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Cost-effectiveness of social oocyte freezing in Germany: estimates based on a Markov model

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Is oocyte freezing for non-medical reasons—the so-called “social freezing” (SF)—cost-effective compared to standard in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in Germany today?


We developed a model based on three strategies for women planning to postpone pregnancy. In each strategy, women actively practiced contraception until 40 then tried to conceive naturally for 1 year. If unsuccessful, women using strategy I (oocyte cryopreservation) attempted ICSI with frozen oocytes in the 2nd year, while women using strategy II (no action) further attempted natural conception. In strategy III (IVF/ICSI), women underwent 1 year of IVF/ICSI. If still unsuccessful, each strategy was followed by attempting natural conception again until 45. We used an adaptive Markov model to estimate and compare live birth rates and cost-effectiveness measures.


For strategy I, cumulative live birth rates at age 45 generally declined with the woman’s age at freezing and were between 71.4% (25 years) and 67.6% (38 years), while the cumulative success rate was 51.5% for strategy II and 60.8% for strategy III. The costs per live birth of egg freezing were age-dependent ranging between 22,418 € (30 years) and 25,590 € (38 years). The costs for strategy III were lower at 20,293 € per live birth.


Based on our results, social freezing in Germany may lead to additional pregnancies among women over 40 but also to significantly higher costs, since given the current live birth success rates and pricing, social freezing does not appear to be cost-effective.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

KCM: Project development, manuscript writing, data collection and analysis. GBH: Manuscript writing and editing, data management. WU: Manuscript writing and editing. ZV: Project development, manuscript writing and editing.

Correspondence to C. M. Klüber.

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Klüber, C.M., Greene, B.H., Wagner, U. et al. Cost-effectiveness of social oocyte freezing in Germany: estimates based on a Markov model. Arch Gynecol Obstet (2020).

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  • Oocyte cryopreservation
  • Social egg freezing
  • Cost-effectiveness
  • IVF
  • Markov model