Egg Freezing Is More Accessible Than Ever — Why Are Black Women Utilizing It Less?

It's a tricky time for reproductive rights: On one end of the spectrum, people are losing their lives over strict abortion laws in their respective states. On the other, fertility preservation is more widely available than ever — and folks are taking advantage. Egg freezing, in particular, has become far more accessible. According to Mercer, an HR consulting firm, about 20 percent of large employers (companies with a headcount of 20,000+) now offer the treatment — great news for those looking to start families.

But even as the number of people with access to egg freezing grows, Black women seem to fall behind when it comes to the use of this treatment. It's not surprising when you consider how systemic racism already creates significant hurdles for Black women to navigate life in general — the healthcare system is not exempt. "A history of medical experimentation, coercion, and mistreatment of Black women has fueled a mistrust," a 2022 study in Health Affairs on Black women's reproductive health observed, "one that shapes Black communities' engagement and satisfaction with medical care."

These systemic issues create a situation of undue difficulty for Black women considering freezing their eggs. It doesn't even start with having (or not having) insurance to cover it: Many Black women enter the landscape already dealing with the failures of a broken healthcare system. They're already more likely to come to the table with certain comorbidities that can make it difficult to get pregnant. "Black women have higher rates of obesity, hypertension, diabetes, and cardiovascular disease — conditions that put them at increased risk for pregnancy complications," the Health Affairs study notes.

Egg freezing could be effective insurance for Black women hoping to start families. And since they are more likely to have certain chronic illnesses, fertility preservation measures like this seem like a no-brainer. So, what's causing the lapse in outcomes? We spoke to a fertility doctor and advocate to learn about its genesis and how to create better outcomes for Black women.

Experts Featured in This Article

Racquel Hill is a fertility advocate based in Atlanta, Georgia.

Obehi Asemota, MD, is a fertility doctor at Hope Fertility in Alpharetta, Georgia.

Access to Care

Health coverage generally became more accessible between 2019 to 2022 thanks to the expansion of Medicaid, according to the Kaiser Family Foundation. However, the percentage of Black people who remain uninsured is higher than it is for white people: 10 percent of Black people in this country lack health insurance, compared to just 6.6 percent of white folks. While Black people don't have the highest rates of being uninsured (American Indians and Alaska Natives are at 19.1 percent and Latines are at 18 percent), the disparity still exists. Lacking healthcare access or being insured and not covered for certain fertility treatments make egg freezing extremely cost-prohibitive. We're talking tens of thousands of dollars, which most Americans simply can't afford.

But coverage isn't the only factor — gaps in the rates of egg freezing among Black women persist, even when insurance is there to help cover the cost. A 2023 study by Fertility and Sterility of patients at private fertility centers in Chicago noted these differences "even in an area where the Black and Hispanic population is approximately 30 percent, and most people have insurance coverage," the study reads. "Chicago has a relatively high percentage of Black people and was chosen to see if the utilization reflected the population. The results showed that despite insurance coverage, egg freezing was underutilized in Black women. White women had a significantly higher proportion of egg-freezing cycles." Scientists noted two reasons to explain this gap: cultural beliefs about egg freezing in the Black community and not knowing that fertility preservation was even an option.

Access to the Right Information

Fertility advocate Racquel Hill attests to the dearth of available information for Black women regarding egg freezing; it's something she experienced in her own fertility journey. "It was only after visiting my third or fourth fertility clinic that a doctor mentioned that I should consider freezing and banking my eggs," says Hill. "No one ever mentioned it as an option to preserve my fertility before then, and at that point, I had seen more than 16 OB-GYNs."

Obehi Asemota, MD, a fertility doctor, highlights this lapse as a significant factor in the low rate of egg freezing she's observed in the Black community. Knowledge barriers also result in Black women "presenting late to treatment," says Dr. Asemota. Since freezing your eggs at a younger age sets you up for a better outcome when you're ready to get pregnant, this is a critical missed opportunity. Folks showing up later than they should — because they didn't know they needed to start earlier — is a clear sign that doctors should do more to make sure their Black patients are aware of all their fertility options.

Black women who do undergo fertility care should also consider sharing their experiences. They've had to speak up and advocate for themselves to navigate this hostile system in the first place, and there's no reason why sharing can't help to close the gap. "To improve their reproductive health outcomes, participants relied on their support networks, found alternatives to hospital care, and prioritized finding and using race-concordant care," a study done by Health Affairs reads.

Not Listening to Black Patients

Beyond sharing all fertility options, it's crucial for doctors to take Black patients' concerns seriously. "Medical professionals' disbelief or dismissal of a reproductive concern resulted in participants having to engage multiple times with medical services to receive a diagnosis or care for a persistent issue," the Health Affairs study explains. "This engagement was described as labor-intensive, requiring a high level of self-direction, and costly." From her own patients, Dr. Asemota has heard complaints about the misinformation, dismissals, and flat-out bad advice they've received throughout the fertility process. "They say things like, 'My complaints were ignored and I was not treated like a patient,' 'A doctor told me I was fine; I was not fine,' 'I was told I should not get pregnant after age 35,' 'I was told my husband is fine, fertility is about the woman and not the man,'" she says.

Make no mistake: It shouldn't solely be up to Black doctors and communities to be diligent about education and mindful, respectful patient interactions. Doctors of all races should be proactive that they're not participating in medical gaslighting and sustaining this culture of distrust. Black women need to feel included and welcome in the egg-freezing process. "Although I live in Atlanta, I noticed two things: First, there were no clinics offering egg freezing in predominantly Black areas (I traveled over an hour one way to my clinic). And, when I arrived at appointments, there was rarely any pamphlet or wall art that looked like me in most clinics," Hill says. "I already felt like an outsider on this journey, and I'm sure for many other Black women it feels the same. By feeling like I didn't 'belong' in a space that was already difficult, the process often felt even more isolating."

It's imperative for doctors to work with patients to alleviate this stress, as it can affect every stage of IVF, as a 2024 study found: "Most studies concluded that stress has a negative effect on IVF treatment," it reads. "The egg retrieval time point was most affected by chronic and acute stress."

How Can We Create Better Outcomes?

Besides creating a lower egg-freezing rate, all these factors combined have an overall detrimental effect on fertility for black women. "Researchers found that Black patients respond just as well to medications that stimulate egg production, produce as many eggs, and produce more good-quality embryos than white patients," a study done by Shady Grove Fertility reads. "However, Black women had lower pregnancy rates, higher clinical pregnancy loss, and lower live birth rates." And while they did find that health issues like uterine fibroids — which the National Library of Medicine reports Black women are more likely to have — contribute to these outcomes, social factors also play a consequential role. "Implicit biases in referral patterns and treatment pursued faced by women of color also influence the worse success rates experienced by Black women," states the Shady Grove study.

So, what should you do in an already-complicated environment for Black women? First, start educating yourself about egg freezing and everything that comes with it. Don't disappear down a WebMD hole — be intentional about your sources, and take a break if you feel yourself getting anxious.

Next, find a doctor you can trust. One who listens to all your concerns and works with you to alleviate them. Use your personal research to ask targeted questions about the process: "By having more 'informed questions,' I found myself getting different treatment from practitioners and more able to make an informed decision," Hill shares. "By the time I started to ask questions about what the egg retrieval process entailed, I realized that I was gaining the keys to an entire world of new information."

Most importantly — spread the word. Black women already look within their own communities for support, and you might know someone thinking about exploring egg freezing as a fertility preservation tool. "No one I knew had personal experience with the process," Hill says. "I decided to start voicing my journey, missteps, and findings I learned along the way. 'Truth Tuesdays' and 'Talk with Racquel' are my attempts at filling a void by candidly sharing what I was learning and dropping nuggets for others. Only after these social media posts did I start to have family and friends begin to open up about their own experiences."

Jihan Forbes is a PS contributor.