Men With Severe Oligospermia Appear to Benefit From Varicocele Repair: A Cost-effectiveness Analysis of Assisted Reproductive Technology

Justin M. Dubin, Aubrey B. Greer, Taylor P. Kohn, Thomas A. Masterson, Lunan Ji, Ranjith Ramasamy

Research output: Contribution to journalArticle

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Abstract

Objective To evaluate the outcomes of men who underwent varicocelectomy for total motile sperm count (TMSC) <2 million and to perform a cost-effectiveness analysis of intrauterine insemination (IUI) and in vitro fertilization with intracyctoplasmic sperm injection after varicocelectomy. Methods We prospectively collected data of men with TMSC <2 million who underwent microsurgical subinguinal varicocelectomy. Men with azoospermia were excluded. Serum testosterone, luteinizing hormone, and follicle-stimulating hormone were measured preoperatively. Postoperative semen analysis was collected first at 3 months and then every 3 months thereafter. Cost-effectiveness for assisted reproductive technologies was calculated using reported costs. Results A total of 17 men underwent varicocele repair for TMSC <2 million. The mean sperm concentration, motility, and TMSC was 1.1 ± 1.4 million/mL, 15.5% ± 12.8%, and 0.44 ± 0.54 million prior to varicocelectomy, respectively. After varicocelectomy, 14 of 17 men had improvements in TMSC. The mean change in sperm concentration, motility, and TMSC was 4.3 ± 4.7 million/mL, 12% ± 17.2%, and 6.0 ± 8.5 million, respectively. The mean postoperative sperm concentration, motility, and TMSC was 5.4 ± 5.4 million/mL, 27.5% ± 25.1%, and 6.5 ± 8.5 million, respectively. A total of 10 of 17 men had TMSC greater than 2 million. Of the 10 men, 1 man achieved spontaneous pregnancy and 7 men underwent a cycle of IUI; 2 of the 7 (28.6%) men achieved successful pregnancy with IUI (cost per pregnancy: $35,924). Conclusion Varicocelectomy increases TMSC in severely oligospermic patients, thus providing previously ineligible couples an opportunity to elect for IUI, a less invasive and less expensive alternative to in vitro fertilization with intracyctoplasmic sperm injection.

Original languageEnglish (US)
Pages (from-to)99-103
Number of pages5
JournalUrology
Volume111
DOIs
StatePublished - Jan 1 2018

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Oligospermia
Varicocele
Assisted Reproductive Techniques
Sperm Count
Cost-Benefit Analysis
Insemination
Sperm Motility
Fertilization in Vitro
Pregnancy
Spermatozoa
Costs and Cost Analysis
Azoospermia
Injections
Semen Analysis
Follicle Stimulating Hormone
Luteinizing Hormone
Testosterone

ASJC Scopus subject areas

  • Urology

Cite this

Men With Severe Oligospermia Appear to Benefit From Varicocele Repair : A Cost-effectiveness Analysis of Assisted Reproductive Technology. / Dubin, Justin M.; Greer, Aubrey B.; Kohn, Taylor P.; Masterson, Thomas A.; Ji, Lunan; Ramasamy, Ranjith.

In: Urology, Vol. 111, 01.01.2018, p. 99-103.

Research output: Contribution to journalArticle

Dubin, Justin M. ; Greer, Aubrey B. ; Kohn, Taylor P. ; Masterson, Thomas A. ; Ji, Lunan ; Ramasamy, Ranjith. / Men With Severe Oligospermia Appear to Benefit From Varicocele Repair : A Cost-effectiveness Analysis of Assisted Reproductive Technology. In: Urology. 2018 ; Vol. 111. pp. 99-103.
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abstract = "Objective To evaluate the outcomes of men who underwent varicocelectomy for total motile sperm count (TMSC) <2 million and to perform a cost-effectiveness analysis of intrauterine insemination (IUI) and in vitro fertilization with intracyctoplasmic sperm injection after varicocelectomy. Methods We prospectively collected data of men with TMSC <2 million who underwent microsurgical subinguinal varicocelectomy. Men with azoospermia were excluded. Serum testosterone, luteinizing hormone, and follicle-stimulating hormone were measured preoperatively. Postoperative semen analysis was collected first at 3 months and then every 3 months thereafter. Cost-effectiveness for assisted reproductive technologies was calculated using reported costs. Results A total of 17 men underwent varicocele repair for TMSC <2 million. The mean sperm concentration, motility, and TMSC was 1.1 ± 1.4 million/mL, 15.5{\%} ± 12.8{\%}, and 0.44 ± 0.54 million prior to varicocelectomy, respectively. After varicocelectomy, 14 of 17 men had improvements in TMSC. The mean change in sperm concentration, motility, and TMSC was 4.3 ± 4.7 million/mL, 12{\%} ± 17.2{\%}, and 6.0 ± 8.5 million, respectively. The mean postoperative sperm concentration, motility, and TMSC was 5.4 ± 5.4 million/mL, 27.5{\%} ± 25.1{\%}, and 6.5 ± 8.5 million, respectively. A total of 10 of 17 men had TMSC greater than 2 million. Of the 10 men, 1 man achieved spontaneous pregnancy and 7 men underwent a cycle of IUI; 2 of the 7 (28.6{\%}) men achieved successful pregnancy with IUI (cost per pregnancy: $35,924). Conclusion Varicocelectomy increases TMSC in severely oligospermic patients, thus providing previously ineligible couples an opportunity to elect for IUI, a less invasive and less expensive alternative to in vitro fertilization with intracyctoplasmic sperm injection.",
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T1 - Men With Severe Oligospermia Appear to Benefit From Varicocele Repair

T2 - A Cost-effectiveness Analysis of Assisted Reproductive Technology

AU - Dubin, Justin M.

AU - Greer, Aubrey B.

AU - Kohn, Taylor P.

AU - Masterson, Thomas A.

AU - Ji, Lunan

AU - Ramasamy, Ranjith

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective To evaluate the outcomes of men who underwent varicocelectomy for total motile sperm count (TMSC) <2 million and to perform a cost-effectiveness analysis of intrauterine insemination (IUI) and in vitro fertilization with intracyctoplasmic sperm injection after varicocelectomy. Methods We prospectively collected data of men with TMSC <2 million who underwent microsurgical subinguinal varicocelectomy. Men with azoospermia were excluded. Serum testosterone, luteinizing hormone, and follicle-stimulating hormone were measured preoperatively. Postoperative semen analysis was collected first at 3 months and then every 3 months thereafter. Cost-effectiveness for assisted reproductive technologies was calculated using reported costs. Results A total of 17 men underwent varicocele repair for TMSC <2 million. The mean sperm concentration, motility, and TMSC was 1.1 ± 1.4 million/mL, 15.5% ± 12.8%, and 0.44 ± 0.54 million prior to varicocelectomy, respectively. After varicocelectomy, 14 of 17 men had improvements in TMSC. The mean change in sperm concentration, motility, and TMSC was 4.3 ± 4.7 million/mL, 12% ± 17.2%, and 6.0 ± 8.5 million, respectively. The mean postoperative sperm concentration, motility, and TMSC was 5.4 ± 5.4 million/mL, 27.5% ± 25.1%, and 6.5 ± 8.5 million, respectively. A total of 10 of 17 men had TMSC greater than 2 million. Of the 10 men, 1 man achieved spontaneous pregnancy and 7 men underwent a cycle of IUI; 2 of the 7 (28.6%) men achieved successful pregnancy with IUI (cost per pregnancy: $35,924). Conclusion Varicocelectomy increases TMSC in severely oligospermic patients, thus providing previously ineligible couples an opportunity to elect for IUI, a less invasive and less expensive alternative to in vitro fertilization with intracyctoplasmic sperm injection.

AB - Objective To evaluate the outcomes of men who underwent varicocelectomy for total motile sperm count (TMSC) <2 million and to perform a cost-effectiveness analysis of intrauterine insemination (IUI) and in vitro fertilization with intracyctoplasmic sperm injection after varicocelectomy. Methods We prospectively collected data of men with TMSC <2 million who underwent microsurgical subinguinal varicocelectomy. Men with azoospermia were excluded. Serum testosterone, luteinizing hormone, and follicle-stimulating hormone were measured preoperatively. Postoperative semen analysis was collected first at 3 months and then every 3 months thereafter. Cost-effectiveness for assisted reproductive technologies was calculated using reported costs. Results A total of 17 men underwent varicocele repair for TMSC <2 million. The mean sperm concentration, motility, and TMSC was 1.1 ± 1.4 million/mL, 15.5% ± 12.8%, and 0.44 ± 0.54 million prior to varicocelectomy, respectively. After varicocelectomy, 14 of 17 men had improvements in TMSC. The mean change in sperm concentration, motility, and TMSC was 4.3 ± 4.7 million/mL, 12% ± 17.2%, and 6.0 ± 8.5 million, respectively. The mean postoperative sperm concentration, motility, and TMSC was 5.4 ± 5.4 million/mL, 27.5% ± 25.1%, and 6.5 ± 8.5 million, respectively. A total of 10 of 17 men had TMSC greater than 2 million. Of the 10 men, 1 man achieved spontaneous pregnancy and 7 men underwent a cycle of IUI; 2 of the 7 (28.6%) men achieved successful pregnancy with IUI (cost per pregnancy: $35,924). Conclusion Varicocelectomy increases TMSC in severely oligospermic patients, thus providing previously ineligible couples an opportunity to elect for IUI, a less invasive and less expensive alternative to in vitro fertilization with intracyctoplasmic sperm injection.

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