title: Fertility preservation for social indications: a cost-based decision analysis.
abstract: 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.
  
  
  METHODS
  Decision analytic techniques.
  
  
  METHODS
  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.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Cost-effectiveness, which was defined as the cost per live birth.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60612, USA. jhirshfeldcytron@gmail.com
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hirshfeld-Cytron
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.forename: Magdy P
authors.initials: MP
authors.lastname: Milad
mesh_terms: D000328:Adult; D000375:Aging; D003362:Cost-Benefit Analysis; D015925:Cryopreservation / Q000191:economics*; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D005298:Fertility; D059247:Fertility Preservation / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D007247:Infertility, Female / Q000191:economics* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D050498:Live Birth; D008423:Maternal Age; D018803:Models, Economic; D009865:Oocytes; D010053:Ovary / Q000637:transplantation; D011247:Pregnancy; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted / Q000191:economics*; D016896:Treatment Outcome