Should you freeze your eggs? What to know about the costs and process

U.S. Rep. Alexandria Ocasio-Cortez’s decision to freeze her eggs — and to document the process on social media — has put a spotlight on the process, which is typically marketed to people hoping to extend their fertility.

Egg freezing has exploded in popularity in the past decade. In 2012, the American Society for Reproductive Medicine declared the procedure no longer “experimental,” but instead a standard regimen for fertility preservation and treatment. Employers made headlines by offering egg-freezing benefits targeted at young employees. Between 2014 and 2021, the number of people freezing their eggs quadrupled, according to a study from UCLA Health.

Freezing eggs doesn’t guarantee pregnancy in the future. And the process — which is not always covered by insurance — is expensive and involved. But it can offer a valuable option for people who are considering pregnancy at some point in their lives.

Below, The 19th explains what egg freezing involves — medically and financially — and what questions to weigh if considering going through the process.

What does “egg freezing” even mean?

People are born with all the eggs they’ll ever carry in their ovaries. But as they age, the number of eggs they have — essentially, the chances they have of getting pregnant — decreases, and so does their quality, including having the correct number of chromosomes. Becoming pregnant can also get more difficult after age 35, and then even more so after age 37; at that point in life, egg quality declines more rapidly. (It’s worth noting that many people still have safe and healthy pregnancies after age 35.)

Egg freezing is an attempt to save eggs before that quality dip takes place. Doctors extract and store a surplus of the patient’s eggs, keeping them in a lab until they are ready to be used for pregnancy. At that point, the egg would be fertilized in the lab with partner or donor sperm and then transferred back to the uterus — the same process as in vitro fertilization, or IVF. 

Is this something I should be considering?

Egg freezing is particularly helpful for people who are medically at risk of losing their fertility. That can include people about to undergo chemotherapy, which can in some cases also reduce the number of available high-quality eggs they carry. It may also be worth considering before gynecologic surgeries, such as ovarian cyst removal, which can also lower egg count. 

But egg freezing can also be an option for people who aren’t ready to be pregnant, don’t have a partner or those who want to keep open the option of giving birth in the future.

In those cases, it makes sense to freeze eggs before they decline in quality. Eggs frozen before age 30 or 35 have a better chance of yielding a successful pregnancy. Eggs frozen at age 36 have a better chance of yielding a successful pregnancy than those frozen at 40. 

Some studies have suggested that people who freeze their eggs earlier have greater chances of a pregnancy resulting in birth.

“Generally speaking, the younger you are, the better your chances are of actually having a baby down the line,” said Dr. Jennifer Eaton, president of the Society for Assisted Reproductive Technology, chief of the division of reproductive endocrinology and infertility at Women and Infants Hospital in Providence and an associate professor at Brown University. 

Research also shows that many people who have frozen their eggs — especially when younger — don’t end up using them to get pregnant. 

One study, tracking patients from 2014 to 2021, found that less than 6 percent of people who froze their eggs returned to use them within a five to seven year follow-up period. People who pursued egg freezing between ages 38 and 42 were most likely to return to use them; about 8 percent did so during the follow-up period.

Bottom line: The decision to freeze eggs is highly personal and based on factors such as whether patients can afford it, their long-term family goals and their own medical history. 

“If this is something you are interested in, then there is some benefit to doing it earlier,” said Usha Ranji, associate director for Women’s Health Policy at KFF, a nonpartisan health policy research, polling and journalism organization. “But I do think it is really individual. It’s not any one factor.”

Can I use insurance to pay for this? How much is it?

States have increasingly begun to require that private health insurance cover fertility treatments, including intrauterine insemination (IUI) and IVF. But those benefits can be limited, and not everyone may qualify for them. Often, they require a diagnosis of infertility. 

For egg freezing, getting coverage is trickier. Some states require that health insurance cover the process if a patient has a medical reason, such as a cancer diagnosis and subsequent need for chemotherapy. Those benefits can also apply to endometriosis patients if they require surgeries that could threaten their fertility. But this type of mandate doesn’t apply to people who are freezing their eggs because they are currently not ready for pregnancy. 

Egg freezing without insurance coverage typically costs at least $10,000 per cycle.

Medicaid, the public insurance program for low-income people, typically does not cover egg freezing or fertility treatments.

Still, some employers have begun offering egg freezing benefits on their own. KFF’s 2024 survey of employer-offered health benefits found that about 12 percent of companies with over 200 employees offered coverage for freezing eggs or sperm. Of large employers with at least 5,000 workers, about 30 percent offered coverage. 

Those benefits can vary. Employers may offer an egg-freezing benefit but not cover the cost of storing the eggs, which can be hundreds of dollars per year.

Those looking to figure out their options, Ranji said, should review their benefits with their employer’s human resources team and see if any state laws might help them qualify for coverage, especially those who might have a medical reason for freezing eggs. 

Clinics sometimes have financial teams devoted to helping patients navigate laws and payment options. And patients can price-shop between clinics. Some might offer a discount for patients paying upfront in cash, others may offer payment plans. But while comparing prices between providers, Eaton said, it’s also important to make sure a clinic is well-rated when it comes to safety and quality of care.

What does the process look like?

Talk to your doctor first about whether egg freezing might be a good idea. If it is, the next step involves getting set up with a fertility specialist.

Patients undergo basic fertility testing, which can include bloodwork that measures particular hormone levels: anti-Mullerian hormone, which doctors use as a proxy to estimate how many eggs a patient has left, or follicular stimulating hormone, which is used to test how well ovaries are working. Doctors also might consider an ultrasound to count a patient’s follicles, another way of estimating the number of remaining eggs.

People taking hormonal birth control are told to stop taking it before beginning the egg retrieval process. But those who use intrauterine devices (IUDs) for contraception generally do not need to have them removed.

The process itself can take about the length of one menstrual cycle. Typically, one egg is released over the course of a menstrual cycle. But for egg freezing, doctors want the patient to produce multiple eggs, which they can then retrieve during surgery. 

To do that, patients will take a combination of medications, a process known as ovarian hyperstimulation. Those drugs are often administered by injection at home for 10 to 14 days. 

During this period, patients will also need to go to their clinic for regular monitoring visits, which entail an ultrasound and bloodwork to track how the cycle is progressing, the number of ovarian follicles growing, whether a medication regimen needs adjusting and, ultimately, when to retrieve the eggs. Those visits can be every couple of days, or even daily, depending on how the cycle is going.

This part of the cycle can involve side effects somewhat similar to pregnancy, including breast tenderness, bloating, headaches and fatigue. Releasing multiple eggs in one cycle means the patient’s ovaries are temporarily enlarged — some doctors describe it as going from the size of a walnut to an orange — which can create pressure on the stomach. Some patients also report mood swings. 

During this part of the process, patients are told to avoid most physical activity to limit the risk of a complication called ovarian torsion, in which an enlarged ovary twists, cutting off blood flow and requiring surgery. That means avoiding heavy lifting, yoga, twisting or anything involving jumping. Brisk walking is safe. Doctors also recommend avoiding penetrative sex.

After the hyperstimulation period, patients take a different injection called a “trigger shot,” which essentially causes ovulation. About 36 hours later, a doctor performs the egg retrieval surgery, a minor procedure typically done while the patient is either sedated or under anesthesia.

After surgery, patients will be told how many eggs were retrieved, and how many were ultimately healthy. Their eggs are then cryogenically frozen until patients are ready to pursue pregnancy.

Patients with polycystic metabolic ovarian syndrome (PMOS, formerly known as PCOS) have a higher risk of experiencing “hyperstimulation” after retrieval, which can cause severe pain, vomiting, rapid weight gain and other symptoms. Those patients should make sure their doctors are aware of this condition early in the process. 

Some patients may end up doing multiple cycles if they don’t get enough eggs the first time.

How do I end up getting pregnant?

Some patients who freeze their eggs won’t end up using them, either because they will be able to get pregnant without fertility treatment or because they change their mind about pregnancy. 

But those who do will essentially go through the IVF process: having their frozen eggs fertilized in a lab with sperm, seeing which eggs develop into healthy embryos and attempting to have an embryo transferred into the uterus. (Typically, not all eggs will properly fertilize with sperm, and not all of those fertilized eggs will ultimately grow into embryos.) 

Insurance coverage of IVF is more common, and it’s worth seeing if a patient’s insurance might pay for that part of the process. If not, transferring an embryo can cost thousands of dollars.

But freezing eggs doesn’t guarantee a successful pregnancy, Eaton emphasized.

“It’s not uncommon for people to come in and have the eggs warmed and fertilized and then no good quality embryos roll out, or they try to use the embryos and don’t have a baby,” she said.

There is also limited data when it comes to measuring how often frozen eggs result in pregnancy, she said. Part of that is because the technology’s popularity is still relatively recent, leaving little time for scientists to thoroughly study how often someone who freezes eggs is able to use those eggs later to give birth.

“Even though it can provide some peace of mind, it’s not a guarantee,” she said.

She advised that patients have a conversation earlier in life — possibly even in their 20s — so that they have a sense of their options, even if they ultimately decide egg freezing isn’t for them.

“The sooner you go talk to a fertility doctor about it the better,” she said. “Talking about it doesn’t mean you have to go through the process. It just gives you the information you need to decide when and if it might be something you want to do.”

Are there any legal considerations I should know about?

When first discussing freezing with a fertility clinic, patients may be asked about contingency plans if they ultimately don’t use their preserved eggs. Clinics may also require patients to sign paperwork outlining what options they would like to pursue.

Freezing embryos is legal in every state, but it can be more politically fraught, as some abortion opponents argue that frozen embryos should be granted the same rights as people. Egg freezing has so far attracted less political scrutiny.

Embryos frozen with a partner are jointly owned by the couple, and both partners typically have to articulate in advance with a clinic what their contingency plans may be if they end up not using their embryos, or if they end their relationships. Patients who freeze their eggs alone typically have sole custody of them, even if they end up marrying someone later.

What if I don’t use my eggs?

Patients who have frozen their eggs can keep them preserved for as long as they’d like. But if there is a point at which they don’t want to use them — if, say, they had children without fertility treatment, their pregnancy goals have changed or the costs of storage have become too much to keep paying — they have options.

Frozen eggs can be donated to other people who may need them for a pregnancy. They can also be discarded, a process that involves formally notifying the storage facility and some legal paperwork.