Fertility options after vasectomy: a cost-effectiveness analysis

Area of Science:

• Reproductive Medicine
• Urology
• Health Economics

Background:

• Postvasectomy infertility presents a unique challenge for men seeking to restore fertility.
• Treatment options include microsurgical vasectomy reversal or sperm retrieval for assisted reproductive technologies like ICSI.
• Evaluating the cost-effectiveness of these initial approaches is crucial for patient and provider decision-making.

Purpose of the Study:

• To compare the cost per delivery of two primary treatment strategies for postvasectomy infertility.
• To analyze the economic and success rate differences between vasectomy reversal and sperm retrieval with ICSI.

Main Methods:

• A cost-effectiveness model was developed using 1994 US data.
• The study compared microsurgical vasectomy reversal against sperm retrieval (epididymal or testicular) followed by ICSI.
• Key metrics included actual treatment charges, complication rates, and pregnancy/delivery rates.

Main Results:

• Microsurgical vasectomy reversal yielded a cost per delivery of $25,475 with a 47% delivery rate.
• Sperm retrieval and ICSI resulted in a significantly higher cost per delivery ($72,521) with a 33% delivery rate.
• Costs varied slightly between percutaneous ($73,146) and surgical ($71,896) sperm retrieval methods.

Conclusions:

• Microsurgical vasectomy reversal is the most cost-effective initial treatment for postvasectomy infertility.
• Vasectomy reversal also offers a higher probability of achieving a delivery after a single intervention compared to sperm retrieval and ICSI.