Sperm harvesting and cryopreservation during vasectomy reversal is not cost effective

Objective: To determine whether sperm harvesting and cryopreservation at the time of vasectomy reversal is cost-effective. Design: Model of actual costs and results at five institutions. Setting: Multicenter study comprising five centers, including university hospitals and private practices. Patient(s): Men undergoing vasectomy reversal. Intervention(s): We established two models for vasectomy reversal. The first model was sperm harvesting and cryopreservation at the time of vasectomy reversal. The second model was sperm harvesting at the time of IVF only if the patient remained azoospermic after vasectomy reversal. Vasectomy reversal procedures modeled included bilateral vasovasostomy and bilateral epididymovasostomy. The costs for each procedure at the five institutions were collated and median costs determined. Main Outcome Measure(s): Median cost of procedure and calculated financial comparisons. Result(s): The median cost of testicular sperm extraction/cryopreservation performed at the time of bilateral vasovasostomy was $1,765 (range, $1,025- $2,800). The median cost of microsurgical epididymal sperm aspiration or testicular sperm extraction with cryopreservation performed at the time of epididymovasostomy was $1,209 (range, $905-$2,488). The average of the median costs for percutaneous sperm aspiration or testicular sperm aspiration for those patients with a failed vasectomy reversal was $725 (range, $400-$1,455). Conclusion(s): Sperm retrieval with cryopreservation at the time of vasectomy reversal is not a cost-effective management strategy.