This article was updated at 9:49 a.m. ET on February 6, 2019.
One of the Instagram ads for Extend Fertility, a New York–based egg-freezing service for women, presents two images. First, there’s a hand with freshly manicured nails, followed by a sassy pink cartoon of a human egg with big eyes and long lashes. “If you can afford this,” text reads above the nails, “you can afford this,” referring to the cartoon egg.
The ad, part of a campaign created by the woman who gave us the Aflac duck and the iconic “yes! yes! YES!” Herbal Essences commercials of the late 1990s, is intended to raise awareness among Millennial women about egg freezing’s capacity to extend their potential fertility well into their 40s. It’s just one of a number of marketing experiments that Extended Fertility and several other egg-freezing upstarts are running to get the word out about their services. Kindbody, which debuted its first New York City clinic in 2018, takes an Instagram-friendly van across the country to dole out free hormone tests. Trellis Health recently popped up at a location of the indoor-cycling studio Flywheel to offer a women’s-empowerment spin class. All three companies partner with popular figures on social media, who spread the gospel of reproductive control to their own audiences.
Cost is often a theme; the campaigns emphasize that egg-freezing services can be in your price range, whatever that might be. But contrary to what Extend Fertility’s sassy little egg suggests, egg freezing costs a lot more than a manicure. The procedure is relatively new, and although it’s no longer considered officially “experimental” by the American Society for Reproductive Medicine, it’s rarely covered by insurance. At traditional fertility clinics, which have long focused on helping people who are already infertile to conceive, egg freezing usually runs in the low five figures. Most of the newer upstart clinics do offer prices that are thousands of dollars below the more traditional settings, but that’s still in the range of a decent used car. Neither price includes the cost of medication, which can be as much as $5,000.
The new clinics compare their services to manicures and blowouts because they offer financing, allowing customers to pay small amounts over time. This is one of many ways the companies tell young women that the procedure is just as easy as, say, getting their roots touched up. They invite prospective patients to come to informational seminars in tastefully appointed offices. They provide young, friendly, female fertility coaches. They associate themselves with green juice and spin class.
The intense pressure to get married and become a mother has long been a source of significant anxiety for young women, and as what it means to be a woman in America changes, those pressures haven’t abated. Instead, they just look a little different. As Millennials delay marriage and worry about their careers, the average age of first-time motherhood in America has crept into the late 20s. For affluent and highly educated women, it’s even older, prompting fears among many people about the viability of having babies well into their 30s.
In that way, an egg-freezing clinic might be the perfect business model. By finding an ambient fear and promising to alleviate it, these new companies paint an expensive, invasive, uncertain procedure as just another normal thing women do to live their best life. There’s a thin line between making something “accessible” and marketing the prospect of motherhood like a beauty product, though, and these new companies are still figuring out which side of it they’re on.
Whether a woman who freezes her eggs will actually be able to have a baby with them years in the future is far from assured. After an expensive retrieval process that requires several weeks of daily hormone injections, half a dozen office visits, and anesthesia for the retrieval itself, the eggs are then kept in a cryogenic freezer until they’re ready to be used for in vitro fertilization. According to James Grifo, the director of the Division of Reproductive Endocrinology and Infertility at New York University’s Langone Fertility Center, skilled practitioners have the same success rate with frozen eggs from young women as they do with fresh-egg IVF, which is 55 to 57 percent in patients under 40. “It is by no means a guarantee,” he says.
Younger or particularly fertile patients sometimes can do a single round of egg retrieval to get the 15 to 20 eggs recommended for decent odds of pregnancy in the future. But many women opt to repeat the procedure multiple times, Grifo says, especially if they’re toward the end of their natural fertility and producing fewer viable eggs with each round.
Despite the costs and daunting odds, egg freezing’s popularity is expanding in the United States. Only 9,000 women nationwide froze their eggs in 2016, but according to Extend Fertility’s CEO, Anne Hogarty, her company alone did 1,000 egg-freeze cycles in 2018. Kindbody, which has only been open for a little more than six months, says it has already done 100. Trellis wouldn’t reveal its numbers so far, but the brand has been around since 2018, and it’s part of IntegraMed, which is the largest network of fertility clinics in the country.*
These new businesses’ Instagram- and Facebook-ad campaigns have put egg freezing on the radar of an untold number of women who likely wouldn’t have thought to visit a fertility doctor while young and single. For those potential patients, the message is one of familiar, friendly empowerment. These new clinics emphasize that they can give working women more time to focus on their nascent professional success. At the same time, research suggests that work isn’t why unmarried women consider their fertility options. Rather, it’s the limited availability of partners with whom they’d want to raise a family. That probably doesn’t make for much of an empowering Instagram caption.
“We’re trying to make what we’re doing into a lifestyle brand that’s more appealing to people, and not something that’s so foreign and sterile,” says Rebecca Silver, Kindbody’s director of marketing. “We don’t want to look or feel like a health-care company.” Extend Fertility and Trellis both told me that their target demographic begins at 27 years old, while Kindbody hopes to reach consumers as young as 25.
That desire to skip the traditional doctor’s-office feel is clear in both Kindbody’s country-crossing van and Trellis Health’s offices, which are appointed in an Instagram-friendly style that includes soft pinks, plants in minimalist pots, and encouraging words on the walls like It’s up to each of us to invent our own future and Invent your future. At its mobile events, Kindbody gives out T-shirts and branded S’well water bottles, in addition to controversial hormone tests, which some doctors fear could be used to stoke unnecessary anxieties in perfectly fertile young patients. (Kindbody says they provide the appropriate medical context to anyone who takes one of its tests.)
Kindbody, Trellis, and Extended Fertility offer regular informational sessions that bring in groups of prospective clients to learn about egg freezing, and they all told me their goal is simply to get the facts to young women who have been underserved by the industry in the past. But a 2017 study from the University of Minnesota Duluth found that marketing messages from egg-freezing companies were usually persuasive instead of neutrally informational, and that few provided detailed information on the process’s limitations or downsides. The three companies emphasized to me that egg freezing isn’t a guarantee of future pregnancy, but if you peruse any of their online egg-freezing FAQs, the numbers that Grifo gave me, which paint a more modest picture of the possibilities, are absent. They also don’t tell you that most of the people who freeze their eggs never thaw them.
Scarlett Leung, Trellis Health’s head of operations, told me that “fertility declines rapidly basically when you hit 32.” But as the psychologist Jean Twenge has reported, American women’s ideas about fertility disappearing in their 30s originated in reviews of birth records for French women living more than a century ago. The modern numbers are far less alarming. A 2004 study found that 82 percent of women in their late 30s conceived on their own within a year of trying, compared with 86 percent of 27-to-34-year-olds. For those worried about birth defects in older mothers, Twenge’s survey of the available research found that 99 percent of pregnancies in 35-year-old moms were chromosomally normal, and 97 percent in 40-year-old moms.
These new egg-freezing companies’ questionable marketing tactics don’t mean that egg freezing serves no purpose, or that there’s no need for more accessible information about women’s reproductive care. Biological clocks are real, even if Americans’ cultural understanding of them is a little off-kilter. The inability to conceive can be heartbreaking for women who just want the opportunity to be moms.
One thing these companies are unambiguously good at is explaining their prices. All three businesses I looked at for this story included detailed cost breakdowns on their website, which is a rarity when planning for any kind of medical expense. Their rates are sometimes as low as half of those of traditional clinics. Additionally, the companies say they intend to make those numbers sustainable in the same way that most start-ups do: Attract enough customers that the business’s cost per patient becomes manageable.
In a way, what these businesses are doing makes perfect sense. They’re corporate citizens in a health-care system that reduces everything to a purchase, including many issues of life and death. The rich have had access to egg freezing for years, and now entrepreneurs are trying to find a way for those in the next several bands of wealth to get on board. It’s the same way appliance-makers and retailers have made stainless-steel kitchen renovations accessible to people who can’t afford professional-grade home kitchens. They take a luxury, make a version of it more affordable at scale, and give people a short-term credit line to buy into a life slightly fancier and more comfortable than the one their current options afford them.
Except it’s not a gas range we’re talking about here. It’s a baby, or motherhood as a concept. The ways Americans have been expected to save up their money to buy these very different things have been uncomfortably similar for a long time, but by dressing up a deeply personal procedure in the visual trappings of modern consumerism, egg-freezing start-ups might have made those similarities just a bit too clear. The little cartoon egg might be a bridge too far, encouraging young women into medical debt for a service they likely won’t need and that itself provides no guarantees. What might be more useful for this generation of women would be a reconsideration of the pressures American culture puts on them to become mothers if at all possible, in spite of their own potential ambivalence or differing personal priorities.
Sidestepping these broader cultural concerns to sell a novel, complicated procedure means companies that want to market egg freezing broadly have some communications challenges to overcome. When Extend Fertility’s cartoon campaign launched, the company told Ad Age that it hoped viewers would be inspired to share it. That has happened, but maybe not in the way the campaign’s creators had hoped. I became aware of the ads in 2018 after seeing a 35-year-old friend complain that she found their sudden arrival on her Instagram feed invasive. Similar sentiments are not uncommon on social media, and a journalist at Wired wrote about why it felt “creepy” to find them inserted into her feed.
Extend Fertility’s Hogarty, who joined the company in early February, also doesn’t seem to love the cartoon egg. “The origins of that ad campaign predate me, and as the market evolves, we certainly want to evolve our brand and our ad campaigns with it,” she says. “You can look to see us doing that shortly.”
* This article previously mischaracterized IntegraMed as the largest network of fertility doctors.