What Does Delaying Childbearing Cost?
[Writer] This is research news from U-I-C – the University of Illinois at Chicago. Today, Dr. Jennifer Hirshfeld-Cytron, assistant professor of obstetrics and gynecology, talks about her recent study that finds neither egg freezing nor ovarian tissue cryopreservation are cost effective for healthy women who want to delay childbearing for social reasons.
Here’s Dr. Hirshfeld-Cytron:
[Hirshfeld-Cytron] Recently we studied the question of how to translate the technologies that we use for fertility preservation for women interested in freezing eggs or ovarian tissue for what is considered social reasons.
Traditionally, fertility preservation – which means freezing eggs or potentially freezing parts of ovarian tissue – was designed for women that were going to undergo treatments that were going to negatively impact their fertility.
Centers around the country have now decided to potentially offer these technologies to women who are not undergoing gonadotoxic therapies, but moreover are just in some sense trying to create a back-up plan.
And so when we think of this group of women we think more about the early to mid- twenties, a woman who is considering entering graduate school, or some type of professional school such as medical school, law school – and wants to, in a sense, create some type of back-up plan if she’s planning on or considering that she may likely delay her childbearing.
So what we did is, utilizing decision analysis techniques, we created three scenarios. We took a woman at age 25 and we offered either to do nothing, to freeze eggs or to freeze ovarian tissue.
And then in our model at age 40 the woman would come back and she would initially try on her own and see what would happen. And then she would, if she had frozen tissue be able to utilize that, and if she hadn’t she would do what we consider to be standard care. And standard care right now is in vitro fertilization. And we used success rates of in vitro fertilization based on age that are available in the literature.
And to create this model we used other data and statistics that is available in the literature.
And what was interesting is that we found in order to create one additional live birth with the mechanisms of freezing either the ovarian tissue or freezing eggs, it would cost society an additional $130,000.
And so to put that number in perspective I think it’s important to keep in mind that our parameter is looking at live births. So often decision analysis studies look at things such as qualities or quality adjusted life years, but our metric is live birth. And so how do you determine cost effectiveness for live birth is something that people really don’t know. So whether or not this is cost effective is something that needs to be talked about and potentially decided as a society.
The one thing that our analysis did show was that freezing eggs was more cost effective than freezing ovarian tissue. And doing nothing was the most cost effective. The other thing to keep in mind is within our model we assumed that every woman at age 25 who froze something did not change her mind. So like everything else in life people often change mind. So even though a woman at age 25 may be set and determined that she will want to delay childbearing, things happen, and that may change.
So at any scenario where someone has undergone a procedure to freeze eggs or part of her ovaries for future use and then she changes her mind that is tissue in a sense that is never used. And so that cost would even be higher. So the cost estimates that we have in some sense are the most conservative.
And the reason that we underdid this study is because obstetrics and gynecology, like all aspects of medicine, sometimes can be victim to the tyranny of technology. Which is, with new techniques, as people get very excited about them and clinician providers get very excited about them we offer them to a wider range of patients.
And our study suggests that before we do this practice that perhaps we take a moment to step back and to consider what is the cost effectiveness to society and how we sort of prioritize this amongst things such as health care reform and health care dollars within our society.
And one of the other things what this does is suggest that multiple centers around the country already offer things like egg freezing – that perhaps we take a step back and try to study some of these differences both in cost effectiveness, both in likelihood of using the tissue before we offer the techniques.
Again, like most aspects of medicine, most studies tend to create more questions than potentially we answer, but I think these are very important questions and very interesting questions to start to ask and to start to investigate when we’re looking at providing delaying childbearing for young women.
I think it’s also possible to argue that in society one of the ways that we could perhaps avoid these costs is really provide an environment for young women that fosters an ability to both develop their career at the same time as that they are developing theirfamily.
[Writer] Jennifer Hirshfeld-Cytron is an assistant professor in obstetrics and gynecology and director of the fertility preservation program at the University of Illinois Hospital & Health Sciences System.
For more information about this research, go to www.news.uic.edu, click on “news releases” and look for the release dated March 14, 2012.
This has been research news from U-I-C – the University of Illinois at Chicago.