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Speaker 1: It feels like there's not enough room in my body

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Speaker 1: for my ovaries right now, Like I can feel how

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Speaker 1: big they are every time I sit up, or laugh

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Speaker 1: or sneeze. It's a really weird feeling. After ten days

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Speaker 1: of injecting myself with hormones, my ovaries had swollen to

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Speaker 1: the size of two big, juicy lemons. This was to

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Speaker 1: be expected. The drugs had rebbed up my reproductive system

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Speaker 1: so that doctors could retrieve as many eggs as possible

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Speaker 1: from it. The days of hormones had made me bloated

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Speaker 1: and exhausted and cranky, but it was the trigger shots

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Speaker 1: that really got to me. After giving myself a final

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Speaker 1: two shots that would make the eggs, I was growing

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Speaker 1: all release at once. I felt almost like I had

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Speaker 1: the flu. The big day had arrived, the day of

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Speaker 1: my retrieval, or as I called it, the harvest. I

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Speaker 1: had fasted since midnight and arranged for my friend picked

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Speaker 1: me up after the procedure. Stub was still living in Scotland,

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Speaker 1: but had frozen his sperm a few weeks earlier after

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Speaker 1: we'd agreed to move forward. Now I was just taking

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Speaker 1: through the to do list i'd been given one last time.

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Speaker 1: Let's read through this sheet of paper. Assessors do not

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Speaker 1: eat after midnight. An estesiagists will review my medical and

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Speaker 1: surgical history and begin an intravenous line for sedation. The

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Speaker 1: egg rechieval procedure takes approximately fifteen minutes from start to finish,

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Speaker 1: so all this has been leading up to fifteen minutes.

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Speaker 1: I was feeling nervous. Nervous because I'd never had any

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Speaker 1: kind of surgery before, and at this point in the

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Speaker 1: process it was clear that freezing eggs or embryos is

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Speaker 1: a serious medical procedure. I was also nervous because I

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Speaker 1: didn't know if it would work. I know, I'm not

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Speaker 1: gonna get like twenty eggs because I don't even seem

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Speaker 1: to have twenty follicles. But I'm hoping that there's like

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Speaker 1: ten good mature ones. I think that's like a pretty

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Speaker 1: conservative hope. I think at the max, maybe I could

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Speaker 1: get like fifteen or sixteen. At my age, that would

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Speaker 1: be amazing. That's like you go, ovaries, you go. This

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Speaker 1: was one of those cases in which knowing a lot

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Speaker 1: about the topic did not make me feel any better.

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Speaker 1: Will my eggs be good quality and then even of

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Speaker 1: darker quality, will they mesh well with Stew's sperm. Because

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Speaker 1: there's a possibility that I get sixteen eggs and we

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Speaker 1: don't even get one embryo. That seems unlikely, but it's possible.

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Speaker 1: Or you know, if we only get one, then I'm

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Speaker 1: gonna have to go through this whole thing again. I'd

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Speaker 1: arrived at NYU's big, gleaming fertility center on fifty third Street.

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Speaker 1: The half hour cab ride had not settled my nerves,

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Speaker 1: so I'm just getting changed to go in. I can't

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Speaker 1: bring my phone or my recorder in there, so I

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Speaker 1: think this will be the last dispatch until after I

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Speaker 1: was about to find out whether this ridiculous gamble was

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Speaker 1: gonna pay off. Feeling nervous, really very nervous. Okay, if

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Speaker 1: you're an extremely type A control freak like me, The

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Speaker 1: next part of the whole process is the hardest. I'd

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Speaker 1: done everything I could to stack the odds in my favor.

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Speaker 1: I had researched clinics and picked one with a good reputation.

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Speaker 1: I'd improve my diet and cut out booze and caffeine.

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Speaker 1: I even took prenatal vitamins. I mean, it couldn't hurt. Now,

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Speaker 1: The fate of my frozen potential future children would be

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Speaker 1: in the hands of lab techs, the part of the

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Speaker 1: process patients don't get to see, but also maybe the

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Speaker 1: most important part. I'm Kristen B. Brown, and this is misconception.

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Speaker 2: Yes, so this is umber number one. See how pretty

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Speaker 2: is this? So I'm gonna go in and suck it

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Speaker 2: up with my feet.

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Speaker 1: I'm in the lab of the Manhattan branch of CCRM,

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Speaker 1: a national fertility clinic chain. Manuela Mullinari is walking me

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Speaker 1: through her day to day. She's an embryologist and the

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Speaker 1: lab director.

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Speaker 3: So you've put.

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Speaker 2: The embryos into the.

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Speaker 3: Little wells there, smith, Nope, one of each, because I

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Speaker 3: need to know which one is what I'm doing genetic

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Speaker 3: testing to them.

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Speaker 1: What you're hearing is a Manuela very carefully sucking a

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Speaker 1: couple's embryos out of a Petri dish in order to

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Speaker 1: biopsy them and send them for genetic testing. I cannot

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Speaker 1: emphasize enough how tiny these things are. Barely visible to

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Speaker 1: the naked eye if you have really good eyesight, which

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Speaker 1: I do not.

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Speaker 3: Now I'm using a big magnification to see very well

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Speaker 3: all the structures of the embrassy This is the ICM,

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Speaker 3: the compacted cells that are going to make the baby.

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Speaker 3: And these are the traffecta themselves. These are the cells

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Speaker 3: that are going to make the placenta.

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Speaker 1: And you could not see anything with your naked eye

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Speaker 1: or not.

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Speaker 2: Nope, it's as big as a grain.

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Speaker 3: So we need to magnify it forty times to be

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Speaker 3: able to see it this way.

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Speaker 1: And Manuela had moved the embryos onto this crazy looking

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Speaker 1: microscope that was outfitted with a laser and these two

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Speaker 1: really fine needles that she could control. I was watching

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Speaker 1: what she was doing on a video screen, a grainy

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Speaker 1: gray mass of cells, all bubbly and lumpy.

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Speaker 2: So now I'm just gonna last night laser and I'm

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Speaker 2: going to zip it.

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Speaker 1: See this has to be one of the craziest things

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Speaker 1: I've seen in my reporting career. And Manuela uses this

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Speaker 1: tiny needle to poke a hole in the side of

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Speaker 1: the embryo and then suck out just a few cells.

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Speaker 2: I use this technique as called flicking technique. I don't

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Speaker 2: pull it. I don't like to. I'm not a puller.

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Speaker 1: And then with a laser, she just lops those cells

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Speaker 1: off to send them in for testing.

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Speaker 2: You understand it. It's a little bit like playing video games.

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Speaker 1: Right, yeah, totally, So that's the laser.

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Speaker 2: Yeah and boom done.

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Speaker 1: Wow. This whole idea of assisted reproduction, it can feel

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Speaker 1: so high tech, but what I was realizing was that

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Speaker 1: it's extremely manual. It's a Manuela and our colleagues carrying

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Speaker 1: around embryos in a cramped lab with music pumping. They're

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Speaker 1: doing a lot of things by hand checking each other's work.

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Speaker 1: Is they move stuff around in a lab to make

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Speaker 1: sure there are no mix ups. This is a side

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Speaker 1: of the whole process. Most patients don't get to see.

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Speaker 1: They talk with their doctors, but they don't see the lab.

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Speaker 1: They probably don't even consider the role that people like

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Speaker 1: Manuela play in their quest for parenthood. And Manuela walked

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Speaker 1: me through some other parts of her day, like freezing embryos.

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Speaker 3: Concentration of water decreases and the cryprotectant gets into the embryo,

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Speaker 3: it will start to slowly sink down to the bottom.

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Speaker 2: And look how it looks now, all crunched up, looks

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Speaker 2: like a cookie.

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Speaker 1: At the end of the day, I was struck by

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Speaker 1: how much skill and finesse her job requires. Manuela isn't

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Speaker 1: just a scientist. She's an artist. It talked to Williams. Schoolcraft,

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Speaker 1: the founder and chief medical officer of CCRM, about the

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Speaker 1: role the lab plays in a patient's success.

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Speaker 4: A friend of mine made a list of all the

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Speaker 4: variables in the IVA flab in one IV of cycle.

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Speaker 4: There's two hundred different variables. There's thirty five five ingredients

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Speaker 4: just in the culture media. Then the media, which is

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Speaker 4: the liquid the embro's grown and is overlaid with oil.

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Speaker 4: There's protein in the media. There's the Petrie dish. There's

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Speaker 4: the instruments called the pipe pets that handle the embros.

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Speaker 4: There's the quality of the air, the settings of the incubator,

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Speaker 4: on and on the list goes, and any of those factors.

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Speaker 4: Let's say a Petrie dish that had toxicity to an embro.

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Speaker 4: If you put good media, good protein, good oil in

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Speaker 4: and you put an inmbro in but the dish is bad,

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Speaker 4: the embro will get killed.

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Speaker 1: The finesse of an embryologist isn't even the only variable

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Speaker 1: in the lab that matters. Another fertility doctor I spoke

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Speaker 1: with Setis Clinic discovered the oil on the door hinges

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Speaker 1: was impacting their success rates, and so now they use

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Speaker 1: plastic hinges. Embryos are so fragile keeping them alive outside

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Speaker 1: of a human womb. It's hard.

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Speaker 4: It's a game of perfection, and I would say it's

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Speaker 4: just being very careful to not induce stress to the embro.

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Speaker 4: So the less we can stress them, the more we

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Speaker 4: can make the inbro think it's in the human Filippian tube,

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Speaker 4: growing in nature, even though it's outside the body, in

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Speaker 4: a petri dish, in an artificial incubator with different pH

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Speaker 4: and CO two and osmilarity. The better we're going to do.

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Speaker 1: I was feeling stressed about my embrew. As being stressed,

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Speaker 1: it was starting to feel like it's a miracle that

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Speaker 1: this ever works at all. We'll be right back. As

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Speaker 1: I was waiting to hear how all my microscopic eggs

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Speaker 1: had fared after my retrieval, I started thinking about what

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Speaker 1: had brought me here in the first place. The time

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Speaker 1: on my biological clock was running out, and I was

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Speaker 1: in no position to start a family. It's not an

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Speaker 1: uncommon story these days. It's a big part of why

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Speaker 1: both egg freezing and IVF are booming. But neither of

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Speaker 1: those things can really stop your biological clock existing. Reproductive

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Speaker 1: technologies can press pause on your fertility or give it

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Speaker 1: a little boost, but once your eggs are too old

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Speaker 1: or gone, that's it. When I looked at success rate

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Speaker 1: data on IVF over the past twenty years, I was

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Speaker 1: shocked to see that rates had barely improved for women

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Speaker 1: over forty two. The number hadn't really changed at all.

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Speaker 1: A doctor who had been involved in the data analysis

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Speaker 1: explained why to me. She said that if you're infertile,

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Speaker 1: there's just only so much technology can do for you.

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Speaker 1: There's a limit to how successful IVF an egg freezing

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Speaker 1: can be. I wondered, then, if anyone was trying to

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Speaker 1: address the root cause here, the rapid aging of human ovaries.

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Speaker 1: That's when I met Daisy Robinson.

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Speaker 5: Our ovaries undergo rapid decline, you know, after age thirty

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Speaker 5: thirty five, and so I became obsessed with this idea

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Speaker 5: of how our ovaries age at an accelerated pace.

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Speaker 1: Daisy is a Harvard PhD. And she teamed up with

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Speaker 1: two other scientists from Massachusetts General Hospital, David Peppin and

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Speaker 1: Pat Donaho. They started a company that is actually trying

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Speaker 1: to slow the aging of the ovaries. Their company is

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Speaker 1: called oviva. Key to that aging they think might be

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Speaker 1: a hormone called AMH.

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Speaker 5: AMH controls our ovarian reserve and how many eggs you

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Speaker 5: know are leaving at any given point in time.

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Speaker 1: You might remember AMH from episode one. It's the hormone

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Speaker 1: I got tested to try and figure out if I

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Speaker 1: was still fertile. The idea here is that if you

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Speaker 1: can regulate AMH, you could control how fast or slow

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Speaker 1: those eggs leave the ovaries. You could slow that aging down. Eventually,

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Speaker 1: they want to create a drug that you could use

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Speaker 1: to slow ovarian aging, to extend your years of fertility,

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Speaker 1: or even delay menopause indefinitely. Their first drug target is

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Speaker 1: for patients not responding well to fertility treatments.

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Speaker 5: If you take a garden hose and you put a

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Speaker 5: kink in it, it blocks the flow of water. When

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Speaker 5: you release the kink, there's a spurt followed by a

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Speaker 5: normal flow of water, and the amh's drug works sort

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Speaker 5: of like this. You get this spurt, so this wave

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Speaker 5: of eggs that are released all at the same time

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Speaker 5: that's greater than normal. You have a greater number of

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Speaker 5: eggs you can actually capture.

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Speaker 1: Generally speaking, more eggs mean better odds in the fertility world.

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Speaker 1: A lot of doctors and scientists I spoke to you

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Speaker 1: for this series mentioned to me that it's been more

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Speaker 1: than a decade since there's been any radical shift in

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Speaker 1: the science behind IVF. Daisy's co founder, David Peppin was

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Speaker 1: one of them.

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Speaker 6: Frankly, it's kind of shameful there. There are a number

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Speaker 6: of women's health indications like say, passistic of Aaron syndrome

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Speaker 6: or endometriosis are huge affecting a large proportion of the

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Speaker 6: population that I have been understudied for so long, and

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Speaker 6: so it's part of a general trend of women's health

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Speaker 6: for being ignored, and hopefully we're starting to see some

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Speaker 6: signs that this is changing and there's more attention being paid.

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Speaker 1: It actually seems like we're at a really exciting moment.

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Speaker 1: This growing interest in fertility is just now starting to

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Speaker 1: lead to new science and technology that could really move

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Speaker 1: the needle. Aviva is a young company. So far, David

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Speaker 1: has just shown the effect of aimage drugs on cats

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Speaker 1: and mice. There's still a few years away from clinical

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Speaker 1: trial in humans, let alone having a drug on the market,

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Speaker 1: but things are happening.

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Speaker 6: I'm actually quite hopeful. There's actually quite a bit of

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Speaker 6: research that has been going on, you know, serve slowly

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Speaker 6: in animal models that could translate into massive leaps in

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Speaker 6: terms of reproductive technology if they are applied to humans.

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Speaker 1: Researchers today are investigating things like how to grow immature

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Speaker 1: eggs in a putrid dish, which could increase the odds

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Speaker 1: of IVF, and scientists in Japan are even trying to

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Speaker 1: make eggs and sperm from stem cells. That would be

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Speaker 1: a game changer not just for patients dealing with infertility,

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Speaker 1: but also LGBTQ families. So far, they've been successful in mice,

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Speaker 1: they made pups from two mouse dads. Robotics and artificial

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Speaker 1: intelligence could bring improvements to IVF clinics and labs even sooner.

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Speaker 1: A company called Overture is one amongst several that it

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Speaker 1: is working to automate some of what an embryologist does,

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Speaker 1: which could help eliminate human error. Many more are using

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Speaker 1: AI to try and fine tune processes, including dosing medications

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Speaker 1: and selecting the best embryo. So much of human reproduction

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Speaker 1: is still a black box, and we were really just

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Speaker 1: starting to peer inside of it. All right, are you there? Yep,

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Speaker 1: and here can you hear me?

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Speaker 5: Okay yep.

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Speaker 1: The day after my egg retrieval, my doctor gave me

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Speaker 1: a call to see how I was doing. How are

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Speaker 1: you feeling today? Ah, just low energy, but otherwise actually

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Speaker 1: better than before the procedure.

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Speaker 6: I'm on good yeah.

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Speaker 3: Yeah.

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Speaker 6: Are you making any pain medication?

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Speaker 1: I've been taking just two ibuprofen like every time. Honestly,

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Speaker 1: even though I was still extremely bloated and tired and

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Speaker 1: well constipated, I was elated. I'd gotten sixteen eggs. That

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Speaker 1: was more than I had ever imagined. I was pretty

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Speaker 1: proud of my now thirty seven year old ovaries. But

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Speaker 1: also I knew that this was just the first stage

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Speaker 1: any long battle of attrition for my little eggs. Now

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Speaker 1: I was going to find out how they fared at

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Speaker 1: the next stage, fertilization. Are you ready for your results?

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Speaker 3: Yes?

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Speaker 4: You did great.

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Speaker 1: Of my sixteen eggs, fourteen were ripe, one was undeveloped,

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Speaker 1: and another, as my doctor put it, was overcooked. Thirteen

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Speaker 1: of those fertilized, So in twenty four hours I had

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Speaker 1: already gone from sixteen eggs to thirteen nimbreos, and only

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Speaker 1: eleven of those were completely normal.

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Speaker 4: This is an awesome start, sir.

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Speaker 1: I guess continuation yesterday. It was a good start.

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Speaker 6: It's good step too.

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Speaker 1: We were going to have to wait a bit longer

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Speaker 1: to find out where we really stood. So I will

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Speaker 1: have all of the information next Saturday for you in

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Speaker 1: terms of what made it to the embryo stage. And

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Speaker 1: then the genetic testing takes another you know, seven to

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Speaker 1: twelve days after that to come back. Okay, cool, Well,

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Speaker 1: thank you so much.

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Speaker 5: You're welcome, very positive so far.

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Speaker 3: It's good.

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Speaker 1: I'm super happy with the results so far.

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Speaker 4: I have a great day.

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Speaker 5: Thanks.

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Speaker 1: Okay. Ye. That two weeks was agony. I am not

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Speaker 1: a patient person. It also gave me a lot of

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Speaker 1: time time to think about everything that had transpired so far.

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Speaker 1: It was going well, but I was feeling kind of

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Speaker 1: burnout and kind of broke. Even with my great insurance,

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Speaker 1: I had been hit by more than one unexpected medical bill.

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Speaker 1: I still couldn't help but feel like somehow winding up

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Speaker 1: in this position was my fault. I felt guilty, like

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Speaker 1: I had taken a wrong turn. Somewhere. I read a

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Speaker 1: book by Yale anthropologists called Motherhood on Ice by Marsha

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Speaker 1: and horn In. It She interviews one hundred and fifty

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Speaker 1: women who froze their eggs, and when I read it,

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Speaker 1: it was striking how many of them had stories like mine.

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Speaker 1: It was cathartic. She concluded that there's a mating gap.

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Speaker 1: The society had changed in a way that just made

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Speaker 1: it harder to start a family earlier in life. Eighty

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Speaker 1: two percent of the women in her study were single

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Speaker 1: with no partner in sight. The rest were either in

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Speaker 1: unstable relationships with men or waiting for their partner to

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Speaker 1: be ready for parenthood. In a way, egg freezing is

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Speaker 1: a technological solution to what is ultimately a social problem.

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Speaker 1: When I talked to her, she said she thought egg

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Speaker 1: freezing is sort of a stop gap, something that works

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Speaker 1: for a lot of people, but is an imperfect solution.

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Speaker 1: I feel hopeful, though our understanding of female biology is

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Speaker 1: changing every day. In the future, maybe single thirty something

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Speaker 1: women won't have to go through any of this, or

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Speaker 1: maybe even if they do, at least their insurance will

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Speaker 1: cover it. After two weeks of waiting, my doctor called

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Speaker 1: with our results. Our final count of embryos STU was

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Speaker 1: an edenberg, so I called them to share the news.

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Speaker 1: So are you ready for it.

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Speaker 7: Yeah, what what's the news? Tell me?

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Speaker 1: It's good news. We got four for like.

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Speaker 7: That are healthy and to have all the right stuff

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Speaker 7: in the right places.

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Speaker 1: Yeah, so we don't have to do it again.

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Speaker 7: Oh, I'm still pleased for you, especially because I know

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Speaker 7: it's been really bloody tough.

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Speaker 1: We had four embryos, three boys and one girl. So

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Speaker 1: how do you feel about it?

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Speaker 7: You know, it's really good to know that we have

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Speaker 7: that sort of option. There these little frozen embryos that

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Speaker 7: they are sitting there, and you know you could pull

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Speaker 7: about and use them at whatever point we decide. I'm

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Speaker 7: glad you, glad you told me.

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Speaker 4: Yeah, I was thinking about not ever telling you.

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Speaker 1: Actually, I'm thinking about just like withholding this information. Yeah,

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Speaker 1: let me wonder.

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Speaker 7: I mean I would I would have asked you at

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Speaker 7: some point, like what happened if you heard back about that.

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Speaker 1: Since we froze embryos in July, a lot has happened.

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Speaker 1: Stu moved to New York, and we got married. Kids.

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Speaker 1: Still feel a bit down the line, but I think

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Speaker 1: in the end we're glad to have our little embryos

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Speaker 1: on ice. Our journey still isn't over. We might use

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Speaker 1: those embryos one day, that is, if we can afford

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Speaker 1: to keep paying for them. The day after I finished

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Speaker 1: the script, I got an email from our fertility clinic.

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Speaker 1: They were raising our embryos rent. This series was written

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Speaker 1: and reported by me Kristen V. Brown. It was produced

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Speaker 1: by Jilda Decarley and Stacy Wong and edited by Cynthia Koons.

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Speaker 1: Additional research was done by Tana's Mcjohnny. It was engineered

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Speaker 1: by Blake Maples. Our theme music was composed and performed

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Speaker 1: by Hannis Brown. Special thanks to Shelley Banjo, Randy Shapiro,

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Speaker 1: Anna Maazarakis, Jeff Grocott, Lauraszlenko, and Creighton Harrison. Sage Bauman

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Speaker 1: is Bloomberg's head of podcasts. Thanks for listening.