Wednesday, July 11, 2007

The Vasectomy Reversal Part 3: Patient Selection

This is part 3 in my series on vas reversals and will deal with issues pertaining to patient selection. When I see a patient who requests a vas reversal, I want to know several things.
1: How old is his wife? This is actually the first question that I ask, since advanced maternal age is the most difficult of all conditions to overcome from a medical standpoint. Men whose wives are in their late 30’s or early 40’s may want to consider proceeding directly to IVF with a sperm aspiration, since time is of the essence in these cases. In other words, the clock is ticking.
2: The medical history. The obstructive interval--how long has it been since the vasectomy--and the man’s overall health are important factors for consideration prior to committing to a vas reversal. In addition, certain physical exam findings may have important implications for a successful outcome and may influence the vas reversal specialist one way or another.
3: Patient preference. Some patients are opposed for a variety of reasons, be they religious, cultural, or philosophical, to assisted reproduction and feel that reversing the vasectomy restores the couple to a “more natural state.” After providing the couple with a proper informed consent, ultimately, I let them decide.
4: Insurance issues: While no one may like to admit it, insurance coverage almost always plays an important role in a couple’s decision to proceed or not with a vas reversal, especially in Suffolk County, Long Island, where I practice urology. Despite the fact that a vas reversal is the most cost-effective approach, if insurance will cover 1 or 2 cycles of IVF, and nothing for a vas reversal, the couple in general will opt for IVF. Occasionally, insurance will only cover IVF after a failed vas reversal, so patients choose the reversal for this reason. When I counsel patients, I rarely know ahead of time the insurance factors, and I give the couples my best advice given the man’s medical history and the woman’s age, then the couples decide. Usually, insurance issues prevail in the ultimate decision.

Thanks for reading. If you have any questions, as always, just contact me.