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Friday, April 25, 2008

My vasectomy reversal schpeel

In essence, vasectomies can be reversed by re-routing the pipes. Basically, I find the site where the vasectomy was performed, remove the damaged tissues, and re-connect the 2 ends. Sounds easy, right?
Actually, vasectomy reversals are challenging, even in the best of hands.
Whether or not a vasectomy reversal will be straightforward or complex depends upon intra-operative findings. In a straightforward vasectomy reversal, the length of missing segment will be short and there will be sperm in the vasal fluid. In this instance, a vaso-vaso—or V-V—can be performed with success rates in the 90% range, or higher. When I detect no sperm in the vasal fluid during intra-operative inspection, you will have a condition known as “blow-out.” Blow-out, in medical terms, is caused by an obstruction at the level of the epididymis. The presence of blow-out requires that I perform an epididymo-vasostomy—or E-V—in order to ensure the highest chances of success for you.
Very few surgeons have the training or expertise to successfully perform an E-V. E-Vs require that the surgeon operate at high magnification and use sutures too small to see with the naked eye. The sutures must be placed perfectly or the procedure will simply not work. While in most operations, “good enough” is sufficient, an E-V requires perfection; nothing less.
The vasectomy reversal is best performed under the aid of a high power, operating microscope. The use of “loupes”, which are low cost magnifying glasses, is not sufficient. Only operating microscopes that have high power magnification, electronic motion, focus, and zoom controls, and vibration dampening are sufficient for vasectomy reversals. I use one that costs in excess of $100,000 and has truly amazing optics.
Finally, many surgeons will do vasectomy reversals under “local” anesthetic. Whether or not this is ok depends upon the patient and the surgeon. Personally, I believe that the patient ought to be asleep and under the care of a board certified anesthesiologist. That way, the patient is comfortable and safe and I can concentrate on the task at hand. I think that outcomes simply are better this way.
The cost of vasectomy reversal will vary depending upon several factors: surgeon cost, facility fee, anesthesia fee, and any additional procedures such as sperm banking and lab fees. Our fees are in the $6500 total cost range. This fee includes my surgical fee, the facility fee, and the anesthesiologist fee. While less than some others, I feel the fee provides me with adequate compensation as the surgeon and is still reasonable for the patient. Others charge more, but a mentor of mine once said to me, “bulls make money and bears make money, but pigs get slaughtered.” I chose not to be a pig. Plus, I enjoy doing the procedures.
The only other option for couples that wish to have a baby after vasectomy is in-vitro fertilization, or IVF. In order for the woman to undergo the IVF, the man must still have a procedure to extract sperm directly from the testicle and the woman must undergo multiple hormone medication injections and an egg retrieval procedure. The IVF process is both emotionally and physically taxing. In addition, it is very expensive; often in the $12,000 to $20,000 range, per attempt. Each attempt, in the best of conditions, in the best of centers, with best doctors and the best embryologists, has only a 30% chance of success, meaning an ongoing pregnancy. Therefore, should you choose IVF rather than a vasectomy reversal, be prepared to pay $50,000.
Success for a vasectomy reversal is defined as sperm returning to the ejaculate. Ideally, enough sperm returns so that you can get your wife pregnant naturally. If you to not impregnate your wife naturally, but sperm returns to the ejaculate, IUI--artificial insemination--is the next option. IUI is inexpensive. If all else fails, you can still proceed with IVF, secure in the knowledge that you did the logical, prudent, safe, and inexpensive treatment first.
Any other questions?