title: Cost-Effectiveness of the Freeze-All Policy.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of freeze-all cycles when compared to fresh embryo transfer.
  
  
  METHODS
  This was an observational study with a cost-effectiveness analysis. The analysis consisted of 530 intracytoplasmic sperm injection (ICSI) cycles in a private center in Brazil between January 2012 and December 2013. A total of 530 intracytoplasmic sperm injection (ICSI) cycles - 351 fresh embryo transfers and 179 freeze-all cycles - with a gonadotropin-releasing hormone (GnRH) antagonist protocol and day 3 embryo transfers.
  
  
  RESULTS
  The pregnancy rate was 31.1% in the fresh group and 39.7% in the freeze-all group. We performed two scenario analyses for costs. In scenario 1, we included those costs associated with the ICSI cycle (monitoring during controlled ovarian stimulation [COS], oocyte retrieval, embryo transfer, IVF laboratory, and medical costs), embryo cryopreservation of supernumerary embryos, hormone measurements during COS and endometrial priming, medication use (during COS, endometrial priming, and luteal phase support), ultrasound scan for frozen- thawed embryo transfer (FET), obstetric ultrasounds, and miscarriage. The total cost (in USD) per pregnancy was statistically lower in the freeze-all cycles (19,156.73 ± 1,732.99) when compared to the fresh cycles (23,059.72 ± 2,347.02). Even in Scenario 2, when charging all of the patients in the freeze-all group for cryopreservation (regardless of supernumerary embryos) and for FET, the fresh cycles had a statistically significant increase in treatment costs per ongoing pregnancy.
  
  
  CONCLUSIONS
  The results presented in this study suggest that the freeze-all policy is a cost-effective strategy when compared to fresh embryo transfer.
authors.affiliation: ORIGEN - Center for Reproductive Medicine, Rio de Janeiro/RJ - Brazil.
authors.forename: Matheus
authors.initials: M
authors.lastname: Roque
authors.affiliation: ORIGEN - Center for Reproductive Medicine, Rio de Janeiro/RJ - Brazil.
authors.forename: Marcello
authors.initials: M
authors.lastname: Valle
authors.affiliation: ORIGEN - Center for Reproductive Medicine, Rio de Janeiro/RJ - Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Guimarães
authors.affiliation: ORIGEN - Center for Reproductive Medicine, Belo Horizone/MG - Brazil.
authors.forename: Marcos
authors.initials: M
authors.lastname: Sampaio
authors.affiliation: ORIGEN - Center for Reproductive Medicine, Belo Horizone/MG - Brazil.
authors.forename: Selmo
authors.initials: S
authors.lastname: Geber
keywords: Cost-effectiveness; Delayed frozen–thawed embryo transfer; Freeze-all