MANHATTAN BEACH, Calif.

Brigitte Adams caused a sensation four years ago when she appeared on the cover of Bloomberg Businessweek under the headline, "Freeze your eggs, Free your career." She was single and blond, a Vassar graduate who spoke fluent Italian, and was working in tech marketing for a number of prestigious companies. Her story was one of empowerment, how a new fertility procedure was giving women more choices, as the magazine noted provocatively, "in the quest to have it all."

Adams remembers feeling a wonderful sense of freedom after she froze her eggs in her late 30s, despite the $19,000 cost. Her plan was to work a few more years, find a great guy to marry and still have a house full of her own children. Things didn't turn out the way she hoped.

In early 2017, with her 45th birthday looming and no sign of Mr. Right, she decided to start a family on her own. She excitedly unfroze the 11 eggs she had stored and selected a sperm donor.

Two eggs failed to survive the thawing process. Three more failed to fertilize. That left six embryos, of which five appeared to be abnormal. The last one was implanted in her uterus. On the morning of March 7, she got the devastating news that it, too, had failed.

Adams was not pregnant, and her chances of carrying her genetic child had just dropped to near zero. She remembers screaming like "a wild animal," throwing books, papers, her laptop — and collapsing to the ground.

"It was one of the worst days of my life. There were so many emotions. I was sad. I was angry. I was ashamed," she said. "I questioned, 'Why me?' 'What did I do wrong?'?"

In an age when egg freezing has become so popular that hip employers such as Apple and Facebook cover it as a perk and grandparents help finance the procedure as they might a down payment for a house, there's surprisingly little discussion about what happens years later when women try to use them. Fertility companies tend to advertise egg freezing — "oocyte cryopreservation" — in scientific terms, as something that can "stop time." And many women believe they are investing in an insurance policy for future babies.

But the math doesn't always hold up. On average, a woman freezing 10 eggs at age 36 has a 30 to 60 percent chance of having a baby with them, according to published studies. The odds are higher for younger women, but they drop precipitously for older women. They also go up with the number of eggs stored (as does the cost). But the chance of success varies so wildly by individual that reproductive specialists say it's nearly impossible to predict the outcome based on aggregate data.

A number of Adams' friends were also early adopters of egg freezing; today they are facing a similar reckoning.

Amy West, 43, a professor in Los Angeles, is one of the lucky ones. She had a baby boy 22 months ago and has numerous eggs left over. Carolyn Goerig Lee, 46, a nurse from Haymarket, Va., froze 25 eggs and planned to have a large family with them. She successfully gave birth to twins, but the other eggs were abnormal or lost to miscarriage. Then there is MeiMei Fox. After the 44-year-old Honolulu-based writer got married, she tried to use her frozen eggs. The whole batch of 18 was destroyed while being shipped from one clinic to another.

The four women's experiences underscore the incredible uncertainty involved in egg freezing. James Grifo, a fertility specialist at NYU Langone Health who is one of the pioneers of the procedure, calls the whole notion of being able to "control" your fertility — perpetuated by the media and embraced by feminists — destructive.

"It's total fiction. It's incorrect," Grifo said. "Your whole life it's beaten into your head that you're in control and if you can't have a baby, you blame yourself. There has to be more dialogue about what women can be responsible for and what they are not responsible for."

NYU Langone began offering elective egg freezing in 2004, one of the first programs in the nation. Since then, about 150 babies have been born using thawed eggs, Grifo said. That represents a 50 to 60 percent success rate — hardly a guarantee.

The fertility cliff

Forty years ago, before "let's chill" egg freezing parties were in vogue, before The Bachelorette's Kaitlyn Bristowe and other celebrities were tweeting about "taking control" of their future, young working women were already being warned about their waning fertility. Washington Post columnist Richard Cohen famously wrote in 1978 that a woman's "biological time clock can create real panic." Since then, countless scientific experiments, advice books and talk show hosts have delved into the topic.

Doctors now know that the No. 1 factor affecting a woman's ability to have children as she grows older has to do with eggs. At the moment she is born, a woman has all the eggs she will ever have already in her body. They are finite, and they sit there in the ovaries, aging. Each month, beginning at puberty, a single egg is released. Even in a healthy young person, the eggs are of varying quality with a certain percentage being flawed in structure or number of chromosomes. That's one reason it can take months or years to get pregnant, and why miscarriage is common.

Around the age of 35, women confront a "fertility cliff," when the chances of becoming pregnant decline sharply as the eggs decrease in number and quality. By age 40, the average woman has a 5 percent chance of getting pregnant in any given month. By 45, it's 1 percent.

In an unfortunate and unfair twist of nature, men are believed to replenish their sperm at a rate of 1,500 a second through most of their lives; there are documented cases of men remaining fertile into their 90s. Age also affects the quality of sperm, according to numerous studies. But the effect on fertility is markedly less dramatic than in women.

Thus the need for "social" egg freezing as it exists today, and why more and more women are willing to pay $10,000 to $16,000 per retrieval cycle, plus hundreds of dollars in yearly storage fees, to put their eggs on ice. While there are no comprehensive national statistics, the Society for Assisted Reproductive Technology, which represents the majority of fertility clinics in the United States, found in its latest survey that the number of women freezing their eggs is skyrocketing — from 475 in 2009 to nearly 8,000 in 2015.

The procedure is growing rapidly in popularity: Gina Bartasi, the former chief executive at fertility benefits company Progyny, predicts that as many as 76,000 women could elect to freeze their eggs this year.

Frozen at 37

Amy West, an academic with degrees from the University of Virginia and Stanford University, is well aware of the research on female fertility. In her 20s, she vowed to have a child by the age of 37. But as 37 approached, she was unmarried and working long hours as a not-yet-tenured assistant professor. So in 2011, she decided to freeze her eggs.

Everything went great, and she got 26 eggs — a very large number.

Three years later, at the age of 40, West was ready to use them. It took two tries and four months to get pregnant, but today, West is the mother of a healthy toddler, with plenty of eggs left over.

"Those eggs really paid off for me. I never imagined being a single mom. Now I think about having more," she said.

Thanks, Oprah

Carolyn Goerig Lee first got the idea to freeze her eggs from Oprah Winfrey. The show aired many years ago, before the procedure was commercially available, but Lee vividly recalls a female doctor, single and in her 30s, talking about the need for the technology.

In 2008, Lee was 37 and starting to think about children just as egg freezing was taking off. She had been dating a great guy she met at the McLean Bible Church in Virginia and, despite their different backgrounds — he is a Korean American engineer and entrepreneur, she is a Hungarian-German-Irish nurse from a military family — they seemed to click. But she was in Seattle and he was in Virginia, which made their future somewhat iffy.

So with his support, she froze her eggs. Because of her age — 39 by the time she decided on a clinic and went through with the procedure — and the results of her blood work, her doctor advised two rounds. It nearly doubled the cost, but it gave her a better shot at having a baby. She got a total of 25 eggs.

Fast forward a few years: Lee and the engineer married and were ready to have a family. Initially, they were worried they had too many eggs.

"The idea of fertilizing 25 eggs was a little overwhelming," Lee recalled. But once they started the process, they realized that each egg was not necessarily fated to become a child.

Reproductive health specialists sometimes describe the success rates of thawing eggs, fertilizing them and transferring them to the womb as resembling an inverted pyramid: You start with a certain number of eggs and lose some at every step.

While the freezing process has advanced significantly in recent years, 5 to 15 percent typically don't survive the thawing process. The eggs that make it are fertilized with sperm. The resulting embryos are left to grow for three to five days and graded on certain characteristics. The most promising are then transferred to the woman's womb, where only some adhere to the wall of the uterus, the first step in a successful pregnancy. From there, the pregnancy faces the usual risks, including spontaneous, unexplained miscarriage.

Lee says she is grateful for her twins, a boy and a girl who are now 4½. But she and her husband always yearned for a larger family. After losing the rest of her eggs, Lee had another set of twins using eggs donated by her younger sister and, recently, she gave birth to a fifth child also using a donor egg. She says she's "over the moon" happy.

"The best piece of advice I have is have a backup plan if your eggs don't work. It's not the end of the world," she said. "You can still be a mom."

Ruined in transit

When MeiMei Fox froze her eggs at 37, the process went more smoothly than she expected. The retrieval, where the doctor removes eggs from the ovaries with a long needle, went without a hitch. She remembers going home and taking a nap.

"I was thrilled and thought it was the best decision I ever made," she said.

Fox immediately started dating "without thinking about long-term commitments but just enjoying the moment." She blogged about her experience in HuffPost. As fate would have it, she found "the love of her life," a filmmaker and fellow writer, months later. The two were soon married.

For almost two years, they tried to get pregnant naturally. When Fox was about to turn 40, she decided to use her frozen eggs.

She was living in Los Angeles; her eggs were in San Francisco. Her new clinic called her old clinic and had them shipped south.

"They knew from the minute they opened the package something was wrong," Fox recalled. A lab tech later showed her the straws in which the eggs were stored, and how they had leaked.

Fox was beyond devastated. But after three years of traditional IVF and fertility treatments with her current eggs, she gave birth to twin boys.

"There's a happy ending, but with a lot of pain and heartbreak and $100,000 along the way," she said. "Their grandparents are always asking if I started their college fund. I'm like, 'The college fund went into creating them.'?"

A bad, bad day

Soon after the Bloomberg Businessweek story ran, emails began pouring into Brigitte Adams' inbox. Women from all over the world wrote to ask for her advice. She launched a blog, Eggsurance, which grew into a thriving community where people shared tips about egg freezing.

In Adams' story, many other young women saw a road map for a happy life. As the years passed and egg freezing took off, she became the de facto poster child for a generation of women considering the procedure.

But that painful March day, when the last of her frozen eggs failed to produce a pregnancy, Adams said she realized how one-sided the conversation about egg freezing had been, and how little information was available about what she calls "part two" — when you actually try to use those eggs to get pregnant.

"There is a huge marketing hype of it, and overpromising," she said.

So Adams dusted off her laptop and began trying to make sense of her situation.

First, she said she learned that the fertility industry is very "cagey" about providing data on success rates. "It's easy for them to say there isn't data right now. And really there is. There is some data. It's just not pretty data," she said.

Individual clinics are often reluctant to share their own information, she said, and many don't refer patients to academic studies that attempt to quantify the probability of success. Only a few such studies exist: A 2016 Fertility and Sterility study of 137 women who tried to use their frozen eggs found that women who froze 10 eggs at the age of 36 faced a 30 percent likelihood of achieving a live birth. Last year, researchers writing in Human Reproduction calculated that the same women should have a 60 percent success rate based on their mathematical model.

Second, Adams said many clinics sell women on a single egg retrieval procedure without mentioning that more may be needed to harvest enough eggs to produce a successful pregnancy. This is what happened with Adams. When she recently reviewed her tests, she said they clearly showed that her fertility already had been in decline, suggesting that she would need more than 11 eggs to conceive. The lack of advice was "unconscionable," she said. "I was never told that x, y and z were a possibility."

While she is still a proponent of egg freezing, Adams said women need to be better educated about the possible outcomes, including the bad ones, and the industry needs to be more transparent.

"We are only seeing half the story, which is a very optimistic story," she said. "But, really, you need to see both."

Her own story has a happy twist. After a dark period of mourning and soul-searching, Adams began IVF again, this time with a donor egg and donor sperm. On a recent weekday afternoon, she was lying on an exam table staring at a computer screen — her first ultrasound.

Picking out a sperm donor was fun, she said, like perusing an online dating site to find the ideal mate. Trying to select an egg donor, on the other hand, was "excruciating," she says: "You are thinking, 'This should be me.'?"

Adams says she is trying to control her emotions, given the ups and downs of her long journey. But then the doctor comes in and locates the thud-thud of a heartbeat, and her eyes start to water.

The baby, a girl, is due in May.

© 2018 Washington Post