Microsurgical vasovasostomy versus microsurgical epididymal sperm aspiration/testicular extraction of sperm combined with intracytoplasmic sperm injection - A cost-benefit analysis

Purpose: Vasovasostomy (VVS) represents the standard therapy of choice for the treatment of obstructive azoospermia following vasectomy. However, rece ntly, intracytoplasmic sperm injection (ICSI) has been suggested by some to represent the solution for all cases of malefactor infertility regardless of its etiology based on its success rates. Therefore, we compared VVS to m icrosurgical epididymal sperm aspiration (MESA)/testicular extraction of sp erm (TESE) and ICSI in terms of pregnancy, complications, and costs. Patients and Methods: Between 1/93 and 6/98, 157 VVS were performed microsu rgically using the double-layer technique. Between 9/94 and 9/97, 69 and 42 couples underwent MESA/ICSI and TESE/ICSI, respectively, for epididymal ob struction and azoospermia of testicular origin. Results: The mean interval of vasal obstruction was 7.6 (0.5-18) years; pat ency after VVS was 77%, pregnancy rate was 52%. Local complication rate was 4.7%, no major complications were observed. Costs per life birth after VVS were 5,447 DM or 2,793 Euro. Pregnancy rates after MESA/TESE and ICSI were 22.5 and 19.5%, respectively, with 16 singletons, 3 twins and 3 abortions; local complications occurred in 3.9% of the men. Multiple births were noti ced in 15.8% following ICSI, but in only 0.7% following VVS. 5.7 and 1.4% o f the female partners experienced serious complications (mild or severe ova rian hyperstimulation syndrome, respectively). Costs per life birth after a MESA/TESE cycle amounted to 28,804 DM or 14,547 Euro. Conclusions: Even in the era of ICSI, microsurgical VVS represents the stan dard approach for obstructive azoospermia following vasectomy. Based on a c ost-benefit analysis, VVS is more successful in terms of pregnancy rates (5 2 vs. 22.5%). VVS does not expose the female partners to complications foll owing treatment of male infertility. In contrast to ICSI, multiple birth ra tes do not increase after VVS. We conclude that MESA/ICSI should be reverse d for patients who are not amenable for microsurgical reconstruction. Copyr ight (C) 2000 S. Karger AG. Basel.