Purpose: An assumption exists that men with older female partners who seek
treatment of post-vasectomy infertility should undergo in vitro fertilizati
on (IVF) with intracytoplasmic sperm injection (ICSI) rather than vasectomy
reversal, Although several studies have reviewed ICSI success rates with a
dvancing maternal age, to our knowledge none has compared them to outcomes
for vasectomy reversal in men with older partners.
Materials and Methods: The records of all patients with ovulating partners
older than 37 years who underwent vasectomy reversal from 1994 through 1998
were reviewed. Patients were contacted to establish pregnancy and birth ra
tes. Costs of vasectomy reversal, testicular sperm extraction, IVF and ICSI
were obtained from the financial office of our institution.
Results: A total of 29 patients underwent vasectomy reversal with a followu
p of 3 to 59 months (median 25). Median male age was 46 years (range 37 to
67) and median female age was 40 years (range 38 to 48), A total of 5 pregn
ancies and 4 live births were achieved, In the 23 patients followed for mor
e than 1 year the pregnancy rate was 22% and live birth rate was 17%. Using
this 17% birth rate at our $4,850 cost for vasectomy reversal the cost per
newborn was $28,530, In comparison, using the 8% birth rate per cycle of I
CSI for women older than 36 years at a cost of $8,315 for testicular sperm
extraction and 1 cycle of IVF with ICSI, the cost per newborn was estimated
at $103,940.
Conclusions: Vasectomy reversal appears to be cost-effective to achieve fer
tility in men with ovulating partners older than 37 years.