Background: Coordination of third-party reproduction cycles with FDA screening requirements and the availability of gestational carriers from geographically distant locales is challenging for most agencies and IVF clinics. Often patients will ask if they can proceed with harvest of eggs and subsequent embryo freeze for transfer to a gestational carrier at a later date. Because autologous IVF cycles are traditionally associated with a higher pregnancy rate in the fresh cycle compared with the frozen embryo transfer cycle, the common assumption is that gestational carrier cycles would yield similar results; however, few studies exist that explore this assumption. Objective: To compare gestational carrier cycle outcomes between fresh and frozen embryo transfers and relevant characteristics of these cycles. Materials and Methods: All gestational carrier cycles were retrospectively reviewed from January 1, 2005, until October 1, 2007. Age and FSH level of intended parent, endometrial thickness of the gestational carrier, indication for third-party reproduction, and embryo quality were recorded. Results: Frozen embryo transfers resulted in a higher live birth rate/ongoing pregnancy rate than fresh embryo transfers to a gestational carrier (15/28 [54%] vs. 13/47 [28%]; P<.05).Tabled 1No. of cyclesClinical pregnancy rateLive birth/ongoing pregnancy rateMultiple pregnancy rateFresh embryo transfer4718 (38%)13 (28%)56% twinsFrozen embryo transfer2817 (61%)15 (54%)71% twins Open table in a new tab Conclusions: Given the logistical hurdles and time delay involved in third-party reproduction with gestational carriers, consideration should be given to proceeding with a “freeze all” cycle at the blastocyst stage and subsequent frozen transfer to optimize delivery rates. Compliance with FDA guidelines, decreased stress, and increased convenience are added benefits. Possible reasons for the increased pregnancy rates may be the ability to effect better endometrial maturation, the improved selection of embryos that comes through freezing at the blastocyst stage, and the elimination of GnRH agonist. Intended parents with diminishing ovarian reserve are less likely to have supernummery embryos to freeze and therefore represent an inherent selection bias in this retrospective study. A future study comparing elective “freeze all” cycles in third-party reproduction to fresh embryo transfer will help to eliminate this selection bias.