Donovan J F, DiBaise M, Sparks A E, Kessler J, Sandlow J I
Department of Urology, The University of Iowa, Iowa City, USA.
Hum Reprod. 1998 Feb;13(2):387-93. doi: 10.1093/humrep/13.2.387.
Since 1986, we have performed microscopic reconstruction in 18 men following failed microscopic vasectomy reversal. Between 1994 and 1996, nine couples have undergone microscopic epididymal sperm aspiration (MESA)/ intracytoplasmic sperm injection (ICSI) treatment for male infertility due either to congenital absence of the vas deferens (CAVD) or inoperable excurrent duct obstruction. We compared the cost efficiency of repeat vasectomy reversal to that for MESA combined with ICSI/in-vitro fertilization (ICSI/IVF). The cost of male partner procedures (vasectomy reversal, MESA) was based on physician and hospital charges, while the cost of ICSI/IVF included preparation of the female partner (medications and physician charges) and procedures (physician and hospital charges including oocyte retrieval, micromanipulation, and embryo transfer). Our cost examination does not include charges related to follow-up visits, prenatal monitoring, complications of pregnancy (i.e. miscarriage) or delivery in either group. Overall patency and pregnancy rates in the repeat vasectomy reversal group were 78 and 44% respectively. The cost per delivered baby (including multiple metachronos deliveries per couple) was $14892. Fertilization of oocytes has been achieved in 37/72 (51%) and pregnancies have occurred in 6/9 (67%) attempts and 5/9 (56%) report delivery. The average cost per pregnancy was $25637 and the average cost per delivered baby (or ongoing pregnancy) was $35570. The cost per delivery by MESA/ ICSI/IVF is 2.4 times the charges per delivery obtained through repeat vasectomy repair. Couples attempting to overcome infertility caused by vasal obstruction should be informed that vas reconstruction remains a cost effective means of re-establishing fertility even in men who have previously failed vasectomy reversal.
自1986年以来，我们对18例显微输精管复通术失败的男性进行了显微重建手术。1994年至1996年期间，9对夫妇因先天性输精管缺如（CAVD）或无法手术的输出管道梗阻而接受了显微附睾精子抽吸术（MESA）/卵胞浆内单精子注射（ICSI）治疗男性不育症。我们比较了重复输精管复通术与MESA联合ICSI/体外受精（ICSI/IVF）的成本效益。男性伴侣手术（输精管复通术、MESA）的成本基于医生和医院收费，而ICSI/IVF的成本包括女性伴侣的准备（药物和医生收费）以及手术（医生和医院收费，包括卵母细胞采集、显微操作和胚胎移植）。我们的成本审查不包括两组中与随访、产前监测、妊娠并发症（即流产）或分娩相关的费用。重复输精管复通术组的总体通畅率和妊娠率分别为78%和44%。每个分娩婴儿的成本（包括每对夫妇多次异时分娩）为14892美元。72次尝试中有37次（51%）实现了卵母细胞受精，9次尝试中有6次（67%）妊娠，9次中有5次（56%）报告分娩。每次妊娠平均成本为25637美元，每个分娩婴儿（或持续妊娠）平均成本为3五万五千五百七十美元。MESA/ICSI/IVF的每次分娩成本是通过重复输精管修复获得的每次分娩费用的2.4倍。应告知试图克服输精管梗阻导致的不育症的夫妇，即使对于先前输精管复通术失败的男性，输精管重建仍然是恢复生育能力的一种具有成本效益的方法。
