It’s a Popular Procedure for Young Women to Consider Undergoing. I Hope They Understand What They’re Actually Buying.

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When Rep. Alexandria Ocasio-Cortez announced that she was freezing her eggs, two words stood out to me. “This is a choice that I am making to feel more in control of my life,” she said.

The first word is “control”: Egg freezing has become culturally synonymous with controlling fertility and offering women agency. I get it. I am a woman around Ocasio-Cortez’s age, 36. I’m also a physician, trained in a profession that asks us to take action by identifying risk factors, diagnosing diseases, and intervening whenever possible. There is something appealing about applying this same approach to the biological clock. You might want kids, but you called it quits with your fiancé and the next few years at work are going to be pretty busy ? Do something about it!

But the second word that stood out to me in Ocasio-Cortez’s announcement is “feel.” She wants to feel more control. This is a savvy way to put it, and one that women considering freezing their eggs should pay attention to. Feeling control isn’t the same thing as having control, and it’s a distinction that we miss all too often when we talk about fertility preservation.

The feeling of control that egg freezing offers is real. In one study of women who underwent egg freezing at the University of California, San Francisco, 88 percent described feeling more control over their reproductive planning thanks to the procedure. A similar percentage reported feeling happy they had frozen their eggs, even if they had not returned to use them. Simply having eggs stored away can offer peace of mind, even before we consider whether the eggs are ever used or how much actual control they end up offering. (The time period between when the women in this study froze their eggs and when they completed the survey was relatively short, a few to several years; the authors note that longer-term studies looking at satisfaction and regret are “greatly needed.”)

In practice, most eggs never leave the cryotank. In one large study using national data from nearly 50,000 women who froze their eggs, fewer than 3 percent returned to use them during the study period. It’s possible that number would go up if the participants were surveyed again—the mean age at the time of egg freezing was 34.5, and the women were followed up with less than a decade later—but a single-digit return rate seems like a reasonable enough ballpark to discuss with women considering the procedure. What can happen that deters women from getting those eggs out of storage? Some may find a partner and conceive on their own; some may decide they no longer want children; and others may choose another path to parenthood, such as adoption. Whatever the reason, the overwhelming majority of eggs remain on ice.

For the small minority of women who do return for their eggs, control remains elusive. A frozen egg is still several biological leaps away from a baby. The egg must survive thawing, then it must successfully be fertilized (even in a lab setting, this is not guaranteed to happen), then it must develop into an embryo.