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MALE FACTOR Markov modeling of vasectomy reversal and ART for infertility: how do obstructive interval and female partner age influence cost effectiveness? Michael H. Hsieh, M.D., Ph.D., Maxwell V. Meng, M.D., and Paul J. Turek, M.D. University of California San Francisco, Department of Urology, San Francisco, California Objective: To apply Markov models to assess the cost effectiveness of the relative impact of obstructive interval and female partner age on fertility using either assisted reproductive technology (ART) or vasectomy reversal, and elucidate the impact of these variables on fertility. Design: Markov models based on review of published literature and available ART outcome data. Setting: University-based clinical practice. Patient(s): Simulation runs of 50,000 patients for each analysis. Intervention(s): Varying vasectomy obstructive interval and maternal age. Main Outcome Measure(s): Cost effectiveness, willingness to pay (WTP), and net health benefit. Result(s): Base case analysis showed ART yields a higher pregnancy rate and higher cost than vasectomy reversal. Sensitivity analysis showed female age has a greater effect on cost effectiveness than obstructive interval. At a WTP $65,000, vasectomy reversal is more cost effective than ART. With increasing WTP, ART is more cost effective over wider windows of female age. Conclusion(s): Markov modeling of fertility after vasectomy suggests female age has more impact than vasectomy obstructive interval on cost effectiveness. (Fertil Steril 2007;88:840–6. 2007 by American Society for Repro- ductive Medicine.) Key Words: Markov process, decis