Baby budgeting: a cost-effectiveness analysis (CEA) of elective oocyte cryopreservation (EOC) as a means to increase live birth rates (LBR) in women delaying reproduction

Oocyte cryopreservation is one of the state-of-art technologies in human reproductive medicine, which brings opportunities for women to preserve their fertility. In the present study, we analyzed the efficiency and outcomes of 8 years’ autologous egg cryopreservation: Frozen oocytes were warmed from 120 cycles and oocyte survival, fertilization, blastocyst development, clinical pregnancy, embryo implantation, live birth rates and birth weights were collected based on the patients’ ages of <35, 35–37 and > 37 years old. The details of oocyte cryopreservation and the efficiency were further analyzed based on different patient categories. During the study period, 849 oocytes from 120 cycles were warmed. Oocyte survival, fertilization, and blastocyst development were not affected by women’s ages at the time of cryopreservation. However, number of patients without blastocyst formation was significantly (P < 0.05) higher in patients >37 years old (31.2%) than that in patients <35 years old (13.1%). Higher live birth rates were observed in patients <35 (51.1%) and 35–37 (46.7%) years old than in patients >37 years old (28.6%) after fresh embryo transfer. Some patients did not have blastocysts mainly due to low fertilization by poor sperm or small number of oocytes warmed. These results indicate that the efficiency of oocyte cryopreservation, evaluated by live birth and embryo implantation rates is affected by women’s age, number of oocytes warmed and sperm quality.

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OOCYTE CRYOPRESERVATION VERSUS OVARIAN TISSUE CRYOPRESERVATION AS FERTILITY PRESERVATION FOR ADULT WOMEN UNDERGOING GONADOTOXIC THERAPY: A COST-EFFECTIVENESS ANALYSIS

Fertility and Sterility ◽

10.1016/j.fertnstert.2020.08.257 ◽

2020 ◽

Vol 114 (3) ◽

pp. e84

Author(s):

Esther H. Chung ◽

Stephanie L. Lim ◽

Haley A. Moss ◽

Kelly S. Acharya

Keyword(s):

Cost Effectiveness ◽

Fertility Preservation ◽

Ovarian Tissue ◽

Cost Effectiveness Analysis ◽

Oocyte Cryopreservation ◽

Ovarian Tissue Cryopreservation ◽

Adult Women ◽

Effectiveness Analysis ◽

Tissue Cryopreservation

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Cumulative live birth rate and cost-effectiveness analysis between GnRH-antagonist protocol and multiple minimal ovarian stimulation in poor responder

10.21203/rs.3.rs-37753/v1 ◽

2020 ◽

Author(s):

Yuan Liu ◽

Yu Wu

Keyword(s):

Cost Effectiveness ◽

Live Birth ◽

Ovarian Stimulation ◽

Gnrh Antagonist ◽

Live Birth Rate ◽

Cost Effectiveness Analysis ◽

Cumulative Live Birth Rate ◽

Effectiveness Analysis ◽

Gnrh Antagonist Protocol ◽

Antagonist Protocol

Abstract Background The overall cumulative live birth rate (CLBR) of poor ovary responders (POR) is extremely low. Minimal ovarian stimulation (MOS) suggested a relative realistic solution in ART for POR. Our study aimed to investigate whether multiple MOS strategy results in higher CLBR compared to GnRH antagonist protocol and the cost-effectiveness analysis in POR. Methods This retrospective study involved 699 patients (1058 cycles) who fulfilled the Bologna criteria in one center performed from 2010–2018. Specifically, 325 women (325 cycles) were treated with one time conventional GnRH antagonist ovarian stimulation (GnRH-antagonist). Another 374 patients (733 cycles) were treated with multiple minimal ovarian stimulations (MOS) including natural cycles. CLBR and cost-effectiveness analysis were performed comparing these two groups of women. Results GnRH- antagonist leads to more oocytes retrieved, more fertilized oocytes and more viable embryos compared to first MOS (p < 0.001) and the cumulative corresponding ones in multiple MOS (p < 0.001). For the first IVF cycle, GnRH- antagonist results in higher CLBR than MOS (12.92% versus 4.54%, Adjusted OR 2.606; 95%CI 1.386, 4.899, p = 0.003). However, GnRH-antagonist induces comparable CLBR with multiple MOS (12.92% versus 7.92%, Adjusted OR 1.702; 95%CI 0.971, 2.982, p = 0.063), but absolutely shorter time to live birth (9 (8, 10.75) months versus 11 (9, 14) months, p = 0.014) and similar financial expenditure compared to repeated MOS (20838 (17953, 23422) ¥ versus 21261.5 (15892.5, 35140.25) ¥, p = 0.13). Conclusion Both MOS and GnRH-antagonist provide low chance of live birth for poor responders. GnRH antagonist protocol is a sound choice for POR with comparable CLBR, shorter time to live birth and similar financial expenditure.

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Oocyte cryopreservation review: outcomes of medical oocyte cryopreservation and planned oocyte cryopreservation

Reproductive Biology and Endocrinology ◽

10.1186/s12958-021-00884-0 ◽

2022 ◽

Vol 20 (1) ◽

Author(s):

Zachary Walker ◽

Andrea Lanes ◽

Elizabeth Ginsburg

Keyword(s):

Fertility Preservation ◽

Live Birth ◽

Oocyte Retrieval ◽

Oocyte Cryopreservation ◽

Utilization Rate ◽

Birth Rates ◽

Aged Patients ◽

Live Birth Rates ◽

Oocyte Yield ◽

Age Related

Abstract Background The utilization of oocyte cryopreservation (OC) has become popularized with increasing numbers of reproductive-aged patients desiring to maintain fertility for future family building. OC was initially used for fertility preservation in postmenarchal patients prior to gonadotoxic therapies; however, it is now available to patients to circumvent age-related infertility and other diagnoses associated with early loss of ovarian reserve. The primary aim of this paper is to provide a narrative review of the most recent and robust data on the utilization and outcomes of OC in both patient populations. Summary OC results in similar oocyte yield in patients facing gonadotoxic therapies and patients undergoing planned OC. Available data are insufficient to predict the live birth rates or the number of oocytes needed to result in live birth. However, oocyte yield and live birth rates are best among patients < 37.5 years old or with anti-mullerian hormone levels > 1.995 ng/dL, at the time of oocyte retrieval. There is a high ‘no use’ rate (58.9%) in patients using planned OC with 62.5% returning to use frozen oocytes with a spouse. The utilization rate in medical OC patients is < 10%. There is currently no data on the effects of BMI, smoking, or ethnicity on planned OC outcomes. Conclusion It is too early to draw any final conclusions on outcomes of OC in medical OC and planned OC; however, preliminary data supports that utilization of OC in both groups result in preservation of fertility and subsequent live births in patients who return to use their cryopreserved eggs. Higher oocyte yield, with fewer ovarian stimulation cycles, and higher live birth rates are seen in patients who seek OC at younger ages, reinforcing the importance of age on fertility preservation. More studies are needed in medical OC and planned OC to help guide counseling and decision-making in patients seeking these services.

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