Why Pay for a Stranger’s Vasectomy Reversal?
May 3, 2010 by David Wilson · 2 Comments
Why are most vasectomy reversals so expensive?
Well, I can give you a host of reasons why…most are performed in facilities or large hospitals with huge overhead costs, most are performed in major metropolitan areas with higher costs of living…but the main reason that most vasectomy reversals are so expensive is because a small number of patients require what is called a “bypass” vasectomy reversal.
This bypass procedure is much more complicated and expensive than the simple reconnection that most patients require. And there are situations where it is required. This is the case about half the time on the rare occasion that a first reversal fails, and also not uncommonly if the time from vasectomy is more than 9 years. Then a complicated bypass is often required.
But this procedure is rarely required for a first vasectomy reversal within 9 years of the vasectomy.
ARE YOU PAYING FOR SOMEONE ELSE’S VASECTOMY REVERSAL?
But, in order to offer the complicated and expensive procedure to the patients who DO need it, the doctors who perform them charge more for the simpler reconnection procedure. This explains the much higher fee for the simple procedure in this setting.
In essence, the patients who DO NOT need the expensive procedure, help pay for the ones who do.
SO HOW CAN I CHARGE SO MUCH LESS FOR THE SIMPLE PROCEDURE THAN MOST SURGEONS?
Because I NEVER perform the more complicated procedure. I refer patients who may need the bypass surgery to other providers.
That way, you only pay for what you need.
The short answer to this question is that I don’t do the bypass procedure. All my patients understand that and are happy for me to do the simple vas reconnection. In the worst case scenario, when no sperm are present (this is very rare less than 9 years from vasectomy) the success rate is still 60% with a simple vas reconnection.
There is no way to diagnose a second blockage before surgery. In fact, most of the time the surgeons who do bypass procedures are not able to make a certain diagnosis even after viewing the epididymis, but rely on their best judgment given the fluid findings and years from vasectomy.
The reason so many men are happy for me to do the simple vas reconnect only is that they are “giving up” very little by not having the bypass option if they are less than 9 years from vasectomy. This is explained in detail below.
If your vasectomy was less than 3 years ago you have a 97% chance of return of live sperm. The pregnancy rate in my practice for this group has been 81%.
If your vasectomy was more than 3 but less than 9 years from vasectomy, then you have a 91% chance of return of live sperm based on the semen analysis results in the practice. The pregnancy rate for the group overall has been 74%.
If you are more than 9 years from vasectomy, then the odds in my practice are 72% for return of live sperm with a 42% pregnancy rate. If you fall into the greater than 9 year category, your odds may be higher if you are able to afford an expert surgeon who routinely does complicated bypass procedures. The results with the simple microscopic vas reconnection I perform are not as good for those greater than 9 years from vasectomy. The vas reconnection I perform works very well, however, for patients less than 9 years from vasectomy.
A few surgeons in the country do a lot of repeat reversals. As much as 50% of their practice may be operating on patients who have already had one reversal. Many of these patients have a second blockage that occurs over time because of the increased pressure in the system after vasectomy. These surgeons do a lot of so called bypass procedures to try to correct these obstructions. Your total cost would likely be at least $10,000 to $15,000 for you to go to a true bypass expert who routinely does this more complicated repair.
If you are less than 3 years from vasectomy
Your chance of surgery success will be decreased less than 1% if these
two conditions apply : 1. You are in the less than 3 year interval from
vasectomy.
2. The higher priced reversal you are comparing
to is being performed by an expert
microsurgeon who routinely does the more
complicated bypass surgery in addition to
the simple vas reconnection
If you are 3-8 years from vasectomy
You will be decreasing your chance of surgery success 1 to 3% if these
two conditions apply : 1. You are in the 3-8 year time interval from
vasectomy.
2. The higher priced reversal you are comparing
to is being performed by an expert
microsurgeon who routinely does the more
complicated bypass surgery in addition to
the simple vas reconnection.
If you are more than 9 years from vasectomy
You will be decreasing your odds by at least 5 to 10% if the following
two conditions apply: 1. You are more than 9 years out from vasectomy.
2. The higher priced reversal you are comparing
to is being performed by an expert
microsurgeon who routinely does the more
complicated bypass surgery in addition to
the simple vas reconnection.
In the bench mark surgical study of the reversal field (The Vasovasostomy Study Group), five expert microsurgeons performed the more complex bypass procedure on only 4% of their patients. So over all 95% of first time reversal patients will likely not benefit from the more complicated, expensive procedure.
Hello Dr. Wilson,
Do you know or can you tell, while in the middle of surgery by the looks of the vasectomy damage, that the bypass procedure should be done to have a greater success rate at pregnancy? Is there a way to tell if it is needed or not even if the vasectomy was done within the 9 years? If you can then tell that the bypass procedure needs to be done what would happen at that point during your surgery with your patient? Thank You So Much