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 a 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: Sperm aspiration in conjunction with in vitro fertilization and sperm injection, IVF/ICSI, is an invaluable tool in the management of the infertile couples. Sperm aspiration is done under local anesthesia with a butterfly needle to obtain viable sperm and is inexpensive; however, IVF/ICSI is not. Aspirated sperm are few in number and immature in function, fertilization requires these sperm be individually injected into each egg in the laboratory. Pregnancy is then established following successful fertilization and embryo transfer to the uterus. Direct insemination is not possible with these sperm and has no role in the management of the vasectomised men prior to reversal.