In the serene, sunlight-filled waiting room of California Fertility Partners in Los Angeles—one of the world’s leading practitioners of in-vitro fertilization (IVF)—some 20 people are seated on blue velvet chairs. Two men, clearly a couple, coo over a pink-cheeked baby girl who is triumphantly waving a stuffed duck. A 40-something blonde woman in black workout clothes punctuated by diamonds sits across from a slightly tense couple conferring in Mandarin. Behind me, I hear a conversation in French; in another corner, a trio of women—perhaps the employees one hears about from companies such as Apple and Google who come here in groups to freeze their eggs, a perk that is generously subsidized by their employers—quietly laugh. More and more, this scene is being repeated all over Los Angeles.
While first-rate fertility clinics can be found throughout the U.S., California, long known as the home of the fresh start and the forward-looking, is becoming a hotbed for advancements in the field—both for American families and for an ever--growing wave of families from abroad who are now flocking to the Golden State for its booming conception business.
Why California? For starters, it possesses some of the country’s most well-regarded labs, surrogacy brokers, and egg donation agencies. According to a published report analyzing the Centers for Disease Control and Prevention (CDC) data from 2016—the most recent year available—out of the 50 busiest IVF clinics in the United States, ten are in California. “Not all clinics report,” cautions James A. Grifo, M.D., Ph.D, the program director at NYU Langone’s esteemed Prelude Fertility Center. “California is certainly represented at higher levels relative to many other states, but there are so many variables—it’s hard to pick one and say, ‘This is the reason.’ ” What is incredibly clear, though, Grifo continues, is that the trend to delay childbearing is “a real and significant phenomenon.” For the first time in the history of the United States, he says, citing another recent CDC study, “we are seeing a drop in birth rates in younger women, and a rise in birth rates in older women.”
An increased need for assisted reproductive technology, or ART, as it’s called, has followed, and California—with its influence from, and proximity to, the tech world—has found itself strategically positioned within the growing field. “If you go out of the country and see some of the IVF labs, they’re over a decade behind,” says Robert Boostanfar, M.D., a specialist with HRC Fertility, which has ten locations from San Diego to Los Angeles and into Ventura County. “It’s very expensive to maintain a high-quality IVF lab, with top personnel, new incubators, and new culture systems,” he says. “We’re able to put a lot of resources back into the infrastructure of the IVF labs here.”
The sheer expense of IVF can’t be overlooked when discussing the rise of the West Coast fertility industry, which for the most part requires patients to pay out of pocket, says Lauri Berger de Brito. As the co-owner of the Agency for Surrogacy Solutions, de Brito helps screen and match gestational carriers with ‘‘intended parents,” and oversees the pregnancy for a $20,000 fee. (There are only a handful of states with fully comprehensive surrogacy legislation, and California is one of them.) “If it all goes perfectly,” she adds, additional costs—a surrogate’s medical and travel expenses—often average around $130,000.
California does require insurance companies to cover infertility treatments such as hormone medications, but not the far pricier IVF, which can start at roughly $15,000 per round. (Only fifteen states offer insurance coverage for IVF to varying degrees; half are in the Northeast.) Subsequently, its doctors, de Brito suggests, do more because patients expect more. “They’re not going to sit back and say, ‘OK, we’ll just take our time and do five IVF cycles,’ because insurance is not going to pay for five IVF cycles.” Pressed for faster results, California clinics, she says, report higher success rates—“and those high numbers get out to the rest of the world.” That the state has some pretty nice beaches has factored into its popularity as well, says Boostanfar. “We call it the ‘fertilization vacation,’ ” he notes with a laugh. Patients come for the IVF, and they stay for the Malibu sunsets.
Aspiring parents from China in particular, spurred by the eradication of the country’s one-child policy, have been making their way to Los Angeles. Three quarters of Agency for Surrogacy Solutions’s patients come from abroad, according to Kathryn Kaycoff, de Brito’s partner, with a large percentage from China. In 2012, the Year of the Dragon in the Chinese Zodiac—an auspicious calendar event associated with luck, strength, and intelligence—the company saw a marked increase in interest from the country. They now work with facilitators in China (where IVF is legal, but surrogacy is not, and egg freezing is prohibited for unmarried women).California is also widely regarded as having a friendly legal environment not just for surrogacy but for the wider world of assisted reproduction. Since 1994, the state’s courts have been establishing case laws that clearly spell out that the intended parents should be considered the baby’s legal parents, according to Richard B. Vaughn, founding partner of International Fertility Law Group. “This easily makes it the state with the most favorable case law in the country,” he continues, detailing the sort of security international couples need to get a baby back into their country of origin. “So in addition to this legal backdrop, and perhaps because of it, there are also more surrogacy and egg donation agencies and more IVF clinics in California than in any other state in the country,” adds Vaughn, who has two children through egg donation and surrogacy with his husband. This being Los Angeles, Vaughn is also a trained fitness instructor.
Ten minutes after arriving at the waiting room of California Fertility Partners, I am met by Kelly Baek, M.D. Tall and slim, with glossy dark hair spilling onto her white lab coat, Baek was mentored by Zev Rosenwaks, M.D., one of the founding pioneers of ART. She is wearing a necklace with large pearls. Each, she tells me, is the size of an ovarian follicle holding a mature egg ready for retrieval—a handy visual guide for patients that was a gift from her husband.
As we tour CFP’s facility, she describes the latest techniques in fertilization and embryo selection. They’ve found that with egg-freezing specifically, using top-of-the-line devices and “media” (the liquid nutrient material in which eggs, sperm and embryos are cultured) from a Japanese company called Cryotec, has resulted in the best survival rates. Leaving embryos undisturbed from day one to day five —when the embryo becomes what’s known as a blastocyst—rather than checking on them on day three, as many centers do, has been similarly revolutionary. “That has really increased our high-quality blastocyst rate,” Baek says.
Baek ushers me into her office, a wash of soothing grays and blues, pierced by a single pink orchid. I ask the 47-year-old mother of three about her own difficulties with infertility, which she occasionally shares with patients to let them know that she empathizes with their fears and worries. “In order to become a fertility specialist, a very competitive field, I delayed having children,” she says. “And when I went through IVF treatment . . .” Baek trails off. “I’m sorry. I haven’t talked about this in a long time,” she continues as her eyes well up with tears. Her oldest children, twin boys, are now twelve, but the trauma of infertility remains on the surface, still raw.
“It can be gut-wrenchingly painful,” confirms Melissa Robinson-Brown, Ph.D., assistant clinical professor of Psychiatry & Adolescent Medicine at Mount Sinai Hospital in New York City. “Many women feel ‘less than,’ defective, and ashamed,” she says. “They somehow feel that their body, and by association, themselves, have failed—and the experience is out of their control.” Studies have even compared the stress of infertility to that of a cancer diagnosis.
This anguish is a remarkably common experience. One in eight American couples will have trouble getting pregnant or carrying a baby to term, owing to everything from delayed parenthood—some one in ten mothers have their first child over the age of 35—to hormonal disorders and endometriosis. This mouth-dropping statistic was once discussed only behind the closed doors of sterile doctor’s offices. But more and more, women are divulging their efforts to become pregnant with one another—and with the world. The openness has lent a cast of empowerment to the conversation, thanks in large part to Hollywood’s female celebrity class, which has been increasingly vocal about their L.A.-based treatments—and their results—often in frank, sometimes granular, detail.
I know about Chrissy Teigen’s struggles to conceive almost as well as I know my best friend’s. For her first pregnancy, the model and TV host went through IVF to generate 20 embryos, which were eventually winnowed down to three. One of these was unsuccessful, another became her daughter Luna, and the third was her son Miles, born last May. Once Kim Kardashian and Kanye West decided to use a surrogate to conceive their daughter, Chicago, Kardashian West introduced her sister Khloé to her fertility specialist and filmed the encounter for TV. Gabrielle Union publicly shared her infertility problems with her husband, Dwyane Wade, last fall, among them a harrowing eight failed IVF cycles and multiple miscarriages, before having a daughter at the age of 46 via surrogate. Women of color are almost twice as likely to experience infertility (among other things, they have higher rates of the hormonal disorder polycystic ovary syndrome, as well as uterine fibroids), something the couple wanted to spotlight in sharing their own story. “In the African-American community, we have a responsibility to educate through our life experiences,” Wade told Oprah Winfrey in a special that aired on the OWN Network in December. And former First Lady Michelle Obama disclosed her previously secret struggle to conceive in her memoir, Becoming. “I think it’s the worst thing that we do to each other as women,” she told Good Morning America anchor Robin Roberts, holding back “the truth about our bodies and how they work, and how they don’t work.”
As more women discuss their personal difficulties, a profusion of new spaces has sprung up where they can share resources and heartache. Kindbody’s “mobile fertility pop-up events” offer women in Los Angeles and New York the opportunity to check their ovarian reserves and receive counsel on IVF and egg-freezing while surrounded by millennial-friendly pink walls and gold accents. (As of 2018, researchers estimate that 76,000 women have electively frozen their eggs—a 15,000 percent increase in less than a decade.)
Last year, Los Angeles saw the opening of its first “boutique” reproductive-education hub with LOOM, which “celebrates inclusivity and choice” in a plant-festooned space. It provides a miscarriage-support group and LGBTQ family-planning classes, among other services. “We wanted to create a physical space that integrated all the aspects of a person’s reproductive experience, from periods to being a parent,” says LOOM cofounder Erica Chidi Cohen. “People are tired of just going to their reproductive endocrinologist and taking the medication. They’re craving to be seen as a whole person moving through the process.”
At a discreet modern building in a manicured Beverly Hills neighborhood, the blurred outlines of staffers at Reproductive Partners Medical Group move behind white frosted glass panels. Following Kim Kardashian West’s recent announcement that she and Kanye are expecting their fourth child via surrogate, I am meeting with their doctor, Andy Huang, M.D., at the end of a long Friday. The office is open seven days a week—ovulation does not take weekends off—and Huang is there most days. Above his desk is a shelf full of baby pictures and emotional cards from patients: “Thank you. Our heart is full. My hero.”
Trim and youthful in charcoal pants and an open-necked white shirt, Huang—who is the sort of doctor who gives patients his cellphone number (“very rarely do they abuse it”)—cautions that although fertility rates are up, he and his colleagues can’t work miracles. “At a top center, depending on your age and medical history, your chances of getting pregnant are really capped at about 70 percent,” he tells me. “There’s no realistic chance of it being 80 or 90 percent.”
But Huang sees those numbers as an incentive for continued innovation. As he excitedly details new technological advances, I think about something de Brito told me back at Agency for Surrogacy Solutions. “For people who get bored easily, this is the industry to be in, because it’s ever-evolving,” she said with enthusiasm. “There are medical issues, ethical, legal, technological, psychological, monetary, creative . . . it hits every button. And California is at the forefront of it all.”
Labor and Delivery
The latest high-tech treatments on the fertility front lines.
Often half the price of a regular cycle of IVF, which can start at $15,000, this big-in-Japan treatment is for women willing to have fewer eggs retrieved per cycle. Slightly more time-consuming but gentler on the body, Mini-IVF requires less medication and has far fewer side effects (nausea, headaches, mood swings). “It has dramatically transformed the landscape of how we practice medicine at our center,” says Andy Huang, M.D., noting that studies are now showing that more eggs aren’t necessarily better for success rates. $5,750 and up.
ZyMōt Sperm Separator Device
Men are accountable for one-third of infertility cases, and their genetic material often faces further complications in labs due to centrifugation, or spinning, a technique that isolates the healthiest sperm but in so doing can cause DNA damage and reduced motility. The ZyMōt Sperm Separator, a little-known FDA-approved device that singles out the strongest sperm by mimicking the uterine pathway that they swim through in the body, is a “huge game-changer,” says Kelly Baek, M.D., who has witnessed higher genetically normal embryo rates while using the tool at her clinic. Initial $385 fee.
Endometrial Function Test
One of the most difficult aspects of timing a successful pregnancy is figuring out when the embryo should be attached to the uterine lining. A endometrial function test (EFT), pioneered by Yale’s famed Kliman Laboratories, is a highly sensitive biopsy that efficiently determines if the endometrium is receptive to implantationor not. “It can look for things like inflammatory cells and underlying infections,” says Baek, detailed knowledge that significantly increases a woman’s chances of implantation. Starting at $2,700.
Preimplantation Genetic Screening
While controversial, the technology for preimplantation genetic screening (PGS)—in which a developing embryo is screened for chromosomal abnormalities—continues to advance. “There are 220-plus common genes that we already screen for, and it grows by the year,” says Huang. “Next year, it could be 322 genes; a year later, it’s going to be 450. Today we can even screen for genes that predispose to a higher risk of certain cancers.” $4,500 and up.