Baby budgeting: oocyte cryopreservation in women delaying reproduction can reduce cost per live birth

Abstract

Objective: To determine whether oocyte cryopreservation for deferred reproduction is cost effective per live birth using a model constructed from observed clinical practice.

Design: Decision-tree mathematical model with sensitivity analyses.

Setting: Not applicable.

Patient(s): A simulated cohort of women wishing to delay childbearing until age 40 years.

Intervention(s): Not applicable.

Main outcome measure(s): Cost per live birth.

Result(s): Our primary model predicted that oocyte cryopreservation at age 35 years by women planning to defer pregnancy attempts until age 40 years would decrease cost per live birth from $55,060 to $39,946 (and increase the odds of live birth from 42% to 62% by the end of the model), indicating that oocyte cryopreservation is a cost-effective strategy relative to forgoing it. If fresh autologous assisted reproductive technology (ART) was added at age 40 years, before thawing oocytes, 74% obtained a live birth, and cost per live birth increased to $61,887. Separate sensitivity analyses demonstrated that oocyte cryopreservation remained cost effective as long as performed before age 38 years, and more than 49% of those women not obtaining a spontaneously conceived live birth returned to thaw oocytes.

Conclusion(s): In women who plan to delay childbearing until age 40 years, oocyte cryopreservation before 38 years of age reduces the cost to obtain a live birth.

Keywords: ART; Oocyte cryopreservation; cost analysis; fertility preservation; vitrification.

Figure 1

Schematic Representation of Treatment Strategies Analyzed in Cost-effectiveness Analysis ^aStrategy 1 (OC): OC × 1.2 cycles (mean number required to obtain 16 MII oocytes at age 35 years), attempt spontaneous conception at age 40 years for 6 months, 2 oocyte thaw cycles using stored oocytes if no live birth ^bStrategy 2 (OC/IVF): OC × 1.2 cycles, attempt spontaneous conception at age 40 years for 6 months, 2 fresh autologous ART cycles if no live birth, 2 oocyte thaw cycles using stored oocytes if still no live birth ^cStrategy 3 (No OC): No OC at age 35 years, attempt spontaneous conception at age 40 years for 6 months, 2 fresh autologous ART cycles if no live birth

Figure 2

Sensitivity Analyses Comparing Cost-Effectiveness Between Treatment Strategies While Varying Individual Model Inputs. Each panel represents a separate sensitivity analysis, in which the model input named on the X-axis was varied, while all other model inputs were held constant. Cost per live birth is represented on the Y-axis, such that lower points on each graph represent the more cost effective strategy for the given model input. Model inputs varied in the sensitivity analyses included: A) age at oocyte cryopreservation (OC), B) probability of live birth at age 40 years from 6 months’ attempts at spontaneous conception, C) cost of OC, and D) cost of an IVF cycle. In all panels, the blue line represents Strategy 1 (OC), the green line represents Strategy 2 (OC/IVF), and the red line represents Strategy 3 (No OC). See Figure 1 and methods for a detailed description of each strategy.