onset need not signal the end of the reproductive life span.
As a technology that is not directed at having children in the present but at “preserving fertility,” egg freezing—unlike conventional IVF—separates the attainment of a technologically mediated form of fertility from the attainment of a pregnancy or live birth. This separation facilitates a reflection on how fertility operates in the absence of (attempted) childbearing. Sarah Franklin has described how IVF is used not only to help people have children but also to provide a “resolution to the uncertainty created by infertility” and a means to counteract future regret because one has “tried everything.”52 This observation is particularly pertinent in the treatment logic of egg freezing, which similarly provides a treatment to resolve uncertainty about infertility—albeit a future infertility—and requires action at present in order to avoid the potential future regret of not having frozen (more) eggs. In this way, the possibility of egg freezing renders these concerns about uncertain fertility and retrospective regret—commonly associated with IVF—relevant to and treatable for a new group of people, who need neither experience a current desire for a child nor have an infertility diagnosis.
Egg freezing is, unusually, an infertility treatment for fertile people. The indication for treatment is not the experience of infertility as such but the anticipation of the arrival of infertility in the future.53 The World Health Organization defines the arrival of infertility as “the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”54 With the advent of reproductive technologies like IVF and IUI (intra-uterine insemination), infertility has shifted from being a condition that is necessarily manifest in the continued absence of pregnancy to being an indication for treatment, which, as the literature on IVF has described, may also function as an injunction of “having to try” treatment.55 In the context of IVF, infertility may then arrive twice: first, an infertility that becomes an indication for ART treatment and, second, an infertility that is the outcome of a complex decision-making process about whether to access and when to stop this treatment. With the emergence of egg freezing, infertility may arrive a third time, earlier in life, as a future possibility that becomes an indication for anticipatory treatment in the present.
Freezing Fertility explores how fertility is rendered precarious earlier in the life course in relation to this possibility of freezing eggs in anticipation of future infertility. Precarious fertility functions as an alternative indication for infertility treatment, which arrives outside of the frame of the couple, and without attempted conception. I use the term “precarious” here both in the sense of uncertainty or “exposure to risk” and with reference to the older Latin “precarius”—derived from “prex,” to pray—which denotes being “vulnerable to the will or decision of others,” thereby signifying a sense of dependency.56 Precariousness refers to the idea that the possibility of freezing one’s eggs produces not only more treatment options but also a particular dynamic of epistemic uncertainty and agentic control over reproductive aging. In other words, egg freezing introduces ways of knowing fertility that create new uncertainties about reproductive risk and ways of controlling fertility that create new dependencies on others.
Following Judith Butler’s reflection on precariousness,57 the first, risk-based aspect of precarious fertility pertains to the discursive construction of female fertility in the context of egg freezing. Not simply referencing a biological reality, the notion of fertility in discourses of OC constitutes a public mode of address directed at a new group of women. Whereas the fertility industry was previously considered “irrelevant” to 85–90% of the population,58 the possibility of egg freezing enlists a larger section of healthy women of reproductive age as potential candidates for treatment. Precarious fertility is the effect of discourses that, in lieu of symptoms that would be an indication for IVF, rationalize a fertility treatment aimed at people who do not currently experience infertility. If, for Butler, precariousness is a concept for thinking through the relationality of human subjectivity and the vulnerability to the constitutive address, the notion of precarious fertility likewise signals the sociality of becoming-(in)fertile through the address—and the importance of considering the public discourses of fertility to understand the reproductive politics of egg freezing.
Lauren Berlant describes precariousness as a “condition of dependency—as a legal term, precarious describes the situation wherein your tenancy on your land is in someone else’s hands.”59 Following from this, the second aspect of precarious fertility references the new conditions of dependency that are produced to render fertility legible and manageable. On the one hand, egg freezing presents a new impetus to make fertility legible prior to the attempt to conceive. After the introduction of IVF, egg donation, and now egg freezing, an egg-based model of fertility has become dominant, in which the egg is the key locus of female fertility.60 In order to know one’s fertility, and decide whether to freeze eggs, one becomes dependent on third parties as these eggs are invisible without technical mediation, immeasurable without testing, obscure until extracted, and in perpetual decline since the time before birth.
On the other hand, precarious fertility signals the particular dependencies that emerge in the call to manage future infertility, including those that are required to freeze, to thaw, to acquire fertility. By extension, the egg freezing procedure itself operates through a logic in which fertility may, quite literally, be more assured by delivering it from the body, by entrusting it “in someone else’s hands.” So while egg freezing ostensibly makes people more fertile, the offer of preserving one’s eggs can in fact intensify fertility precarity by making people vulnerable to pressures to maximize the future fitness of a fertility that is always already in decline. This transformation of fertility in the face of cryopreservation may be understood as exemplifying a broader sense of reproductive bioprecarity, which characterizes contemporary orientations towards the body—and biological substances like eggs—through a mutually reinforcing dynamic of intensified biotechnological dependency and speculative epistemic uncertainty.61
When fertility becomes legible with reference to the freezable and extractable egg, reproductive aging gains a cellular component. By dislodging the time of the egg from the time of the body, the possibility of OC complicates a clear, chronological, age-related trajectory from fertility to infertility. For example, if female fertility is understood as the ability to conceive with a chosen partner or donor, the presence of frozen eggs after the onset of age-related infertility gives rise to a state that can be characterized as neither fully fertile nor fully infertile, but rather as what we may call “postfertile.” Likewise, when frozen eggs symbolize a timeless and “extended” fertility alongside the body’s finite and aging fertility, the relation between fertility and infertility becomes further complicated. Postfertility, then, denotes the ambiguously in/fertile states that emerge when the possibility of egg freezing reconfigures the temporal logic of reproductive aging. This is not to say that categories of fertility and infertility have become obsolete—quite the contrary. Rather, precisely because notions of fertility and infertility can be mobilized for a variety of personal, political, and commercial ends, it is important to consider what is at stake when these categories are called into question, redefined, or reaffirmed in the context of OC.
Freezing Fertility aims to characterize the postfertile condition that emerges after the introduction of egg freezing. It explores fertility after its preservability has become commonplace, imaginable, and attainable, if out of reach for many. Postfertility signifies not so much a leaving behind of fertility but rather the conceptual and material flexibility of fertility enabled by new repro- and cryotechnologies. Specifically its postness references a preoccupation with “what comes after,” with the futurity of fertility—a futurity that can easily reframe embodied fertility as always already in the process of being lost. More broadly, the “post” of postfertility points to the importance of temporal orientations—such as anticipation, retrospection, suspension, and acceleration—through which constructions of (non)reproductive futures and (in)fertile pasts come to bear on the present moment. In relation to these temporal orientations, egg freezing allows experiences of fertility and infertility to exist alongside one another in new ways as the frozen egg brings the concern and treatability of infertility earlier into the life course and extends new forms of emergent fertilities beyond the onset of age-related infertility.
In Freezing Fertility, I explore how the possibility of egg freezing is not just relevant for the increasing but still limited number of women who freeze their eggs but rather is so interesting because it destabilizes fertility—as concept, as practice, as finite—at large. The postfertile condition emerging with egg freezing, as a condition, refers to states of (non) reproductive embodiment shared by the wider public, beyond the people who consider or choose OC. Accordingly, this study analyzes public discourses, which engage this broader audience, that reconstruct what it means to be (in)fertile in the face of the possibility of cryopreservation. It also engages with the social structures that provide the conditions of emergence for these newly politicized and commercialized modes of becoming fertile. At stake here are not only fundamental changes to the meaning of fertility but a destabilization of some of the central tenets of aging and reproduction through which gendered organizations of social life are naturalized and themselves reproduced.
In the other, medical sense of the word, the condition of postfertility references its proximity to biomedicalization, as frozen eggs have instigated public renegotiations of when and whether (in)fertility becomes a medical condition that requires technological intervention. This is not only relevant for a new group of (potential) patients; the strict regulation as well as the slick promotion of egg freezing also articulate norms about the differential timing and desirability of childbearing for different groups of people—whether they naturalize age limits to pregnancy or normalize new technologized forms of reproductive life course management.
The postfertile condition does not start with oocyte cryopreservation; 20th-century reproductive technologies like the contraceptive pill, IVF, and egg donation have all radically redefined the temporal relationship between fertility and infertility. Nevertheless, by analyzing a reproductive choice that is uniquely oriented towards reproductive aging and future age-related infertility, Freezing Fertility gives insight into the particular types of postfertility that emerge when frozen eggs allow the relation between fertility and aging to become modifiable, contigent, and mediated in novel ways. In doing so, oocyte cryopreservation instigates a broader reshaping of the gender politics of aging as frozen eggs travel across time and space, across bodies and borders, with far-reaching effects.
Aging and the Frozen Egg
As the frozen egg shifts clinical possibilities and cultural ideas pertaining to the timing of fertility, aging—and particularly female reproductive aging—becomes politicized in new ways. If biopolitics describes the power, as Foucault famously suggested, to “make live and let die,”62 the work of “mak[ing] live” relates quite literally to new reproductive technologies like egg freezing, which bring questions of (dis)allowing its attendant technologized forms of reproduction into the realm of politics. Yet the biopolitics of egg freezing is not only generative; it not only “makes live” but reorients the finitude of “let[ting] die” by keeping the eggs in a frozen, deathless state. Kowal and Radin theorize this point as the “cryopolitics” that emerges with contemporary efforts to augment life by making live and not letting die. Cryobiology, they argue, gives rise to a duality of a “latent life” oriented towards future potential and an “incomplete death,” the deferral of which becomes subject to agentic control.63 Likewise, frozen eggs can embody a latent fertility and an incomplete arrival of infertility at different times in the life cycle; reproductive aging is thereby not simply a given “fact of life” but is reconstituted in the realms of discourse, regulation, and industry. As the frozen eggs exist alongside the lived time of the body, it is then not just life and death, but the remaking of aging that is central to the cryopolitics of egg freezing.
The possibility of remaking reproductive aging with frozen eggs emerges at a time when growing biomedical and “cosmeceutical” industries cater to a general “will to youth”—Michelle Smirnova’s term for “a civic duty of the aging female to pursue eternal youth”—that shapes many aspects of social life, including the lived experience and popular understanding of the body.64 Contemporary examples are numerous, whether we consider a highly gendered market in anti-aging cosmetics (worth $1.15 billion in the United States alone), the medicalization of midlife, or the double standards of representing aging in popular culture.65 Gender is a key organizing factor in contemporary biopolitics of aging, which, Brett Neilson argues, pertains to both the disciplinary effects of knowledge production about aging and the control exerted through the nation-state and the market logic of global capitalism, in which aging is increasingly understood as an individual risk rather than a collective responsibility.66 This intersection of gender and age is at the heart of the particular reproductive politics emerging with egg freezing.
In order to understand the intersection of gender and aging as organizing principles within the promiscuous prefixing of the bio-, cryo-, and repropolitics, this study takes as its starting point the construction of gendered age normativities that inform contemporary egg freezing practices and their reconfiguration of life, latency, and reproduction.67 Through this lens, the discursive production of reproductive aging and age-related infertility in the context of OC does not simply reflect a biological reality but emerges in relation to historically specific norms of aging and organizing time.
Age normativities specific to women have historically been predicated on reproductive changes in the female body.68 With the establishment of gynecology and the concomitant pathologization of the many “diseases of women,” mid-19th-century Western medicine fostered the institutionalization of a gender-specific history of naturalizing age-appropriate acts—such as when to have a partner and when to reproduce—with reference to (non)reproductive physical phenomena such as menstruation, childbearing, and menopause.69 The anticipation and arrival of age-related infertility is a contemporary equivalent of a body-based moment in the female life span that becomes a reference point in validating or resisting a set of age- and gender-specific norms governing when to have children, when (in)fertility may be assumed, when infertility ought to be anticipated, when medical interventions are appropriate, and how the passage of time may be recognized in the body. In OC discourses, age normativities may be expressed in mediatized medical advice on when to pick Mr. Good Enough over Mr. Right, women’s public accounts of the anxiety experienced at turning 35, and the proposition to offer egg freezing as a graduation gift, to name but a few examples that I will discuss in this study.
In the context of egg freezing, such age norms emerge in relation to broader, historically specific cultural organizations of time that Elizabeth Freeman defines as “chrononormativities.” The term refers to the “hidden rhythms” of “schedules, calendars, time zones” that “seem natural to those whom they privilege.” These rhythms, she argues, function as “technique[s] by which institutional forces come to seem like somatic facts.”70 Freeman’s definition of chrononormativity as “the use of time to organize individual human bodies toward maximum productivity” points to an industrialized organization of time, which was first standardized in 19th-century England (1847) and temporalized the gender division into the “separate spheres” system.71 In contrast with an industrialized time of standardized scheduling, women’s space of the home was idealized within a discourse of domesticity that “validated a set of feelings—love, security, harmony … motherly instincts—in part by figuring them as timeless.”72 This domestic maternal space was associated with a cyclicality of a feminine “corporealized time” attendant to the “human tides,” which was rhetorically opposed to the “linear time of history” and wage time of industrial capitalism.73 What emerged was a cultural logic in which a nonlinear time seen to belong to the female reproductive body lay at the foundation of the reification of the gender binary in distinct “spheres” that became separated not only in space but in the particular chrononormativities that organized their temporal schemes.
The naturalization of this feminized chrononormativity was challenged in the 20th century not only by women’s increased participation in the industrialized time of the public sphere and wage labor but also by the entrance of industrialized temporal schedules into the female reproductive body, primarily through the advent of reproductive technologies offering increased agency over the timing of menstruation and maternity. Hormonal contraceptives allowed the introduction of alternative temporal schemes into the cyclical rhythms of menstruation. Through precisely timed hormonal stimulation, in vitro fertilization techniques decoupled attempts at childbearing from cyclical ovulatory patterns and synchronized them with specific time schedules, such as those of the fertility clinic.74 These developments did not necessarily entail a conceptual severing of femininity and fertility from cyclical rhythms. In fact, as Nelly Oudshoorn argues, they can reinforce a notion of “natural cycles” in contradistinction with these interventions.75 Nevertheless, these reproductive technologies did posit the timing of menstruation and ovulation as manipulable by synthetic hormones and allowed for the popular reconceptualization of childbearing within linear temporalities as “family planning.” In this way, the temporal regulation of the female reproductive body in relation to the chrononormativities implicit in standardized treatment protocols, mass-produced hormone strips, and clinical time schedules exemplifies Freeman’s definition of chrononormativity as, this time more literally, becoming recognizable as “somatic facts.”76
With this increased technologically mediated agency over the timing of childbearing, the end of the female reproductive life span gained cultural significance as a temporal limit to “family planning.” Friese and colleagues describe the public concern with a female reproductive “deadline” following the increasing availability of contraceptive and abortion services, which centered on the notion that “the public domain, organized around paid labor, interferes and competes with a woman’s fertile years.”77 The widespread preoccupation with this deadline—often referred to as the “biological clock”—also emerged in relation to the idea that age-related infertility is “the price women pay” for increased participation in paid labor, politics, and higher education.78 Adopted in the neoconservative political climate of the 1980s, the female “biological clock” was popularized as a “temporal signifier of inter-gender difference” that naturalized a proximity between the female body and the family with reference to the temporality of women’s bodies—particularly so in the face of a changed social order that permitted, and required, more participation of women in the workplace.79 This coincided with the publication of influential scientific studies arguing that contemporary and historical data demonstrate that “female fecundity [is] a function of age.”80 The popularization of such findings, along with the advent of new reproductive technologies like IVF, displaced the common conceptualization of menopause as the end of the reproductive life span and menstruation as an affirmation of fertility in favor of an understanding of “ovarian reserve” and the age of the eggs as determinants of reproductive capacity.81 This shift entails a move away from the easily observable and cyclical indicator of presumed fertility in menses to a more elusive notion of the age of the eggs that may be assessed through medical interventions like hormonal blood tests or ovarian ultrasound scans—or deduced from one’s age in years since birth.
Rather than a cyclical conceptualization of women’s reproductive embodiment, the dominant presentation of the temporality of female fertility in egg freezing discourses is characterized by a life-long decline of egg quantity and quality. The female reproductive body does not adopt an idealized position outside of standardized time, but becomes itself synonymous with clock time in tropes of “ticking ovaries” and the “biological clock.” In this linear loss model of reproductive aging, eggs may themselves begin to function as measurements of time. As eggs may be “banked” as a means of “fertility insurance,” they somatize an economy of time, in which time is understood to be quantifiable and delimited—a “‘thing’ that can be ‘spent,’ ‘saved,’ and ‘lost’; indeed, it is frequently ‘invested.’”82 Alongside the more familiar family planning, these egg-based conceptualizations of female reproductive aging facilitate the popularization of “fertility planning,” which references practices of timing not only when to have children but also when to have the ability to have children.
If the end of the female reproductive life span is then located in egg quality and quantity, the possibility of fertility planning with frozen eggs destabilizes the very previously naturalized temporal limits that govern when women can be considered fertile. It is therefore no surprise that the introduction of egg freezing has once more rekindled cultural negotiations over the relation between female reproductive aging and gendered chrononormativities. It is characteristic of the postfertile condition, with its temporal instability of in/fertility distinctions, that we may now witness cultural efforts to restabilize temporal limits to fertility that appeal to the notion of “normal reproductive years” to motivate bans or rejections of egg freezing.83 Conversely, egg freezing is promoted precisely as a means to “extend fertility” and adjust these limits to the chrononormativities of labor arrangements or the “will to youth.” In the context of egg freezing, the gender politics of aging thus pertains not only to norms associated with particular ages but also to the chrononormative temporal schemes in relation to which the time of female fertility may be understood, organized, and politicized.
The Egg’s Journey: Outline
Freezing Fertility follows the journey of the egg in the OC process.84 Each chapter addresses a step of the OC treatment, thereby reflecting the fact that egg freezing is not a single procedure but a set of consecutive interventions in which the egg undergoes various transformations. Immature eggs are stimulated in the ovaries; extracted eggs are cryopreserved and stored in the freezer; eggs may be thawed, fertilized, incubated, and implanted; frozen eggs also may become mobile, traveling between clinics and countries in portable freezers. Accordingly, the chapters focus on eggs in the body, their extraction for preservation, their frozen existence in the freezer, their incubation after fertilization, their subsequent return to the womb, and the implications of their unprecedented movement in global flows of eggs. By following the egg’s journey in OC, I examine how the reproductive youth attributed to the egg propels it across time and space in trajectories that reflect economic, regulatory, and social power asymmetries, while also giving rise to a broader postfertile condition in which fertility and aging are repoliticized in ways that affect the public at large.
An interdisciplinary project, Freezing Fertility integrates insights from science and technology studies, medical sociology, cultural analysis, feminist theory, reproductive studies, and critical gerontology in order to analyze the discourses and practices of egg freezing. Rather than offering an exhaustive overview of one dimension of the OC practice, I offer a series of critical readings of cultural objects that are pertinent to understanding the situatedness and implications of egg freezing in relation to a broader gender politics of aging. Some of the selected objects, such as widely read newspapers and televised documentaries, are indicative of egg freezing’s prominence in public debates and popular culture, while others, such as cellular images or informed-consent contracts, present a particular novel aspect of OC that distinguishes it from other reproductive technologies. My reading of these objects adopts a “cultural analysis” approach, which is an interdisciplinary research practice that employs diverse analytic lenses to offer detailed readings of case studies that are sensitive to the “interplay between the text and [its] context.”85 This approach allows me to situate critical readings of cultural objects within broader social frames, thereby positioning OC as a key technology for understanding new 21st-century biopolitical regimes of reproductive aging.
In order to examine how egg freezing is politicized in public discourses, chapter 1 analyzes coverage of OC in US, UK, and Dutch news media. It focuses on the time prior to the egg freezing procedure, when the eggs remain in the body, and considers how, and with what consequences, female fertility becomes precarious in the face of cryopreservation. New and old norms of reproductive timing become evident in criticisms and endorsements of egg freezing, in which categorizations of “lifestyle” versus “single” or “medical” versus “social” freezing play an important rhetorical role. The news coverage also features new subject positions for women who freeze their eggs, as their reproductive, relational, and life course decision making becomes subject to public scrutiny. Key elements in OC discourses are the trope of the “biological clock” and related egg-focused conceptualizations of reproductive aging, which shape both the need for and the nature of the reproductive choices associated with egg freezing. Drawing on these elements, the news coverage of OC reveals a gendered politics of aging, predicated on reproductive ability as the organizing principle for the temporal structuring of life, which both interpellates a contingent of women who may want to reproduce later in life and positions their reproductive decision making as a public concern.
Moving on to the decision to freeze one’s eggs, the next chapter focuses on the new cultural and clinical practices of anticipating bodily futurity. The Dutch documentary Eggs for Later86 gives insight into the anticipatory terms and affective states through which women’s future age-related infertility is conceptualized in relation to the possibility of freezing eggs. The analysis draws attention to the contesting interpretations of egg freezing as either a postponement of motherhood or an extension of fertility—and proposes an alternative reading of OC as a means of transforming reproductive bioprecarity into biopreparedness for future infertility. At stake in these various conceptualizations of egg freezing is the reconfiguration of ideas and practices of what constitutes healthy embodiment, the reproductive process, and responsible aging. The analysis explores how egg freezing may function not only to (potentially) achieve future reproduction but also to resolve anticipatory anxiety by maintaining the futurity of potential motherhood.
Once extracted and frozen, the cryo-egg represents an emergent cultural entity that hitherto did not exist. Chapter 3 focuses on these disembodied, frozen eggs and the new modes of governing fertility emerging within broader reproductive bioeconomies. While the eggs remain in the freezer, discursive mediations of the cryopreserved cells become an important reference point in the reconceptualization of reproductive aging as distributed across bodies, freezers, and wider cryopolitical infrastructures. Reflecting the large capital investments in fertility preservation, the figure of the visible and quantifiable frozen egg also plays a key role in the treatment rationales and calculative practices presented by fertility companies. By tracing these developments, this chapter explores the relation between fertility accumulation and capital accumulation. With an analysis of the framing of frozen eggs in marketing efforts, treatment packages, and fertility insurance, the chapter moreover highlights how the mediated frozen egg plays a key role in the rationalization of OC as not just a single procedure but an ongoing process of technologized fertility management.
After the eggs are fertilized in vitro, it has to be decided which one(s) will be implanted in the womb in a process called “embryo selection.” Time-lapse embryo imaging, a widely used method for embryo selection, analyzes the timing of embryonic development to predict the embryos’ future viability. In keeping with this study’s focus on aging, chapter 4 draws attention to the visualization and instrumentalization of embryonic aging in time-lapse embryo-imaging systems. Drawing on the politicized history of imaging prenatal life, it analyzes the cultural, political, and commercial significance of a new set of images of fertilized eggs—and their division into embryos—that circulate beyond the laboratory into the clinic, the intended parents’ iPads, and their online social networks. What is at stake in the instrumentalization of embryonic aging in time-lapse systems is the creation of new risks and modes of value creation through the patenting of embryonic aging, the datafication of embryo selection, and the “packaging up” of treatment plans to include both egg freezing and time-lapse imaging. This method of embryo selection, then, may not just result in more or less “IVF success” but also affects the conceptualization and commercialization of aging at an embryonic level.
If selected, the egg—now embryo—proceeds to the next stage of its journey, in which it may be implanted into the intended mother’s womb and a pregnancy may ensue. Focusing on this step, chapter 5 explores several new, technologically mediated ways of attaining fertility and motherhood with frozen eggs after the end of the reproductive life span, which both reflect and transform existing notions of “older motherhood.” Since the emergence of donor-egg IVF in the late 20th century, older motherhood has become particularly politicized—whether as chrononormative transgression or as sign of successful aging. This chapter revisits these discussions and explores how younger women become newly implicated in the politicization of older motherhood when they freeze their eggs. Drawing on the stories of women who thawed their eggs, the analysis subsequently focuses on the social significance of conception in the context of OC and discusses how this technology allows fertility to be extended, but also to be lost in new ways. Egg freezing also opens up possibilities for new forms of posthumous conception and motherhood. Informed-consent forms institutionalize an encounter with one’s own mortality and allow for the formation of intended kinship bonds beyond death. This chapter addresses these new configurations of fertility and motherhood by exploring how reproductive aging intersects with willfulness, kinship, and mortality.
Given that only a very limited percentage of cryopreserved oocytes result in live births, motherhood—older or not—is not a self-evident endpoint of either the egg’s journey or this study on egg freezing. Consequently, chapter 6 zooms out to explore the alternative trajectories of frozen eggs in egg-donation networks for reproductive and research purposes. Once frozen, the eggs become as portable as the liquid nitrogen tanks that hold them; egg freezing is thus a key condition for the development of global flows of eggs. The US-based World Egg Bank ships frozen eggs to clinics worldwide and provides a case study for considering the implications of the transnational mobility of frozen eggs for reproductive egg donation. The analysis focuses on US-UK egg flows and discusses the regulations, matching practices, financial inducements, online platforms, and marketing strategies that are imported and exported along with the eggs. Such global flows of frozen eggs moreover emerge at a time when new developments in stem cell science revive the need for donor eggs. These stem cell technologies radically reconfigure the egg’s relation to bodily time, and thereby raise questions about the relation between aging and reproductivity in new ways. They moreover provide a context in which to consider the potential rerouting of eggs frozen for one’s own use into egg-donation networks, which is particularly pertinent given the fact that, so far, only a small percentage of women have returned to use their cryo-eggs. These developments in reproductive and research egg-donation practices allow me to highlight the significance of the frozen egg in a global biopolitics of aging. As the egg travels across bodies and geopolitical boundaries, as it is instrumentalized to halt, counteract, or regenerate age, OC’s emergence radically transforms how the passage of time becomes meaningful, visible, and political in bodies and eggs alike.
