Related Experiment Video
Updated: Jul 2, 2026

Combination of High Ligation and Intraoperative Embolization Using Polidocanol for Treatment of Varicoceles
Published on: December 22, 2023
A decision analysis of treatments for nonobstructive azoospermia associated with varicocele
Richard Lee1, Philip S Li, Marc Goldstein
1James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, 525 E. 68th St., New York, NY 10021, USA.
Objective:
To examine the economic impact of initial treatments for varicocele-associated nonobstructive azoospermia, specifically varicocelectomy versus microsurgical testicular sperm extraction (TESE) with IVF/intracytoplasmic sperm injection (ICSI).
Design:
Decision analytic model based on 1) outcomes data from Society for Assisted Reproductive Technology (SART) database and peer-reviewed literature and 2) costing data from Medicare Resource-Based Relative Value Scale and sampling of high volume US IVF centers.
Setting:
Academic medical center.
Patient(S):
Simulation with a decision analytic model.
Intervention(S):
Variation of successful spontaneous live delivery after varicocelectomy versus rate of successful live delivery after IVF/ICSI.
Main Outcome Measure(S):
Cost-effectiveness.
Result(S):
Microsurgical TESE was more cost effective than varicocelectomy. In 1999, initial treatment with microsurgical TESE was more cost effective ($65,515) than varicocelectomy ($76,878). Relative cost-effectiveness was unchanged in 2005: $69,731 versus $79,576. The cost-effectiveness of both treatments improved in relation to projections by inflation. Sensitivity analyses suggest that the relative cost-effectiveness of TESE versus varicocelectomy can only be changed with either substantial improvement in spontaneous live delivery rates after varicocelectomy or with deterioration in IVF success rates.
Conclusion(S):
Microsurgical TESE appears to be more cost effective than varicocelectomy for treatment of varicocele-associated nonobstructive azoospermia when indirect costs are considered. The cost-effectiveness of both treatments has improved with time. These results may be tailored with institution-specific data to allow more individualized results.
Related Concept Videos
Varicose Veins II: Diagnostic Studies and Interprofessional Care
Infertility in Males
Urinary Tract Calculi VI: Surgical Management
Urinary Tract Calculi III: Medical Management

