Insurance-related and racial factors were the strongest predictors of planned oocyte cryopreservation (POC) in women in the US, based on new data presented at American Society for Reproductive Medicine Scientific (ASRM) 2025.

POC allows individuals to preserve fertility potential before age-related decline, lead author Marie Elise Abi Antoun, MD, a resident at Tufts Medical Center, Boston, told Medscape Medical News.

The use of POC has increased from approximately 4000 patients in 2014 to more than 16,000 in 2021, according to a recent review published in Fertility and Sterility, said Antoun, who conducted the study in collaboration with Boston IVF physicians on research funded by IVI RMA.

However, only 60% of patients in the US who seek consultation for POC opt to proceed, said Antoun. Previous research has suggested cost, insurance coverage, and racial or ethnic factors as influencers of a decision to proceed with cryopreservation, but data on how these factors affect real-world patients are lacking, she said.

In the new study, Antoun and colleagues reviewed data from 4032 individuals who presented for POC consultation over a 10-year period. Of these, approximately half (51.3%) attended only an initial consultation and did not proceed, and 48.7% went ahead with the procedure. The median age of the study participants was 35 years, the median BMI was approximately 24, and most were White individuals.

In a multivariate analysis, the researchers examined the association between proceeding with POC and factors including insurance coverage, race/ethnicity, age, BMI, and anti-Müllerian hormone (AMH) levels.

Overall, insurance coverage was the strongest predictor of proceeding with POC, with an adjusted odds ratio (aOR) of 5.1. Race/ethnicity also was a strong predictor; Black individuals were significantly less likely than White individuals to proceed (aOR, 0.5). No differences were noted between White and Hispanic/Latino or Asian individuals in proceeding with POC.

Although age was not significantly associated with proceeding with POC, higher BMI reduced the odds of proceeding by 4% for each unit increase. In addition, the odds increased by 10% for each 1-ng/mL increase in AMH.

Interconnecting Factors

“What surprised us most was the degree to which insurance coverage differed by race, and how completely that difference explained the gap in who proceeded with egg freezing,” Antoun told Medscape Medical News. “Initially, it looked like there were racial disparities in uptake, with Black patients about half as likely as White patients to proceed with POC, she said. However, this difference disappeared after we controlled for which patients had insurance with fertility-preservation coverage,” she noted.

The findings highlight how inequities in insurance coverage drive inequities in care, and the importance of integrating cost counseling and insurance navigation into clinical services to promote equitable access, she added.

Limitations of the study include the retrospective design, single-network and state data, lack of socioeconomic variables, self-reported race/ethnicity, and missing data on factors including AMH and BMI for some patients, Antoun noted.

The next step for research is to broaden the review beyond Massachusetts and link it to long-term outcomes, she said. Massachusetts has one of the strongest infertility mandates in the US, but it does not cover POC, so access still depends almost entirely on employer-provided fertility-preservation benefits, Antoun explained.

The current findings likely underestimate the impact of insurance, she added. “In states without coverage mandates or among patients working for smaller employers, we would expect even fewer people to have coverage and much larger socioeconomic and racial gaps,” Antoun said.

Additional research is needed to explore how state policies, employer type, and income level influence who can freeze eggs, and how differences translate into downstream outcomes such as who returns to use frozen eggs and who achieves pregnancy, Antoun told Medscape Medical News. Future studies can then explore whether expanded coverage actually leads to better reproductive success and equity over time, she said.

High Impact of Insurance

The study’s most striking finding was that individuals with insurance coverage were five times as likely to proceed with POC, said Mark P. Trolice, MD, who was not involved in the study.

“The high cost of POC and limited insurance coverage are obstacles for women as they pursue reproductive autonomy and justice,” said Trolice, professor at the University of Central Florida College of Medicine and founder/medical director of the IVF Center of Central Florida, Orlando, Florida.

“The persistence of lower odds for Black individuals, even after adjusting for insurance, was not entirely surprising given longstanding disparities, but it is concerning that these gaps remain despite financial access,” Trolice told Medscape Medical News.

The data highlight the need to expand insurance coverage to improve access to POC, said Trolice. In addition, reproductive healthcare providers should continue to address racial and socioeconomic barriers and advocate for policy changes, he said.

This study was funded by IVI RMA North America. Antoun disclosed no financial conflicts of interest. Trolice disclosed no financial conflicts of interest.