Reassessing reconstruction in the management of obstructive azoospermia: reconstruction or sperm acquisition?

Treatments for male factor infertility secondary to reconstructable obstructive azoospermia include either surgical reconstruction or direct sperm retrieval. We examine the risks and benefits of both types of therapies and discuss their respective medical and economic implications. Most male factor infertility studies comparing vasectomy reversal with sperm retrieval favor the former as the more cost-effective therapy for obstructive azoospermia. Analysis should include assessment of direct procedural costs and indirect costs, including the cost of complications, lost productivity, and multiple gestation pregnancies. When considering sperm retrieval, the impact of in vitro fertilization-related indirect costs, specifically that driven by multiple gestation pregnancies, is significant.