IS ASSISTED REPRODUCTION THE OPTIMAL TREATMENT FOR VARICOCELE-ASSOCIATED MALE-INFERTILITY - A COST-EFFECTIVENESS ANALYSIS

Objectives. To evaluate the cost-effectiveness of assisted reproductio n using in vitro fertilization (IVF) with intracytoplasmic sperm injec tion (ICSI) as a primary treatment for varicocele-associated infertili ty. Methods. Analysis of cost per delivery using published and contemp orary results for treatment with ICSI in the United States for male fa ctor infertility was compared with cost per delivery after surgical va ricocelectomy. Only results from controlled trials of varicocelectomy were used for evaluation of pregnancy and delivery rates. Cost estimat es were based on prevailing nationwide charges for services in 1994. R esults. The cost per delivery with ICSI was found to be $89,091 (95% c onfidence interval $78,720 to $99,462), whereas the cost per delivery after varicocelectomy was only $26,268 (95% confidence interval $19,13 8 to $44,656). Assuming the highest possible Published success rate fo r ICSI resulted in a cost estimate as low as $62,263. The average publ ished U.S. delivery rate after one attempt of ICSI was only 28%, where as a 30% delivery rate was obtained after varicocelectomy. Conclusions . Specific treatment of varicocele-associated male factor infertility with surgical varicocelectomy is more cost-effective than primary trea tment with assisted reproduction. Continued evaluation and treatment o f the man with infertility is warranted. Despite the apparent success of ICSI for the most severe cases of male factor infertility, applicat ion of assisted reproduction for all cases of male factor infertility also does not necessarily provide as high a delivery rate as specific treatment of the cause of male factor infertility. Copyright 1997 by E lsevier Science Inc.