Continuous Quality Improvement (CQI) and Key Performance Indicators (KPIs) in Cryopreservation: Aspiring for the Best Results

Cryopreservation of gametes and embryos is a fundamental aspect of medically assisted reproduction (MAR), as it enables efficiency, safety and flexibility across many scenarios. Over the last decade or so, increasing confidence in, and application of, cryopreservation has helped reshape the landscape of fertility treatment and preservation. The proportion of frozen embryo transfers has increased in recent years whilst fresh embryo transfers have decreased correspondingly. As with all aspects of fertility treatment, IVF laboratories require validated and effective operating procedures (SOPs) to enable successful outcomes, which can be measured against key performance indicators (KPIs) with control limits set to trigger investigation where required. An effective way to approach performance monitoring is to consider two levels: a basic competency level and an aspirational but realistic benchmark, or target, level which laboratories should strive to reach. This chapter describes the cryopreservation of oocytes, sperm, and embryos and explores how KPIs can be established and used to drive standards within a continuous quality improvement program, using examples from the literature and authors’ experience.