Fertility preservation for social indications: a cost-based decision analysis

Capsule:
Neither oocyte cryopreservation nor ovarian tissue cryopreservation appears to be cost-effective for healthy women planning delayed childbearing.

Authors:
Jennifer Hirshfeld-Cytron, M.D., M.S.C.I., William A. Grobman, M.D., M.B.A., Magdy P. Milad, M.D., M.P.H.
Volume 97, Issue 3 , Pages 665-670, March 2012

Objective:
Age-related infertility remains a problem that assisted reproductive techniques (ART) have limited ability to overcome. Correspondingly, because an increasing number of women are choosing to delay childbearing, fertility preservation strategies, initially intended for patients undergoing gonadotoxic therapies, are being applied to this group of healthy women. Studies supporting the effectiveness of this practice are lacking.

Design:
Decision analytic techniques.

Setting:
We compared the cost-effectiveness of three strategies for women planning delayed childbearing until age 40: oocyte cryopreservation at age 25, ovarian tissue cryopreservation (OTC) at age 25, and no assisted reproduction until spontaneous conception had been attempted.

Patient(s):
Not applicable.

Intervention(s):
Not applicable.

Main Outcome Measure(s):
Cost-effectiveness, which was defined as the cost per live birth.

Result(s):
In this analysis, the strategy of foregoing fertility preservation at age 25 and then choosing ART only after not spontaneously conceiving at age 40 was the most cost-effective option. OTC was dominated by the other strategies. Sensitivity analyses demonstrated the robustness of the model; no analysis existed in which OTC was not dominated by oocyte cryopreservation. Increasing the cost of an IVF cycle beyond $22,000 was the only situation in which oocyte cryopreservation was the most preferred strategy.

Conclusion(s):
Neither oocyte cryopreservation nor OTC appear to be cost-effective under current circumstances for otherwise healthy women planning delayed childbearing. This analysis should give pause to the current practice of offering fertility preservation based only on the desire for delayed childbearing.

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