Speaker 1: It feels like there's not enough room in my body
Speaker 1: for my ovaries right now, Like I can feel how
Speaker 1: big they are every time I sit up, or laugh
Speaker 1: or sneeze. It's a really weird feeling. After ten days
Speaker 1: of injecting myself with hormones, my ovaries had swollen to
Speaker 1: the size of two big, juicy lemons. This was to
Speaker 1: be expected. The drugs had rebbed up my reproductive system
Speaker 1: so that doctors could retrieve as many eggs as possible
Speaker 1: from it. The days of hormones had made me bloated
Speaker 1: and exhausted and cranky, but it was the trigger shots
Speaker 1: that really got to me. After giving myself a final
Speaker 1: two shots that would make the eggs, I was growing
Speaker 1: all release at once. I felt almost like I had
Speaker 1: the flu. The big day had arrived, the day of
Speaker 1: my retrieval, or as I called it, the harvest. I
Speaker 1: had fasted since midnight and arranged for my friend picked
Speaker 1: me up after the procedure. Stub was still living in Scotland,
Speaker 1: but had frozen his sperm a few weeks earlier after
Speaker 1: we'd agreed to move forward. Now I was just taking
Speaker 1: through the to do list i'd been given one last time.
Speaker 1: Let's read through this sheet of paper. Assessors do not
Speaker 1: eat after midnight. An estesiagists will review my medical and
Speaker 1: surgical history and begin an intravenous line for sedation. The
Speaker 1: egg rechieval procedure takes approximately fifteen minutes from start to finish,
Speaker 1: so all this has been leading up to fifteen minutes.
Speaker 1: I was feeling nervous. Nervous because I'd never had any
Speaker 1: kind of surgery before, and at this point in the
Speaker 1: process it was clear that freezing eggs or embryos is
Speaker 1: a serious medical procedure. I was also nervous because I
Speaker 1: didn't know if it would work. I know, I'm not
Speaker 1: gonna get like twenty eggs because I don't even seem
Speaker 1: to have twenty follicles. But I'm hoping that there's like
Speaker 1: ten good mature ones. I think that's like a pretty
Speaker 1: conservative hope. I think at the max, maybe I could
Speaker 1: get like fifteen or sixteen. At my age, that would
Speaker 1: be amazing. That's like you go, ovaries, you go. This
Speaker 1: was one of those cases in which knowing a lot
Speaker 1: about the topic did not make me feel any better.
Speaker 1: Will my eggs be good quality and then even of
Speaker 1: darker quality, will they mesh well with Stew's sperm. Because
Speaker 1: there's a possibility that I get sixteen eggs and we
Speaker 1: don't even get one embryo. That seems unlikely, but it's possible.
Speaker 1: Or you know, if we only get one, then I'm
Speaker 1: gonna have to go through this whole thing again. I'd
Speaker 1: arrived at NYU's big, gleaming fertility center on fifty third Street.
Speaker 1: The half hour cab ride had not settled my nerves,
Speaker 1: so I'm just getting changed to go in. I can't
Speaker 1: bring my phone or my recorder in there, so I
Speaker 1: think this will be the last dispatch until after I
Speaker 1: was about to find out whether this ridiculous gamble was
Speaker 1: gonna pay off. Feeling nervous, really very nervous. Okay, if
Speaker 1: you're an extremely type A control freak like me, The
Speaker 1: next part of the whole process is the hardest. I'd
Speaker 1: done everything I could to stack the odds in my favor.
Speaker 1: I had researched clinics and picked one with a good reputation.
Speaker 1: I'd improve my diet and cut out booze and caffeine.
Speaker 1: I even took prenatal vitamins. I mean, it couldn't hurt. Now,
Speaker 1: The fate of my frozen potential future children would be
Speaker 1: in the hands of lab techs, the part of the
Speaker 1: process patients don't get to see, but also maybe the
Speaker 1: most important part. I'm Kristen B. Brown, and this is misconception.
Speaker 2: Yes, so this is umber number one. See how pretty
Speaker 2: is this? So I'm gonna go in and suck it
Speaker 2: up with my feet.
Speaker 1: I'm in the lab of the Manhattan branch of CCRM,
Speaker 1: a national fertility clinic chain. Manuela Mullinari is walking me
Speaker 1: through her day to day. She's an embryologist and the
Speaker 1: lab director.
Speaker 3: So you've put.
Speaker 2: The embryos into the.
Speaker 3: Little wells there, smith, Nope, one of each, because I
Speaker 3: need to know which one is what I'm doing genetic
Speaker 3: testing to them.
Speaker 1: What you're hearing is a Manuela very carefully sucking a
Speaker 1: couple's embryos out of a Petri dish in order to
Speaker 1: biopsy them and send them for genetic testing. I cannot
Speaker 1: emphasize enough how tiny these things are. Barely visible to
Speaker 1: the naked eye if you have really good eyesight, which
Speaker 1: I do not.
Speaker 3: Now I'm using a big magnification to see very well
Speaker 3: all the structures of the embrassy This is the ICM,
Speaker 3: the compacted cells that are going to make the baby.
Speaker 3: And these are the traffecta themselves. These are the cells
Speaker 3: that are going to make the placenta.
Speaker 1: And you could not see anything with your naked eye
Speaker 1: or not.
Speaker 2: Nope, it's as big as a grain.
Speaker 3: So we need to magnify it forty times to be
Speaker 3: able to see it this way.
Speaker 1: And Manuela had moved the embryos onto this crazy looking
Speaker 1: microscope that was outfitted with a laser and these two
Speaker 1: really fine needles that she could control. I was watching
Speaker 1: what she was doing on a video screen, a grainy
Speaker 1: gray mass of cells, all bubbly and lumpy.
Speaker 2: So now I'm just gonna last night laser and I'm
Speaker 2: going to zip it.
Speaker 1: See this has to be one of the craziest things
Speaker 1: I've seen in my reporting career. And Manuela uses this
Speaker 1: tiny needle to poke a hole in the side of
Speaker 1: the embryo and then suck out just a few cells.
Speaker 2: I use this technique as called flicking technique. I don't
Speaker 2: pull it. I don't like to. I'm not a puller.
Speaker 1: And then with a laser, she just lops those cells
Speaker 1: off to send them in for testing.
Speaker 2: You understand it. It's a little bit like playing video games.
Speaker 1: Right, yeah, totally, So that's the laser.
Speaker 2: Yeah and boom done.
Speaker 1: Wow. This whole idea of assisted reproduction, it can feel
Speaker 1: so high tech, but what I was realizing was that
Speaker 1: it's extremely manual. It's a Manuela and our colleagues carrying
Speaker 1: around embryos in a cramped lab with music pumping. They're
Speaker 1: doing a lot of things by hand checking each other's work.
Speaker 1: Is they move stuff around in a lab to make
Speaker 1: sure there are no mix ups. This is a side
Speaker 1: of the whole process. Most patients don't get to see.
Speaker 1: They talk with their doctors, but they don't see the lab.
Speaker 1: They probably don't even consider the role that people like
Speaker 1: Manuela play in their quest for parenthood. And Manuela walked
Speaker 1: me through some other parts of her day, like freezing embryos.
Speaker 3: Concentration of water decreases and the cryprotectant gets into the embryo,
Speaker 3: it will start to slowly sink down to the bottom.
Speaker 2: And look how it looks now, all crunched up, looks
Speaker 2: like a cookie.
Speaker 1: At the end of the day, I was struck by
Speaker 1: how much skill and finesse her job requires. Manuela isn't
Speaker 1: just a scientist. She's an artist. It talked to Williams. Schoolcraft,
Speaker 1: the founder and chief medical officer of CCRM, about the
Speaker 1: role the lab plays in a patient's success.
Speaker 4: A friend of mine made a list of all the
Speaker 4: variables in the IVA flab in one IV of cycle.
Speaker 4: There's two hundred different variables. There's thirty five five ingredients
Speaker 4: just in the culture media. Then the media, which is
Speaker 4: the liquid the embro's grown and is overlaid with oil.
Speaker 4: There's protein in the media. There's the Petrie dish. There's
Speaker 4: the instruments called the pipe pets that handle the embros.
Speaker 4: There's the quality of the air, the settings of the incubator,
Speaker 4: on and on the list goes, and any of those factors.
Speaker 4: Let's say a Petrie dish that had toxicity to an embro.
Speaker 4: If you put good media, good protein, good oil in
Speaker 4: and you put an inmbro in but the dish is bad,
Speaker 4: the embro will get killed.
Speaker 1: The finesse of an embryologist isn't even the only variable
Speaker 1: in the lab that matters. Another fertility doctor I spoke
Speaker 1: with Setis Clinic discovered the oil on the door hinges
Speaker 1: was impacting their success rates, and so now they use
Speaker 1: plastic hinges. Embryos are so fragile keeping them alive outside
Speaker 1: of a human womb. It's hard.
Speaker 4: It's a game of perfection, and I would say it's
Speaker 4: just being very careful to not induce stress to the embro.
Speaker 4: So the less we can stress them, the more we
Speaker 4: can make the inbro think it's in the human Filippian tube,
Speaker 4: growing in nature, even though it's outside the body, in
Speaker 4: a petri dish, in an artificial incubator with different pH
Speaker 4: and CO two and osmilarity. The better we're going to do.
Speaker 1: I was feeling stressed about my embrew. As being stressed,
Speaker 1: it was starting to feel like it's a miracle that
Speaker 1: this ever works at all. We'll be right back. As
Speaker 1: I was waiting to hear how all my microscopic eggs
Speaker 1: had fared after my retrieval, I started thinking about what
Speaker 1: had brought me here in the first place. The time
Speaker 1: on my biological clock was running out, and I was
Speaker 1: in no position to start a family. It's not an
Speaker 1: uncommon story these days. It's a big part of why
Speaker 1: both egg freezing and IVF are booming. But neither of
Speaker 1: those things can really stop your biological clock existing. Reproductive
Speaker 1: technologies can press pause on your fertility or give it
Speaker 1: a little boost, but once your eggs are too old
Speaker 1: or gone, that's it. When I looked at success rate
Speaker 1: data on IVF over the past twenty years, I was
Speaker 1: shocked to see that rates had barely improved for women
Speaker 1: over forty two. The number hadn't really changed at all.
Speaker 1: A doctor who had been involved in the data analysis
Speaker 1: explained why to me. She said that if you're infertile,
Speaker 1: there's just only so much technology can do for you.
Speaker 1: There's a limit to how successful IVF an egg freezing
Speaker 1: can be. I wondered, then, if anyone was trying to
Speaker 1: address the root cause here, the rapid aging of human ovaries.
Speaker 1: That's when I met Daisy Robinson.
Speaker 5: Our ovaries undergo rapid decline, you know, after age thirty
Speaker 5: thirty five, and so I became obsessed with this idea
Speaker 5: of how our ovaries age at an accelerated pace.
Speaker 1: Daisy is a Harvard PhD. And she teamed up with
Speaker 1: two other scientists from Massachusetts General Hospital, David Peppin and
Speaker 1: Pat Donaho. They started a company that is actually trying
Speaker 1: to slow the aging of the ovaries. Their company is
Speaker 1: called oviva. Key to that aging they think might be
Speaker 1: a hormone called AMH.
Speaker 5: AMH controls our ovarian reserve and how many eggs you
Speaker 5: know are leaving at any given point in time.
Speaker 1: You might remember AMH from episode one. It's the hormone
Speaker 1: I got tested to try and figure out if I
Speaker 1: was still fertile. The idea here is that if you
Speaker 1: can regulate AMH, you could control how fast or slow
Speaker 1: those eggs leave the ovaries. You could slow that aging down. Eventually,
Speaker 1: they want to create a drug that you could use
Speaker 1: to slow ovarian aging, to extend your years of fertility,
Speaker 1: or even delay menopause indefinitely. Their first drug target is
Speaker 1: for patients not responding well to fertility treatments.
Speaker 5: If you take a garden hose and you put a
Speaker 5: kink in it, it blocks the flow of water. When
Speaker 5: you release the kink, there's a spurt followed by a
Speaker 5: normal flow of water, and the amh's drug works sort
Speaker 5: of like this. You get this spurt, so this wave
Speaker 5: of eggs that are released all at the same time
Speaker 5: that's greater than normal. You have a greater number of
Speaker 5: eggs you can actually capture.
Speaker 1: Generally speaking, more eggs mean better odds in the fertility world.
Speaker 1: A lot of doctors and scientists I spoke to you
Speaker 1: for this series mentioned to me that it's been more
Speaker 1: than a decade since there's been any radical shift in
Speaker 1: the science behind IVF. Daisy's co founder, David Peppin was
Speaker 1: one of them.
Speaker 6: Frankly, it's kind of shameful there. There are a number
Speaker 6: of women's health indications like say, passistic of Aaron syndrome
Speaker 6: or endometriosis are huge affecting a large proportion of the
Speaker 6: population that I have been understudied for so long, and
Speaker 6: so it's part of a general trend of women's health
Speaker 6: for being ignored, and hopefully we're starting to see some
Speaker 6: signs that this is changing and there's more attention being paid.
Speaker 1: It actually seems like we're at a really exciting moment.
Speaker 1: This growing interest in fertility is just now starting to
Speaker 1: lead to new science and technology that could really move
Speaker 1: the needle. Aviva is a young company. So far, David
Speaker 1: has just shown the effect of aimage drugs on cats
Speaker 1: and mice. There's still a few years away from clinical
Speaker 1: trial in humans, let alone having a drug on the market,
Speaker 1: but things are happening.
Speaker 6: I'm actually quite hopeful. There's actually quite a bit of
Speaker 6: research that has been going on, you know, serve slowly
Speaker 6: in animal models that could translate into massive leaps in
Speaker 6: terms of reproductive technology if they are applied to humans.
Speaker 1: Researchers today are investigating things like how to grow immature
Speaker 1: eggs in a putrid dish, which could increase the odds
Speaker 1: of IVF, and scientists in Japan are even trying to
Speaker 1: make eggs and sperm from stem cells. That would be
Speaker 1: a game changer not just for patients dealing with infertility,
Speaker 1: but also LGBTQ families. So far, they've been successful in mice,
Speaker 1: they made pups from two mouse dads. Robotics and artificial
Speaker 1: intelligence could bring improvements to IVF clinics and labs even sooner.
Speaker 1: A company called Overture is one amongst several that it
Speaker 1: is working to automate some of what an embryologist does,
Speaker 1: which could help eliminate human error. Many more are using
Speaker 1: AI to try and fine tune processes, including dosing medications
Speaker 1: and selecting the best embryo. So much of human reproduction
Speaker 1: is still a black box, and we were really just
Speaker 1: starting to peer inside of it. All right, are you there? Yep,
Speaker 1: and here can you hear me?
Speaker 5: Okay yep.
Speaker 1: The day after my egg retrieval, my doctor gave me
Speaker 1: a call to see how I was doing. How are
Speaker 1: you feeling today? Ah, just low energy, but otherwise actually
Speaker 1: better than before the procedure.
Speaker 6: I'm on good yeah.
Speaker 3: Yeah.
Speaker 6: Are you making any pain medication?
Speaker 1: I've been taking just two ibuprofen like every time. Honestly,
Speaker 1: even though I was still extremely bloated and tired and
Speaker 1: well constipated, I was elated. I'd gotten sixteen eggs. That
Speaker 1: was more than I had ever imagined. I was pretty
Speaker 1: proud of my now thirty seven year old ovaries. But
Speaker 1: also I knew that this was just the first stage
Speaker 1: any long battle of attrition for my little eggs. Now
Speaker 1: I was going to find out how they fared at
Speaker 1: the next stage, fertilization. Are you ready for your results?
Speaker 3: Yes?
Speaker 4: You did great.
Speaker 1: Of my sixteen eggs, fourteen were ripe, one was undeveloped,
Speaker 1: and another, as my doctor put it, was overcooked. Thirteen
Speaker 1: of those fertilized, So in twenty four hours I had
Speaker 1: already gone from sixteen eggs to thirteen nimbreos, and only
Speaker 1: eleven of those were completely normal.
Speaker 4: This is an awesome start, sir.
Speaker 1: I guess continuation yesterday. It was a good start.
Speaker 6: It's good step too.
Speaker 1: We were going to have to wait a bit longer
Speaker 1: to find out where we really stood. So I will
Speaker 1: have all of the information next Saturday for you in
Speaker 1: terms of what made it to the embryo stage. And
Speaker 1: then the genetic testing takes another you know, seven to
Speaker 1: twelve days after that to come back. Okay, cool, Well,
Speaker 1: thank you so much.
Speaker 5: You're welcome, very positive so far.
Speaker 3: It's good.
Speaker 1: I'm super happy with the results so far.
Speaker 4: I have a great day.
Speaker 5: Thanks.
Speaker 1: Okay. Ye. That two weeks was agony. I am not
Speaker 1: a patient person. It also gave me a lot of
Speaker 1: time time to think about everything that had transpired so far.
Speaker 1: It was going well, but I was feeling kind of
Speaker 1: burnout and kind of broke. Even with my great insurance,
Speaker 1: I had been hit by more than one unexpected medical bill.
Speaker 1: I still couldn't help but feel like somehow winding up
Speaker 1: in this position was my fault. I felt guilty, like
Speaker 1: I had taken a wrong turn. Somewhere. I read a
Speaker 1: book by Yale anthropologists called Motherhood on Ice by Marsha
Speaker 1: and horn In. It She interviews one hundred and fifty
Speaker 1: women who froze their eggs, and when I read it,
Speaker 1: it was striking how many of them had stories like mine.
Speaker 1: It was cathartic. She concluded that there's a mating gap.
Speaker 1: The society had changed in a way that just made
Speaker 1: it harder to start a family earlier in life. Eighty
Speaker 1: two percent of the women in her study were single
Speaker 1: with no partner in sight. The rest were either in
Speaker 1: unstable relationships with men or waiting for their partner to
Speaker 1: be ready for parenthood. In a way, egg freezing is
Speaker 1: a technological solution to what is ultimately a social problem.
Speaker 1: When I talked to her, she said she thought egg
Speaker 1: freezing is sort of a stop gap, something that works
Speaker 1: for a lot of people, but is an imperfect solution.
Speaker 1: I feel hopeful, though our understanding of female biology is
Speaker 1: changing every day. In the future, maybe single thirty something
Speaker 1: women won't have to go through any of this, or
Speaker 1: maybe even if they do, at least their insurance will
Speaker 1: cover it. After two weeks of waiting, my doctor called
Speaker 1: with our results. Our final count of embryos STU was
Speaker 1: an edenberg, so I called them to share the news.
Speaker 1: So are you ready for it.
Speaker 7: Yeah, what what's the news? Tell me?
Speaker 1: It's good news. We got four for like.
Speaker 7: That are healthy and to have all the right stuff
Speaker 7: in the right places.
Speaker 1: Yeah, so we don't have to do it again.
Speaker 7: Oh, I'm still pleased for you, especially because I know
Speaker 7: it's been really bloody tough.
Speaker 1: We had four embryos, three boys and one girl. So
Speaker 1: how do you feel about it?
Speaker 7: You know, it's really good to know that we have
Speaker 7: that sort of option. There these little frozen embryos that
Speaker 7: they are sitting there, and you know you could pull
Speaker 7: about and use them at whatever point we decide. I'm
Speaker 7: glad you, glad you told me.
Speaker 4: Yeah, I was thinking about not ever telling you.
Speaker 1: Actually, I'm thinking about just like withholding this information. Yeah,
Speaker 1: let me wonder.
Speaker 7: I mean I would I would have asked you at
Speaker 7: some point, like what happened if you heard back about that.
Speaker 1: Since we froze embryos in July, a lot has happened.
Speaker 1: Stu moved to New York, and we got married. Kids.
Speaker 1: Still feel a bit down the line, but I think
Speaker 1: in the end we're glad to have our little embryos
Speaker 1: on ice. Our journey still isn't over. We might use
Speaker 1: those embryos one day, that is, if we can afford
Speaker 1: to keep paying for them. The day after I finished
Speaker 1: the script, I got an email from our fertility clinic.
Speaker 1: They were raising our embryos rent. This series was written
Speaker 1: and reported by me Kristen V. Brown. It was produced
Speaker 1: by Jilda Decarley and Stacy Wong and edited by Cynthia Koons.
Speaker 1: Additional research was done by Tana's Mcjohnny. It was engineered
Speaker 1: by Blake Maples. Our theme music was composed and performed
Speaker 1: by Hannis Brown. Special thanks to Shelley Banjo, Randy Shapiro,
Speaker 1: Anna Maazarakis, Jeff Grocott, Lauraszlenko, and Creighton Harrison. Sage Bauman
Speaker 1: is Bloomberg's head of podcasts. Thanks for listening.