Rep. Alexandria Ocasio-Cortez’s decision to share her egg-freezing journey online has brought more attention to the process— and its cost, especially in one of the most expensive cities for fertility treatment.
Her Instagram posts have highlighted affordability challenges, as well as the physical and emotional labor the process demands: undergoing the injections, the hormonal fluctuations, the logistics of timing a cycle around daily life and explaining what’s happening in the body.
Even as more women share their experiences online, clear information about the costs and decisions involved can be difficult to navigate early on – and the stigma around fertility treatment persists.
It’s why many reproductive justice advocates and fertility experts alike are praising Ocasio-Cortez’s call for women who are curious about or considering fertility options such as egg freezing to educate themselves and talk to their OB-GYN or fertility doctor.
To break down what New Yorkers should know before considering egg freezing, Epicenter NYC spoke with Dr. James Stelling, the medical director of Stony Brook Medicine’s Island Fertility Center in Commack, Long Island. Excerpts from the interview, below, have been edited for clarity.
Epicenter NYC: When someone first comes to you for egg freezing, what are they usually most concerned about?
Dr. Stelling: The most common egg freezing patient is a 37- or 38-year-old who just recently broke up with a long-term partner and they don’t know when the next situationship is going to happen. So, in their previous relationship, they may or may not have tried to get pregnant, but now they know they’re single and they don’t know when their next partner will come around.
We discuss potentially getting pregnant now, if just getting a baby is the most important thing, or we’re talking about freezing, if they want to keep it more open for seeing how the future goes.
Epicenter NYC: How does their reason for egg freezing or the age that they’re thinking of doing IVF inform any part of that process?
Dr. Stelling: There have been many patients that came in to discuss egg freezing, but their bloodwork comes back that [their ovaries] are really pretty young. And if sometimes they will have a partner that they’re not sure if they’re going to be the long-term forever partner. But if they have a partner and they might be the long-term thing, then maybe I don’t have to freeze eggs. They can just follow their AMH to see if [their ovaries] stay young and if they can get pregnant when they want to try to get pregnant.
If someone, say, is 30 years old and they think they want to get pregnant when they’re 32, if I do their ovarian reserve testing and they come back pretty young, maybe I don’t have to do anything. Like a 30-year-old with a good number [of eggs], two years later, it is probably fine to get pregnant spontaneously. If on the other hand, they’re 30 and their ovarian reserve testing is poor, maybe we do want to consider getting pregnant sooner, because that’s going to be the most successful thing, if they have a partner or get a donor sperm.
Or it could be freezing eggs earlier so we don’t have the problem of infertility later.
Epicenter NYC: What are the biggest surprises for patients, either financial or about the process itself?
Dr. Stelling: It can cost $5,000 to $8,000 or $9,000 in drugs. It’s another several thousand dollars in bloodwork and ultrasounds. I’ll say $5,000 to $7,000 for getting out the eggs and freezing them. So the whole process can easily be $15,000 for freezing eggs. And if you create embryos, the cost can run up to $20,000 or so. Costs are highly geographically related. That is probably the biggest limiting thing.
In terms of the inconveniences and discomforts, when the infertile person is doing IVF, they do hate every injection. For the proactive egg freezing patient, they’re scared about the first injection, but they’re taught to do it and by the third day the injections don’t really bother them too much because they got used to it and know how to do it and they’re not as scared.
Both infertile patients doing IVF or egg freezing patients do get more pressure and bloating down below because the ovaries are more active. And you can have a lot of pressure, discomfort from that.
Epicenter NYC: For those patients considering egg freezing who are seeing a fertility specialist for the first time, how do you guide them through the process?
Dr. Stelling: So I first tell them to think about what their plans are: getting pregnant now, getting pregnant later, and we want to do the evaluation of how effective IVF or fertility preservation would be.
The most important thing that we do then is assess what we call ovarian reserve: how many eggs do we have and how many eggs would they likely get if they were doing an IVF cycle, and that egg number will correlate with pregnancy rates.
So, say a woman is 35 years old. Some 35-year-olds are very young and have a good number of eggs and could freeze a good number for a good insurance policy that they could use for the future to have kids. But some 35-year-olds are not as young as they should be and don’t have as many eggs and can have a lower success rate.
Epicenter NYC: What do you mean, ‘not as young as they should be’?
Dr. Stelling: We have three main ways to assess their ovarian reserve besides looking at their age. Age is still the most important thing. But you can do an ultrasound and look at their ovaries. And when you tilt the number of little eggs, the more eggs they have, the more fertile they would be. The fewer you see on the ultrasound, the less fertile that they would be. If you’re looking online, it’s either called the antral follicle count or AFC or baseline antral follicle count.
I mentioned ultrasound samples look at the age of the eggs, but we also take a hormone test on cycle day 3, FSH or follicle-stimulating hormone, which should be low. It gets elevated as people get closer to menopause and then accordingly with the number of eggs that you’re going to get and the corresponding pregnancy rates.
The best measure besides age for assessing ovarian reserve is a hormone called AMH or anti-mullerian hormone. And this number does correlate fairly well with the number of eggs that they would likely retrieve.
Epicenter NYC: When you mention someone who’s a certain age but their eggs aren’t like the typical age of someone that age, what are typically those contributing factors? Are those part of the conversation?
Dr. Stelling: It’s part of the conversation, but unfortunately it’s not always under their control. It’s obviously better to be a healthy person. Drinking, other habits like that — there hasn’t been a correlation. The only one that’s clear is smoking. Smoking is definitely one of the things that can age ovaries faster. Extreme things like surgery on the ovaries, particularly endometriosis, can also do that. But endometriosis without cysts in the ovaries does not necessarily make the ovaries swollen.
Epicenter NYC: What factors within their control are often part of your conversations around slowing egg aging?
Dr. Stelling: Many patients, whether infertile patients or for freezing, ask about supplements or something they can do to make their eggs healthier. But there’s not great evidence that most of the supplements work. Coenzyme CoQ10 probably has the most potential. But the evidence is still not great. Most studies are small, most of the studies really weren’t performed very well.
And I would say, a lot of people who smoke, people know smoking’s not good, but they do it anyway. And they are often not the same person who comes in for egg freezing. There’s been a few exceptions to that. But in general, because these patients are typically the personality type who’s being very proactive, they tend to come in relatively healthy.
Epicenter NYC: What egg freezing cases are typically covered by health insurance?
Dr. Stelling: New York State passed a law several years ago that egg freezing should be covered for medical reasons. The insurance companies tend to interpret that as cancer.
We do definitely have younger patients for fertility preservation — we do a lot of cancer preservation. So if they have cancer and they go to receive chemotherapy or radiation or something that would affect the quality of the eggs and ability to make good eggs.
Epicenter NYC: If someone is doing multiple cycles of egg freezing, are they typically consecutive, or do patients need some time for patients to recover before starting the next cycle?
Dr. Stelling: I don’t need them to take time off to heal and recover. But many patients may want to take a break because it’s about two or three weeks of a lot of work, a lot of going back and forth to the doctor’s office.
It’s only one day [the egg-retrieval day] where you can’t have your relatively normal life. So maybe you just do want to go back to back.
Epicenter NYC: You oversee the tissue bank at Stony Brook Medicine’s Island Fertility Center. What would you say patients need to understand about what happens after eggs or embryos are frozen?
Dr. Stelling: For egg freezing, most insurance companies are in general not going to cover the cycle, exceptions for cancer kind of things. Even the insurance companies that do cover fertility preservation for cancer, they don’t usually cover long-term storage. Well, the fee usually includes the first six months at any center. But it will get a monthly, or more frequently, a quarterly, bill to their credit card.
Ranges are geographically related. Any year it might be say $600 or so. In New York City it can be definitely more than that too.
Dr. Stelling: So, for egg freezing, most insurance companies generally aren’t going to cover the cycle, with exceptions for cancer. Even those that cover fertility preservation for cancer don’t usually cover long-term storage. The fee usually includes the first six months, but then there’s a monthly or quarterly bill.
I think we’re probably around $50 a month for eggs, sperm or embryos, or roughly $600 a year. In New York City, it can definitely be more. Most insurance companies won’t cover that.
They’re stored in liquid nitrogen using a freeze process called vitrification, which is most often done for eggs. They’re stored relatively indefinitely because biological processes don’t happen in liquid nitrogen. So it doesn’t matter whether they’re frozen for a week, a month or 10 years.
We are better now than we were 15 years ago, so if you froze eggs then, the success rate will depend on the technology at the time. Most fertility centers maintain eggs or embryos in on-site laboratories, though long-term storage facilities are becoming more common. Eggs can be shipped to these facilities, which can be useful if, say, you froze your eggs in New York and later moved to Florida.
Epicenter NYC: How different is the experience for someone who needs to preserve their eggs pretty quickly, like before they do chemotherapy or radiation or surgery?
Dr. Stelling: The way it works, for cancer patients in general, is we get a call from the patient or the cancer center, or, say, today, we will usually either see them the same day or the next day.
And you can pick any cancer patient, you can do what’s called a random start. You don’t have to do the birth control pills. You can start them on their stimulation injections wherever they are in the cycle. And it takes 10 days on average, but basically within the next two weeks, you will get the eggs. And then they can go on to their chemotherapy treatments as needed.
So the cancer patients, come in, don’t have time. It does depend a bit on the cancer.
Epicenter NYC: Who are the patients who don’t usually have time to freeze eggs at all before?
Dr. Stelling: They’re usually too sick to delay the chemo. The tumor patients, we in general have a decent amount of time and can freeze the eggs usually with less scrambling.
Breast cancer is a little bit complicated. Historically, like, say, 15 years ago, they more frequently did surgery and then they delayed chemo for 6-8 weeks to let the breast surgery heal.
Now they commonly do what’s called neoadjuvant chemotherapy, where they commonly do chemo before they do the surgery, and that gives us less time to freeze the eggs beforehand.
Epicenter NYC: And with gender-affirming care?
Dr. Stelling: We usually have time. And depending on the age of the patient and whether they have been on hormones or not on hormones before, it can generally depend on what hormones you use and when and the dosing and the timing, but usually it can be at a scheduled time that can work with their life.
Most of the gender-affirming care that I do, they commonly are students and they do try to do it at their school breaks to minimize the interference with work and school and stuff.
Epicenter NYC: What’s one practical piece of advice you would give to someone who’s considering egg freezing?
Dr. Stelling: I would say check your AMH levels to assess your reserve. Now that’s hard to do because they are going to worry a lot of people who may not have a problem. But it can help them decide what they want to do.
