The Journal of urology · 2026
Male-First Evaluation Reduces Costs and Time to Pregnancy in Couples with a Varicocele: A Theoretical, Discrete-Time Markov Model.
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Wayne George, Ha Albert, Egbuonu Kenechukwu, Brant Aaron, Silver Sarah, Alukal Joseph
Аннотация
PURPOSE: To develop a discrete-time Markov model estimating pregnancy success rates and costs of a "male-first" evaluation compared to alternative infertility treatment approaches in couples where the male partner has a clinically significant varicocele.
MATERIALS AND METHODS: A novel discrete-time Markov chain was constructed using transition probabilities, treatment success, and discontinuation rates derived from published data. Simulation analyses were performed across varying levels of varicocele repair efficacy. The model evaluated hypothetical couples <35 years old with ≥12 months of infertility due to varicocele-associated oligospermia. Four treatment strategies were compared: Current Practice (CP), Male-First Evaluation (MFE), Intrauterine Insemination-First (IUI), and In Vitro Fertilization-First (IVF). The primary outcomes were time and mean cost estimates for the population.
RESULTS: At a 1% post-varicocele repair improvement, 75% achieved pregnancy at 20.1 months ($35,551) with CP, 21.2 months ($38,892) with MFE, 16.8 months ($41,325) with IUI, and 12.3 months ($49,537) with IVF. At a 5% improvement, MFE became cost-favorable (19.2 months, $33,977) versus CP (19.9 months, $34,172). At 15%, MFE reduced time to pregnancy by 1.7 months and cost by approximately $6,000 compared to CP, and remained $11,000-$21,000 less costly than IUI or IVF. Results remained robust across all three analyses (analytic propagation and both Monte Carlo simulations).
CONCLUSIONS: In varicocele-related infertility, MFE modestly reduces cost and time to pregnancy compared to CP. Immediate assisted reproductive technologies (ART) shorten time to pregnancy but increase costs by 40-80%. MFE represents a cost-conscious strategy that may optimize outcomes for the selected population.
MATERIALS AND METHODS: A novel discrete-time Markov chain was constructed using transition probabilities, treatment success, and discontinuation rates derived from published data. Simulation analyses were performed across varying levels of varicocele repair efficacy. The model evaluated hypothetical couples <35 years old with ≥12 months of infertility due to varicocele-associated oligospermia. Four treatment strategies were compared: Current Practice (CP), Male-First Evaluation (MFE), Intrauterine Insemination-First (IUI), and In Vitro Fertilization-First (IVF). The primary outcomes were time and mean cost estimates for the population.
RESULTS: At a 1% post-varicocele repair improvement, 75% achieved pregnancy at 20.1 months ($35,551) with CP, 21.2 months ($38,892) with MFE, 16.8 months ($41,325) with IUI, and 12.3 months ($49,537) with IVF. At a 5% improvement, MFE became cost-favorable (19.2 months, $33,977) versus CP (19.9 months, $34,172). At 15%, MFE reduced time to pregnancy by 1.7 months and cost by approximately $6,000 compared to CP, and remained $11,000-$21,000 less costly than IUI or IVF. Results remained robust across all three analyses (analytic propagation and both Monte Carlo simulations).
CONCLUSIONS: In varicocele-related infertility, MFE modestly reduces cost and time to pregnancy compared to CP. Immediate assisted reproductive technologies (ART) shorten time to pregnancy but increase costs by 40-80%. MFE represents a cost-conscious strategy that may optimize outcomes for the selected population.