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By Thoai D Ngo
Chair and Professor of the Heilbrunn Department of Population and Family Health at Columbia University Mailman School of Public Health
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When Representative Alexandria Ocasio-Cortez revealed that she is freezing her eggs, she made an intensely personal reproductive decision unusually public.
At 36, Ocasio-Cortez has shared a video of herself administering hormone injections and talked openly about a process that remains poorly understood by much of the American public. She said she wanted women to have more information about their bodies and reproductive choices.
That openness matters.
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As someone who has spent much of my career working in reproductive health and studying population change, I see something bigger in her decision. Egg freezing can give women more time to decide whether, when and under what circumstances they want to become parents.
But her story raises a more uncomfortable question: Who actually gets that choice?
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Reproductive freedom is often discussed in terms of the ability to prevent or end a pregnancy. Those discussions are fundamental. But it should mean something broader: Having the information, resources and health care necessary to decide whether and when to have a child—and ultimately to raise that child with dignity and security.
American women are having fewer children and increasingly having them later. The annual number of births per 1,000 women ages 15-44 has fallen 23 percent since 2007, according to the Centers for Disease Control and Prevention, while childbearing has increasingly shifted toward older ages.
The shift toward later childbearing reflects, in part, important social changes—women have greater educational and professional opportunities and more control over their reproductive lives. Those gains, however, are neither universal nor guaranteed, as recent restrictions on reproductive health care have made clear.
Yet as women gain greater freedom over when to have children, age remains an important constraint on fertility. Egg freezing offers one way to preserve future reproductive possibilities.
And more women are choosing it. A 2025 study found that planned elective egg-freezing cycles in the U.S. nearly quadrupled, from 4,153 in 2014 to 16,436 in 2021. Women were also freezing their eggs at younger ages.
It is an option, not a guarantee. Outcomes are strongly associated with age at freezing, and uncertainty remains for any individual woman.
Then there is the price.
National estimates put one egg-freezing cycle at roughly $10,000 to $15,000, with medications potentially adding another $3,000 to $5,000. Storage can cost around $1,000 annually, and some women need multiple retrieval cycles.
Compare that with what American women earn. In 2025, the median woman working full time earned $1,089 per week, according to the Bureau of Labor Statistics—about $56,600 annually.
At $15,000, one cycle alone represents nearly 14 weeks of the median woman's gross earnings. Add medications, and the cost can approach four months of gross pay—before taxes, housing, food or other necessities.
For many women, egg freezing is simply financially out of reach.
Insurance coverage does little to close the gap. Among large U.S. employers, 47 percent cover in vitro fertilization, while just 21 percent cover elective egg freezing, according to Mercer's national employer survey. In other words, nearly four in five large employers do not cover elective egg freezing—and coverage may be even less common elsewhere in the labor market.
The American Society for Reproductive Medicine acknowledges that high costs and limited insurance coverage create substantial barriers to access and can deepen economic, racial and ethnic disparities. The result is a reproductive technology that expands choice - but disproportionately for women who can afford it.
Consider what that means in practice. A lawyer at a large firm or a technology worker with generous fertility benefits may be able to freeze her eggs and buy herself additional time. A teacher, home health aide, restaurant worker or woman working multiple hourly jobs may face the same biological clock and have the same hopes for a future family—but far fewer options.
Reproductive choice is constrained when the ability to exercise it depends on your paycheck or your employer.
That is why our conversation about reproductive rights needs to expand. Protecting access to contraception and abortion remains essential. But reproductive justice is also about whether people have the resources and conditions to decide whether, when and how to have children—and to raise them with dignity and security.
Expanding insurance coverage for fertility preservation is one place to start. But affordability cannot be the end goal. Nor should egg freezing become another responsibility placed on women—something they are expected to pursue early enough so motherhood does not interfere with their careers.
Technology can give women more time. It cannot provide paid family leave, affordable childcare, stable housing, a living wage or accessible healthcare. Those are political choices.
That is what makes Ocasio-Cortez's disclosure particularly powerful.
Much of her political career has focused on the economic conditions that shape Americans' lives—from wages and housing to healthcare and protections for working families. Her decision to freeze her eggs should remind policymakers that reproductive freedom is inseparable from those conditions.
AOC has made her reproductive choice public. Now policymakers should ensure that income, employment and circumstance do not determine who gets to make that choice.
Thoai D. Ngo, PhD, MHS, is the chair and professor of the Heilbrunn Department of Population and Family Health at Columbia University Mailman School of Public Health.
The views expressed in this article are the writer's own.
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