(077) ECONOMIC ANALYSIS OF POST-VASECTOMY FERTILITY RESTORATION OPTIONS
Authors: Kassab J , Mutascio C , Lipshultz L 
Published: December 2024

Abstract

Introduction
When a couple seeks family planning information following a prior vasectomy, they are burdened with fertility restoring options with vastly different costs, insurance coverage options, success rates, and risks. The couple is tasked with making a personalized decision by attempting to prioritize these factors as well as taking into account their own individualized circumstances. The limited available options for the vasectomized male are in vitro fertilization (IVF) or undergoing a vasectomy reversal (VV). In order to undergo IVF treatment, a male post-vasectomy must undergo testicular sperm extraction (TESE) prior to the treatment cycle; however, men opting for the VV route, may attempt to conceive naturally following their surgery.

Objective
To better understand the efficacy of a vasectomy reversal vs. TESE and IVF/ICSI post-vasectomy employing an economical and statistical approach utilizing a decision tree economical model.

Methods
Following an extensive literature review to assess the current landscape of IVF, TESE, and VV costs and success rates by age, we stratified the demonstrated success rates by ascending age benchmarks for each assessed fertility treatment (25, 30, 35, 40, 42, and 45 years old). The decision tree mathematical modeling technique was employed to assess sequential events with uncertain outcomes following a decision tree paradigm outlining a sample couple’s fertility restoration pathways (Figure One). This statistical model simulates each of the sample couple’s expected financial expenditure and likelihood of conception while incorporating the limiting factor of their age through statistical predictions, outputting a weighted average cost of success.

Results
The performed analysis demonstrated an economic preference of prioritizing a VV, utilizing average probability and costs associated with each procedure (Figure Two). This vast financial discrepancy as well as opportunities for natural conception suggested utilizing VV as a first line treatment for post-vasectomized men. The data predicts a strong indicator of success, while minimizing costs, in the pathway to initiate a VV prior to IVF efforts. However, for couples over the age of 40, the data becomes less divisively in favor of VV, and may favor proceeding with IVF earlier to accommodate the couple’s advanced ages.

Conclusions
Our economic-success rate data compilation supports the conclusion that a VV is a superior choice in post-vasectomy patients due to its higher likelihood of a successful conception and the potential for less undue financial toxicity. This highlights the current underutilization of this surgical approach in eligible couples, revealing a lack of rational decision-making based on economics and efficacy for patients making use of this highly successful procedure. Further, this surgical restoration of fertility approach is more inclusive as a first-line treatment for those who may be morally or religiously opposed to artificial reproductive technologies. Finally, in addition, both state-based mandates and specific insurance plans should be consulted to identify the most economically viable option for each couple considering these fertility options.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: LIL: AbbVie (Consultant), American Medical Systems/Boston Scientific (Speaker), Aytu BioScience (Consultant), Contraline, Inc. (Consultant), Endo Pharmaceuticals (Consultant/Speaker), Inherent Biosciences (Advisor), Lipocine (Consultant).