In the last decade, assisted reproductive techniques such as intracytoplasmic sperm injection (ICSI) have revolutionized the treatment of male infertility. The rising success rates and widespread availability of ICSI has led some gynecologists and reproductive endocrinologists to bypass both the evaluation and treatment of the male while proceeding straight to assisted reproduction. This is unfortunate because many cases of male infertility are caused by correctable conditions such as varicocele.
The managed care era has ushered in a heightened awareness of cost effectiveness and outcomes research. Schlegel recently performed a comparison of ICSI and varicocelectomy for the treatment of varicocele-associated infertility using a cost per delivery analysis. Total hospital delivery costs, complication costs, and costs attributable to multiple gestations were taken into account along with the published pregnancy and delivery rates for the two procedures. Lee and Schlegel reported the overall cost per delivery for varicocelectomy averaged $38,300 compared to a striking $89,000 per delivery for ICSI in 2006. The European experience is similar. Comhaire, et al. has estimated that varicocelectomy is seven times more cost effective than ICSI. Although ICSI can clearly facilitate pregnancies in couples with varicocele-associated infertility, it is a very expensive alternative.