Q: How important is it to carefully select the physician who will be performing my vasectomy
reversal?
A: Infertility treatment, vasectomy reversal included, remains to be lucrative in the current medical
economic environment and the competition is intense. You have undoubtedly come across numerous
websites designed to educate and to attract your business, ours included. If a quick browse via the
internet is less than convincing, one needs to go no further than to consult the local Yellow pages.
You will notice that nearly all the urology practices advertise vasectomy reversal as an area of
expertise and will gladly schedule a reversal at your request.
In a study surveying 622 urologists in California, Crain (2003) noted that 367 (59%) of the
respondents perform vasectomy reversal; of these, only 29 (8%) were fellowship trained. On average,
the non-fellowship trained practitioners perform 7 reversals per year and only 56% reported the use of
an operating microscope.
The best chance for a successful reversal is the first attempt; the surgeon needs to be skilled to
perform the proper operation as dictated by the intra-operative finding as well as a technically
superior one to ensure maximum chance of success. To limit patient’s option to vasovasostomy
under all circumstances is a disservice, irrespective of fee discount and money back guarantee.
I urge you to select your physician based on his or her credential and avoid assembly line operations
with superfluous peripherals. Few, if any, of fellowship trained specialists limit their practice to
vasectomy reversal only; many are well versed in all aspects of urology beyond treating the infertile
males. The fact is these are the specialists and their services command a higher premium; you as the
consumer decide the product you want.
Q: I know of an urologist who performs reversal in the office for half the price, how it that
possible?
A: There are still urologists who perform reversal in the office under local anesthesia with loupe
magnification, including some here in metro Atlanta. On occasions, we are asked to waive or discount
the fee difference to earn the caller’s “business”; my response has been that we offer no bargain
basement or pro rated procedure based on the amount of payment. A $3000 reversal is exactly what
it is; the catch is a $10,000 reversal may not be much different depending who you choose.
Vasectomy reversal requires the presence of an anesthesiologist to safely administer light general
anesthesia so the patient will remain perfectly stationary for the duration of the procedure; local
anesthetics is inadequate since the slightest movement will distort the magnified operative view.
Proper equipment, trained staffs and supply are integral to any surgical procedure, all of which cost
money.
Q: Should I simply go to one of those facilities performing “hundreds” of reversals per year
instead?
A: Intuitively, I think some of the “high volume” practices are very good at providing an important service
while keeping the cost reasonable. After all, there is no mystery to microsurgery, provided one is an
astute student with good surgical discipline and plenty of practice. The difficult question is how does
one separate the bona fide micro-surgeon from the one with a fancy website touting some surgical
refinements of one’s own creation?
As a regular attendee to our annual meetings, I do not recall coming across these “vas only experts”
or reading about their surgical refinements in any of the peer-reviewed journals. One would reasonably assume that unparalleled volume and success should be reported and surgical
refinements be shared among the medical community.
Personal skepticism with some of these practices aside, I would recommend that you do your
homework and personally meet the physician prior to making any commitment.
Q: How do I go about finding the right doctor?
A: You have several resources, which are readily available
• I recommend you visit www.maleinfertilityMDs.com for a fellowship-trained specialist near you.
In contrast to some of the vasectomy reversal search sites, physician listing with chinnurology.com is free of charge but it requires formal fellowship training. Doctor
Werner created this site as a service to allow patients easy access to specialists in our field.
• Visit American Society of Reproductive Medicine at www.asrm.org and do a physician search
under urology for your area. You may also request a member listing for Society for Male
Reproduction and Urology at www.smru.org; a sub-society of ASRM consists mostly of
urologists with male fertility interests.
• Your local RESOLVE chapter
• The Internet: identify physicians in your area and carefully study their websites; armed with the
knowledge you now have, you should be able to have some ideas of whom you would like to
consult with. If the site reminds you of an infomercial, perhaps you should look elsewhere.
• Contact the IVF Centers in your area and find out who they refer their male factor couples to;
typically, this is a male infertility urologist who also performs sperm retrieval for the IVF program.