COMFFETI, Combined Fresh and Frozen Embryo Transfers per Individual: A New Index of Quality Control for The Performance of Embryologic Labs in The Emerging Era of Segmentation of Cycle and Freeze-All Strategy

The efficacy of in vitro fertilization (IVF) for treating human infertility has only one final efficacy index and that is the achievement of a delivery. However, with the evolution of the freeze-all strategy, a new problem is arising for evaluating the performance of an embryological team. The aim of the study was to present a new representative index, combining fresh and frozen embryo transfer success rates. In this opinion article, apart from the effectiveness of managing fresh gametes and embryos, we wish to evaluate the efficacy of the processes of both freezing and thawing of the produced embryos. The reporting of pregnancy rates of an IVF unit in the past was primarily laying in the fresh embryo transfer (ET) pregnancy rates. Now with the most frequent utilization of freeze-all strategy, it does not seem logical to report only on poor prognosis patients as all the good cases are postponed for thawed cycles. Ongoing implementation of the freeze-all strategy has indicated the need to establish a new representative index that may combine the success of both fresh and frozen cycles performed in the same woman; an index that may not be biased by the policy of an IVF center towards or against the freeze-all strategy. This newly proposed index, which is referred to as COMFFETI (Combined Fresh & Frozen Embryo Transfers per Individual), describes the optimal way to report final reproductive outcomes in the present opinion article.