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Could bird flu cause a human pandemic? A dairy farm worker prepares cows for milking in Ontario, Canada, in July 2022. | Irfan Khan/Los Angeles Times via Getty Images Here’s what’s worrying experts right now about H5N1’s spread among dairy cows — and what isn’t. Last year, when an H5N1 avian flu virus — commonly known as bird flu — was spilling over from bird populations into a variety of wild mammals, Seema Lakdawala, a virologist and influenza A transmission specialist at Emory University, was “not overly concerned” about human risk. We don’t have “much of an interface with seals or with foxes, for that matter, or polar bears,” she says. But when it comes to cows, that interface is vast. People on dairy farms regularly interact with cows and their milk; when the animals and their milk are infected with a virus that can cause disease in humans, and that mutates constantly, each of those interactions functions as an opportunity for the virus to workshop its adaptability. Now, says Lakdawala, “I am more concerned than I have been, and it’s not for the general public — it is for dairy workers.” The H5N1 outbreak among cows on 34 dairy farms in nine states has so far led to only one very mild human infection. However, the virus was likely spreading among cows for months before it was detected. Lakdawala’s greatest concern is that this highly changeable virus has now arrived at an important point of human-animal convergence, and that we are not prepared. For a virus to cause a human pandemic, it has to have three important characteristics, say flu experts. It has to cause human disease; it has to be something our immune systems haven’t encountered before; and it must spread easily among humans, especially through the air. The latest events do not yet demonstrate that H5N1 has new capacities in any of these categories. However, they hint that the virus has the machinery to evolve those capacities — and that it could do so before we know it. In dairy cows, H5N1 has found an excellent laboratory for evolving traits dangerous to humans Although Lakdawala was concerned when mink, seals, and other mammals were infected with H5N1 last year and the year before, cows are different. An outbreak among “mammals with a large interface with humans” is a red flag to her. It’s a numbers game. Although all viruses mutate routinely, flu viruses are particularly good at shapeshifting and can even swap entire chunks of genetic material with other flu viruses if an animal is co-infected with more than one of them. These mutations happen randomly, and most don’t make the viruses more dangerous to humans — but it’s entirely realistic to imagine that some occasionally do. If that occasionally human-threatening mutation happens to a flu virus that has infected, say, a wild fox, it doesn’t pose a particularly high risk of causing a pandemic among humans. After all, few wild foxes have contact with humans. If it happens in a cow, however, there are far more opportunities for the virus to effectively workshop its new features. People who work on dairy farms are constantly interacting with cows and their milk — they check udders, hook and unhook milking machines, and perform other tasks to care for the animals. That puts them in lots of contact with any virus infecting the cows. If the virus were one that didn’t infect and kill people or that doesn’t mutate and adapt as easily as the flu does, perhaps it wouldn’t be as concerning — but H5N1 does infect people at close proximity to animals, and at least half of the more than 900 people who’ve been infected with the virus since it came on the scene in 1996 have died. “There is a high viral load in milk of these infected cows, and so it is a concern to me in terms of spillover [from] cows into workers,” says Lakdawala. “And the more often the virus has an attempt to spill over, the more likely it is to adapt.” We already know the virus is adapting in mammals, she says. “The more spillover events, the more attempts that the virus has to find a successful variant that can take off or infect the human — and then one infected individual, three infected individuals, go home” to their families, where they could potentially spread the virus further. It’s not a pandemic right now, she says, but now is the time to act to reduce the opportunities for spillover events. For the first time, we have proof of H5N1 spreading among a mammalian species When a virus leaps from one species into another, that’s not usually enough to cause a large outbreak. You could look at H5N1’s history: Although the virus has leapt from animals into people hundreds of times, it has very rarely spread among people. When infections effectively stop spreading once they cross species lines, the non-transmitting species is called a “dead-end host.” Birds readily transmit H5N1 to other birds, but until recently, scientists have thought mammals getting infected with H5N1 were dead-end hosts. In the past couple of years, they’ve had some sneaking suspicion that minks and other mammals getting infected with the virus were spreading it among themselves — but they never had definitive proof. That is, they couldn’t rule out the possibility that all the animals had gotten infected by eating bits of the same sick bird, or through another so-called “common source” exposure. It’s much harder to contain a pathogen’s spread within a species if members of that species can transmit it to each other. What the dairy cow outbreak shows for the first time is that mammals can indeed now infect each other with H5N1 — and can do it efficiently. “Genetic data and epidemiologic data are all quite strongly suggesting that these viruses are getting transmitted in some way between these cows,” says Louise Moncla, a veterinary pathobiologist at the University of Pennsylvania School of Veterinary Medicine whose team has analyzed genetic data from infected cows that the US government recently made available. This virus’s mode of transmission isn’t apparent yet — and it matters It’s not yet clear how the virus is being spread through and between dairy cow herds. High viral loads in cows’ udders and in their unpasteurized milk make it possible that contact with contaminated milking machines is doing most of the transmission. However, it’s also possible the virus is spreading through the fecal-oral route or through contaminated air; the latter would be particularly concerning because it’s so much harder to prevent. (Moncla notes that while the classic genetic fingerprint for a bird flu’s ability to spread through air between mammals is absent from this strain of H5N1, that doesn’t mean we’ve ruled out respiratory spread.) Regardless of exactly how H5N1 is spreading among cows, the significance that they’re transmitting the virus to each other is clear to flu experts: If the virus has adapted to spread among one mammalian species, it raises the specter that it can also adapt to spread among humans. There is a precedent for flu viruses to spread from livestock to humans, leading to a pandemic: The H1N1 flu outbreak began when a flu virus spread from pigs to humans. It caused far less death than expected through a stroke of luck — because the virus had similarities to strains that circulated in the first few decades of the 20th century, many older adults still had some flu immunity left over from childhood infections. If H5N1 develops the ability to spread among humans, it would be a novel infection to most immune systems, giving us much less protection from old flu infections. There are “no signs of that [ability] so far in the cattle sequences,” says Andrew Pekosz, a virologist who studies respiratory virus biology at Johns Hopkins University’s Bloomberg School of Public Health. “That’s a good thing.” Still, because we don’t know much about how influenza A viruses like H5N1 behave in cows, we don’t yet know what cautionary measures will do the most to slow their spread. In 2011, scientists learned that the influenza D virus causes respiratory illness in cattle. However, not all flu viruses are created equal: “I did not ever anticipate seeing an influenza A in cattle,” says Lakdawala. While influenza D infections don’t appear to cause much disease in humans, influenza A viruses very much do: All of the past global flu pandemics have been caused by influenza A viruses. Because this is such an unusual event, says Moncla, “we know very little about how flu replicates and transmits in cows.” That makes it hard to quickly design and implement precautions to prevent the virus from spreading to the people who handle them. “What would calm me down is if we started implementing interventions that would mitigate the presence of the virus and its transmission amongst cattle, and spilling over into humans,” says Lakdawala. “Say, okay: Every dairy farm worker is gonna wear a face shield,” she said. It would help to know whether cows that are infected but asymptomatic have infectious virus in their milk, and whether they can transmit virus to each other, says Pekosz. Ongoing studies by academics and federal agencies should help answer those questions. Here’s why you shouldn’t panic At the moment, there are more “coulds” than “ares” with H5N1: Although the virus is showing that it couldadapt further to spread among humans, so far it hasn’t; and while it’s reasonable to conduct studies to ensure pasteurization works against this particular strain of H5N1, there’s no reason to think it won’t. It’s also worth noting that according to the USDA spokesperson, the virus has so far not caused severe disease or death in the cows it has infected — they’ve all recovered with supportive care. In that way, this outbreak is very different from the ones we’ve seen in some other mammals. Furthermore, testing at the Centers for Disease Control and Prevention has already demonstrated that existing antiviral medications are effective at preventing human infections with this strain of H5N1 and that two existing candidate vaccines could be used to rapidly scale up mass production of human vaccines against this virus if needed. So for now, the general public shouldn’t be overly concerned about the virus, says Pekosz. “Scientists are … working extra overtime for this. But the general public should still feel safe.”vox.com
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Why we keep seeing egg prices spike With a new wave of bird flu affecting hens, egg prices are ticking up again. | Matthew Hatcher/Bloomberg via Getty Images How corporate greed plays a role in making bird flu outbreaks — and egg prices — worse. Egg prices are rising again. The culprit, again: bird flu. At least, that’s the surface-level reason. In the current wave, according to the CDC, the H5N1 bird flu has been found in over 90 million poultry birds across almost every state since 2022, and has even spread to dairy cattle, with over 30 herds in nine states dealing with an outbreak at the time of this writing. The last time bird flu struck US farms, in early 2022, egg prices more than doubled during the year, reaching a peak of $4.82 for a dozen in January 2023. During the bird flu outbreak in 2014 to 2015, egg prices also briefly soared. While prices now are still nowhere near the peak they reached in January 2023, they’ve been creeping up again since last August, when a dozen large eggs cost $2.04. As of March, we’re bumping up against the $3 mark, which is a nearly 47 percent increase. It’s also a huge increase from the price we were used to a few years ago: In early 2020, a dozen eggs were just $1.46 on average. The H5N1 strain of bird flu is highly contagious and obviously poses a big risk to hens. But the fact that bird flu outbreaks keep battering our food system points to a deeper problem: an agriculture industry that has become brittle thanks to intense market concentration. The egg market is dominated by some major players The egg industry, like much of the agricultural sector, is commanded by a few heavyweights — the biggest, Cal-Maine Foods, controls 20 percent of the market — that leave little slack in the system to absorb and isolate shocks like disease. Hundreds of thousands of animals are packed tightly together on a single farm, as my colleague Marina Bolotnikova has explained, where disease can spread like wildfire. According to the government and corporate accountability group Food & Water Watch, three-quarters of the country’s hundreds of millions of egg-laying hens are crammed into just 347 factory farms. The system also uses genetically similar animals that farms believe will maximize egg production — but that lack of genetic diversity means animal populations are less resistant to disease. When a hen gets infected, stopping the spread is an ugly, cruel business; since 2022 it has led to the killing of 85 million poultry birds. For the consumer, it often means paying a lot more than usual for a carton of eggs. Preventing any outbreaks of disease from ever happening isn’t realistic, but the model of modern industrial farming is making outbreaks more disruptive. And it’s not just these disruptions driving price spikes. Egg producers also appear to be taking advantage of these moments and hiking prices beyond what they’d need to maintain their old profit margins. “It is absolutely a story of corporate profiteering,” says Rebecca Wolf, senior food policy analyst at Food & Water Watch. Cal-Maine’s net profit in 2023 was about $758 million — 471 percent higher than the year prior, according to its annual financial report. Most of this fortune was made through hoisting up prices; the number of eggs sold, measured in dozens, rose only 5.9 percent. Last year, several food conglomerates, including Kraft and General Mills, were awarded almost $18 million in damages in a lawsuit alleging that egg producers Cal-Maine and Rose Acre Farms had constrained the supply of eggs in the mid- to late 2000s, artificially bumping prices. A farmer advocacy group last year called on the FTC to look into whether top egg producers were price gouging consumers. Are we doomed to semi-regular price surges for eggs? Our food system didn’t become so consolidated — and fragile — by accident. We got here because of three big reasons, Wolf says: by not enforcing environmental laws, by not enforcing antitrust laws, and by giving away “tons of money” to the agriculture industry. During the New Deal era, the federal government put in place policies that would help manage food supply and protect both farmers and consumers from sharp deviations in what the former earned and the latter paid. Under Secretary of Agriculture Earl Butz in the 1970s, though, those policies started getting chipped away; Butz’s famous motto was for farmers to “get big or get out.” The spread of giant factory farms is in part a product of this about-face in managing supply. Because our food system is so concentrated and intermingled, it also means any single supply chain hiccup — whether due to disease, wars, or any other reason — can have ripple effects on others, affecting prices in a vast number of essential consumer goods and services. “When we have things like E. coli outbreaks, it’s hard to know where the problem lies because the way that we process and manufacture is so hyper-industrialized that you then have a problem with millions of pounds of food,” says Wolf. Thankfully, the Biden administration has been making some strides in loosening up food industry consolidation, often by shoring up enforcement of long-existing antitrust laws. But there’s still more we could do. There are bills that have been introduced to Congress, like Sen. Elizabeth Warren’s Price Gouging Prevention Act, that would give the FTC the authority to first define what counts as price gouging and then crack down on companies that raise prices excessively. The cycle of food chain snags and higher prices doesn’t have to keep repeating. “We are maximizing profit truly over everything else — over the welfare of the animals, over the rights and wages of people who work in the food system, for even consumers who are at the grocery store,” Wolf says. “None of this is inevitable — we shouldn’t have to be here.” This story appeared originally in Today, Explained, Vox’s flagship daily newsletter. Sign up here for future editions.vox.com
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After decades of inaction, states are finally stepping up on housing California Gov. Gavin Newsom at a press conference on September 28, 2022, in San Francisco, California. | Justin Sullivan/Getty Images The affordability crisis is forcing politicians’ hands. For years, the easiest thing to doaboutbuilding new housing was nothing. The federal government largely deferred to state and local governments on matters of land use, and states mostly deferred to local governments, which typically defer to their home-owning constituents who back restrictive zoning laws that bar new construction. That’s slowly changing as the housing supply crisis ripples across the country. Experts say the US is short somewhere between 3.8 millionand 6.8 million homes, and most renters feel priced out of the idea of homeownership altogether. The lack of affordable housing is causing homelessness to rise. In Washington, DC, Congress has held more hearings on housing affordability recently than it has in decades, and President Joe Biden has been ramping up attention on the housing crisis, promising to “build, build, build” to “bring housing costs down for good.” But it’s at the state level where some of the most consequential change is taking place. Over the last five years, Republican and Democratic legislators and governors in a slew of states have looked to update zoning codes, transform residential planning processes, and improve home-building and design requirements. Some states that have stepped up include Oregon, Florida, Montana, and California, as well as states like Utah and Washington. This year, Maryland, New York, and New Jersey passed state-level housing legislation, and Colorado may soon follow suit. Not all state-level bills have been equally ambitious in addressing the supply crisis, and not all states have been successful at passing new laws, especially on their first few tries. And some states have succeeded in passing housing reform one year, only to strike out with additional bills the next. Real housing reform requires iterative and sustained legislative attention; it almost never succeeds with just one bill signing. Trying to determine why exactly a housing reform bill passes or fails on the state level can be difficult, though advocates say it certainly helps when a governor or other powerful state lawmaker invests time and political capital in mobilizing stakeholders together. Given that housing challenges are not spread equally across a state, sometimes it can be hard to decide whether to pass statewide laws that apply equally to all communities or to pass more targeted legislation aimed only at certain areas. Partly due to pressure from voters and from more organized pro-housing activists, legislative trends are starting to emerge. More states and housing experts are thinking not only about passing laws to boost housing production, but also about how best to enforce those laws, close loopholes, and demand compliance. States can make it easier to build more housing in a wider variety of places While states typically grant local communities a lot of discretion in land use policy, more lawmakers are realizing that balance may have tilted too far. As researchers with the Federal Reserve Bank of Minneapolis outlined last fall, some states are now looking to increase housing production by enabling more multifamily housing and accessory dwelling units (ADUs) to be built without having developers first seek approval from local planning agencies or elected boards. This accelerated construction process is known as building “by right.” For example, Oregon passed a law in 2019 allowing fourplexes (a multifamily home that typically houses four families under one roof) to be built anywhere in large cities and for duplexes to be built anywhere in mid-size cities. Before, a developer would have needed to seek special permission to build such housing. States like Utah and Massachusetts are incentivizing the construction of new multifamily housing near public transit, while states like California and Florida are making it easier to build residential housing in places zoned for retail. Other states, like Maine and Vermont, are making it easier to build ADUs, which are second (and smaller) residential units on the same plot of land as one’s primary residence, like apartments or converted garages. State lawmakers sometimes impose new rules on localities to adjust their housing planning requirements, which can mean lowering the barriers builders must go through to begin construction or incentivizing cities to set more ambitious targets for production. Sometimes it means easing requirements like minimum lot sizes or parking spot mandates. Not all state-level bills will move the needle on the housing crisis Under pressure to do something about the housing crisis, some state lawmakers are advancing bills that allow politicians to claim they’re taking action, although the legislation itself is weak and unlikely to make big dents on the various problems. Some bills may even make affordability issues worse over the long term. For example, after failing to pass housing reform last year, lawmakers in New York came together again this year to push something through. Democratic Gov. Kathy Hochul and her allies in the state legislature are cheering their recently agreed-upon housing package, which includes tenant protections and incentives to spur new construction,but experts and activists say it lacks real ambitious zoning and productionmeasures and will be unlikely to drive new affordability. Likewise in Maryland, Democratic politicians are cheering the passage of a new statewide housing reform package that includes renter protections and incentives to spur new affordable and dense development,though Yes-In-My-Backyard pro-housing advocates concede they do not expect the legislation to create much new housing, at least in the near term. Still, given that it was housing advocates’ first real attempt at passing statewide legislation in Maryland, they are hailing it as an impressive first step. “This is the first time the Maryland legislature overrode local zoning in a pro-housing way, and I would say this is a surprisingly drastic shift from the status quo even though it’s not enough,” said Tom Coale, a housing lobbyist in Maryland. When it comes to state-level housing reform, implementation and compliance matter Passing legislation for housing reform on the state level is often just the first step, as opponents then sometimes seek to challenge the new laws in court or localities search for loopholes or other ways to avoid compliance. Sometimes lawmakers water down housing production mandates and other enforcement mechanisms before the bills even pass through the legislature. While it’s not uncommon for local communities to try and avoid compliance when a housing law is first passed, somestates have also been firing back in subsequent sessions to close loopholes and ramp up penalties for local governments. While some statutes have strong enforcement mechanisms built in to begin with, many lawmakers are recognizing the housing reform process will just need to be dogged and responsiveto resistance and new challenges. Housing experts with the Lincoln Institute of Land Policy say it’s likely to take at least three to five years after a statewide policy is passed before the public should expect to see any real changes in housing production, and they urge patience before claiming a reform has failed or succeeded. “Many of the ambitious state housing policies that have been adopted are still in the early stages of implementation, so we don’t yet have definitive evidence about what works and what doesn’t,” they wrote in September. “Without realistic expectations about this time frame, pro-housing advocates may get discouraged, while opponents claim that zoning changes are ineffective—all before the policies have kicked in.”vox.com
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The AI grift that can literally poison you Amanita muscaria mushrooms, a poisonous variety, are seen at a garden in Poland on October 2, 2022. | Jakub Porzycki/NurPhoto via Getty Images When AI comes for mushroom foragers. Six months ago, I spoke with a man named Elan Trybuch about a problem he was seeing online. He kept coming across different ebooks about mushroom foraging that looked somehow off. Off as in: maybe poisonous. The books were shorter than most foraging guides were, and way, way cheaper, says Trybuch. He’s a software engineer and volunteer secretary for the New York Mycological Society, a nonprofit devoted to “spreading knowledge, love and appreciation of fungi.” He knows mushrooms and he knows AI, and he thought the covers of these books were probably AI-generated. “They had mushroom structures that don’t quite make sense,” says Trybuch. They were the mycological equivalent of a picture of a hot blonde with six fingers and too many teeth. Most disturbing was the information inside the books was totally wrong. “They aren’t even giving you descriptions of real mushrooms. They’re giving you something completely made up,” Trybuch says. Any readers looking to try to use these books to figure out which mushrooms were safe to eat and which weren’t would be out of luck, which to Trybuch was seriously concerning. “It could literally mean life or death” if you eat the wrong mushroom, he says. The problem of very low-quality, very low-priced, probably at least partially AI-generated ebooks is not confined to mushroom foraging. Garbage ebooks have been a problem on Amazon for at least a decade, but — not unlike many strains of fungi — they’ve exploded over the last few years. I spent months investigating the shadowy economy where they’re produced, and what I learned took me by surprise. Inside the scammy world of garbage ebook publishing Garbage ebooks are all over Amazon’s Kindle store, on every topic. Searching for Jonathan Haidt’s bestselling new book The Anxious Generation, I found Jonathan Haidt: The Biography of Jonathan David Haidt, Navigating Morality and Policy; A Joosr Guide to... The Happiness Hypothesis by Jonathan Haidt: Finding Modern Truth in Ancient Wisdom; and The Jonathan Haidt Story: Exploring the Life and Work of a Renowned Social Psychologist, Author, and Advocate. None of these are actually books so much as book-shaped digital files, designed to be picked up in keyword searches and get clicked on in a hurry by someone a tiny bit distracted or not digitally savvy enough to notice what they’re doing. This kind of grift has been around for a while. Now, with the rise of large language models, garbage ebooks have become easier and cheaper than ever to make. Garbage book grifters often don’t use AI to write their books, but they do use it to pick a topic and build an outline. Then they give the outline to a wildly underpaid ghostwriter to flesh it out into something that will pass muster as a real book. The model is a dangerously inviting prospect for anyone who’s ever toyed with the idea of publishing a book but doesn’t want to actually write one. It turns out, though, that the people who make garbage ebooks mostly lose money. The real cash seems to come from the people who teach others the garbage ebook scheme. These teachers claim they’ve shared the key to a life of passive income, but their students say all their courses offer is demands for more and more money, with the ever-deferred promise to teach you the real secrets to easy money once you’ve paid just a few thousand more dollars. Even these grifters are not the real villains. They are often small-time operators working one level of a very big grift industry. The grift is that technology and retail platforms have incentivized a race to the bottom when it comes to selling books. They’ve built an ecosystem where all the incentives are to sell at high volume and low cost. In book production, the biggest cost-saving and time-saving measure you can take is cutting out the labor of writing the actual book. Together, without ever caring enough about the issue to deliberately try to do so, these corporations have built a landscape in which it’s hard to trust what you read and hard to sell what you write. In the end, everyone loses: the would-be writers getting grifted in a fake publishing school, the real writers whose products are getting choked out of the marketplace by floods of cheap garbage, and the readers who just want to be able to buy a book without having to check to make sure the author isn’t a robot. I asked Elan Trybuch if he thought anyone was buying all those fake mushroom foraging guides. “Yeah,” he said. “I mean, there’s a sucker born every minute.” Read the full article here. This version of the story appeared originally in Today, Explained, Vox’s flagship daily newsletter. Sign up here for future editions.vox.com
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The failed promise of egg freezing Yuliia Antoshchenko/Getty Images The costly procedure was supposed to give women a new kind of freedom. Is that what it really offers? “For me, it was almost like a message from the universe,” says MeiMei Fox. It was 2009, and Fox was a 36-year-old divorced writer and editor when she sat down to interview a fertility specialist for an upcoming book. He pulled out a chart showing female fertility after age 35 — in her memory, a curve swooping exponentially downward. “I was like, holy moly, this is not a pretty picture,” Fox recalled. She’d always wanted a family, but since her divorce, she hadn’t met the right person to share it with. That’s why she took notice when she and the doctor discussed a technology called egg freezing, still experimental, that could help preserve people’s eggs until they were ready to have kids. At about $10,000, it was expensive, and typically not covered by insurance. She started pulling the money together right away. Fox was an early adopter of a technology that was about to explode in popularity. Initially used primarily by people undergoing chemotherapy or other treatments that can harm fertility, the procedure became more mainstream after the American Society for Reproductive Medicine (ASRM) announced in 2012 that it should no longer be considered “experimental.” Since then, the number of egg-freezing cycles performed each year has skyrocketed, from around 7,600 in 2015 to 29,803 in 2022, the most recent year for which data is available, according to the Society of Assisted Reproductive Technology. In the beginning, expectations were high. Despite the eye-popping cost of the procedure, experts predicted it would usher in a new era of gender equality and career advancement for women. A now-famous 2014 Bloomberg BusinessWeek cover story promised a new option for professional women: “Freeze Your Eggs, Free Your Career.” Big companies such as Facebook and Apple started covering egg-freezing expenses for employees. Startups devoted to the procedure began wooing potential customers with parties and prosecco — and attracting millions in VC funding. Egg freezing was also hailed as the next big step in reproductive health. “It was supposed to revolutionize the whole field just as much as the birth control pill did,” says Janet Takefman, a reproductive health psychologist at McGill University. For Fox and for many, many people who underwent the procedure, however, freezing their eggs was more than just a medical decision; after an increasingly frantic race against the clock to find a partner, it felt like a way to take back control over their own lives. “Oh my god, I just bought myself years,” Fox remembers thinking. “The stress level went way down.” Many patients report the same sense of relief after making the decision to freeze eggs. Marcia Inhorn, a professor of anthropology and international affairs at Yale, interviewed more than 100 women about their egg-freezing experiences for her 2023 book, Motherhood on Ice: The Mating Gap and Why Women Freeze Their Eggs. After the procedure, more than 90 percent of women had something positive to say. But in other ways, egg freezing has failed to live up to its early hype. For many years, the effectiveness of the procedure was a bit of a black box: Not enough people had tried to use their frozen eggs for scientists to pull together reliable data. Now, however, a picture is emerging. “It was supposed to revolutionize the whole field just as much as the birth control pill did” In one groundbreaking 2022 study conducted at NYU Langone Fertility Center and looking at 543 patients over 15 years, the chance of a live birth from frozen eggs was 39 percent. “There isn’t a guarantee of having a baby from egg freezing,” says Sarah Druckenmiller Cascante, a reproductive endocrinologist at NYU Langone Fertility Center and one of the study’s authors. The study made a splash because it provided numbers where little comprehensive national data exists, though experts at other clinics tell Vox that its results are in line with what they’ve found. And far from ushering in a new era of gender equality, some experts say, the procedure serves as another way for companies to make money from stoking women’s anxieties. Sales pitches about egg freezing, rather than liberating women from their biological clocks, simply became another way to put pressure on them, says Jody Madeira, a law professor at Indiana University Bloomington and author of the book Taking Baby Steps: How Patients and Fertility Clinics Collaborate in Conception. “In a capitalist society, you’re going to have that incentive to get women’s dollars by piggybacking on this guilt, shame, anxiety, whatever you want to call it, about how we’re supposed to reproduce and we haven’t done so yet.” About a decade after it shed its “experimental” label, the procedure has become ubiquitous in pop culture and ballooned in popularity, with over a million frozen eggs or embryos stored in the United States today. It has done little, however, to materially change women’s lives. The first successful births from frozen eggs were twins, born in Australia in 1986. But the procedure used in this case was difficult to replicate, and egg freezing didn’t begin to take off until the 1990s, starting at a clinic in Bologna, Italy. The Italian government had passed a law, backed by Catholic politicians, that gave embryos the same rights as citizens and restricted freezing them. Freezing eggs instead became a way to circumvent the law and still treat patients with infertility. In the early 2000s, the procedure spread to the US and around the world, gaining more interest after 2012, when the ASRM removed the “experimental” label. For patients, egg freezing can be an arduous process. It starts with 10–14 days of hormone injections, often two or three per day, to stimulate the ovaries to produce large numbers of eggs at once, Cascante said. On top of that, the patient also has to visit a clinic two or three times a week for ultrasounds and bloodwork. Finally, when the eggs are the right size, another injection known as a “trigger shot” gets the eggs ready for collection. “Physically, you go through a lot,” says Fawziah Qadir, a 38-year-old education professor at Barnard College who froze her eggs in 2022. If all goes well, patients under 38 can expect to retrieve between 10 and 20 eggs, which are frozen using liquid nitrogen and stored in a lab until they’re ready to be used. If it doesn’t, more cycles may be necessary — meaning more shots, and more money. When egg freezing first became widely available, there wasn’t a lot of long-term data on its effectiveness. But there was buzz — lots of it — especially around the idea that it would give women more time to focus on their careers. “Imagine a world in which life isn’t dictated by a biological clock,” Emma Rosenblum wrote in the 2014 Bloomberg BusinessWeek story. “If a 25-year-old banks her eggs and, at 35, is up for a huge promotion, she can go for it wholeheartedly without worrying about missing out on having a baby.” In the next few years, new companies sprang up to market the procedure to women, often with a millennial-pink, girlboss sheen. Extend Fertility, launched in 2016 in New York City, offered Instagram influencers reduced rates in exchange for posts. Trellis, a “fertility studio” in Manhattan’s fancy Flatiron district that opened in 2018, offered Turkish-cotton bathrobes and called itself “the Equinox of egg freezing,” a reference to the upscale gym chain. One wall bore the slogan, “It’s up to each of us to invent our own future.” The startup Kindbody, also launched in 2018, hosted parties with drinks and scented candles and peppered its social media ads with taglines like “Plan your path.” “Egg freezing has become like a mantra for how to be an independent woman,” Rebecca Silver, director of marketing for Kindbody, told NBC in 2018. “The people who have frozen their eggs are doing the cool new thing.” That cool new thing, however, was pricey. It took Fox a year to save up the money. Today, with the process still coming in at $10,000 to $15,000 per cycle, several companies offer loans specifically for egg freezing. Qadir’s procedure in 2022 cost about $14,000, which her mom paid as a gift to her, Qadir says. That included storage fees, which are rising rapidly and can run to $800 a year or more. The costs of egg freezing and storage usually aren’t covered by insurance, although more large companies are beginning to offer fertility benefits that include them. The price tag of the procedure limits who can access it; the majority of egg-freezing patients are white women with professional jobs. For Black women like herself, “sometimes it’s unattainable just because it’s so expensive, or we don’t have the jobs that would cover it,” Qadir said. Some experts say stigma and stereotypes, dating back to the history of slavery in America, also contribute to lower rates of fertility treatment among Black women. Startups have attracted enough customers to draw interest from deep-pocketed backers, with fertility companies gaining more than $150 million in investment in 2019, according to the New York Times. “It is an attractive investment for venture capitalists who are looking to make money because it’s an almost unlimited market, potentially, of people who think they need to extend their fertility,” says Karey Harwood, a professor of women’s, gender, and sexuality studies at North Carolina State University and the author of The Infertility Treadmill: Feminist Ethics, Personal Choice, and the Use of Reproductive Technologies. It’s no surprise that people will pay tens of thousands of dollars, or even go into debt, for the chance to build the family they’ve always imagined. But that key word — chance — can fall by the wayside in an industry built on selling optimism. Getty Images The year after she froze her eggs, Fox got together with her now-husband. After about a year of trying to get pregnant and one miscarriage, the couple had Fox’s frozen eggs shipped from the San Francisco Bay Area, where they were stored, to Los Angeles, where Fox and her husband lived. “Here’s where the story goes rotten,” Fox says. The Bay Area clinic had failed to pack the vials properly, and when they arrived in LA, all the eggs were destroyed. It was “one of the worst days of my life,” Fox recalls. She’s not the only patient to fall victim to storage or transportation mistakes. One 2022 study found at least nine storage tank failures over 15 years, affecting 1,800 patients. Egg-freezing patients also have had to contend with the unpredictable nature of the human body. The process can fail at many points, Cascante said. The ovaries may not produce enough eggs, the eggs may not survive the freezing process, they may not fertilize properly, or the fertilized embryos may not implant in the uterus. One UK-based woman, who asked to remain anonymous because she was concerned about professional ramifications, told Vox she froze 14 eggs, beginning about 10 years ago when she was 36. At the equivalent of about $1,200 per egg, the process wasn’t cheap. But by the end, she says, “I felt really proud that I was doing something proactive, and something that gave me options.” When she decided to use the frozen eggs to conceive on her own at 40, however, none of them fertilized. “I felt really angry at the universe,” she says. She later married and had a child using a donor egg. “In a single cycle of egg collection and fertilization, our donor produced more eggs and created more embryos than I had done in seven cycles.” Despite her experience, “I never felt like I was mis-sold,” the woman says. “I’m a nerd; I did my research.” At the same time, when she was freezing her eggs a decade ago, there wasn’t much research to do. “There weren’t a lot of people who had frozen their eggs, and there were even fewer who had gone back to try and conceive.” Today, there’s more data available, and mainstream fertility clinics are likely to be frank with patients about success rates, says Madeira, the author of Taking Baby Steps. Findings at other clinics have been in line with the NYU study, with another study finding that about a third of patients who returned to use their eggs ended up having a live birth. “Clinics have an actual ethical imperative to give accurate information.” But egg-freezing parties hosted by for-profit companies may be another story. There’s also a difference between listing success rates in fine print and really emphasizing the uncertainty of a procedure. Even Brigitte Adams, the woman featured on the 2014 Bloomberg cover after freezing her eggs, eventually told the Washington Post that she was unable to conceive using her frozen eggs. “They’re going to tell you, in all the paperwork you sign, that this is no guarantee, but you’re still going to have a sense of, oh, this works,” Fox says. Some of that feeling may stem from a kind of relentless optimism in American culture — or, perhaps, a Protestant work ethic — around the idea of having biological children, the message that if people simply try hard enough and long enough, they will eventually be rewarded with a child. This messaging has led some women to open up in recent years about their unsuccessful infertility treatments, to destigmatize their experiences. “For those of us who close our infertility chapters without a baby, we’re often met with unsolicited advice, reinforcing the narrative that we obviously gave up too early,” one woman, Katy Seppi, told CNN. For their part, fertility companies and practices say they work hard to make patients aware of the possibility of failure. At Extend Fertility, every prospective egg-freezing patient gets a free consultation session that includes information on their odds of a live birth from frozen eggs, based on their age and initial test results, says Joshua Klein, the company’s chief clinical officer. After that, “we try to trust women” to make an informed decision, he said. Kindbody also provides every prospective client with “expected outcomes based on their individual hormones and sonograms,” and offers a fertility calculator that estimates a patient’s chance of a live birth based on test results and number of eggs retrieved, Margaret Ryan, the company’s VP of communications, said in an email. “They’re going to tell you, in all the paperwork you sign, that this is no guarantee, but you’re still going to have a sense of, oh, this works” For some people, egg freezing isn’t the only option on the table. Another path is freezing embryos, which are denser and have a lower water content, making them “less sensitive to the freeze-thaw process,” said Amanda Adeleye, a reproductive endocrinologist and the medical director of CCRM Fertility of Chicago. Doctors also are able to screen embryos to help give patients a better sense of how likely they are to have a successful pregnancy. The process has even found its way into the American cultural imagination, with Succession’s Shiv Roy suggesting to her beleaguered husband Tom that they freeze embryos because they “survive way longer than eggs.” Embryos, however, require sperm. The majority of people freezing eggs are single, and they’re often hoping to have biological children with a partner one day. Using donor sperm would defeat that purpose. Fox, for example, was told that freezing embryos might be more effective but “I had zero interest,” she says. “I did not want to be a single mom.” If a patient has a partner or is comfortable using a donor, doctors may recommend embryo freezing. But “if you’re doing all of this to expand your flexibility and time to build your family, to prematurely close the door on part of that by fertilizing the eggs doesn’t necessarily help you,” Adeleye said. Eggs, embryos, freezing, thawing, shots, ultrasounds, thousands of dollars — it’s a lot for patients to navigate, often without much guidance. For example, there’s no single regulatory agency overseeing fertility centers in the US, as NBC has reported. That means no one is ensuring that patients are given a clear picture of the effectiveness of procedures. A lack of oversight also allows companies to use sales pitches that experts say are misleading, like an Instagram ad for Extend Fertility that claimed, “When you freeze your eggs, you #freezetime.” Klein calls that message “oversimplified,” but says it contains a kernel of truth because the procedure gives patients a chance to get pregnant with younger, more viable eggs. Advertising egg freezing is always a difficult balance, he tells Vox. The company doesn’t want to be too aggressive, but at the same time, to keep silent about a technology that can be “life-changingly impactful” risks doing a disservice to all the people who could benefit, Klein says. Others, however, argue that egg-freezing companies are being too aggressive, not just about the effectiveness of the procedure but about its necessity. Companies can “scare women into freezing their own eggs when they might not really need to,” Madeira says. In recent years, fertility startups have reached out to younger and younger groups of women. “We are now targeting women in their 20s and early 30s,” Susan Herzberg, the president of Prelude Fertility, told the New York Times in 2018. “Fertility declines at 22,” Jennifer Lannon, founder of the website Freeze.Health, told the publication. It’s true that egg quality declines with age and that younger patients have better luck with egg freezing. But the American College of Obstetricians and Gynecologists puts the age of significant fertility decline at 32, not 22 (the chance of conceiving drops more precipitously after 37). In the NYU study, the success rate rose to 51 percent for patients who froze their eggs when they were under 38. But the idea that large numbers of people should be freezing eggs in their 20s to guard against future infertility is misguided, some experts say. People in their 20s and early 30s often have time to conceive naturally, without the need for a lengthy, expensive medical procedure. Indeed, only about 12 percent of patients worldwide actually go back for their frozen eggs. Many patients conceive without assistance, Takefman says, while others decide not to become parents. Patients who froze eggs when they were younger than 34 are especially unlikely to use them, Madeira says. Those numbers don’t capture people who froze eggs only a few years ago and might still return, Klein says. And it’s not necessarily a problem that not everyone uses frozen eggs — after all, the process is meant as a “proactive investment,” he says. “You don’t know if you’ll need it.” To some, that investment comes at too high a cost. “More women are freezing eggs, and paying a lot to freeze eggs, than are actually ever going to need [them],” Madeira says. Ten years ago, egg freezing was seen as a path to economic and social empowerment for women. But most people aren’t freezing their eggs so they can work; they’re freezing their eggs so they can date. Eliza Brown, now a sociology professor at the University of California Berkeley, and her team interviewed 52 women who had frozen or were considering freezing their eggs in 2016 and 2017. None of them cited a desire to climb the corporate ladder. Instead, almost all were interested in egg freezing because they lacked a romantic partner. “Most of our participants understood egg freezing as a way to actually temporarily disentangle romantic and reproductive trajectories,” Brown tells Vox. However, in many cases, egg freezing was a bandage on a bigger problem. The women Inhorn interviewed for her book Motherhood on Ice were largely educated professionals who could afford a five-figure elective medical procedure. “They wanted an eligible, educated, equal partner,” Inhorn said, and “they were having trouble finding that.” Both Brown and Inhorn spoke with some egg-freezing patients who were seeking female partners. However, the majority were dating or seeking men, and struggling with the process. Some had tried dating men with less education or career success, but found “there was a lot of intimidation,” Inhorn said. “Men were not comfortable with who they were.” Others were frustrated with “men who will just wine you and dine you, but really have no intention of committing.” MeiMei Fox describes the sense of rush and pressure that can be attached to dating for women in their late 30s: “You go on the first date and you’re like, well, do you want to have kids? No? Okay, bye.” Egg freezing doesn’t change the fact that women are outpacing men in educational attainment, nor that social norms still fetishize the male-breadwinner family, pressuring women and men alike to look for something that may no longer fit them or the times they live in. It also doesn’t change the fact that many women find dating men to be a frustrating and demoralizing experience, as Anna Louie Sussman writes in the New York Times. Daniel Cox, a senior fellow at the American Enterprise Institute who has surveyed more than 5,000 Americans about dating, told the Times that many men were “limited in their ability and willingness to be fully emotionally present and available” and that dating today “requires a level of emotional sensitivity that I think some men probably just lack.” To actually fix straight women’s dating problems, you would need to “fix men,” one of Inhorn’s study participants told her. Until then, Inhorn writes in her book, “egg freezing will remain educated thirty-something women’s single best reproductive option — a techno-medical solution to a fundamental gender inequality that provides them with some hope and allows them to retain their motherhood dreams.” For Fox, freezing her eggs indeed took the feeling of time pressure away. She felt more relaxed and confident. “It was really positive for me,” she says. “Until I tried to use them.” After Fox’s frozen eggs were destroyed, she and her husband went through three rounds of IVF. It cost about $100,000, but she eventually got pregnant and gave birth to twin sons. Today, she’s not against egg freezing but says, “I tell people it is no guarantee.” Fertility centers don’t always “present that to their clients in an honest way,” she adds. Only about 12 percent of patients worldwide actually go back for their frozen eggs Better regulation would help, experts say. Creating a single regulatory agency to oversee fertility centers — as the Human Fertilisation and Embryology Authority does in the UK — could make it easier to require those centers to educate patients on the risks and effectiveness of egg freezing and to follow accuracy guidelines in their advertising, Rachel Strodel argues in an NBC op-ed. “I still certainly respect people’s freedom to make the decision that’s best for them, but they’ve got to be armed with the facts and realize that it’s a gamble,” says Harwood, the Infertility Treadmill author. Federal lawmakers should also require that egg storage facilities follow proper freezing protocol and report any failures, legal scholars Naomi Cahn and Dena Sharp write at the Conversation. Meanwhile, helping women with the relationship problems that push many to freeze eggs in the first place may require bigger social changes. “Maybe men are going to need to get more comfortable marrying women who are more educated than they are and make more money than they do,” Harwood said. “Maybe the change happens there, in our gender ideologies and how we think of family.” Greater support for single parents and other family forms beyond the heterosexual two-parent household could also take the pressure off of women to bank eggs in hopes of meeting a male partner. So, too, could a greater social acceptance of the value of a child-free life, especially since more and more people are choosing not to have children. While many people who freeze eggs have a deep and personal desire for children, it’s also the case that women, especially, experience enormous social and even political pressure to reproduce — and reducing that pressure could free some people to pursue other shapes for their lives. Patients and scholars alike are clear that they don’t want to see egg freezing disappear as an option. “Reproductive choices are being eclipsed in this country,” Inhorn said. “This is a technology that does give women some help with difficult situations they find themselves in.” The process could take on added importance now that an Alabama court ruling has cast doubt on the future of IVF using frozen embryos. Federal oversight of and research into fertility technology and treatment in general have been hampered by opposition to abortion in the US, which has made it difficult to form nationwide policies around reproductive health. Egg freezing also remains an especially important option for people dealing with cancer or other conditions or treatments that can damage ovarian function, and it can be a useful tool for trans people who want to remove their ovaries or who are taking hormones that affect them, Adeleye said. For many patients, however, experts say that the sense of control that egg freezing offers — at a high price — turns out to be illusory. If anything, Fox’s experience with the procedure was an exercise in letting go. “It’s taught me some more patience with life and the universe,” she says. “There are many different pathways to getting what you dream of.”vox.com