Vasovasostomy versus MESA/TESE combined with ICSI - a cost benefit analysis

WS represents the standard procedure of choice for the treatment of obstruc tive azoospermia following vasectomy. However, recently, ICSI has been sugg ested by some to represent the solution for all cases of male factor infert ility regardless of its etiology based on its success rates. Therefore, we compared WS to MESA/TESE and ICSI in terms of pregnancy, complications, and costs. Between 1/93 and 6/98 157 VVS was performed microsurgically using t he 2-layer technique in 157 patients following prior vasectomy. Between 9/9 4 and 9/97 69 couples underwent MESA/ICSI for epididymal obstruction not am enable to microsurgical reconstruction such as postinfiammatoryobstruction and congenital absence of the vas deferens; in the same time period 42 coup les underwent TESE/ICSI for azoospermia of testicular origin due to cryptor chidism, testicular atrophy,obstruction of the rete testis. In most cases M ESA or TESE acid ICSI were performed metachronously. Mean intervall of vasa l obstruction was 7.6 (0.5-18) years; patency after WS was 77%, pregnancy r ate was 52%. local complication rate was 4.7%, no major complications were observed. Costs per life birth after WS were as high as 5.447,- DM or 2.800 Euro. Pregnancy rates after MESA/TESE and ICSI were 22.5% and 19.5%, respe ctively with 16 singletons, 3 twins and 3 abortions; local complications oc cured in 3.9% of the men. Multiple birth were noticed in 15.8% following IC SI, but only in 0.7% following WS.5.7% and 1.4% of the female partners expe rienced serious complications as a mild or severe ovarian hyperstimulation- syndrome, respectively. Costs per life birth after MESA/TESE cycle were as high as 28.804,- DM or 14.100 Euro. Even in the era of ICSI microsurgical v asovasostomy represents the standard approach for obstructive azoospermia f ollowing vasectomy. Based on a cost-benefit analysis WS is more successful in terms of pregnancy rates (52% vs. 22.5%). We conclude that MESA/ICSI sho uld be reserved for patients not amenable for microsurgical reconstruction.