Planned oocyte cryopreservation (Planned OC): systematic review and meta‐analysis of cost‐efficiency and patients’ perspective

Abstract

Background Advances in vitrification techniques have enabled planned oocyte cryopreservation (‘Planned OC’). Objectives To explore the cost‐efficiency and utilisation of planned OC, as well as patients’ perspectives on the process. Search strategy A systematic search in PubMed/MEDLINE, Embase, Cochrane Database and PsychINFO, for all relevant studies published between January 2007 and December 2019. Selection criteria The protocol followed PRISMA guidelines in PECO format, and was registered with PROSPERO. Data collection and analysis Two independent reviewers evaluated all manuscripts for inclusion eligibility. Authors were contacted for missing data. Included studies were assessed for risk of bias and for heterogeneity. Weighted effects were measured and plotted. Main results The search yielded 12 545 records, of which 43 were included. Planned OC is cost‐efficient at 35, assuming 60% utilisation; and at 37 assuming utilising donor sperm when necessary. At 38 it is cost‐efficient to defer planned OC in favour of undergoing 2 IVF cycles. Currently, utilisation of banked‐oocytes within 22–58 months, is up to 15%. Nine percent of warmed banked oocytes result in life births. Online resources and treating physicians are equally important sources of information regarding planned OC. Most patients think planned OC is ideal before age 35 and are not fully aware of what the process entails and tend to overestimate the success rates. The main barrier to wider endorsement of planned OC is being wary of potential health implications or of limited success. Conclusion Planned OC is an adequate method for preserving fertility. However, knowledge gaps result in under‐utilisation leading to reduced cost‐efficiency. Tweetable abstract Identifying facilitators and barriers for wider adoption of banking oocytes can enhance the cost‐efficiency of this modality.

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

“…A systematic review and meta-analysis done by Fuchs Weizman et al included 43 studies and found that planned OC is the most cost efficient at 35 years old (assuming a minimum of 60% utilization) [39,40]. Another study by Mesen et Goldman et al conducted a modeling study from a retrospective analysis of their academic infertility center data.…”

“…They also found that of the 88 patients who utilized their vitrified oocytes most returned to thaw/warm oocytes with a partner (n = 55, 62.5%) compared to donor sperm (n = 33, 37.5%) and this did not differ based on age. Fuchs Weizman et al also evaluated the utilization of oocytes after planned OC in a systematic review and found that 12.1-15% of oocytes were used 22-58 months after freezing [39].…”

Oocyte vitrification for elective fertility preservation: a SWOT analysis

“…Patients did not use their cryopreserved oocytes because they conceived naturally, because they did not want to be a single mother, or because of their social, personal, or professional situation (ACOG, 2014). A very low return rate makes the cost-effectiveness of the technique considerably uncertain (Ben-Rafael, 2018;Fuchs Weizman et al, 2021), and depending on the cost of EEF per cycle and the return rate, the calculated societal cost per live birth could amount to several hundreds of thousands of euros (Ben-Rafael, 2018).…”

Oocyte cryopreservation versus ovarian tissue cryopreservation for adult female oncofertility patients: a cost-effectiveness study

“…Given that for many patients these services are not covered by insurance due to lack of a state mandate, charge data is frequently used in cost-effectiveness analyses within the reproductive endocrinology and infertility literature, which may contribute to an over-estimation of OC cost (mainly based on charge data) relative to the underestimation of OTC (cost data) [13,14,30]. Additionally, costs were estimated from published literature, which is fairly limited based on a recent review published in 2020 [15]. The institutions from which the pricing ranges were queried may also have had considerable variations.…”

“…The costs related to oocyte cryopreservation and IVF, including storage fees, thawing, fertilization, and fresh and frozen embryo transfers, were obtained from literature that obtained charges from 17 randomly selected regionally diverse clinics [13][14][15]. All charges were confirmed with other primary studies [16], and when available, with published cost ranges through the Oncofertility Consortium (oncofertility.msu.edu), Livestrong Foundation (livestrong.org), Attain Fertility (attainfertility.com), Cost Helper Health (health.costhelper.…”