COMPARISON OF MICROSCOPIC EPIDIDYMAL SPERM ASPIRATION AND INTRACYTOPLASMIC SPERM INJECTION IN-VITRO FERTILIZATION WITH REPEAT MICROSCOPIC RECONSTRUCTION FOLLOWING VASECTOMY - IS 2ND ATTEMPT VAS REVERSAL WORTH THE EFFORT

Since 1986, we have performed microscopic reconstruction in 18 men fol lowing failed microscopic vasectomy reversal, Between 1994 and 1996, n ine couples have undergone microscopic epididymal sperm aspiration (ME SA)/intracytoplasmic sperm injection (ICSI) treatment for male inferti lity due either to congenital absence of the vas deferens (CAVD) or in operable excurrent duct obstruction, We compared the cost efficiency o f repeat vasectomy reversal to that for MESA combined with ICSI/in-vit ro fertilization (ICSI/IVF), The cost of male partner procedures (vase ctomy reversal, MESA) was based on physician and hospital charges, whi le the cost of ICSI/IVF included preparation of the female partner (me dications and physician charges) and procedures (physician and hospita l charges including oocyte retrieval, micromanipulation, and embryo tr ansfer), Our cost examination does not include charges related to foll owup visits, prenatal monitoring, complications of pregnancy (i.e. mis carriage) or delivery in either group, Overall patency and pregnancy r ates in the repeat vasectomy reversal group were 78 and 44% respective ly, The cost per delivered baby (including multiple metachronos delive ries per couple) was $14892, Fertilization of oocytes has been achieve d in 37/72 (51%) and pregnancies have occurred in 6/9 (67%) attempts a nd 5/9 (56%) report delivery, The average cost per pregnancy was $2563 7 and the average cost per delivered baby (or ongoing pregnancy) was $ 35570, The cost per delivery by MESA/ICSI/IVF is 2.4 times the charges per delivery obtained through repeat vasectomy repair, Couples attemp ting to overcome infertility caused by vasal obstruction should be inf ormed that vas reconstruction remains a cost effective means of re-est ablishing fertility even in men who have previously failed vasectomy r eversal.