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


      To determine whether oocyte cryopreservation for deferred reproduction is cost effective per live birth using a model constructed from observed clinical practice.


      Decision-tree mathematical model with sensitivity analyses.


      Not applicable.


      A simulated cohort of women wishing to delay childbearing until age 40 years.


      Not applicable.

      Main Outcome Measure(s)

      Cost per live birth.


      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.


      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.

      Key Words

      To read this article in full you will need to make a payment


      Subscribe to Fertility and Sterility
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mills M.
        • Rindfuss R.R.
        • McDonald P.
        • teVelde E.
        • on behalf of the ESHRE Reproduction and Society Task Force
        Why do people postpone parenthood? Reasons and social policy incentives.
        Hum Reprod Update. 2011; 17: 848-860
      1. OECD Family Database, SF2.3. Mean age of mothers at first childbirth.
        (Last updated: February 24, 2012. Available at:) (Accessed September 7, 2014)
        • Martin J.A.
        • Hamilton B.E.
        • Osterman M.J.K.
        • Curtin S.C.
        • Mathews T.J.
        Births: final data for 2012.
        Natl Vital Stat Rep. 2013; 62 (Available at:) (Accessed September 7, 2014): 1-87
        • Tietze C.
        Reproductive span and rate of reproduction among Hutterite women.
        Fertil Steril. 1957; 8: 89-97
        • Guttmacher A.F.
        Factors affecting normal expectancy of conception.
        J Am Med Assoc. 1956; 161: 855-860
        • Schwartz D.
        • Mayaux M.J.
        Female fecundity as a function of age: results of artificial insemination in 2193 nulliparous women with azoospermic husbands. Federation CECOS.
        N Engl J Med. 1982; 306: 404-406
        • Leridon H.
        Human fertility: the basic component.
        Chicago University Press, Chicago1977
        • Wood J.
        Fecundity and natural fertility in humans.
        in: Milligen S. Reviews of reproductive biology. Oxford University Press, Oxford1989: 61-109
        • Leridon H.
        A new estimate of permanent sterility by age: sterility defined as the inability to conceive.
        Popul Stud. 2008; 62: 15-24
        • American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee
        Female age-related fertility decline. Committee Opinion No. 589.
        Fertil Steril. 2014; 101: 633-634
        • Leridon H.
        Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment.
        Hum Reprod. 2004; 19: 1548-1553
        • Hourvitz A.
        • Machinger R.
        • Maman E.
        • Baum M.
        • Dor J.
        • Levron J.
        Assisted reproduction in women over 40 years of age: how old is too old?.
        Reprod Biomed Online. 2009; 19: 599-603
      2. Society for Assisted Reproductive Technologies National Data Summary.
        (Available at:) (Accessed August 26, 2014)
        • Hodes-Wertz B.
        • Druckenmiller S.
        • Smith M.
        • Noyes N.
        What do reproductive-age women who undergo oocyte cryopreservation think about the process as a means to preserve fertility?.
        Fertil Steril. 2013; 100: 1343-1349
        • Rienzi L.
        • Cobo A.
        • Paffoni A.
        • Scarduelli C.
        • Capalbo A.
        • Vajta G.
        • et al.
        Consistent and predictable delivery rates after oocyte vitrification: an observational longitudinal cohort multicentric study.
        Hum Reprod. 2012; 27: 1606-1612
        • Boldt J.
        Current results with slow freezing and vitrification of the human oocyte.
        Reprod Biomed Online. 2011; 23: 314-322
        • Grifo J.A.
        • Noyes N.
        Delivery rate using cryopreserved oocytes is comparable to conventional in vitro fertilization using fresh oocytes: potential fertility preservation for female cancer patients.
        Fertil Steril. 2010; 93: 391-396
        • Cobo A.
        • Kuwayama M.
        • Pérez S.
        • Ruiz A.
        • Pellicer A.
        • Remohí J.
        Comparison of concomitant outcome achieved with fresh and cryopreserved donor oocytes vitrified by the Cryotop method.
        Fertil Steril. 2008; 89: 1657-1664
        • Nagy Z.P.
        • Chang C.C.
        • Shapiro D.B.
        • Bernal D.P.
        • Elsner C.W.
        • Mitchell-Leef D.
        • et al.
        Clinical evaluation of the efficiency of an oocyte donation program using egg cryo-banking.
        Fertil Steril. 2009; 92: 520-526
        • Goldman K.N.
        • Noyes N.L.
        • Knopman J.M.
        • McCaffrey C.
        • Grifo J.A.
        Oocyte efficiency: does live birth rate differ when analyzing cryopreserved and fresh oocytes on a per-oocyte basis?.
        Fertil Steril. 2013; 100: 712-717
        • Practice Committees of American Society for Reproductive Medicine
        • Society for Assisted Reproductive Technology
        Mature oocyte cryopreservation: a guideline.
        Fertil Steril. 2013; 99: 37-43
        • Hirshfeld-Cytron J.
        • Grobman W.A.
        • Milad M.P.
        Fertility preservation for social indications: a cost-based decision analysis.
        Fertil Steril. 2012; 97: 665-670
        • Van Loendersloot L.L.
        • Moolenaar L.M.
        • Mol B.W.
        • Repping S.
        • van der Veen F.
        • Goddijn M.
        Expanding reproductive lifespan: a cost-effectiveness study on oocyte freezing.
        Hum Reprod. 2011; 26: 3054-3060
        • Hirshfeld-Cytron J.
        • van Loendersloot L.L.
        • Mol B.W.
        • Goddijn M.
        • Grobman W.A.
        • Moolenaar L.M.
        • et al.
        Cost-effective analysis of oocyte cryopreservation: stunning similarities but differences remain.
        Hum Reprod. 2012; 27: 36-39
        • Practice Committee of the American Society of Reproductive Medicine
        Diagnostic evaluation of the infertile female: a committee opinion.
        Fertil Steril. 2012; 98: 302-307
        • Miller J.F.
        • Williamson E.
        • Glue J.
        • Gordon Y.B.
        • Grudzinskas J.G.
        • Sykes A.
        Fetal loss after implantation. A prospective study.
        Lancet. 1980; 2: 554-556
        • Florida Institute for Reproductive Medicine
        (Available at:) (Accessed September 7, 2014)
        • NYU Fertility Center
        (Available at:) (Accessed September 8, 2014)
      3. Extend Fertility.
        (Available at:) (Accessed September 7, 2014)
        • Egg Freezing Center
        (Available at:) (Accessed September 8, 2014)
      4. Cost Helper: Health.
        (Available at:) (Accessed September 8, 2014)
        • Livestrong Foundation
        (Available at:) (Accessed September 8, 2014)
      5. Attain Fertility.
        (Available at:) (Accessed July 11, 2014)
        • RESOLVE: The National Infertility Association
        (Available at:) (Accessed September 7, 2014)
        • Klein J.
        • Sauer M.J.
        Assessing fertility in women of advanced reproductive age.
        Am J Obstet Gynecol. 2001; 185: 758-770
        • Cil A.P.
        • Bang H.
        • Oktay K.
        Age-specific probability of live birth with oocyte cryopreservation: an individual patient data meta-analysis.
        Fertil Steril. 2013; 100: 492-499
        • Richardson W.S.
        • Detsky A.S.
        Users' guide to the medical literature: VII. How to use a clinical decision analysis: A. Are the results of the study valid?.
        JAMA. 1995; 273: 1292-1295
        • Goldman M.B.
        • Thornton K.L.
        • Ryley D.
        • Alper M.M.
        • Fung J.L.
        • Hornstein M.D.
        • et al.
        A randomized clinical trial to determine optimal infertility treatment in older couples: the Fortyand Over Treatment Trial (FORT-T).
        Fertil Steril. 2014; 101: 1574-1581
        • Yu B.
        • Mumford S.
        • Segars J.H.
        • Armstrong A.Y.
        Cost-effectiveness analysis comparing continuation of art with conversion to iui in patients with low follicle numbers.
        Fertil Steril. 2011; 96: S2