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 IVF for treating human infertility has only a 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 quantifying the performance of an embryological team. As apart from the efficacy of the management of fresh gametes and embryos, we shall furthermore calculate the efficacy of the freezing of the total produced embryos plus the efficacy of the thawing. Therefore the reporting of pregnancy rates of an IVF unit in the past was lying in the fresh-ET pregnancy rates primarily, and now with the most frequent utilization of freeze all strategy risks to report only on poor prognosis patients as all the good cases are postponed for thawed cycles. Ongoing implementation of 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 opposite to freeze-all strategy. This new index proposed as COMFFETI (Combined Fresh & Frozen Embryo Transfers per Individual) is described in the present opinion article as the optimal way to report final reproductive outcome.