OBJECTIVES: The Italian government recently banned embryo cryopreservation for in vitro fertilization (IVF). The objective of this study was to compare the cost effectiveness of IVF with and without the option of embryo freezing over three cycles of IVF from the Italian NHS perspective. METHODS: A decision analytical model was developed to evaluate the cost and cost-effectiveness of two potential treatment approaches in couples attempting IVF: (A) To perform three IVF fresh cycles including the option of frozen embryo transfer; and (B) To perform three IVF fresh cycles with no frozen embryo transfer. No treatment was used as the reference strategy. Efficacy data were derived from clinical trials and the Italian IVF registry. A micro-costing approach was used to determine the cost of fresh and frozen IVF cycles. Drug costs and hospitalization costs were derived from published sources. The primary outcome was measured in terms of a live birth. Uncertainty surrounding the CE ratio was tested using one-way sensitivity analysis. RESULTS: The model predicted a cumulative live birth rate after three completed IVF cycles of 30.9 % in the strategy using cryopreservation compared to 25.3% in the IVF without cryopreservation approach. The total cost per treatment was €4905 with the no frozen embryo transfer strategy versus €5453 for the frozen embryo transfer. The strategy to perform IVF without cryopreservation was extensively dominated by the combination of no treatment and IVF plus cryopreservation strategies. The incremental cost per additional live birth was €21,863 for the IVF with embryo cryopreservation compared to the no treatment alternative. Results were most sensitive to variations in the cost of an IVF treatment cycle. CONCLUSIONS: Providing three cycles of IVF with the frozen embryo option on the National Health Service in Italy compares favorably to the option of allowing infertile couples only three cycles of IVF.