观点：冻卵经历让我看清生育行业的反女性主义本质

In August, Democratic Rep. Alexandria Ocasio-Cortez’s egg-freezing journey incited a national debate about fertility and reproductive rights, with women on both sides of the aisle hailing her decision as a feminist one (amid, of course, the expected right-wing conservative backlash).

I agree that Ocasio-Cortez’s choice to freeze her eggs, and do so publicly, is certainly feminist. But the industry as a whole is not.

A few years ago, I, an internal medicine physician who works on health policy and financing, froze my eggs — and the experience was anything but empowering.

My journey began when I learned that my employer subsidized “family planning” — including egg freezing, in vitro fertilization (IVF), and adoption — by several thousand dollars per attempt for up to two attempts. As a woman in my 30s, I thought it would be harmless to at least consult a fertility specialist to make an informed decision. I always imagined that if I wanted children and could not naturally conceive, I might pursue adoption — but why not make an appointment to properly assess, with a specialist, the pros and cons of freezing my eggs?

From the moment I entered the doctor’s office, I felt reduced to nothing more than a vessel for reproduction — a severely flawed, cracked vessel, through which my eggs were rapidly escaping and deteriorating with every passing day. As the doctor reviewed my age and hormone levels, she urged me to freeze my eggs right away, lest I regret the decision down the road. At the time, I was single — what if, she posited, I met a man who wanted children? I would certainly look back on this moment and wish I had gone through with the procedure. Time is ticking, she reminded me.

Not once did she ask me about my own reproductive goals.

Instead, my doctor sent me down a path of extreme body-shaming. Explicit in her “advice” was the message that the train had already left the station: My body’s decline was well in motion since the day I was born — and something must be done right away. She had me sign up for egg freezing within a week. I felt rushed, unsure if it was right, but that thinking was overwhelmed by the immense fear, anxiety, and shame that every single day I waited was another day my ovarian function would further depreciate.

It took an immense amount of self-reflection to pull myself out of the mental spiral she triggered: that my body was failing me. To the contrary, I reminded myself, my body has accomplished incredible feats. In 2020, when I fell ill while on the front lines of the Covid-19 pandemic, I had difficulty breathing while walking around my apartment. When the symptoms did not resolve for months, I seriously worried my body would never return to normal. Now, a few years later, I was back to hiking mountains. My body was fine. My body was healthy. Just because my future fertility was in question — as it is with all people as we age, to varying degrees — did not mean that my body itself was failing. My body’s sole function, and my life’s sole purpose, was not biological reproduction. What business did any hypothetical future partner have to guilt me over it?

But the damage had already been done, the seed of shame planted, and I signed the paper and handed over the money to get started.

It should have been entirely unsurprising that my doctor pushed this narrative. After all, the fertility industry is exactly that — an industry. Indeed, a study published in the American Journal of Obstetrics and Gynecology in February showed that the number of patients undergoing egg freezing in the U.S. has increased exponentially, from 4,153 patients in 2014 to 16,436 in 2021. Over that same period, the average age decreased from 36.0 years to 34.9 years.

Some of this trend may certainly reflect positive drivers — for example, increased awareness and access, as in my case, facilitated by employer subsidies. But much of this increased demand is undoubtedly also driven by the financialization of fertility.

The global egg and embryo banking industry was valued at $4.49 billion in 2024 — and based on current trends, projected to increase to $11.26 billion by 2030. Fertility startups have proliferated and expanded across the country, undergirded by colossal private equity and venture capital investments seeking returns. These investments go hand-in-hand with efforts to consolidate the market. In 2023, private equity backed more than 32% of all fertility clinics, which performed an estimated 54% of all IVF cycles across the U.S.

These trends are more stark in certain geographies: A 2025 JAMA study found that in 14 states and Washington, D.C., more than half of fertility clinics were private equity affiliated, and were estimated to perform somewhere between 60%-100% of all IVF cycles. At least as of a few years ago, fertility was thought to be the medical specialty with the greatest private equity owned market share, with expectations that consolidation would continue, decreasing provider competition, restricting patient choice, and increasing high-volume facilities that patients often characterize as impersonal “fertility factories,” with limited face time with their doctors.

Directly marketing toward younger and younger clientele, fertility clinics compel women to shell out tens of thousands of dollars to proactively preserve their fertility. But their often simplistic messaging around “fertility preservation” masks the reality that egg freezing neither guarantees future use nor future success. The same February American Journal of Obstetrics and Gynecology study showed that only 5.7% of all patients who had frozen their eggs returned to utilize them within 5-7 years, and only 28.9% of their attempts resulted in live births. Not to mention the health risks that both mother and fetus face with increased maternal age, whether the pregnancy is spontaneous or through IVF — with marginalized patients facing worse outcomes, likely due to the structural discrimination they face before, during, and after pregnancy.

Certainly, there have been scientific advances in fertility treatment, but overall women’s health research has been vastly underfunded. National Institutes of Health funding has disproportionately favored research into conditions primarily impacting men over those primarily impacting women. And while the absolute amount of research dollars for women’s health has increased over time, the share of NIH funds decreased from 9.7% in 2013 to 7.9% in 2023. Particularly under-resourced are common (and likely significantly underdiagnosed) conditions like polyendocrine metabolic ovarian syndrome, endometriosis, autoimmune conditions, and menopause — all of which substantially impact fertility.

These trends are worse when we look at marginalized communities. Though infertility among Black women is twice as high as for white women, research into the causes is scant. And while funding for research on sexual and gender minoritized population health has grown over time, the overall amount remains woefully inadequate, particularly for fertility.

One can assume that if these conditions were better understood, our clinical guidance regarding overall reproductive health including fertility would be better. The Trump administration’s cuts to research funding, and the increasing influence of private equity over reproductive endocrinology and infertility training, may further threaten future progress.

As I began my egg freezing cycle, my doctor reminded me that much of the medication and dosing is “guess and check.” We cannot really predict what regimens will work best for each person. This is why patients are extensively monitored while undergoing egg freezing — to assess how their bodies are responding to the medications, and make adjustments based on more “guessing and checking.”

This “guess and check” approach has meaningful financial (and emotional) repercussions. You may over-order the medications you need, which can result in thousands of dollars’ worth of waste. You may need to order more medications midcycle, which is quite common and manageable — except in the event of shipping delays, which I had the misfortune of experiencing. My replenishment, expected to arrive the day before my last remaining dose, was delayed by at least two days in transit. My options were limited: I could drive hours to a specialized pharmacy in the snow (though they might close by the time I arrived); use a friend’s leftover medications (not advised); or cancel the cycle altogether (though I was halfway through, and had already spent thousands on the first round of medications).

The stress of feeling somewhat coerced into having the procedure was compounded by having to navigate these unexpected hiccups and the finances — without any support from my providers themselves. On top of the physical and emotional toll of deciding and then pursuing egg freezing, patients are advised to spend hours shopping around to find which specialty pharmacy might supply their medications at the lowest price.

I also found that I had to maintain constant vigilance over the fees from my fertility provider. Surprise charges regularly appeared on my account — duplicate charges for services already bundled in my upfront self-pay package (e.g., extra laboratory fees, extra charges to my insurance and co-payments for clinic visits) — which took hours on the phone and in person to have canceled or reduced. This included my Natera testing — a blood test that screens for risk of passing on genetic conditions, strongly advised by my doctor — which was advertised as $250, but resulted in a bill exceeding $700. (In September, Natera settled a class action suit alleging deceptive billing practices. It did not admit to any wrongdoing.) I had to make yet another hours-long phone call to sort this out.

The “surprise bills” did not end there. As I was arranging for a friend to help with my “trigger shot,” my nurse advised me that I could instead have a nurse administer it at the clinic at my precise trigger time — a preferable option, I thought, best not to take any chances.

When I arrived, I was shocked at the nurse’s greeting: “You can Venmo me $150.” Had I been informed of the extra charge, I would have made alternate arrangements in advance. But five minutes before my precisely timed trigger shot was to be given, I had no other option. I transferred the money to her personal account. There would be no official record or billing of the service in my chart.

Having studied “informal payments” — extra under-the-table payments for health care services, common in other countries but not in the U.S. — I was concerned that this exchange at the health facility could be considered illegal. When I asked my doctor and the billing department about this practice, they simply shrugged their shoulders. Upon discussing with other people who had frozen their eggs, I found that several had the same experience.

Like all health care in the United States, fertility care is mired by fragmentation and inadequate transparency on cost, price, and billing. What makes it perhaps worse than general health care is that its billing architecture can be even more complex — with clinics, specialty pharmacies, laboratories, and anesthesia providers individually charging fertility benefit administrators, health insurers, and patients through a variety of mechanisms including bundled cycle packages and fee-for-service. This results in errors costing patients hundreds to thousands of dollars, whether intentional or not, as I experienced: failure to submit insurance claims, incorrect coding, duplicate billing to patients and insurance. Though I knew that my employer benefits would not cover the full costs of elective egg freezing, I did not realize that I would end up paying over half the costs out-of-pocket until all was said and done. There is considerable variability in how much of the total cost fertility benefits cover, even in the case of IVF for medically documented infertility. 

As a physician who had the privilege of an employer-subsidy, I should have found the journey relatively easy to navigate — yet I found it entirely disempowering.

To the contrary of right-wing pronatalist and anti-IVF arguments, the solutions are not to abandon IVF altogether, but rather improve innovation, quality, access, and informed decision-making. If fertility “preservation” were truly a feminist enterprise, we would have significantly more research to increase its precision beyond “guess and check.” We would teach and empower primary care providers and others to properly counsel patients on their fertility, eliciting their goals, carefully advising on their options, and making referrals to fertility specialists accordingly. And, as Ocasio-Cortez suggested in one of her follow-up videos, we would make it affordable for all people, not only those rich enough to access it, and not only those already medically defined as having or being at high risk of infertility.

But most of all, we would strengthen regulation of the industry. It is likely that the high costs of fertility treatment in the U.S. compared to European countries like France and Spain, and the frustrating patient experiences, stem from several factors: self-pay or fragmented payment models, growing private equity investments, market concentration, less government regulation, and higher labor costs. Expanding insurance coverage for elective egg freezing, as New York state is exploring, as opposed to relying on employer subsidies which perpetuate inequities and the administrative burden on self-paying patients, is a critical step.

Simultaneously, we need to strengthen regulation of the industry — the service providers, labs, and pharmaceuticals — toward greater transparency, competition, and safeguarding of patient safety and interest.

Years on, I do not regret freezing my eggs. I have largely put my experience behind me, out of mind (except for the over $100 monthly storage fee, of course). I have since regained my sense of self-worth both within and outside the context of fertility. And in truth, I do not know whether I will ever attempt to use my frozen eggs. Regardless, I am keenly aware that I was privileged to access the services, no matter how flawed, out of reach for many who seek them.

So, while I cannot know if I would have made a different decision under different circumstances, I can at least try to contribute to an honest conversation about fertility care.

If we are serious about the “fertility industry” being feminist and inclusive, we must ensure that “reproductive choice” is truly at the heart of the care provided — that all people are empowered to make the decisions and access the care that are right for them.

Pooja Yerramilli, M.D., is a clinical assistant professor at NYU Grossman School of Medicine. She has previously worked at the World Bank, World Health Organization, and various nongovernmental organizations on improving affordable access to high-quality health care and public health. Her views represent her own and not those of her current and former employers.