Routine Sperm Cryopreservation before Vasectomy Is Not Cost-Effective and Does Not Increase Live Birth Rates Compared to Surgical Sperm Retrieval or Vasectomy Reversal.
Bradley J Roth, Andrew D Shumaker, Petar Bajic, Sarah C Vij, Pietro E Bortoletto, Scott D Lundy
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引用次数: 0
Abstract
Objectives: To determine if routine pre-vasectomy sperm cryopreservation is more cost-effective than fertility restoration for patients who desire additional children following vasectomy?
Methods: A scoping review was performed to collect published data regarding efficacy and outcomes of cryopreservation, vasectomy reversal, surgical sperm retrieval, and assisted reproductive technologies (ART). Cost data were collected from US-based facilities performing cryopreservation and andrology clinical care. A cost-effectiveness model was generated using TreeAge Pro cost-effectiveness modeling software with three different variations representing a balanced scenario with median expected parameter values, a scenario with assumptions/variables favoring pre-vasectomy cryopreservation, and a scenario favoring fertility restoration. The primary outcome was cost per live birth and the secondary outcome was overall live birth rate.
Results: Pre-vasectomy cryopreservation cost ($140,247, range $48,232 - $552,807 per live birth) was significantly higher than with fertility restoration ($20,059, range $20,059 - $30,698). Surprisingly, pregnancy success rates appeared to be incrementally higher in the fertility restoration group (62%, range 44% - 66%) compared to cryopreservation (46%, range 36% - 58%) when using published literature values.
Conclusions: Routine sperm cryopreservation prior to vasectomy conveys a significantly higher cost to patients and the healthcare system and does not appear to increase live birth rate compared to fertility restoration with sperm retrieval or vasectomy reversal. Patients without fertility risk factors should be counseled on the added cost and need for ART with pre-vasectomy cryopreservation but should still be allowed to proceed if desired.
期刊介绍：
Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology
The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.
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