Routine Sperm Cryopreservation Before Vasectomy Is not Cost-effective and Does not Increase Live Birth Rates Compared to Surgical Sperm Retrieval or Vasectomy Reversal.

Objective: To determine if routine pre-vasectomy sperm cryopreservation is more cost-effective than fertility restoration for patients who desire additional children following vasectomy?

Methods: A scoping review was performed to collect published data regarding efficacy and outcomes of cryopreservation, vasectomy reversal, surgical sperm retrieval, and assisted reproductive technologies (ART). Cost data were collected from US-based facilities performing cryopreservation and andrology clinical care. A cost-effectiveness model was generated using TreeAge Pro cost-effectiveness modeling software with 3 different variations representing a balanced scenario with median expected parameter values, a scenario with assumptions/variables favoring pre-vasectomy cryopreservation, and a scenario favoring fertility restoration. The primary outcome was cost per live birth and the secondary outcome was overall live birth rate.

Results: Pre-vasectomy cryopreservation cost ($140,247, range $48,232-$552,807 per live birth) was significantly higher than with fertility restoration ($20,458 range $20,458-$30,698). Surprisingly, pregnancy success rates appeared to be incrementally higher in the fertility restoration group (62%, range 44%-66%) compared to cryopreservation (46%, range 36%-58%) when using published literature values.

Conclusion: Routine sperm cryopreservation prior to vasectomy conveys a significantly higher cost to patients and the healthcare system and does not appear to increase live birth rate compared to fertility restoration with sperm retrieval or vasectomy reversal. Patients without fertility risk factors should be counseled on the added cost and need for ART with pre-vasectomy cryopreservation but should still be allowed to proceed if desired.