STUDY QUESTION What are couples’ preferences for fresh embryo transfer versus freezing of all embryos followed by frozen embryo transfer and the associated clinical outcomes that may differentiate them? SUMMARY ANSWER Couples’ preferences are driven by anticipated chances of live birth, miscarriage, neonatal complications, and costs but not by the differences in the treatment process (including delay of embryo transfer linked to frozen embryo transfer and risk of ovarian hyperstimulation syndrome (OHSS) associated with fresh embryo transfer). WHAT IS KNOWN ALREADY A policy of freezing all embryos followed by transfer of frozen embryos results in livebirth rates which are similar to or higher than those following the transfer of fresh embryos while reducing the risk of OHSS and small for gestational age babies: it can, however, increase the risk of pre-eclampsia and large for gestational age offspring. Hence, the controversy continues over whether to do fresh embryo transfer or freeze all embryos followed by frozen embryo transfer. STUDY DESIGN, SIZE, DURATION We used a discrete choice experiment (DCE) technique to survey infertile couples between August 2018 and January 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS We asked IVF naïve couples attending a tertiary referral centre to independently complete a questionnaire with nine hypothetical choice tasks between fresh and frozen embryo transfer. The alternatives varied across the choice occurrences on several attributes including efficacy (live birth rate), safety (miscarriage rate, neonatal complication rate), and cost of treatment. We assumed that a freeze-all strategy prolonged treatment but reduced the risk of OHSS. An error components mixed logit model was used to estimate the relative value (utility) that couples placed on the alternative treatment approaches and the attributes used to describe them. Willingness to pay and marginal rates of substitution between the non-cost attributes were calculated. A total of 360 individual questionnaires were given to 180 couples who fulfilled the inclusion criteria, of which 212 were completed and returned Our study population included 3 same sex couples (2 females and 1 male) and 101 heterosexual couples. Four questionnaires were filled by one partner only. The response rate was 58.8%. MAIN RESULTS AND THE ROLE OF CHANCE Couples preferred both fresh and frozen embryo transfer (odds ratio 27.93 and 28.06, respectively) compared with no IVF treatment, with no strong preference for fresh over frozen. Couples strongly preferred any IVF technique that offered an increase in live birth rates by 5% (P = 0.006) and 15% (P < 0.0001), reduced miscarriage by 18% (P < 0.0001) and diminished neonatal complications by 10% (P < 0.0001). Respondents were willing to pay an additional £2451 (95% CI 604 − 4299) and £761 (95% CI 5056–9265) for a 5 and 15% increase in the chance of live birth, respectively, regardless of whether this involved fresh or frozen embryos. They required compensation of £5230 (95% CI 3320 − 7141) and £13 245 (95% CI 10 110–16 380) to accept a 10 and 25% increase in the risk of neonatal complications, respectively (P < 0.001). Results indicated that couples would be willing to accept a 1.26% (95% CI 1.001 − 1.706) reduction in the live birth rate for a 1% reduction in the risk of neonatal complications per live birth. Older couples appeared to place less emphasis on the risk of neonatal complications than younger couples. LIMITATIONS, REASONS FOR CAUTION DCEs can elicit intentions which may not reflect actual behaviour. The external validity of this study is limited by the fact that it was conducted in a single centre with generous public funding for IVF. We cannot rule out the potential for selection or responder bias. WIDER IMPLICATIONS OF THE FINDINGS If a strategy of freeze all was to be implemented it would appear to be acceptable to patients, if either success rates can be improved or neonatal complications reduced. Live birth rates, neonatal complication rates, miscarriage rates, and cost are more likely to drive their preferences than a slight delay in the treatment process. The results of this study have important implications for future economic evaluations of IVF, as they suggest that the appropriate balance needs to be struck between success and safety. A holistic approach incorporating patient preferences for expected clinical outcomes and risks should be taken into consideration for individualized care. STUDY FUNDING/COMPETING INTEREST(S) No external funding was sought for this study. A.M. is the chief investigator of the randomized controlled trial ‘Freeze all’. S.B. is an Editor in Chief of Human Reproduction Open. The other co-authors have no conflicts of interest to declare. Graham Scotland reports non-financial support from Merck KGaA, Darmstadt, Germany, outside the submitted work. TRIAL REGISTRATION NUMBER N/A.

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评估夫妻对新鲜或冷冻胚胎移植的偏好：离散选择实验

研究问题 夫妻对新鲜胚胎移植与冷冻所有胚胎然后冷冻胚胎移植的偏好是什么，以及可能区分它们的相关临床结果是什么？摘要 回答 夫妻的偏好是由预期的活产、流产、新生儿并发症和成本驱动的，而不是由治疗过程的差异（包括与冷冻胚胎移植相关的胚胎移植延迟和卵巢过度刺激综合征 (OHSS) 的风险）驱动的。与新鲜胚胎移植有关）。已知情况 冷冻所有胚胎然后移植冷冻胚胎的政策导致活产率与移植新鲜胚胎后的相似或更高，同时降低了 OHSS 和小于胎龄儿的风险：它可以，然而，增加先兆子痫和大于胎龄子代的风险。因此，关于是否进行新鲜胚胎移植或冷冻所有胚胎然后冷冻胚胎移植的争论仍在继续。研究设新鲜和冷冻胚胎移植之间的九个假设选择任务。替代方案在几个属性的选择发生中有所不同，包括有效性（活产率）、安全性（流产率、新生儿并发症发生率）和治疗成本。我们假设全冷冻策略延长了治疗时间，但降低了 OHSS 的风险。使用误差成分混合 logit 模型来估计夫妇对替代治疗方法的相对价值（效用）和用于描述它们的属性。计算了非成本属性之间的支付意愿和边际替代率。共向符合纳入标准的180对夫妇发放了360份个人问卷，其中212份已完成并返回我们的研究人群包括3对同性夫妇（2对女性和1对男性）和101对异性恋夫妇。四份问卷仅由一位合作伙伴填写。响应率为58.8%。主要结果和机会的作用 夫妇更喜欢新鲜和冷冻胚胎移植（优势比 27.93 和 28.06，分别）与没有IVF治疗相比，没有强烈偏好新鲜而不是冷冻。夫妻强烈倾向于任何能将活产率提高 5% (P = 0.006) 和 15% (P < 0.0001)、将流产率降低 18% (P < 0.0001) 并将新生儿并发症降低 10% 的 IVF 技术(P＜0.0001)。受访者愿意分别额外支付 2451 英镑（95% CI 604 - 4299）和 761 英镑（95% CI 5056-9265），以分别增加 5% 和 15% 的活产机会，无论这是否涉及新生儿或冷冻胚胎。他们要求赔偿 5230 英镑（95% CI 3320 - 7141）和 13 245 英镑（95% CI 10 110–16 380），以接受新生儿并发症风险分别增加 10% 和 25%（P < 0.001） . 结果表明，夫妻愿意接受 1.26% (95% CI 1.001 - 1. 706) 活产率降低，每次活产新生儿并发症的风险降低 1%。与年轻夫妇相比，老年夫妇似乎不太重视新生儿并发症的风险。限制、谨慎的原因 DCE 可能引发可能无法反映实际行为的意图。这项研究的外部有效性受到以下事实的限制：它是在一个为 IVF 提供大量公共资金的单一中心进行的。我们不能排除选择或响应者偏见的可能性。研究结果的更广泛意义 如果要实施全部冻结策略，如果可以提高成功率或减少新生儿并发症，患者似乎可以接受。活产率、新生儿并发症发生率、流产率、与治疗过程的轻微延迟相比，成本和成本更有可能推动他们的偏好。这项研究的结果对体外受精的未来经济评估具有重要意义，因为它们表明需要在成功和安全之间取得适当的平衡。对于个体化护理，应考虑综合考虑患者对预期临床结果和风险的偏好。研究资金/竞争兴趣 本研究未寻求外部资金。AM是随机对照试验“全部冻结”的首席研究员。SB 是人类生殖公开赛的主编。其他合著者没有需要声明的利益冲突。Graham Scotland 报告了来自德国达姆施塔特的默克集团在提交的工作之外的非财务支持。