The major alternative to vasectomy reversal is a technique called sperm aspiration. Sperm aspiration is generally performed by one of two means: percutaneous aspiration or open surgical aspiration. In percutaneous aspiration, a fine needle is inserted into the testes or the epididymis under local anesthesia. Since only a tiny amount of sperm can be retrieved, in vitro (IVF or “test tube”) fertilization must be used. This procedure must be repeated if the fertilization does not succeed.
Open surgical aspiration allows the retrieval of a greater quantity of sperm, some of which may be frozen for subsequent IVF attempts. The expense of each attempt at pregnancy using this approach is commonly $8-10,000 or more, and most studies show only 5-10% pregnancy rates per attempt. Therefore, vasectomy reversal is generally a much better approach for most patients.
The following charts show the relative costs of vasectomy reversal to open epididymal sperm extraction (MESA) and ICSI (intracytoplasmic sperm injection) — the most common and successful alternative to vasectomy reversal. Keep in mind how the costs are calculated: if a reversal costs $5000, and one in two men undergoing vasectomy reversal achieve pregnancy (50% pregnancy rate), the cost per pregnancy will be $10,000. Similarly, if three cycles of ICSI are required on average for pregnancy, at $10,000 a cycle, the cost per pregnancy achieved will be $30,000. Also keep in mind that the surgical costs in this study — estimated at $10,000 — are much higher than Dr. Finnerty’s costs.
As you can see, uncomplicated vasectomy reversal is one-third the cost of aspiration plus ICSI for every pregnancy achieved. But what if you need a more expensive, complicated repair — a vasoepididymostomy?
MESA/ICSI remains nearly twice as expensive in total cost per pregnancy achieved as vasoepididymostomy in such cases. But what if you’ve had a prior reversal which failed, and choose to undergo another surgery?
Even when repeat surgery is required, the costs per pregnancy with reversal are still substantially better than MESA/ICSI.
MESA requires a open surgical procedure to collect sperm from the epididymis, which is more costly than simpler sperm aspiration techniques such as testicular sperm extraction (TESE). But this procedure also collects far fewer sperm than the open procedure –and their fertility is much lower.
Here’s how these compare with vasectomy reversal on total costs per pregnancy achieved:
In almost every case, microsurgical reversal performed by an experienced reversal surgeon will result in better pregnancy rates at lower costs than in-vitro fertilization.
Other references:
- University of Cologne (Germany): Cost-benefits of vasovasostomy vs. ICSI
- The Impact of Obstructive Interval and Sperm Granuloma on Outcome of Vasectomy Reversal
- Pregnancy Outcomes After Vasectomy Reversal for Female Partners 35 Years Old or Older
- Success of repeat vasectomy reversal after prior failed reversal
- American Society of Reproductive Medicine Review (1999) - Techniques for sperm retrieval in obstructive azoospermia.
