Vice | Avery Stone
May 26, 2020, 8:00am
This article appears in VICE Magazine’s Means of Production issue. Conceived of pre-COVID-19 and constructed during it, it explores the organization and ownership of our world.
On a clear, unusually warm weeknight in March, more than 140 women joined a Zoom meeting. The occasion was not a virtual happy hour, fitness class, or any other pillar of daily life that’s shifted online during the spread of COVID-19—in fact, the women weren’t there to discuss the world’s strange new normal at all. Instead, they showed up to dive into a totally different health topic: freezing their eggs.
Titled “Virtual Fertility 101,” the meeting was an online version of a fertility seminar held by Kindbody, a woman-led healthcare startup that offers, among other services, egg freezing and in vitro fertilization (IVF). Over the course of an hour, Fahimeh Sasan, a board-certified obstetrician-gynecologist and the company’s founding physician gave a rundown of egg freezing with Kindbody—what’s involved physically, logistically, and financially.
Sasan closed her presentation with the following: “We know that there are a lot of employers that are starting to add benefits for their employees, and one of those benefits is starting to be egg freezing,” she said, her smiling face aglow against a backdrop of dark windows. “[Or] maybe you work somewhere where you don’t have any [fertility] benefits. We actually have a designated team of people that can help champion that cause for you and your coworkers. We’ve had patients come to us and say, ‘You know, I really wish my job would cover this.’ We can navigate that for you.”
As recently as a decade ago, this part of Sasan’s presentation wouldn’t have happened at all, much less during a global pandemic as an economic recession looms. It wasn’t until 2014 that companies began offering the benefit, starting with Facebook and Apple. Facebook COO Sheryl Sandberg in particular brought the topic to the forefront by advocating that her company subsidize the cost of the procedure for employees—who included healthy, fertile young women who wanted to freeze their eggs to delay having kids, a practice also known as social egg freezing.
In a 2015 interview with Bloomberg Television, Sandberg explained her rationale: “There’s a young woman working at Facebook who had got cancer,” she said, “and I knew her and she came to me and said, ‘I’m going to go through the treatment, and that means I won’t be able to have children unless I can freeze my eggs, and I can’t afford it, but our medical care doesn’t cover it.’ I talked about it with our head of HR, and said, ‘God, we should cover this.’ And then we looked at each other and said, ‘Why would we only cover this for women with cancer, why wouldn’t we cover this more broadly?’”
Suddenly, at Facebook, the major factor prohibiting women from freezing their eggs—the exorbitant cost—was no longer a barrier. Over the next few years, several of Facebook’s peers, including Google, followed suit and added the benefit. By 2017, egg freezing was considered the hot new perk in Silicon Valley.
But just as the policy had its champions, it also had critics, who argued that it encouraged women—particularly healthy women—to delay having children in favor of staying tethered to their jobs 24/7. Or, in other words, the overt message was one of reproductive autonomy, but implicitly, the signal was lean in—and do it sans children.
In a 2018 essay for Girlboss, the former Facebook product manager Bo Ren argued that this combination of corporate paternalism and implicit societal pressure was why she opted not to freeze her eggs at age 28 while working for the company: “The hiring marketplace in tech has become highly competitive, and to reel in top talent, companies have taken to piling on the signing ‘perks,’” she wrote. “The downside to all the shiny extras? It’s huge. More and more of our personal decisions and life planning choices are being unwittingly shaped by the paternalistic systems that supposedly are in place for our benefit.” (Plus, as Ren pointed out, the American College of Obstetricians and Gynecologists [ACOG] and the American Society for Reproductive Medicine [ASRM] don’t yet endorse the use of egg freezing “for the sole purpose of circumventing reproductive aging in healthy women.”)
The egg freezing benefit also raises deeper questions about race and class inequality when it comes to fertility care. The cost of egg freezing and IVF is prohibitively high—which, according to a recent study, makes infertility treatments “impractical, if not impossible, for many couples, especially low-income families.” Plus, when examining barriers to women receiving care, this study found that an “inability to pay for infertility treatment” was a concern expressed by minority women. Because the benefit affects employees at largely white-collar companies—who tend to be highly educated, higher-income, and predominantly white—the policy would help alleviate the financial burden for those who are already at an advantage.
Still, the egg freezing benefit has generated more than enough buzz to get Wall Street’s attention, and in rushed a new wave of fertility-focused startups, including Future Family (2016), Extend Fertility (2016), and She’s Well (2018). There are also fertility benefits companies—like Carrot Fertility (2016), Progyny (2016), and Stork Club—which operate more like traditional insurance companies in that they connect employees with doctors. Of course, there’s also Kindbody (2018), which is a hybrid—it offers employer benefits but is also a clinic, with a full range of fertility services, plus well-woman visits, gynecology, and virtual counseling.
This explosion of fertility-benefits companies means another thing: that more and more employers are starting to cover egg freezing. In that first wave, five years ago, it was mainly finance and tech companies in Silicon Valley. Today, startups, media companies, and universities across the country are adding it, too. VICE and Uber offer it through Progyny. Carrot Fertility has nearly 100 employer partners, including Slack, Foursquare, and Stitch Fix. Kindbody, one of the fastest-growing providers of the benefit, currently partners with 19 U.S. companies, including the telemedicine platform GoodRx and the media companies BuzzFeed, Complex, and The Skimm. Last December, Kindbody secured an additional $10 million from Google Ventures to sell its services directly to U.S. employers, bringing the total amount raised to $32 million.
Early in March, I met with the founder and CEO of Kindbody, Gina Bartasi, at the company’s New York flagship clinic, which opened in Manhattan in September 2019. We sat in an upstairs nook overlooking the lobby—which, with cool-toned wood floors, low beige couches, perky succulents, and Easter egg–yellow accent pillows, looked more like a West Elm than a doctor’s office. While waiting downstairs, I thumbed through a coffee-table book titled Work Wife: The Power of Female Friendship to Drive Successful Businesses. The company’s slogan, Own Your Future, hung in black cursive lettering on the white wall behind my back.
Kindbody is not Bartasi’s first fertility rodeo, so to speak. A graduate of UNC-Chapel Hill and Harvard Business School, Bartasi began her career in publishing, founding an Atlanta-based business magazine before launching FertilityAuthority.com, an online resource and social network for those struggling with fertility issues, in 2008. In 2015, Bartasi led a merger between her company and Auxogyn, a biotech company, to launch Progyny—which, last year, became the first fertility benefits startup to go public.
But why found another fertility company three years later? “It didn’t dawn on me until five years ago,” said Bartasi, who is both brisk and upbeat. “Literally, [I was] sitting in front of an employer, and they’re like, ‘Well, you’re an insurance company—you sit between us and the doctors.’ I’m like, ‘Wow! Right. I’m an insurance company.’ They’re like, ‘We don’t want to buy from an insurance company… We want to buy from the doctors.’ And I’m like, ‘ Oh, OK.” She snapped her fingers and cocked her head, her chestnut-brown hair swishing to one side. “Note to self.”
Bartasi’s note to self prompted her to take a risk that, so far, has paid off. By eliminating any type of middleman—insurers like Aetna, Cigna, or even Progyny—Kindbody says it can afford to offer these services at a lower price, including to employers have to shell out fees to brokers who sell insurance plans.
For example, Kindbody offers a single egg freezing cycle to employers for $5,300; elsewhere, that cost can range anywhere from $6,000 to $20,000. This figure is a bundled rate that includes the appointments and blood draws involved with the cycle, the retrieval procedure, and storage for the first year; from there, each additional year of storage is $500.
However, this sum doesn’t include one vital part of the equation—the fertility drugs. Where those are concerned, employers have two choices: run the specialty fertility drug benefit through their major medical plan and pharmacy benefit manager (PBM), or, alternatively, carve the fertility drugs out of that plan and have the benefit administered directly through Kindbody. (According to Kindbody, the latter choice saves employers an average of 20 percent of the cost of the drugs.)
From there, the employer can subsidize any percentage of that total sum for its employees. For example, VICE offers fertility benefits through Progyny; since Progyny has its own network of clinics, as well as its own pharmacy, all costs are considered in-network. According to a representative from VICE’s HR department, if a woman were to freeze her eggs, the most she would expect to pay is her out-of-pocket maximum—which, this year, ranges from $2,000 to $3,000. Another example is GoodRx, which offers the fertility benefit via Kindbody. According to Reena Scoblionko, vice president of people at GoodRx, the company gives $1,000 per employee total (lifetime) to be used toward any fertility-related procedure offered by Kindbody.
Bartasi said that, of the services that Kindbody offers to employers, egg freezing—especially social, or elective, egg freezing—is the most popular with patients. “This social egg freezing [is something] the employers have really gotten behind,” she said. “It’s the majority of patients we see; it’s the majority of patients other clinics see.”
In addition, although the average age of the egg freezing patient at Kindbody is 33—near the beginning of the age range when women’s fertility begins to decrease gradually, according to the American College of Obstetricians and Gynecologists—Bartasi has seen interest from women as young as their mid-20s. “You better believe it,” she said. “These women are smart today. It’s like the next generation just gets smarter than the previous generation… When you talk to patients who are in their mid-to-late 30s, they say, ‘Why didn’t people tell me this when I was younger?’” (Bartasi, who had her twin boys via IVF, is one such woman. When I asked if she would have frozen her eggs when she was younger, she repeated: “You better believe it.”)
This idea of egg freezing as proactive—as a way to take control of your fertility—is central to Kindbody’s branding message of female empowerment. This message dovetails with the argument that Sandberg helped shape, at Facebook and beyond, five years ago: that egg freezing gives women real agency rather than the illusion of it.
For some, however, this emphasis on feminist messaging from all sides helps obscure another force at play: capitalism. Vardit Ravitsky, a bioethics professor at the University of Montreal whose research focuses on reproductive ethics, explained that this is especially prevalent with egg freezing because there’s no way for fertility clinics to show success—at least not right away. (In general, success rates with egg-freezing are still relatively unknown and the procedure does not guarantee a pregnancy. According to Yale Medicine, success depends on the age of the woman at the time she froze her eggs—plus, there’s not enough data on how many women have actually thawed their eggs and attempted pregnancy in the first place.)
“When you do IVF, you really care about your success rates in terms of pregnancies and live births,” Ravitsky said. “[With egg freezing], what you have at stake is how many eggs are good enough to freeze, but you don’t have to show the end result. It’s a great moneymaking machine. And for the fertility industry to combine their interests with those of employers to offer good deals or packages—it’s a win-win for the employer and for the fertility industry [that rests], for me, on the backs of women.”
“I really worry about how this benefit may—instead of creating many different opportunities for how we’re going to manage our fertility and our work—move this into one particular way of doing that.”
The reason for this, according to Ravitsky, is that the benefit, from a pure policy perspective, incentivizes women to delay having children—which, in turn, actually decreases their agency. “The issue with the employer benefit is that it reinforces this societal message that having a baby in your 20s is too young,” she said. “It’s almost treated like teen pregnancy, you know? Most women would like to have babies in their 30s, but either they’re still building their professional status or it’s very difficult to meet someone with whom you want to reproduce. So, to reinforce this social message that we should all be having children later in life… that’s very problematic as a message,” because the chances of reproducing at that stage are significantly lower, with or without egg freezing.
Ravitsky also acknowledges that this argument can be polarizing. “It’s not obvious to argue this,” she said, “because as soon as you say it, you’re perceived as either anti-choice or anti-feminist. Because what am I telling you? I’m telling you women should have kids earlier in life. ‘That’s totally anti-feminist! They should get an education and get a job and lean in!’ I’m not coming from that place, of course, but that’s how these arguments are interpreted and that’s how they’re contextualized—if you dare to make them.”
For the egg freezing benefit to be implemented appropriately, Ravitsky said it’s not enough as a standalone perk; it would need to be offered along with a larger suite of fertility and family-related benefits for both women and men.
Joya Misra, a sociology professor at the University of Massachusetts Amherst and the vice president of the American Sociological Association, agrees. Misra feels that the egg freezing benefit should come along with other benefits that “normalize” parenthood. “I would feel much better if it was offered [along with] a set of other policies that allow for paid parental leave and childcare assistance,” she says. “[The message should be] you may want to be having children now, instead of, ‘You might want to think about what to do to ensure that you’ll be able to have children later.’ I do think some of these companies do that… but I really worry about how this benefit may—instead of creating many different opportunities for how we’re going to manage our fertility and our work—move this into one particular way of doing that.”
Any particular policy can, however, resonate very differently in theory than in practice. Many women who’ve used their company’s egg freezing benefit do feel that it has empowered them. One such woman is Emma, who is 37 and works at VICE (she asked that her name be changed for privacy reasons). Since last year, she’s completed one round of embryo freezing with her husband’s sperm, as well as two rounds of egg freezing, via the employer benefit.
Although she’s still unsure if she wants to have children, she looked into egg freezing once she found out it was included in her benefits package. “It’s been in my peripheral view for a long time,” she said, “but I didn’t even consider it an option until I found out that it was being offered through VICE. I hadn’t even really thought about it because of the fact that it was so expensive and I didn’t know much about the process—it seemed really invasive and difficult and complicated. But as soon as I had heard that it was being offered, I was like, ‘Oh, I’m definitely going to look into this and figure out if this is the right decision for me.’”
Using Progyny’s online portal, Emma then connected with a fertility doctor at Columbia University. After one consultation appointment with this doctor, she decided that the procedure was, in fact, the right move for her: “We just talked about everything and she broke everything down,” she said. “I walked out of that meeting being like, ‘I’m going to do it.’ I felt really confident.”
After one embryo freezing cycle and two egg freezing cycles, Emma’s confidence and happiness—with her own experience and the benefit itself—remains a constant. “It’s very cool that this specific benefit is also being offered,” she said. “I feel like it’s giving women a lot more power in decision-making and determining what they want to do with their lives. It’s giving them the time to sort of figure out whether or not they want to have kids and make a decision later. I felt a lot of pressure through my age—that if I did want to have kids, I’d have to do it very, very soon. And now I definitely feel like that pressure has been released. I feel like that weight is off my shoulders.”
She also said that she’s never thought of the benefit as something that pressured her to stay tied to her job. “And even if it was—like, who cares?” she said. “I mutually benefit from it because I get to freeze my eggs for free.”
Another woman, Nyasha Foy—who works for Complex Media in its legal department—also had a positive experience freezing her eggs via the benefit. Foy completed two social egg freezing cycles at Kindbody, but had more mixed feelings about the policy itself. (Kindbody put me in touch with Foy; she is also a former employee of VICE.) Although Foy froze her eggs at age 34, she first considered the procedure in her late 20s—when, at a Wesleyan alumni networking event in New York, an older former sorority sister asked her if she’d thought about freezing her eggs. “I’m a cis-gendered, heterosexual, straight black woman,” Foy remembered thinking. “I would love to get married someday—I’m just not there, and you know, statistics are what they are, so I don’t know how this is all going to happen for me.”
Interested, Foy consulted her primary care physician, who encouraged her to wait and revisit egg freezing when she was in her 30s. It remained in the back of her mind, until, while working at Complex, Kindbody held its Fertility 101 presentation at her office. “I was just like, ‘All right,’” she said, “‘Is this one of these divine intervention things?’”
From there, Foy booked a fertility assessment at Kindbody while keeping in mind that her period started soon—meaning that it was an ideal moment in the month to begin the process. “My appointment was actually twice as long because before I left, they were already showing me how to prep the needles,” she said. “I was like, ‘I think I’m just going to do this. Right time, right opportunity. Let me not think about this too much more and jump in.’”
Foy said that Kindbody made her aware of the potential side effects, risks, and outcomes of freezing her eggs, including the potential that upon thawing them, none would result in pregnancy—in other words, nothing is guaranteed. The most difficult part for her, physically, was dealing with a paralyzing fear of needles; she actually asked that same former sorority sister from Wesleyan to inject hormones for her throughout the process. At the end of two cycles, Foy had 14 viable frozen eggs and a positive experience. She also said that since freezing her eggs, it’s helped her forge a community with other women at Complex who’ve utilized the benefit, too.
But she believes that the benefit can merely be a shiny distraction, depending on the culture of your company. “In order for a person—the employee, the worker, whomever—to do whatever they need to do, they need to feel fully supported by their employer,” she said. “There is a part of me that appreciates what the Facebooks and the Googles were doing by offering [egg freezing] as a benefit—but there’s a shallowness, to me, that came from some of that. Because it felt like, ‘I’m only doing this because I want to get more work out of you. You don’t have to worry about this, you can sit here for two or three more years, give me more work, I made sure your eggs are frozen, you’re going to have that baby one day—don’t worry about it.’ That’s great, but what happens when I have the kid? Are you helping me with benefits from there? Is there an employee resource group I could go to that will be able to support me when I’m trying to figure out what kind of Pampers to buy or how to get my kid into kindergarten? Do I have the paternal leave so you’re not putting the whole onus on the mom?”
That said, Foy feels that corporate culture, overall, is beginning to shift. “I think millennials really put the foot on the gas,” she said. “It’s like, well, why don’t you have [these policies]? I might not come work with your company unless you have this, because I’m wanting to come here and experience a work-life balance that I can’t have if you’re going to shackle me to this desk, and I may not find that experience to be worth it.”
Today, Foy encourages her friends and coworkers to at least consider engaging with fertility proactively—which doesn’t mean freezing your eggs, necessarily. “If you have the opportunity and you’re interested in becoming a mom—if this is something you’re thinking about doing, even if it’s like a tiny mustard seed in the back of your head—just go get a fertility assessment,” she said. “Hear about it. If it makes you anxious to know this information, just put it away for a while, but get that first part taken care of.”
Ravitsky, the bioethics professor from the University of Montreal, reiterated that, if you’re considering egg freezing, it’s important to weigh your other options, as well as the potential outcomes and risks. “When I say women need full information, I’m talking about all the steps,” she said. “The fact that it’s a voluntary choice and that there are other options—a discussion that reminds you that other options include not having children, adopting, egg donation—there are other options. Then, the risks of what you’re doing now, the chances that what you’re doing now will actually get you what you want in 10, 15, 20 years… and the risks of being pregnant when you’re 38 or 40.”
Ravitsky stressed the importance of fertility doctors giving patients time to process this information. “They should be counseling you and supporting you and giving you the time to digest and to come back and ask questions. That’s proper informed consent,” she said. “I really doubt that this is always the case.”
At the end of my phone call with Foy, I told her I admired her commitment to doing her research before freezing her eggs—how important that is to do before making any big medical decision. “Absolutely,” she said. “Especially one that’s like, ‘ So, the end result of this is another human.’”