Artificial Reproductive Technologies (ART) have grown exponentially this century, showcasing the emancipatory and risk-management power of biotech. ART promises not only “reproductive freedom” for individuals and couples unable to procreate through sexual intercourse, but also, for fertile, heterosexual women, the freedom to begin motherhood at later ages. Celebrity forty-somethings sport tech-assisted babies on immaculate figures, boutique clinics advertise domestic bliss on individual terms, while egg freezing has become an increasingly ubiquitous insurance policy for professional thirty-something women uncertain about their romantic and reproductive futures. 

The number of egg-freezing cycles in the US performed annually climbed from 7,600 in 2012 to 29,803 in 2022, with roughly a million eggs and embryos stored in the country today. Women are freezing eggs at progressively younger ages, with fertility clinics actively targeting women in their 20s. The “baby panic” of the early aughts, in which professional women worried about waiting too long to have a baby for career or romantic reasons and regretting it, has putatively been solved. Women, it seems, really can now have it all, free to pursue professional, maternal, and romantic goals and dreams with greater independence and optionality. No longer enslaved by their “biological clock,” women have gained control of what psychoanalyst Katie Gentile calls their “reprofuturity.” But what sort of freedom is actually offered through reproductive technologies—and to whom?

The cost of ART is staggering. A cycle of egg freezing or IVF runs $10,000-$30,000; many cycles of each, if not both, are often required, often on top of additional hormones, medications, storage fees, and so on. These procedures are rarely covered by state and private insurance in the US. That said, insurance contractors for major companies increasingly provide ART, with professional women in large corporations commonly incentivized to freeze eggs through this coverage. At least one economist found that every year a woman postpones having kids leads to a 10% increase in career earnings, making ART economically advantageous to the affluent women who can obtain them. For everyone else, ART often remains prohibitively expensive. 

Indeed, the cost of ART has only risen with demand, with companies capitalizing on the willingness of women with means to pay nearly anything for the chance at motherhood. Psychological research tells us that once people have invested in something, they are more likely to continue to invest. This holds true here, with failures often leading to redoubled effort. And, even for those who can financially afford it, the biological and psychological costs are high. ART involves grueling procedures, including intensive monitoring, hormone injections, multiple surgeries—and all often leading to heartbreak. Rates of success are surprisingly low, given the hype: the chances of having a baby through ART are hard to predict precisely, but data suggests a success rate of 30-40%. And only about 12% of women who freeze their eggs wind up retrieving them.  

Given these costs, the desired gains must be immense. And indeed, what could be more precious than a baby? Or more empowering than female emancipation from bio-repro-chrono limitations and compulsions? As a psychotherapist in private practice in San Francisco, I’ve had plenty of occasion to reflect on both the benefits and discontents of ART.

Certainly, success cases sparkle with opportunity and promise. Heather, a highly driven C-suite executive self-consciously willing to trade domestic for professional success, froze her eggs as an insurance policy. When she met Will, an investment banker capable of supporting a family single-handedly, she was glad she’d done so. Delivering twins at 42 was physically demanding, but motherhood brought immense joy. Heather stopped working until her twins started kindergarten.Then she launched a successful private consulting business, with flexibility to continue to focus on parenting. 

Many stories, however, are less positive, and not just for the obvious reasons. Cases of multiple rounds of IVF ending in failure, eggs destroyed in storage or transition, and other starkly difficult experiences abound. But painful stories of failure only point to the need for more effective, reliable ART. Less catastrophic experiences point to more complex problems. 

Consider Mindy and Michael, a couple who first came in for treatment in their mid-thirties. Both worked in tech and had insurance coverage for ART. They’d been together nearly five years, enjoying the Bay Area’s “work hard, play hard” lifestyle. Michael was ready for a new chapter, eager to buy a home and start a family. Mindy wanted to delay, stating that while she wanted these things too, she wasn’t ready yet. She wanted to travel more, have fun, and further advance her career before motherhood. Her ambivalence about children was pronounced: “I like the idea of kids—and grandkids—but being a mom? I don’t know. It makes me uncomfortable. Just hearing the word ‘mom’ kinda stresses me out.” We began to explore Mindy’s ambivalence in therapy, but the couple quickly decided to freeze embryos to allow Mindy more time and freedom—or more time for freedom. They also purchased a home, which initially brought Michael a sense of life stage progression. The frozen embryos felt relieving and reassuring for them both. 

After two years, however, Michael’s pressing desire for children resurfaced. Mindy shared that their home had amplified the part of her that wanted children, but she still wanted more time. She resented Michael’s urgency. “It’s my body, after all,” she said, “I have to give up so much more than you, I want you to be supportive of me and my choices.” Michael agreed he couldn’t fully comprehend the sense of sacrifice and constriction she experienced when thinking about motherhood. They decided to delay for another 18 months and then begin a pregnancy. They also agreed to open their relationship to allow Mindy to experience a greater sense of freedom before committing fully to Michael and motherhood. Mindy’s anxiety and ambivalence only intensified, however. She very much wanted a family and couldn’t imagine not having children, but she also wasn’t able to shake the perception of motherhood as a sentence: the end of everything she enjoyed about her current life. 

When she met someone else, no one was surprised. There was a painful separation and the embryos were destroyed. Michael, hurt and angry, might well go on to have children. Mindy, confused, regretful, and now 40, most likely will not. Perhaps that’s what she ultimately wanted, but I’m not convinced. Freezing embryos had allowed her to leave an internal conflict unresolved. ART offered this couple a frozen freedom that suspended their life, an agency engineered to evade a choice that would have allowed them to move forward one way or another. 

In another example, Christina, a corporate attorney who struggled with dating, froze her eggs to de-couple romantic and reproductive choices. Christina had suffered a series of traumatic relationships in her teens and early twenties and had become self-protective and highly selective when I met her shortly following her thirty-second birthday. She thought deeply about what she wanted in a partner: intelligence, creativity, kindness, generosity, humor, adventure, and professional passion and success. She dated methodically but did not encounter anyone worth pursuing. Some men bored her. Others annoyed her with their arrogance and “mansplaining.” If she did find someone suitable, he either had no interest in procreating or was  divorced with young children. She vacillated between blaming herself for being too picky and blaming men for being ubiquitously disappointing. Consistently, she communicated that she would rather be single than settle, and that she only wanted to have children with a partner—and that she needed to have children soon or risk loss of fertility. 

The tension between these things created panic. Feeling desperate at 34, she froze eggs to allow her to date with more freedom. But freezing her eggs only intensified her selectivity: now that she had spent tens of thousands of dollars and put her body through the process, she was determined to find the right mate, who stubbornly remained a fantasy. According to some, Christina is the victim of the “mating gap”, in which motherhood-ready, highly educated professional women outpace their male counterparts and struggle to find partners on equal footing. A medical anthropologist at Yale interviewed 150 women who volunteered for her study through their egg freezing clinics. Of these, 115 were fertile heterosexual women in their mid-thirties driven to freeze their eggs through persistent frustration in dating. These women reported being financially and emotionally ready for children, leading the anthropologist to conclude that something often billed as a female crisis may in fact reflect a male one. Certainly, men today are struggling across multiple domains, giving rise to widespread alarm. Perhaps egg freezing extends women’s odds in a difficult field. 

And yet I wonder: if Christina had settled, would she perhaps have found a way to make it work? Could she have had children, gotten divorced, and returned to dating, decoupling her romantic and reproductive timelines in a different manner? Regardless, Christina, now 38, is unhappy with the state of her life. Recently she asked me, “Do you remember Sebastian?” I said I did. “He was okay. Not great, but definitely okay. He would have had a family with me. Maybe I should have done that. I’ll never know. And I know it’s dumb to regret things. But I think about it. I guess I think about it because I feel so stuck now, I don’t know what to do any more.” Sometimes by expanding our limits, we narrow our possibilities. Or rather, limits can generate possibility just as their absence or transcendence can.

Talia, a successful manager in tech sales, feels enormous pressure to freeze her eggs at 33. Talia knew from a young age that professional success was important to her and has worked hard as a young woman in sales to manage a large team at a renowned company. She loves the work and thrives in the competitive environment. Her goal is to be a VP at 35. She’s not sure whether or not she wants children: “I guess I always figured I would. I’m not opposed, but it hasn’t been on my radar. I’d like to cross that bridge later.” She has been dating someone she really likes for about a year, and in theory she has many reproductive years ahead of her. Everyone is different, but evidence suggests that fertility doesn’t begin to decline precipitously until 40. 

Friends and family keep pressuring her to freeze her eggs, however. “You might regret it if you don’t,” they tell her, “It’s the intelligent thing to do.” Egg freezing is covered by Talia’s insurance, but she still would rather not go through the physical and emotional experience. “I get it, it’s the smart, safe thing, but it’s not nothing, and I have to wonder about all the pressure. Like, I’m in sales, and this is being sold hard! And what if I find out something I’d rather not know? What if I find out I can’t have kids and that’s devastating now, whereas it might not be in four years? Maybe I actually don’t want to have kids, but I don’t know that yet, and now I’ll just wind up having them because I froze my eggs, so I’ll feel like I have to, and I’ll hate it?” Whatever Talia decides to do, she’s asking good questions. She’s aware that something that seems like an obviously positive choice might have unintended consequences. Ultimately, though, she decided the potential benefits outweigh the potential risks and froze her eggs. Talia is part of a cohort of women for whom the supposed optionality of egg freezing has become compulsive. 

Among other things, ART can be seen as yet another neoliberal perversion of freedom, in which freedom is understood as the removal of constraints (freedom from the body, from sex, from time) in order to do whatever you want (preferably without question or consequence). It’s an impoverished and immature vision. In children’s dreams of the pleasure of choice, adulthood is often confused with omnipotence. But adult reality is inevitably a disappointment. Indeed, the central project of adulthood is finding pleasure within reality, freedom within limits. In health, we negotiate a good enough balance between desire and reality—otherwise, we remain neurotically tortured. 

To escape neurotic captivity, we must learn to pursue our desires creatively and courageously. The seductive fantasy of having it all fosters anxiety and ambivalence by perpetuating the impossible architecture of the infantile desire for freedom. We attempt to control experience at the expense of living it—losses, regrets, and messes included. Modern women often feel especially pressured to have or be it “all,” so perhaps women are especially prone to want it all too—to be seduced by the illusion of limitless optionality, the tyranny of infinite choice… for the right price. Of course, we want freedom from external compulsion, but a substitute for internal compulsion proves a raw deal. ART promises women the ultimate freedom from biological procreation, but in so doing, it stimulates ambivalence about motherhood, paralysis about mating, and compulsion around costly procedures. The neurotic version of agency gets mistaken for the real thing, leaving women less satisfied—and also less free.

Amber Trotter is a psychologist in private practice in San Francisco. She thinks and writes about the nexus of psychoanalysis and contemporary society, including ethics, freedom, social change, and digital technology. She is the author of Psychoanalysis as a Subversive Phenomenon (2020) and an editor at Damage. She teaches at the San Francisco Center for Psychoanalysis and Access Institute for Psychological Services.