AOC’s egg freezing sparks conversation about fertility

0:00N. Meltem Daysal:Support for Here and Now Anytime comes from MathWorks, creator of MATLAB and Simulink software, to design and develop engineered systems, accelerating the pace of discovery in engineering and science. Learn more at mathworks.com. WBOR Podcasts, Boston. I think we need to show more depictions of women having full lives in every context and every choice. AOC announces she's planning to freeze her eggs. So what should people know about the process? It's Monday, August 10th, and this is Here and Now Anytime from NPR and WBUR Boston. I'm Kalyani Saxena.

0:51N. Meltem Daysal:Today on the show, we'll unpack a story that made this youngest child a little cranky. It's all about older siblings and why they tend to have higher educational achievements and lifetime earnings. Turns out it might have something to do with germs.

1:08Emi Nietfeld:Second born children exposed to more respiratory illness early in life were less likely to finish high school or college.

1:18N. Meltem Daysal:But first, Congresswoman Alexandria Ocasio-Cortez had an interesting announcement this weekend. sharing on Instagram that she plans to freeze her eggs. You know, it's not the typical statement that you hear from officials. And AOC acknowledged that there's a political risk in revealing something so personal, especially as she weighs a run for president in 2028. Just by me choosing to not keep this private, there may be a consequence.

1:47Emi Nietfeld:But you know what? I'm OK with that.

1:50N. Meltem Daysal:This is a choice that I am making to feel more in control of my life. So how exactly does freezing your eggs work? Indira Lakshmanan speaks with Emmy Neatfield, a journalist and author covering fertility technology, about the process and the state of egg freezing today. So how big of a deal is it for a public figure, especially a high-profile female politician, who, as we know, are judged so harshly for how they dress, how much they smile, Hillary Clinton and Kamala Harris know this firsthand, to go public about something as personal as egg freezing? It's a really big deal. The rise of egg freezing is largely from growing awareness, and AOC is putting so much awareness out there by live posting all the shots on Instagram.

2:43N. Meltem Daysal:Right. Well, you yourself got interested in fertility when you worked as a software engineer at Google and Meta. Tech giants, of course, pioneered generous policies for covering the cost of egg freezing for employees. Critics say that's because they wanted young females like you to work longer and harder if they felt they could put off childbearing. Talk us through how you got interested in this and take us through the process that AOC is going through. When I was a 25-year-old software engineer, I had this new benefit at work, egg freezing. It seemed really exciting. It seemed like the promise to have an empowered future.

3:22N. Meltem Daysal:And so I went through it at 25. Now, all of my friends who are single basically have gone through it. And a lot of people who are engaged or married are also freezing their eggs. And it involves about 10 to 14 days of injecting yourself with medications that cause multiple eggs to mature. In a normal month, you have one egg released when you ovulate. And with these medications, you might get five or eight or 10 or 30 or 60 eggs to all be mature at the same time. When you do a trigger shot that causes your body to be willing to release them, and then they do a surgery, usually with a needle through the vagina to extract the eggs.

4:08N. Meltem Daysal:Well, Ocasio-Cortez is 36 years old. Research shows that most women who freeze their eggs are in their mid-30s. I'm curious, though, what are the trends in terms of how young women are freezing their eggs, and what is the success rate? Because I've certainly read that it's more successful the younger you are when you freeze your eggs. the vibes are definitely that younger and younger women are going for this um there's so many tiktoks about women in their mid-20s or even early 20s freezing their eggs um in part because you really do get more eggs and higher quality eggs um the the statistics are that if you're 35 or younger you have a 50 chance of having a living baby from frozen eggs and if you're 40 the rate drops to a 20 % chance if you're 40 or over.

5:00N. Meltem Daysal:So it's pretty dramatically different numbers based on when you do it. And there is so much more awareness now coming to younger women, even though the data hasn't really borne out that they're really actually flocking to the fertility clinic and finding$20 ,000 to do this. Yeah. Well, tell us about the data. What percentage of women, as far as we know, are doing this and then coming back for their eggs? And how has the price point changed or the medical insurance coverage changed to make it more accessible to more people? Yeah. So between 2014 and 2021, there were four times as many women were freezing their eggs.

5:40And just in the year 2023, 40 % more women were doing it than in 2022.

5:45N. Meltem Daysal:So this is really, you know, hugely on the rise. But the cost is very substantial. AOC says she's spending about $8 ,000 to freeze. The national average is closer to$16 ,000 for one cycle. But most women who are freezing eggs do two cycles in order to have enough eggs to have, you know, a 70 to 85 % chance of having one baby. And then women are not really coming back for them at the rates you might expect. So the estimate is that more than 90 % of women never come back and never use the eggs. And that number is higher the younger you are when you freeze. Right, right, right. Well, we know that there are higher rates of successful implantation for freezing embryos than for freezing eggs.

6:35N. Meltem Daysal:But of course, there are ethical considerations that come up more so if people are not coming back for frozen embryos. All right, in the few seconds we have left for listeners who may be considering freezing their eggs, what should they consider first? The most important thing is the age at which you freeze, that if you do it early, mid-30s or younger, higher success rates. I think the other thing to keep in mind is that experts are really clear that egg freezing is not an insurance plan. There is no guarantee that it will lead to a baby and that women tend to need a lot more eggs frozen to have good chances than they might expect.

7:12N. Meltem Daysal:Journalist Emmy Neatfeld, thank you so much. Thanks so much for having me.

7:22N. Meltem Daysal:Coming up next. As a younger sibling, I maintain that the siblings that come after the eldest are the best. We're just funnier, more easygoing, more spirited, etc, etc. No bias, of course. Now, before you older siblings listening to this get mad, you're not actually getting the short end of the stink. Because research shows that older siblings actually tend to make more money. So why is that? Well, we're still trying to figure it out. But it might have something to do with germs. And I feel vindicated because I always knew that my older brother had more cooties than me. After the break, Scott Tong, a fellow younger child, speaks with the author of a new book called Germs in the Family, the short and long term consequences of intra-house disease spread.

8:16N. Meltem Daysal:That's coming up in just a moment. But first, take a moment to leave us a comment. Are you one of those younger siblings or maybe an older one? We'd love to hear from you about the stories we're covering. Let us know in the comments.

8:32Alexandria Ocasio-Cortez:Let's talk birth order. Older siblings in general make more money over the course of their lives, get more schooling than their younger brothers and sisters. Now, as a little brother, I find this problematic. But here's the data. Researchers are finding that parental attention and family and social dynamics play a role, as do germs, according to a new study in the American Economic Review. And joining us is co-author M. Meltem-Desall, associate professor at the University of Copenhagen's Economics Department. Meltem, welcome to the program. Thank you for having me. So Meltem, can I ask you to set the table for understanding your study, first of all, by talking about what we know, what have we measured about firstborns where they do measurably better than younger siblings?

9:19Emi Nietfeld:Yeah, that's right. There's a well-known finding in economics that second-born children earn less as adults than their older siblings. about, you know, 1.9 % less in our data. And the standard explanation about this fact has been about parenting. As a family grows, each child gets a smaller share of parents' time and attention.

9:44Alexandria Ocasio-Cortez:Oh, so if you're the firstborn, you don't have to share any parent time with your sibling. That's the idea? Yeah.

9:51Emi Nietfeld:So you have that one-on-one time with your parents where you get all the attention, where you get all the resources. And then as the family grows, both the time and the available resources get divided between the siblings.

10:05Alexandria Ocasio-Cortez:And this may be outside of your field, but are there other measures that we should know about as far as firstborn siblings compared to younger siblings? Health measures, longevity measures?

10:17Emi Nietfeld:Yeah, so I mean, one interesting fact is that actually secondborn children have higher birth weight than older siblings. So they actually have a better health endowment at birth. And despite that fact, their socioeconomic outcomes and educational outcomes tend to be worse in adulthood.

10:36Alexandria Ocasio-Cortez:Wow. Well, so let's talk about your study, which looked into whether there's a role of germs and illness that can also account for these differences. Just kind of top-level findings. What did you learn?

10:51Emi Nietfeld:What we find is that when an infant has an older sibling, that baby is two to three times more likely to be hospitalized for a respiratory illness in their first year of life than their older sibling was at the same age. And the reason is intuitive once you hear it. An older child in daycare or school is constantly picking up flu, cold, RSV. Of course, bringing them all home. Exactly, bringing them all home. As a parent, yeah, of course. We've all been there, I think. Yeah. And then the younger baby's immune system hasn't caught up yet. But the real headline isn't just that babies get sick more.

11:31Emi Nietfeld:It's that this early sickness leaves a lasting mark. So we use data on 1.2 million Danish children and follow them for decades and document that greater exposure to this respiratory disease in infancy is linked to lower adult income, less education, more chronic respiratory illness, and more mental health care use years and even decades later.

11:58Alexandria Ocasio-Cortez:Is there an understandable explanation, a straight line or a dotted line, between disease early in life for, say, a younger sibling and that younger sibling doing more poorly on these measures we've talked about?

12:13Emi Nietfeld:Yeah. So the challenge in the type of work that we do is that we can point to plausible pathways, but we can't isolate one exact mechanism from the data that we use. So based on our findings, we can expect more chronic respiratory illness disrupting school and later work and possibly early life inflammation affecting brain development. but we can say how much of the effect runs through these specific pathways or confirm them directly. That would require more targeted biological data than the administrative data that we use in the study.

12:51Alexandria Ocasio-Cortez:Can you explain in basic terms how you did the study, how you gathered the data?

12:56Emi Nietfeld:So Denmark keeps an extraordinary administrative data set. So we're really, really spoiled with data here. So every hospital administration for the entire population goes back to 1981 and can be linked across family members. So we could follow every child born in Denmark, connect them to their siblings and track their outcomes into their 30s. And what we did is we layered two things together. The first one is the birth order. So we ask, is this the first or the second child? And the second layer is a disease index that we built. And this index aims to basically capture how much respiratory illness was circulating among young children in a given town, in a given month, based on hospitalization records.

13:47Emi Nietfeld:I like to explain this disease index to my students as kind of like a local flu season thermometer, you know. So how much illness is going around in the first year of a child. And respiratory viruses move in irregular local waves, almost like weather. We ask when a second born baby happens to spend their first year in a heavy disease month in place, are they affected more than their older sibling under the similar conditions? And with that sort of design, I mentioned there are short-term hospitalization effects on children. And then we documented long-term effects in three areas, education, health, and economic outcomes.

14:35Emi Nietfeld:And what we find is that second-born children exposed to more respiratory illness early in life were less likely to finish high school or college. they earned about 1 % less as adults, and they were more likely to have chronic respiratory problems like asthma. And they were also more likely to use psychiatric care as teenagers and young adults.

15:01Alexandria Ocasio-Cortez:You said economically kind of a 1 % difference, but these, I gather, you consider them meaningful differences when you kind of think about the broader implications? Yes.

15:12Emi Nietfeld:So one thing is that they are consistent across every domain we looked at. They're spread across an entire population. And because of that, they adapt to something worth taking seriously. So what you can think about comparing to is the earnings effect we get is in the same range as what researchers have found for a 10 % reduction in birth weight or a 9 % higher air pollution in your year birth. So they are economically meaningful effects.

15:46Alexandria Ocasio-Cortez:Yeah. So I guess I'm trying to think about takeaways from the study. I'm listening. I'm a younger sibling and I'm like, OK, I could see, you know, if I were in one of these towns which had more of a flu outbreak and my big brother brought home the germs and suddenly it syncs up with my life. I actually have asthma that's worse than his. And he over his lifetime has surely made more money than I have. I mean, that could be one takeaway, right? Germs might be destiny. But are there broader questions that this raises for parents or for society, policymakers? How should they think about, we have to better protect maybe younger siblings in society?

16:26Emi Nietfeld:So I'd love for this to change how we calculate the value of prevention. So right now, when health systems or employers weigh the cost of a child staying home sick or the value of a vaccine, they usually think about one missed workday, one hospital bill avoided. But our research says the stakes are bigger than that. An infection prevented in a two-month-old today may be protecting that child's earnings and health 30 years from now. So that's a case for taking prevention seriously. There's already like a good amount of steps taken towards this, specifically with respect to RSV vaccination.

17:09Alexandria Ocasio-Cortez:Early life vaccine choices.

17:12Emi Nietfeld:Yeah, and this happens in both in Denmark and the US. So CDC recommends maternal vaccination at gestational ages 32 to 36 weeks. And they recommend the antibody for any infant under eight months entering their first RSV season. Yeah. We've been talking to Meltem Desaw, co-author of the study Germs in the Family,

17:33Alexandria Ocasio-Cortez:the Short and Long-Term Consequences of Intra-Household Disease Spread. It's published in the American Economic Review. Meltem, thanks very much for the time.

17:42Emi Nietfeld:Thank you so much for having me again.

17:58N. Meltem Daysal:This message comes from NPR sponsor, the NPR Wine Club, a place to find boutique wines from around the world and bottles inspired by popular NPR shows, as well as to explore the producers, regions, and exciting stories that bring each selection to life. Whether you buy a few bottles or join the club, all purchases support NPR programming and help fund quality reporting. You can learn more at nprwineclub.org slash podcast. must be 21 or older to purchase. And we're not quite done talking about birth on today's podcast. Hospital-based maternity care in the U.S. is dwindling, raising serious concerns about the impact on mothers, especially in rural regions where giving birth is becoming riskier.