Expanding reproductive lifespan: A cost-effectiveness study on oocyte freezing

Background The average age of women bearing their first child has increased strongly. This is an important reproductive health problem as fertility declines with increasing female age. Unfortunately, IVF using fresh oocytes cannot compensate for this age-related fertility decline. Oocyte freezing could be a solution. Methods We used the Markov model to estimate the cost-effectiveness of three strategies for 35-year-old women who want to postpone pregnancy till the age of 40: Strategy 1: women undergo three cycles of ovarian hyperstimulation at age 35 for oocyte freezing, then at age 40, use these frozen oocytes for IVF; Strategy 2: women at age 40 attempt to conceive without treatment; and the reference strategy: women at age 40 attempt to conceive and, if not pregnant after 1 year, undergo IVF. Sensitivity analyses were carried out to investigate assumptions of the model and to identify which model inputs had most impact on the results. Results Oocyte freezing (Strategy 1) resulted in a live birth rate of 84.5 at an average cost of €10 419. Natural conception (Strategy 2) resulted in a live birth rate of 52.3 at an average cost of €310 per birth. IVF (the reference strategy) resulted in a cumulative live birth rate of 64.6 at an average cost of €7798. The cost per additional live birth for the oocyte freezing strategy was €13 156 compared to the IVF strategy. If at least 61 of the women return to collect their oocytes, and if there is a willingness to pay €19 560 extra per additional live birth, the oocyte freezing strategy is the most cost-effective strategy. Conclusion Oocyte freezing is more cost effective compared to IVF, if at least 61 of the women return to collect their oocytes and if one is willing to pay €19 560 extra per additional live birth. Our Markov model shows that, considering all the used assumptions, oocyte freezing provides more value for money than IVF.