Over the weekend, Rep. Alexandria Ocasio-Cortez (D-NY) announced on Instagram that she had joined the thousands of American women who freeze their eggs every year, a number that has been steadily growing for the past decade.

“This is a choice that I am making to feel more in control of my life,” Ocasio-Cortez said in her Instagram story sharing her decision. 

As politicians in the public eye often do, Ocasio-Cortez turned her personal choice into a statement:

Usually I keep my private life quite private, but I have made the decision to start freezing my eggs, and I want to share this because I was weighing it for a very long time. I was saving for it for a very long time, and there just isn’t a ton out there, I feel, and sometimes it can feel very daunting. As women in general, we are not taught about our own bodies. We are not prepared for our own lives. … We need to show more depictions of women having full lives.

At the same time, she acknowledged being “in a very privileged position” to be able to take advantage of egg freezing. The process still typically costs $10,000 or more — and most insurance still doesn’t cover it. Not even AOC’s federal health plan. Egg freezing is a luxury afforded only to the people who can pay for it and take on the significant burden of the treatment and all of the uncertainty that comes with it.

Ocasio-Cortez’s announcement underscores the awkward place that egg freezing still occupies in the landscape of fertility access — at a moment when Republicans in power are lamenting falling birth rates and searching for ways to encourage more people to start families. In theory, egg freezing gives women the flexibility to take more control of their decisions about having kids and preserve that possibility for themselves in the future. But in reality, the promises of this important procedure have often been unfulfilled. 

Beyond the intimidating price tag, as AOC alluded to, many young women don’t know some of the basics about age-related fertility decline and how to maximize their chances that egg freezing will lead to an actual pregnancy. There are some “significant gaps in fertility knowledge amongst Gen Z women in particular,” said Danielle Melfi, CEO of Resolve, a fertility treatment advocacy group. 

“That points to why someone like AOC who has such broad awareness and broad reach across her channels,” Melfi told me, “specifically younger people who aren’t tuned into any politician but would be tuned into her. Her sharing her story and journey matters.”

Egg freezing is not a panacea, and it never will be. But it can give individuals options and a sense of empowerment. And right now, as AOC acknowledged in her video, those are privileges reserved for the people who are in the know and have the means to take advantage of it. For everyone else, significant barriers still remain.

Freezing time doesn’t come cheap — or easily

On average, the cost of egg freezing averages between $10,000 and $20,000. And, for most people, including AOC, who makes $174,000 a year on her congressional salary alone, health insurance coverage is not an option. According to a 2024 KFF employer survey, just 12 percent of large employers who offer health insurance provide egg or sperm freezing.

That’s not for lack of trying.

As of now, 21 states have mandates requiring health insurers to provide some level of coverage for “fertility preservation” when it is deemed medically necessary — for a younger cancer patient who is about to undergo chemotherapy, for example, a more and more common scenario these days. But coverage for what is viewed as elective freezing, as AOC is doing, is still generally not included in those requirements.

But even the state-level mandates come with a huge carveout. Under America’s Frankenstein healthcare system, there is a very important type of health insurance plan that is exempt from such state laws: self-funded employer plans, meaning those that fully cover their workers’ medical expenses without relying on an outside insurance company. They are governed only by a federal law known as the Employee Retirement Income Security Act, and that law provides no guarantees for egg freezing or other reproductive care. 

About half of Americans get their insurance through their work, and of those employer plans, more than 60 percent are self-funded. That is a lot of people who have no guarantees for this kind of service, even when a serious medical reason is motivating them to freeze their eggs. The select few who can get egg freezing covered are typically higher-income, too, adding to the disparity between the US healthcare system’s haves and have-nots.

Support for IVF among the American public has been rising, with 70 percent saying in 2024 that access to IVF was a good thing. And fertility coverage is having a political moment, too: the HOPE With Fertility Services Act, which would require insurers to cover some basic fertility treatment when it is deemed medically necessary, was introduced this year with a bipartisan slate of more than 20 sponsors, though it remains stuck at the committee level for now. The Trump administration has fixated on dropping fertility rates, but, beyond a limited IVF executive order, they have not seriously pursued plans to expand access to egg freezing. A national mandate to cover egg freezing, even only when medically necessary, could end up being opposed by both health insurers (which have fought all kinds of benefit requirements in the past) and the religious right (which has specifically challenged mandates for reproductive healthcare, like the Affordable Care Act’s contraceptive mandate).

It will likely take a variety of policy changes to give people more financial support for this important but expensive service. So what now? Unfortunately, I think we are stuck with patchy coverage and can expect only incremental improvements for the foreseeable future. On the plus side, Melfi said, more employers may increasingly offer these benefits as a competitive advantage.

But access isn’t the only problem.

Egg freezing works best when people actually know how to take advantage of it

Even if a person is able to access egg freezing, it doesn’t always pay off. 

A study published in the American Journal of Obstetrics and Gynecology in February found that fewer than 6 percent of people who froze their eggs electively had come back to thaw them within five to seven years. Of those people, 79 percent had a usable embryo after warming and 29 percent had a pregnancy that resulted in a live birth.

Of course, just because some people haven’t warmed their eggs within seven years doesn’t mean they won’t come back in nine: The point of this service is you could freeze your eggs at 30 even if you’re not ready for kids until you are 40. Those numbers will likely grow with time. And some of those people might end up successfully getting pregnant on their own the old-fashioned way, which means they won’t need their frozen eggs at all. 

“Typically, people who are coming in to freeze their eggs haven’t actually tried to conceive yet. When they are ready to start conceiving, a lot of people may not have any issues conceiving,” said Dr. Mabel Lee, a reproductive endocrinologist and infertility specialist at HRC Fertility in Pasadena, California who led the published study. 

What is true is that getting pregnant is difficult no matter how you go about it — even conceiving through intercourse only results in a 20 to 25 percent success rate on a given try, Lee said — and success with frozen eggs depends on how young the person was when their eggs were preserved: The younger they are, the higher the chances of success. That makes it all the more important that people — particularly younger people — know about the realities of egg freezing and how to make the most of it, whether they are spending thousands of dollars of their own money or whether they are using insurance to pay for it. Awareness among young people of the basic relationship between age and fertility remains discouragingly low. Lee said she has patients come in all the time who say they wish they had known more about egg freezing sooner.

The likelihood of a live birth may go up if the eggs were younger, but is that enough to convince someone in their mid-20s to pay out of pocket to freeze their eggs? In the midst of an affordability crisis, is that even an option? It might not be; in the meantime, Lee said women could get a blood test to measure their ovarian reserves, which estimates a person’s egg count, and use that to make an informed decision about egg freezing in consultation with their doctor.

Once you have decided to freeze your eggs, using a high-quality clinic is a must: That’s the other major variable in success, Lee told me. The Society for Assisted Reproductive Technology maintains a national database covering clinics across the country and tracking birth success rates and other metrics. It’s like a report card of sorts, so you can hopefully choose the best provider for you.

There are still no guarantees. Fertility is too fickle. But by improving access and raising awareness, there are clear steps we can take to try to maximize egg freezing’s potential.

“Let him kiss me with the kisses of his mouth!”

No, that isn’t the latest Heated Rivalry fanfiction — it’s the opening line of a 2,000-year-old erotic poem. Yes, in the middle of the Hebrew Bible, a text that has so often been weaponized to shame sexual desire, there is a collection of straight-up filth: 

“I arose to open to my beloved,

    and my hands dripped with myrrh,

my fingers with liquid myrrh,

    on the handles of the bolt.” 

Girl. Tell me more…

As a gay kid growing up in the 1990s, sex was far from holy. Indeed, it was deemed dirty, diseased, and damned by the church. The shadow of AIDS lingered long and information readily accessible to me was limited to guidance on birth control. Nothing about pleasure; certainly nothing practical about the mechanics of gay sex. It meant that my first time, aged 18 at a youth conference with a Brazilian boy whose name I hardly knew, was both messy and painful.

For years, it didn’t cross my mind to look at what religion had to say about having good sex. Why trust these traditions that have been so callous and cruel to queer people like me? Well, it turns out that those sages of yore were just as horny as we are. And the practice of worship, the experience of divine intimacy, and the sweetness of surrender are as applicable in sex as they are in spiritual life.

To get more insight into this, I called author and Rabbi Jay Michaelson, whose book, God in Your Body: Kabbalah, Mindfulness, and Embodied Spiritual Practice, first got me thinking about sex as a spiritual practice. In it, he argues that spirit and body are not separate at all, and that our bodies are the very place where holiness expresses itself in the world. 

For Michaelson, there are three key gifts that religion offers us as a way of connecting with our sexual selves. First is the cultivation of presence. Michaelson isn’t just a rabbi; he’s also a meditation teacher, and so Buddhist practice is core to his spiritual life. “I don’t understand how people have sex without meditation!” he jokes. “To miss out on the intimacy with the other person or just with one’s own experience, with one’s own body, is, to me, a shame. … It can be really simple.” He adds that if you can have mindful eating, you can have mindful sex.

How can we practice presence? Take inspiration from religious rituals! Think about the ways in which worship services use incense, music, even mood lighting through stained-glass windows. The incantation of holy words, the eating of special food, the anointing with holy oil…these are all tools to help people be present in the here and now. So, the same is true for sex: Light some candles, use massage oil, tell your partner (or yourself) what you want and how, and put on a playlist to be truly present.

But just like meditating, sometimes being fully present to our sexuality can bring up unexpected negative emotions. Maybe we worry about how we look, or the sounds we’re making, or how we taste. We judge ourselves or get embarrassed about what we want. That’s where the second gift religion can offer us comes into play.

It’s “about really embodying the knowledge that pleasure is a blessing,” Michaelson says. Whether that blessing comes from God or is just the experience of being alive is immaterial to Michaelson; what matters is believing it. “That is something that is easy to read, but, like any other spiritual insight, to actually take it in and really believe it…that takes a lifetime of practice,” he says. 

In a story from the Talmud, a rabbi by the name of Kahana follows his teacher home and hides under the bed in order to learn how he should make love. He waits and listens — and when he’s discovered and scolded for his voyeurism, he tries to defend himself by saying, “It is Torah, and I must learn!” Luckily for us, we have better strategies for learning pleasure these days. 

Court Vox is an intimacy coach based in Los Angeles who helps gay, bi, trans, and queer men learn the language of their embodied pleasure. Through hands-on workshops that center sensation, touch, breath, and movement, Vox teaches men to understand their own nervous system and what feels good. You could try this by simply spending some time moving different objects over your body: a feather, a stone, a fork, a hand. Slow down enough to notice what really feels good, and where. You will likely be surprised by what does and doesn’t give you pleasure as you explore.

Fundamental to Vox’s work is moving people out of a state of hypervigilance so they can actually let go enough to enjoy themselves. “You cannot surrender when you are still managing,” he says. And for many, surrender can be so very sweet. Vox explains that for him, true letting go feels like being inside “some sort of Jell-O or honey, almost like a womb.” But for that to happen, you have to feel safe. If you don’t feel safe, you’re not going to find real pleasure — which means that consent is a prerequisite for everything that Vox does, and it should be for the rest of us too. 

So, if good sex is about presence and pleasure, the final element Michaelson says that we can pull from religious tradition is integration. “It’s not where I want to be spiritually to have great sex and then 15 minutes later…I go on as if it never happened,” he says. Sex shouldn’t be a random experience that’s separate from who we are in every other part of life. Sex connects us to the world; to each other; to the very force of life. 

Religious traditions have often integrated sex into daily living through myths and storytelling. By integrating stories of sex into their own creation myths, sex was deemed natural and necessary. Usually, these myths focus on fecundity — new life literally coming from some sexual activity. For example, the Mesopotamian goddess of the salt sea Tiamat mates with the freshwater god Abzû to birth a pantheon of newer gods. Or the Sumerian god Enki masturbates and ejaculates semen to create the Tigris and Euphrates rivers.

So, how might we find stories and rituals that give sex a meaningful place in our everyday lives? Yes, we might entwine our sex lives with the cycles of the moon, or host board game nights with a host of lovers! But some old traditions can find new life when we look at them anew, too.

Father Jarel Robinson-Brown is an Anglican priest. On Sunday mornings he officiates the Mass, or Eucharist, which is a ritual retelling of a story of love, sacrifice, death, and resurrection. This ritual has integrated core theological ideas into worshippers’ everyday lives for 2,000 years.

But for Robinson-Brown, this church service isn’t the only place where God’s presence is felt. Speaking in a personal capacity in an episode of the podcast All Out With Jon Dean earlier this year, he explained that dark rooms and cruising grounds can be similarly sacred. “The space of a dark room [is a] kind of metaphor for what I think a particular experience of God can be and with other people can be in terms of intimacy and safety. … People are not judged on their appearance, or their differences, but come to each other as they are.” In these sexual encounters where individuals are nameless to one another, there is an experience of union that transcends identity, biography, and status. They are simply bodies together. And for Robinson-Brown, being embodied is what Christianity is all about. “Not only does God belong in the bedroom, or wherever the erotic space might be,” he tells me, “God is already in us.”

What Robinson-Brown is modeling here is the integrating of our sex lives into a larger pantheon of meaning. Cruising and sex in a dark room is an affirmation of each person’s sacredness and the necessity of human connection. 

That’s our task: to find ways of narrating (through stories and rituals) the presence and pleasure we experience in sex. To celebrate it; to delight in it; to see its holiness. That’s why there’s an erotic love poem at the heart of the Bible. Its closing words offer us this invitation: 

“Come away, my beloved,

    and be like a gazelle

or like a young stag

    on the spice-laden mountains.“

Whatever you believe, and however you have sex, I hope you find presence, pleasure, and stories that can integrate it all into your life. Good sex is spiritual. And good religion is full of sex. Let us be glad for it!