P.S. Li

A decision analysis of treatments for obstructive azoospermia.

BACKGROUNDnTreatments for post-vasectomy obstructive azoospermia include vasectomy reversal, microsurgical epididymal sperm aspiration (MESA) or percutaneous testicular sperm extraction (TESE) with IVF/ICSI. We examined the cost-effectiveness of these treatments.nnnMETHODSnA decision analytic model was created to simulate treatment. Outcome probabilities were derived from peer-reviewed literature and the Society for Assisted Reproductive Technologies database. Procedural costs were derived from a sampling of high-volume IVF centers and the Medicare Resource Based Relative Value Scale. Indirect costs of complications, lost productivity and multiple gestation pregnancies were considered. Sensitivity analyses were performed.nnnRESULTSnVasectomy reversal was more cost-effective than either MESA or TESE under all probability conditions. In 1999, vasectomy reversal demonstrated superior cost-effectiveness to TESE and MESA (

Full field optical coherence tomography can identify spermatogenesis in a rodent sertoli-cell only model

19,633 versus

Use of the ShangRing circumcision device in boys below 18 years old in Kenya: results from a pilot study

45,637 and

Importance of male infertility microsurgery training

48,055, respectively, equivalent to

Outcomes of varicocelectomy in men with history of orchiopexy for undescended testes

25,321 versus

Longitudinal intussusception vasoepididymostomy learning curve

58,858 and

An improved model of varicocele in rats using microsurgical technique

61,977 in 2005 dollars). In 2005, vasectomy reversal (

Increased body mass index in men with varicocele is associated with larger peritesticular vein diameters when supine

20,903) remained the most cost-effective treatment over TESE (

Indications, technique and outcomes for microsurgical spermatocelectomy

54,797) and MESA (

Changes over time of testicular sperm extraction (TESE) with IVF/ICSI for treatment of male factor infertility

56,861). The cost-effectiveness of all treatments improved over projections by inflation. The relative cost-effectiveness of the therapies was unchanged over time.nnnCONCLUSIONSnVasectomy reversal appears more cost-effective than percutaneous TESE and MESA for treatment of obstructive azoospermia when the impact of indirect costs is considered. The absolute cost-effectiveness of all therapies improved over time. These results may be tailored with institution-specific data to allow more individualized results.