ECONOMIC STRATEGIES FOR THE TREATMENT OF MALE INFERTILITY

 

Application of assisted reproduction technologies and high success rate of ICSI in the treatment of male factor infertility have led to the attempts to bypass evaluation and treatment of specific and correctable causes of male factor infertility. The treatment of correctable causes of male factor infertility is efficient and enables couples to conceive without assisted reproduction. Cost/benefit analysis of different treatment modalities is an important decision making information.

Recent data have analyzed the treatment of most common correctable causes of male infertility including microsurgical varicocelectomy, microsurgical vasectomy reversal, microsurgical vasoepididymostomy, second attempt vasectomy reversal compare to assisted reproduction techniques (sperm retrieval with IVF/ICSI)

 

Cost per delivery / delivery rates after specific vs. ART treatment of male factor infertility

 

Procedure

Surgical correction

Cost / Delivery rate

Assisted reproduction

Cost / Delivery rate

Microsurgical varicocelectomy(Schlegel, 1997)

$26,268 / 30%

$89,091 / 28%

Microsurgical vasectomy reversal(Pavlovich, 1997)

$25,475 / 47%

$75,221/ 33%

2nd attempt vasectomy reversal(Donovan, 1998)

$14,892/ n/a

$35,570/ n/a

Vasoepididymostomy (Kolettis, 1997)

$31,099 / 36%

$51,024/ 29%

 

The estimated cost for surgical treatment and assisted reproduction varies in different institutions.

Cost-effectiveness should not be the only concern for the physician treating an infertile couple. Other factors may influence the decision. Although varicocelectomy is one of the cheapest and highly efficient treatments with low complication rate, pregnancy after this procedure may take up to 1 year or more.

In older couple with critical female age this may not be a very attractive options since pregnancy after ICSI most commonly occurs within months.

On the other hand, ICSI procedure is always possible if varicocelectomy is unsuccessful. Sperm retrieval with cryopreservation and subsequent use for ICSI is also possible during vasectomy reversal and vasoepididymostomy.

Presently specific treatment of correctable causes of male infertility remains highly successful and cost-effective. Therefore, every infertile man has to be examined by a male infertility specialist, specific problem diagnosed and treatment options discussed. This part of the evaluation of infertile couple should never be bypassed.

 

Selected Bibliography

  1. Pavlovich CP, Schlegel PN. Fertility options after vasectomy; a cost-effectiveness analysis. Fertil Steril 1997;67:133-141
  2. Schlegel PN. Is assisted reproduction the optimal treatment dor varicocele-associated male infertility? A cost-effectiveness analysis. Urology 1997;49:83-90
  3. Comhair F. Economic strategies in modern male subfertility treatment. Hum Reprod 1995; suppl 1, vol 10: 103-196
  4. Donovan JF, DiBaise M., Sparks AET, Kessler J., Sandlow J. Comparison of microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection/in-vitro fertilization with repeat microscopic reconstruction following vasectomy: Is second attempt vas reversal worth the effort. Hum Reprod 1998;13:387-393.
  5. Kolettis PN, Thomas AJ Jr. Vasoepididymostomy for vasectomy reversal: A critical assessment in the era of intracytoplasmic sperm injection. J Urol 1997;158:467-470
  6. Pavlovich CD, Schlegel PN. Cost-effectiveness of treatment for male infertility. Assisted Reproduction Reviews 1998; 8(1):40-46

 

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