The Rise and Challenges of Egg Freezing for Family Planning in the U.S.

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Inside a section of the Aspire Houston Fertility Institute, smaller cryo storage containers each hold roughly 150 egg samples. These samples are kept in liquid nitrogen, showcasing modern methods of fertility preservation.

Last month, Rep. Alexandria Ocasio-Cortez (D-N.Y.) drew attention to a growing issue among women who choose to have children later. The reasons vary; some are focused on careers, others lack a partner, or they might not be ready financially or emotionally. Ocasio-Cortez herself is undergoing the process of egg freezing and has openly shared her journey on Instagram. Her posts have received both praise and criticism. Despite differing opinions, her experience highlights the significance of egg freezing for those planning to have children in the future.

Increasingly, women pursue this option as they extend their educational pursuits and delay starting families. Studies in reproductive health indicate that as women age, they face greater challenges in conceiving and carrying a pregnancy to term. Egg freezing emerges as a potential solution, allowing women to have biological children later in life.

Although Ocasio-Cortez enjoys numerous privileges as a Congress member, she shares common issues with many American women regarding health insurance and fertility. Her Congressional health plan does not cover egg freezing, requiring her to pay around $10,000 out-of-pocket. This is a familiar scenario for many women with private insurance, as most lack coverage for egg freezing. Insurers have the option to include such coverage, yet it typically requires state mandates, which are rare. When states do require coverage, it often pertains to medical conditions affecting ovulation, not elective procedures.

Public insurance offers no help for low-income women wishing to delay motherhood. Medicaid usually does not cover egg freezing, leaving those reliant on it without this reproductive option. Unlike Ocasio-Cortez, they lack the financial means to afford the process, forcing them to either have children before readiness or forgo parenthood altogether. This underlines the disparities in U.S. family planning.

While contraceptives are widely available through private insurance and public programs like Title X and Medicaid, support for delaying childbearing is absent. This reflects an imbalance where controlling fertility is prioritized, but planning for future children is not supported.

The U.S. has seen a decline in birth rates for decades. Demographers predict that by the mid-2050s, population growth may halt and begin to decrease. This trend contributes to vulnerabilities in Social Security and could affect future economic growth and military strength. To address these issues, the U.S. must develop policies that encourage population growth and enable women to plan their families effectively. Family planning should encompass both fertile control and childbearing support.

Leonard M. Lopoo, the Paul Volcker Chair in Behavioral Economics at Syracuse University, explores these themes in his book, “Wanting Children: Family-Planning Policies and the Engineering of America’s Population.”