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

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. (C) 2015 by American Society for Reproductive Medicine.