LAUSR

OBJECTIVES To evaluate reproductive urologist and reproductive endocrinologist practice patterns for post-vasectomy surgical sperm retrieval at American private practice fertility clinics. METHODS Private practice American fertility clinics were contacted by telephone and administered a telephone survey. In states with multiple large cities, several clinics in different cities were surveyed. Our primary endpoint was to determine what specialty of physician (urologist or reproductive endocrinology gynecologist) performed sperm retrieval procedures. Secondarily, we inquired about the location that these procedures were performed (urology versus gynecology clinic), type of anesthesia used, and cash cost for the procedure. RESULTS 225 infertility clinics were contacted (per state range 2-10). 90.2% (203/225) of clinics responded to our queries. Zero clinics had an on-site urologist. An on-staff gynecologist with reproductive endocrinology training performed post-vasectomy sperm retrievals in 9.4% (19/203) of clinics. A urologist "partnered" with the infertility clinic performed sperm retrievals at the fertility clinic 11.8% (24/203) of clinics. 18.7% (38/203) did not offer sperm retrieval on-site, but did have a referral pattern established with a local urologist. Amongst reproductive endocrinologist performing sperm retrievals, intravenous anesthesia was used in 76.9% (10/13) of clinics. The quoted costs for surgical sperm retrieval performed by a reproductive endocrinologist ranged from $1,000-10,000. CONCLUSIONS Surgical sperm retrieval post-vasectomy performed by an on-site reproductive endocrinologist was offered by 9.4% of contacted fertility clinics. The majority (76.9%) of these cases were routinely performed under intravenous anesthesia. Costs for reproductive endocrinologist performed sperm retrievals varied considerably. The reasons for, and safety of reproductive endocrinologists performing these procedures remains to be determined.