Abstract: PD13-12
Sources of Funding: none

Introduction

Vasectomy is an effective family planning method; however 6% will request vasectomy reversal (VR). Average time to VR is 6-10 years after vasectomy with a female partner age of 31-37. VR alone is a cost effective method of regaining fertility; however, the presence and degree of advanced maternal age (AMA) in this population has not been well studied. We evaluated different management options to resume family building in a couple with prior vasectomy using a cost effectiveness analysis model.

Methods

A model-based cost-utility analysis was performed estimating the mean cost and quality adjusted life years (QALYs) in couples with infertility due to a male history of vasectomy and a female history of AMA over a 1 year time period. The model was constructed evaluating fertility outcomes on 3 surgical options for the male partner: VR, testicular sperm extraction (TESE), or combination VR with TESE. Separate models were then built stratifying for female partner age: <35, 35-37, 38-40, and >40 years. Model QALY estimates obtained from the literature were: 0.56 for an infertile couple and 0.63 for an infertile couple who becomes pregnant. Average patient charges for VR, TESE, and in vitro fertilization (IVF) were calculated from data supplied by high volume academic centers. TreeAge was utilized as the modeling software.

Results

The surgical options for the male resulted in 4 fertility strategies: natural conception, IVF, failed natural conception followed by IVF, and failed IVF followed by natural conception. The table below lists the cost/QALY for the 4 different fertility strategies stratified by female age.

Conclusions

VR with natural conception is the most cost effective means of fertility in all age groups evaluated. The back-up VR (combination VR and TESE) was more cost-effective and had a better monetary benefit profile than IVF alone in the maternal age groups of <35, 35-37, and 38-40. In couples with maternal age >40 years, the relatively low per cycle success rate of either approach (VR and natural conception, TESE and IVF) shows that the opportunity to conceive naturally post VR in any non-IVF ovulatory cycle added greatly to the potential success without significantly increasing cost. The back-up VR approach allows for this unique opportunity.

Funding

none