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

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.