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This is an article that you need to read critically, beyond the headline.

Even a few paragraphs down they say this:

> The optimal age to freeze eggs varies depending on the source and metric, but almost all sources agree it's sometime between 19 and 26.

So there's some heavy bias inserted already into the title.

The next chart shows a peak around 19, but if you read the fine print it's not a chart about eggs at all. The subtitle says it shows:

> probability of getting pregnant for couples not on birth control

Not the quality of eggs frozen. They're saying one thing in text and showing a chart of something else. If you can't imagine why couples in their early 20s might have a higher rate of pregnancy than couples in their 50s then you might want to think a little deeper about the factors that go into that.

The writeup then goes into polygenic embryo screening, which then jumps to improving IQ by selecting embryos, which gets to their final argument which is that it's easier to collect more eggs when younger. So freezing a lot of eggs when you're younger allows for more boosting of your child's IQ through genetic screening based on a company called Herasight's data. Herasight has been widely criticized for overselling their abilities. Also, why do so many rationalist writeups end up back at a conversation about genetics and IQ?

Having done IVF with my wife I think this is the most underrated fertility advice available today.

I don't understand why governments of countries with increasing average age and low birth rate don't pay for this for all women. This is one the best pro-family policies that can be implemented.

Most 19 year olds probably wouldn't opt into injecting themselves twice a day for weeks and dealing with the side effects of the injections, then the subsequent extraction procedures (likely for multiple rounds) even if it was paid for. Which is reasonable, considering most women who want children will have them without IVF and don't need to go through any of that.

Doesn't that just make it a cheaper policy to implement, since very few will take advantage of it?

It still might end up as yet another thing we do to women's bodies.

Thanks for bringing in some common sense.

> This is one the best pro-family policies that can be implemented

Hard disagree on that. You're coming from an angle of someone who wanted to have kids and do it in a mathematically optimal way. A lot of people see egg freezing as a way to delay having kids until they're older, which can become a disincentive to raising families when they're young and healthy enough to do it. If you want a pro-family policy, you should be spending the money on people with families and their children, not on a tool that is used to delay having children in common use.

Another huge problem with this proposal is that freezing eggs is only a small part of the cost. The cost of IVF later in life could push into six figures depending on how many rounds are needed. If we're talking about pro-family policies that can cost upwards of $50,000 to $100,000 per family, there are many more effective places to spend that like on childcare options.

That money is better invested in providing affordable family housing. Even if IVF is available no one is going to actually have kids if you do nothing to make it economically sustainable to start a family.

Do we really want to rely on IVF to solve the fact that people can only afford a family home once they're well into their 40s? It's insanity if you ask me.

We, in the US, don't even have universal day care, or hundreds of other sensible things that would make child-rearing easy/less expensive. Jumping straight to "let's cover expensive IVF programs" is... well a big leap.

I went through it with my wife too and expecting a 19 y/o women to go through the IVF process as an insurance policy is a bit insane to me. In our modern, western society, this is age is still solidly childhood with not much definitive thoughts of future family, marriage, etc.

Governments need to make COL more affordable, birth rate will go up naturally

We definitely need better COL but I'm not convinced it's is the main factor for low birth rates as most countries living in poverty have very high birth rates. I think its a cultural difference that values earlier marriage and heavy family involvement in raising children which, the latter, reduces the stress of having to parent by yourself.

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If you're curious what it's like for a couple of normies doing IVF, I wrote down our experience here to the degree I remembered: https://wiki.roshangeorge.dev/w/IVF

If I'm understanding that right, it cost $25k per run, and you did 3 runs, so $75k total? Or was it $25k for the full thing? Did insurance cover anything?

Our IVF clinic has a publicly available price sheet[0] so that is correct (thought he prices are higher now): $75k total for us. My wife and I are relatively old. Friends who were approximately 10 years younger collected some 50 eggs on a single cycle. There is a drop-off in egg -> embryo but the women with the 50 eggs are likely going to end up with more usable embryos than us.

Insurance coverage is broader now. When we did it, we used cash pay but nowadays where we live in California there is SB 729 that means most big insurance plans will cover IVF. Personally, I think that's a bit regressive. Older, more established couples like us are benefiting from what will be primarily paid into by younger couples. But if pre-implantation testing becomes widespread (a good thing, imho) then IVF will be more widespread so perhaps this is a forward-looking policy. Still, expanding the child tax credit and raising it to 10x what it is would be good, I think.

0: https://springfertility.com/finance/

Didn't read that account but I went through it with wife. The egg collecting / embryo creating process is the expensive part, so depends on how many times you have to do that process. The re-implantation was significantly cheaper, so also depends on how many times you have to do that part but at least its less costly.

We ended up doing 1 extraction and 2 implantations. If I remember it was roughly ($15k-20k) then (~$5k * 2). This was about 8-9 years ago. We had no fertility issues and had other reasons for doing IVF, but if you do have fertility issues it's more risk the extraction and embryo process will fail and need repeating.

how were the adverse effects during the hormone / endocrine therapy for her?

This is a common question we get. I will ask her again and add it there, but she described:

* feeling bloated during the process (and feeling heavy in the stomach)

* the discomfort of the actual injections (there are two daily)

* pain post-retrieval that was reminiscent of cramps

One of our other friends who had many eggs retrieved on a single cycle actually got ovarian torsion which is supposed to be outrageously painful.

It's also the optimal age to have children. Fertility is highest, the woman is likely healthy and strong, lowest risk of complications.

It's also the optimal age to not have children! You're still figuring out your life, probably no stable partner or job, time to do some stuff you'll regret later, etc.

Yes, I was only speaking biologically.

"Figuring out your life" was not a thing when humans evolved.

Biological optimal vs societal optimal.

I would reframe it from

> Biological optimal vs societal optimal

to

> Biological optimal vs personal optimal

Aside from the part where you have to raise them, sure.

If everyone had kids at 18-20, then the grandparents could take care of the grandkids while in their 40s while the parents build their careers from 20-40, then start taking care of the grandkids as the cycle repeats

Peoples 40s and 50s are their most productive years. We would be better off just letting people take 10 years off in their twenties - but most people would just party party party (what they do anyway)

And then you end up raising your grandkids instead of the kids you gave birth to. It's not something that comes without cost. And what if you don't particularly trust your parents to raise kids? I suppose you would have no idea whether you did or not, because they would not have parented you...

I don't see a very big reason mentioned: You might not need it at all. Sure, the optimal age to freeze might be 19, but if 80% of women are done with children by age 30, why would you have every woman spend the equivalent of buying a small car on something they're overwhelmingly not going to need?

Waiting to get a good balance of "your eggs are still reasonably healthy" and "if you haven't had kids until now, it'll probably be a while still" is probably the reason behind the current advice.

Apparently the harvesting procedure typically (but not always?) involves general anesthesia. That alone is never entirely risk-free. In this context, the temporary loss of bodily autonomy could be particularly problematic. All that comes on top of the required hormone treatment. It's not a trivial procedure.

On the other hand, it may be a useful tool to resist expectations to become a mother until it becomes socially acceptable to say no. So it might be important even if the eggs are not getting used.

The optimal age to have children is way before you need to rely on frozen eggs (one reason among many being that this process doesn't always work)

My parents and my spouse's parents were all in their late 30s having children, now we're in the same position due to infertility and now finally going through IVF. We're happy it's working but at the same time it's sad knowing they'll grow up never really knowing their grandparents.

The grandparent situation is sad af. It's also pretty sad being a mid-40s year old dad that doesn't have the energy to keep up with their kid. I pitched a little league game yesterday and it wiped me out. Also, the fact I (and you) will not know our grandchildren very well also is quite sad.

If my son has his first kid the same age I had him, I'll be in my 80s when that kid is starting little league (or that age). Then, factor in the fact that I don't know of any men in my family that have lived past 80 and it gets really grim. They were all heavy smokers and drinkers I remind myself with fingers crossed.

The most sad part for me, is I realized by delaying parenthood - I was just being selfish - and the net result is I minimized "shared time on earth" with the person I love the most. It's easy to say I wouldn't have been a good parent or I wanted X job/income first, but it's all just excuses and selfishness.

Employers encouraging egg freezing by offering egg freezing benefits is an abysmal conflict of interest. Employers reap tremendous medium-term benefits and the woman bears all of the long-term risks -- in this case the biggest risk of all .

Employers should be required to pay for future maternity disability care insurance e.g. 2-3 years of maternal leave fully paid, elective at any time, even after they separate from the company. Also disability compensation in the event that fertility fails. e.g. $500k / missed fertility .

That would reveal the true success rate of the procedure. If employers or fertility clinics believed it to be a deterministic process, the risks for the employer would be low.

> Lastly, the stem cells we're planning to use to make these eggs accrue mutations with age, and we don't currently have a good method to fix these before making them into eggs. These mutations will bring additional risk of various serious diseases, only some of which we currently have the genetic screening to detect.

I've always found this one fascinating. Somehow human cells age and humans get old and die but humans can somehow make an entirely new creature through reproduction where that is reset and most of the defects from the parent are gone as well.

How does that work and what stumbling blocks exist that prevent us from replicating it?

> Somehow human cells age and humans get old and die but humans can somehow make an entirely new creature through reproduction where that is reset

I think the eggs aren't dividing as you age (you are born with them, so to speak) and the sperm is held "outside" the body.

One is in original packaging and the other is produced in a "cooler" enviroment by the billions with a heavy QA failure of 99.9999%.

I don't know anything about this subject, but I thought it was just natural selection that effectively filtered out the 'bad eggs', as it were. On that same note, I've worried about the effects that modern medicine might have in short-circuiting evolution/natural selection. Would love to hear from someone with qualifications to speak on this matter.

Modern medicine absolutely short-circuits natural selection. If you have an older sibling who was delivered via C-section chances are you wouldn't exist.

That’s not true for the USA however.

The large award for a medical malpractice trial was the reason for doctors pushing for a C-section if there’s any possibility of a complication. (Sometimes called defensive medicine.)

Most people point to the cases won by John Edwards, trial lawyer and vice presidential candidate as the reason for the great increase in C-sections. His case wins include 30 trials at which he won at least $1 million dollars each.

In my generation (80s-90s) pretty much everyone in Brazil that was born in a hospital was born through C-section. Only recently did the practice of defaulting to c-section is beginning to fade.

Modern medicine is part and parcel of natural evolution. There is no short-circuiting of evolution. That's not a thing.

We’re were photocopying photocopies. But I guess if you’re taking two copies and tracing a third that is based on them but doesn’t actually have to be a facsimile, it gives nature more flexibility?

Like I’m not sure it actually works this way but I can intuit why it’s possible, given the new life doesn’t have to be an exact replication.

Isn’t that what stem cell therapy is?

There are a bunch of mechanisms in sperm/eggs for better protection/repair/removal by suicide than in any other tissue. It makes sense that these evolved to be the best in these cells compared to any other. Also other tissues might have significantly worse problems having cells kill themselves instead of continuing to operate with a corrupted genome.

Naturally the reset happens before most cells have grown, part of the trick in doing it with grown humans is doing so without destroying existing tissue or causing cancer.

It's almost like trying to change the flavor of a cake after it's been baked. Significantly easier to swap out ingredients before it's that far in the process.

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It's wild that in the year 2026 modern science can't recreate a SINGLE cell (which is what a human egg/ovum is).

It wouldn't be wild if you understood how complex cells are.

Well, that seems a bit reductive because nothing can create a single cell right now. All cells are self-copied-and-divided. Omnis cellula e cellula, as they say. There is no cell constructor anywhere. Both Nature and Artifice use the same device to make more cells: a previous cell.

Trees are high technology. I’m not sure we’ll match that even in 100 years.

To encode all the atomic data and relative position of a single human cell probably would take a good chunk of all the hard drives in the world. A cell is not like a silicon chip where 99% of it is just repeating the same patterns.

https://en.wikipedia.org/wiki/Mycoplasma_laboratorium describes the closest we've gotten; synthesizing the DNA and swapping it into an existing cell which then propagates the synthetic gene line.

it's possible to convert stem cells or skin cells into functional egg cells (ova) in lab settings, though the technology remains experimental and not yet ready for routine clinical use

I'm always reading about amazing stuff like this with modern medicine. Things that work great in lab settings: cures for cancer, organ scaffolding, regrowing teeth, etc etc.

Never hear about it again after the initial news.

> Never hear about it again after the initial news.

Perhaps it is because you're not a specialist—all of these things are still worked on.

Lots of tech gets discovered, is heavily patented, and then 20 years late,r when that large first round of patents expire, people start working on and developing the tech.

Are you looking for an explanation,

or a fix,

for this?

(The fix is to consume less popular science types of sources.)

I honestly don't look forward to the day that we can do that. It may redefine our very existence more so than even automation.