Being Neurotic about Fertility: Notes from the 2026 Reproductive Frontiers Conference

boba_girl

In light of AOC freezing her eggs at 36, someone on X commented:

That might be so, but in absence of getting knocked up by the closest Chad ASAP, I figured I, like AOC, had no great options.

Well, maybe AOC has more options than me:

Anyway, I think the men hating on AOC are missing an obvious point when they imply women should just have babies sooner. No matter how much some of us want kids, the modern constraints of career and, more importantly, meeting the right person remain bottlenecks.

Even though I'm only 26, it was something I thought about, having not met the right person yet myself.

So in my own quest to be neurotic about fertility, I attended the Reproductive Frontiers conference earlier this year in June. I ended up learning a lot of things about fertility and embryo selection that felt personally relevant to my personal planning (mid-twenties, healthy, single). I hope this post can be helpful to you if embryo-selection is something you’ve also been considering!

If you work in the field, please feel free to add nuance or corrections! Also, since science is always evolving, please consider this only up to date in mid-2026.

Epistemic disclaimer: I am not a scientist and I don't work in the fertility tech industry.

Acknowledgements/Disclosure:

Thanks to my friend Chase Deneke from Herasight for providing some relevant context/links.

I paid for the conference ticket myself, and am not financially affiliated with any reproductive tech company.

Should I freeze my eggs?

If having kids is a priority for you and you can afford to, yes.

Egg-freezing is often pitched to single women in their thirties as an dating insurance policy. As someone in my mid-twenties, I was in the wait-and-see camp before attending the conference. Why go through the not-so-pleasant process of egg-freezing if there was a chance I didn't need to?

Attending the conference pushed me to the just-do-it camp for a couple reasons:

1. Fertility is hard to predict before you start trying. Even if I am perfectly fertile, if my future partner’s sperm has issues, then the number of eggs would still be a bottleneck. This was the case for someone at the conference!
2. There may be predictable genetic disorders between me and my partner that would push me to do IVF down the line anyway.
3. Having frozen eggs/embryos increases the flexibility to have the number of kids I’d want to down the line. At some point, natural conception gets difficult, and I wouldn’t want that to be the bottleneck for not having more kids.

The above reasons convinced me egg-freezing was probably worth doing even if I didn't necessarily have to do it for the typical fertility timeline reasons. And if I leaning towards freezing my eggs anyway, I should act sooner rather than later, since freezing eggs when I'm younger would yield more eggs, and eggs of a higher quality.^[1]

When should I have kids?

Scientists at the conference kept emphasizing how much better it was to have kids earlier, and that the modern myth that “you’ll probably be fine fertility-wise until your mid-thirties” was misleading. A couple parents and prospective parents expressed regret that they didn’t have children earlier.

Here are some reasons I found compelling:

1. Fertility is difficult to predict before you start trying. The sooner you and your partner know you have issues, the more time you have to try different treatment options.
2. Having kids earlier (both maternal and paternal ages matter) predicts good health outcomes.
3. Trying earlier gives you more flexibiliy for having the number of kids you want.
4. Having young kids when you have the energy to raise them is great.
5. The earlier you have your kids, the more time your parents will have with them.

I have updated my having-kids timelines to be closer to “as soon as I find the right partner” as opposed to “when the timing is perfect”.

What is polygenic embryo scoring?

Basic IVF screening includes screening for chromosomal abnormalities or single-gene mutations. If doctors find these abnormalities, the embryo almost certainly has the predicted trait.

Polygenic embryo scoring is more predictive and statistical. It uses data and algorithms to give you an embryo’s predicted risk profile for a range of more complex traits, like lifetime susceptibility to certain diseases. It can also be used to predict complex traits like intelligence with some level of accuracy.

What are some of the risks of the IVF process?

Ovarian Hyperstimulation Syndrome is a real risk, and it is worth looking into before you decide to do egg-freezing. The risk is higher if you are young, or have PCOS.

Anecdotally, I’ve heard the recovery from egg-freezing ranges a lot—from very little downtime to two months of brain fog.

As somone who is quite cautious about my health generally, I was wondering if there was any way to lower the risks of IVF. Someone at the conference mentioned that there are clinics that have a more hollistic and personalized appraoch if hormone sensitivity/health was something I was concerned about.^[2]

Should I freeze eggs or embryos?

Honestly I didn’t even think there was much of a difference going into the conference, so I just assumed I would freeze eggs because I currently don’t have a partner. Having learned more, I think when I find a partner I would also try to freeze some embryos.

Here are some things I’ve learned about the trade-offs:

Reasons to freeze eggs:

1. It doesn’t require you to commit to a partner.
2. Although we are not necessarily close to being able to do sophisticated sperm selection, if you are bullish on sperm selection technology,^[3] you could freeze eggs to leave open the possibility of fertilizing your eggs with specially selected sperm. There are a lot more sperm than eggs so this potentially is quite powerful.

Reasons to freeze embryos:

1. Freezing embryos is better than freezing eggs in translating to live births. ^[4] This makes sense, because embryos are bigger and more robust than eggs, which are single-cell.
  
  Because embryos have a higher chance of implantation success than eggs, how many healthy embryos you have also gives you a more realistic sense of how many babies you can expect. This reduces the risk of having false confidence that you've frozen “enough” eggs to have the number of kids you want!
2. There are two methods of egg-fertilization with IVF: conventional and ICSI.
  
  Conventional egg-fertilization is basically soaking the egg in sperm and letting the sperm naturally race to fertilize the egg.
  
  ICSI, or Intracytoplasmic Sperm Injection, is when a technician injects a specific sperm cell into an egg to assist in the fertilization process. We don't currently have sophisticated methods of differentiating better sperm from worse sperm, so the specific sperm that is injected is basically chosen at random.
  
  If you freeze eggs, you bascially have to rely on ICSI fertilization because after eggs are thawed, the cell walls are probably too strong to rely on conventional fertilization to penetrate them.
  
  If you choose to freeze embryos, you can try conventional fertilization. Intuitively, one may suspect that eggs have some “natural selection” process for which sperm fertilizes it naturally, which suggests conventional selection might be better.
  
  Still, it's not like conventional fertilization always works. Some couples have more success of fertilization with one method than the other.
  
  Here’s a website that compares some of the health outcomes: https://remembryo.com/do-children-conceived-through-ivf-have-long-term-health-problems/. It doesn't seem that drastic, but still worth considering.

How much alpha is there in polygenic embryo selection?

You can get up to date information for what Herasight offers here: https://www.herasight.com/. As the calculator on the website illustrates, you can expect to have greater selection power the more healthy embryos you have.

I also found this post from late 2025 quite helpful. It details one couple’s embryo selection process and the traits they were considering. The technology might not be as powerful as you’d expect!

Should I do embryo selection to minimize disease risk?

It probably depends on your risk tolerance and risk profile. If you or your partner have a family history of a genetic condition you’d strongly prefer to avoid, you probably should! If you aren’t sure, you can do some preliminary screening before deciding to commit to IVF and embryo selection.

There are different kinds of genetic screening:

1. You and your partner can get genetic sequencing independently before trying to conceive naturally.
  
  If you go to your OB-GYN and tell them you want to start trying soon, they would probably take your and your partner's family history and might recommend some basic genetic screening tests.^[5]

Some caveats:

1. 1. Chase Deneke: The type of screening OB-GYNs offer is usually basic carrier screening for stuff like sickle cell, not polygenic risk scores like the ones for breast cancer or diabetes. Hopefully in the future one of the polygenic embryo screening companies will offer this, but they don't yet.
  2. This would not catch de novo mutations (mutations that occur spontaneously in the embryo that are not inherited from either parent), because you're just screening the parents, not the embryo.
2. You can run genetic screening tests on embryos from IVF.
  1. This would catch some of the de novo mutations that occur after fertilization.
3. If you have a high-risk pregnancy, you can run genetic screening tests on early pregnancies.
  1. If they find something it would be up to you whether to terminate.

If you’re debating doing egg-freezing, you can get some genetic testing done on yourself even before you have a partner! The results might push you in one direction or the other.

How much does IVF/embyro selection cost?

I’d estimate 100k^[6] is what you could expect all-in for a couple cycles of IVF and Herasight screening, though there are many ways to save money on the IVF part of it.

Some companies offer fertility benefits that can cover the IVF part, but they can be tricky to navigate and are worth looking into well in advance^[7].

Is embryo selection for positive traits “worth it”?

Ultimately, this is up to you.

My sense leaving the conference is that if I were going to do IVF anyway, I’d probably do it.

If optimizing traits was really important to me, I’d also probably do multiple rounds of IVF to get the most meaningful difference. Again, the article here is great for calibrating what you could expect: https://nudgedice.substack.com/p/our-son. The alpha doesn’t seem radical if you don't have that many viable embryos.

The sticker price for polygenic embryo selection itself is kind of steep—but when compared to other disease-intervention costs down the line, or even the amount many parents are willing to spend on private education (with debately negligible impacts on life outcomes)^[8], it seems pretty reasonable to me.

You could also choose to only screen for disease risk if you don't care/don't want to optimize for other traits, which would make the testing cheaper.

How much should I factor in the rate of progress on technology on when to have kids?

This is very handwavey epistemically but from asking around at the conference:

Every year, we are getting a bit better at doing polygenic screening.^[9]

We’re pretty far (maybe 20 years?) away from safely doing gene-editing for polygenic traits. We are closer technologically (maybe 3 years) to doing single-gene edits, but pretty far from it being legal.

We are pretty far away from being able to do sperm selection (20 years? 3 if we get AGI?)^[10], but if you’d like to keep your options open to that just make sure to freeze at least some eggs and not just embryos.

Should I use a surrogate?

I’ll leave the ethics part of this up to you, but here are some things to consider:

1. You would not be able to control the conditions of the pregnancy. The surrogate mother could eat whatever they want, and engage in any kind of risky behavior you might not approve of.
2. You have no legal say in major medical decisions during the pregnancy.
3. Surrogate mothers are at much greater health risk carrying someone else’s child than their own.

Generally, it seems more risky to use a surrogate, so it seems like you should factor in how many healthy embryos you have when making that decision.

How would embryo selection affect my relationship with my kid?

This question is a little fuzzy, but I felt like it was worth addressing. Before the conference, I was quite worried that the process of doing embryo selection would negatively affect my relationship with my future child. In particular, I had a couple concerns:

What if, in the process of doing embryo selection, I unknowingly selected for other unwanted traits?

Polygenic testing cannot screen for everything. It currently can’t even screen for some pretty important things, like depression. However, a lot of good health and cognitive traits are positively correlated^[11], so there is no reason to believe that by doing embryo selection, I would be putting my future child more at risk.

Specifically, diseases are not correlated with each other, so by selecting against a known disease, you are actually less likely to accidentally select for different disease.^[12] This was greatly reassuring to me.

If you’re still worried about unintended outcomes of selecting incorrectly, due to “unknown unknowns”, a relevant point of comparison is the default process for selecting embryos for IVF. What usually happens in IVF is that the technician looking at the embryos and picking what “looks” to be the healthiest, but this process is a lot more error-prone than genetic testing.^[13] If you’re going to do ivf anyway and have enough healthy embryos, selecting with polygenic screening seems a lot better.

What if the process of embryo selection causes me to project a lot of unhealthy expectations on my child?

I talked to a mother who actually went through with the process, and she assured me that once the baby was actually here, she had no trouble loving him exactly as he was.

Moreover, according to her, early parenthood involves so many practical realities of caring for a baby that her pre-pregnancy anxieties about whether her child would be “smart enough” just didn’t seem as important anymore.

Embryo selection as a way of enabling life.

While I originally came into the conference with an understanding of embryo selection as a way of “optimizing”, a couple people in the conference brought up a different perspective.

Especially because the modern age pushes people to have kids later and later, reproductive technology is a way to enable us to have more children than we could have otherwise.

A stance held by a few people who wanted multiple kids was that: when they are young, they would opt for natural conception, and when they get older they would rely on IVF and embryo selection to protect against some of the hazards of having children beyond their reproductive prime.

“It’s just another way of creating life”, as one attendee put it. I think that’s a good way of looking at it.

Some more information I am interested in but don't have:

- I know we don’t have data on polygenic-embryo screened babies (since it’s only been a few years since the tech was available), but I would love even anecdotal evidence of its results.
- Does the current embryo selection process bias towards a certain kind of intelligence? Like a high-neurotic kind of intelligence?
- Predictions on how close we are to accurately predicting neuroticism, or depression. I understand that we are quite data-constrained since these are fuzzy definitions to begin with.
- More stories about families using embryo selection, and more spreadsheets on the real trade-offs potential parents face.
- More detailed predictions for upcoming reproductive tech, like gamete selection or gene-editing.
- More stories about surrogacy.
- Real financial breakdowns of ivf + embryo selction process.
- Any other relevant, actionable information to family planning!

I would greatly appreciate if people more knowledgeble than I write posts on these! Or even just tweet their takes!

Also, please feel free to link other relevant posts/tweets on this post. I see my post as just a starting point, and would love it if it encouraged more people to share relevant information. We can be a resource to future parents who want to neurotic about fertility together :)

^{^}
https://www.lesswrong.com/posts/dxffBxGqt2eidxwRR/the-optimal-age-to-freeze-eggs-is-19
^{^}
Most clinics will start with the standard cocktail of hormones and then adjust for future egg-freezing cycles after seeing how you react the first time around, but some clinics like The Egg Whisperer will adjust the hormones for your first round based on your individual profile.
^{^}
One estimate from an optimistic fertility doctor is 20 years.
^{^}
Chase Deneke: Roughly 9-18% of eggs are lost after thawing, with the biggest chunk of variance coming from the mother's age when the eggs are frozen.
And then roughly 6% fewer fertilize after thaw if they've been frozen, at least according to some studies.
This study showed 74.4% fertilization of fresh eggs vs 68.2% for vitrified eggs, even after controlling for losses from thawing: https://academic.oup.com/humrep/article/35/10/2262/5898360?login=false
^{^}
According to a friend, usually they screen the mother for heritable conditions first, and then if there is something concerning, they will screen the father. However, it is not too expensive to pay for genetic screening yourself (my male friend paid ~$400 from labcorp to get their screening).
^{^}
The average IVF cycle costs ~20k in 2026, but you could definitely get it done for much cheaper if you are willing to do it in a different country or buy your own medication.
As of 2026, Herasight currently charges 50k for genetic testing for up to 20 embryos.
If you have actually done embryo selection yourself and would like to share, I’d be curious how much you spent all-in.
^{^}
Some companies have fertility benefits that can cover one or more rounds of IVF. I would caution that it's worth looking into the fine print of your company's policy and planning in advance if you want to use them.
Here are just a few surprises I've found:
1. These fertility benefits may or may not be tax-deductible.
2. They may or may not require you to be on a PPO plan. I'm not sure how common this is, but I breifly looked into my company's fertility benefits and discovered that I cannot be on Kaiser insurance if I want to use the fertility benefits. So I have to delay my egg-freezing plans until next year because I have to wait for open enrollment to get off Kaiser insurance.
3. Some companies/insurances will only cover ivf after a diagnosis of infertility. My friend mentioned that in order to use his benefits, he needs to prove that he and his partner have been trying for at least a year, or his partner needs to be over 35.
^{^}
Attending private high school has no significant impact on SAT scores https://gwern.net/doc/iq/high/2014-dobbie.pdf
^{^}
Chase Deneke: I don't know if we have enough data yet to make a Moore's law of polygenic screening. We've gone from a correlation of 0.3 to 0.45 with IQ over the last 4 years or so.
Other predictors have improved more.
^{^}
One estimate from an optimistic fertility doctor is 20 years. Someone working in the space claims closer to 1-3.
^{^}
Intelligence and Social Mobility: https://www.cremieux.xyz/p/intelligence-and-social-mobility?utm_source=publication-search
Cognitive epidemiology: https://en.wikipedia.org/wiki/Cognitive_epidemiology
^{^}
https://infoproc.blogspot.com/2020/03/pleiotropy-myths-and-reality.html
^{^}
https://x.com/GeneSmi96946389/status/2057885079096184891?s=20

[-]Viliam13d30

the modern constraints of career and, more importantly, meeting the right person remain bottlenecks.

Yeah. A plan "I will have kids when N years old" assumes that at your Nth birthday, you will have the right person next to you, and that the right person will agree on the timing. It may be more realistic to assume that if you get serious about having kids at the age of N, you will find the right person at about N+5.

Also, if you want to have more than one child, what time intervals do you want between them? Because wanting to have two kids, with start at N and interval X means the second child comes at N+X or maybe N+5+X. For three children, it is N+2X or maybe N+5+2X... and that number may turn out to be uncomfortably large. Also, random things may happen to disrupt your plans, such as COVID recently, or some economical crisis.

(In the opposite direction, sometimes pregnancies come unplanned earlier.)

Even more uncomfortable question is to ask how old you want to be when your youngest child is a teenager? Because they will still need you at that point. So, N+(k-1)X+15 or maybe N+5+(k-1)X+15...

Then you realize on gut level how short is human life.

[-]Richard_Kennaway13d40

"I will have kids when N years old" also assumes that when you are N years old, you will want to have kids.

[-]sugarspicedxdy6d10

I try not to ask people to do things for me that have >50% risk of injuring them, especially when the injury is likely to scar and need stitches, and especially if there is a smaller concurrent risk of permanent injury like levitator ani avulsion* or pelvic organ prolapse. I see rates for the former at 10-30%, depending on the study, and rates for the latter at around 10%. When considering surrogacy, we should include the risk of all possible injury and ask ourselves what ethical weight we assign to that. Cost/benefit goes beyond the price of the contract.

*internal muscle tearing off the bone - surgical interventions are still being tested, so don't count on a 'solution' for all cases

[-]zebrask8d10

On the question of having kids young: I am very torn on this because I had my kids around 30 and I definitely feel like it would have been physically so much easier and nicer to have them up to a decade earlier. My back didn't start really hurting until I was in my late 30s, I had horrible sleep habits in my 20s anyway, plus I would have more time with teenage / adult children, more time with potential future grandkids, etc.

That said, I was a grad student for half my 20s and didn't start making good money until my late 20s / early 30s, and money makes basically everything easier. Don't like the local school? Pay for private school or move. Need a bigger car? No worries, it's just money! Oh no they charged me $3000 for an ambulance ride to the hospital to give birth! Ah well, guess I will retire 1 week later or something.

I do usually suggest to people that they have kids earlier than they otherwise would have for all the reasons you mention, but I don't know about the counter factual world where I had to do bargain shopping for baby formula instead of just getting the best one and maybe because of childcare duties I didn't have time to prepare for the interviews for the high paying jobs I eventually got.

Maybe the best advice is to be born into money (or marry into money) and have kids when you are 20.

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