Vasectomy Reversal can be done in the office under local anesthesia!

TECHNIQUE...
Vasectomy Reversal takes about 3 hours. It is performed under local anesthesia similar to the anesthesia used for vasectomy but with a longer-acting drug. Continuity of both vas tubes can be restored through a single 1/2-inch incision. Magnification is accomplished with both a surgical microscope and optical loupes, the high-power glasses used by gem-cutters and by cardiac surgeons when bypassing the small coronary blood vessels. A small soft drain covered with a gauze pad is removed in the office the next day, and the small incision will seal by itself within another day or two.

DOWN TIME...
Dr. Stein usually performs three vasectomy reversals per week, one on Monday afternoon, one on Tuesday morning, and one on Thursday morning. Patients may return to work on the following Monday, but should avoid sports and lifting more than 20 pounds for an additional week. Detailed instructions for before and after the reversal are available here as a PDF file.

FEES...
The fee for office-based reversal procedures is $3900 after a $50 consultation fee. We are often told that these fees are less than charges elsewhere. There are a number of reasons for this:

1. Since vasectomy reversal is performed in the office, there are no facility fees.
2. Because it is done under local anesthesia, there are no fees for an anesthesiologist or nurse anesthetist.
3. We believe strongly that vasectomy is an excellent method of long-term pregnancy prevention, one that prevents unintended pregnancy far more effectively than any other form of contraception.  Many men who are considering vasectomy might be discouraged from undergoing a vasectomy were it not for the availability of vasectomy reversal at a price that is within the financial grasp of the average vasectomy candidate. If you are one of the few for whom vasectomy reversal does not succeed, it will be difficult enough, without a $5000-$10,000 bill!
4. Finally, from a practical standpoint, vasectomy reversal takes about 10 times longer than a vasectomy. That is, Dr. Stein can perform 10 vasectomies in the time that it takes to perform one reversal. So the fee for a reversal is 10 times the fee for a vasectomy.

If the patient opts for an office-based VV, and if lower end findings are so unfavorable that upstream secondary obstruction is likely (correctable by OR-based VE under general anesthesia at a later date), the fee for that "exploration" alone is only $950. This is the Approach Number 3 described in our Vasectomy Reversal 101 page.

OUT OF TOWNERS...
Our office is about 20 minutes from Tampa International Airport and 2 miles from Busch Gardens. Seven new chain hotels are just down the street. After reading this page, click on our Information for Patients from Out of Town. Patients arriving by air must come to the office for a consult visit at least one day before the reversal and are free to fly home two days after the reversal. A deposit of $950 (refundable only for M.D.-documented illness of the patient, not a family member) is due within 10 days of scheduling the reversal, but will be returned if the consult examination reveals technical challenges too great to proceed in the office (this has occurred only twice in over 1100 reversal candidates). Patients who live over 1 hour away by car should stay in a local hotel on the night of the reversal but may drive home after an office visit next day.

PAYMENT...
As stated above, a deposit of $950 is due within 10 calendar days of scheduling the reversal.  If not received within 10 days of scheduling, the chosen reversal date will be offered to other candidates. For cancellation or postponement more than 28 days prior to the reversal, $850 will be refunded or credited. Within 28 calendar days of the reversal date, the deposit is refundable only for M.D.-documented illness of the patient, not a family member. The balance is due on the day of the reversal. A payment plan is not offered by our office, but we accept VISA & MasterCard whom candidates can repay at whatever pace they choose. According to the Federal Tax Code, the expenses of attaining medical treatment to correct a functional impairment (in this case sterility) are tax-deductible. This includes the reversal fee, airfare, mileage expenses at $0.20 per mile, and lodging expenses up to $50 per night.

We are usually booked three to six months in advance, but cancellations do occur and we can sometimes move a patient's scheduled procedure to an earlier date.

SUCCESS RATES...
Nationwide vasectomy reversal success statistics are readily available. The most commonly cited article is the report of the Vasovasostomy Study Group which appeared in the Journal of Urology in March, 1991 (J Urol 145:505-511, March,1991; we'll mail you the abstract or you can review or copy the article at your local hospital medical library). Our office success rates compare favorably with these statistics and our updated results (kept on an Access© database) are immediately available on request. The single most important parameter determining success is the number of years since vasectomy. Within the first 3 years after vasectomy, reversal results in sperm recovery in over 97% of cases. From 3 to 8 years, about 91%; from 9 to 14 years, about 82%; and beyond 14 years, about 69%. Overall 85%, considering all patients who seek vasectomy reversal. Click here to see a recent sperm recovery results graph.  Pregnancy rates (without fertility assistance) also drop slowly with time (from about 86% in the 3-year group to 35% in the >15-years group), but we have had patients cause pregnancies after intervals as long as 30 years! Click here to see a recent pregnancy results graph. As with any surgery, success does not always occur and guarantees are fraught with problems of interpretation, so we do not offer them.

We are fully aware that other web sites claim that loupe magnification is inferior to magnification using a microscope. Dr. Stein used a microscope for years when he performed vasectomy reversals at a local surgery center, and in his experience, the microscope provided no advantage over quality loupe magnification in most cases. For those cases in which the vas tubes are very thin or the vasectomy sites are down in the convoluted (curly) portions of the vas tubes behind the testes, a microscope is used. All of our results are entered onto a database which is updated every 2-4 weeks and available on request and via the links in the last paragraph. Similar data should be made available by all offices performing vasectomy reversal so that candidates can draw fair comparisons. If any other office can provide accurate data claiming results superior to those above, then only the candidate can decide whether the few percentage points of greater success is worth the cost differential.

We are also aware that some offices stress a need for immediate vasoepididymostomy (VE) when no sperm is seen in the fluid which exudes from the freshened testicular ends of the vasectomy sites or when the fluid is thick and creamy. VE requires delivery of the testes from the scrotum, which we feel is too involved for an office setting and should be done in a surgical facility. We have analyzed our findings to learn that when sperm are absent from thin fluid on both sides at the time of reversal, sperm recovery in the semen is still 53%. When the fluid is thick and creamy, chances of sperm return to the semen are so minimal that we do not proceed with vas-to-vas connections (or charge a full fee), but the fluid is thick on both sides in only 5% of patients.  Most patients thereby avoid the fees for a surgical facility and still get accurate vas-to-vas connections. Dr. Stein's technique of office-based vasectomy reversal (Approach Number 3 in our Vasectomy Reversal 101 page) does not create enough scar tissue that VE at a later date would be more difficult. Again, only the candidate can decide whether availability of immediate VE is worth the cost differential of the surgeons who perform reversals in more formal (and expensive) operating room settings.

606 REFERRALS! ...
Every doctor has success stories and testimonials from patients who think that he or she is wonderful. But offering the names of only those patients whose procedures have been successful doesn't allow the reversal candidate an unbiased spectrum of opinions about a surgeon or the reversal process.

In April 1999, we began to ask every reversal patient for permission to release his first name and phone number to reversal candidates who would like to learn more about the reversal process here in our office. We ask this permission at the time of each reversal, even before we know if there are any complications or if the reversal has restored sperm to the semen. It is therefore an unselected list of all patients willing to provide advice to reversal candidates. As of November 2007, 606 reversal patients were listed by state and telephone area code.

Please post your desire for this list on our Visitor Page, and we will send it to you (along with other office info that supplements what you've read here in vasweb.com) via either e-mail or, if you prefer, postal mail.

You may also call toll-free 866-827-8463 during working hours (M-F 9-4 ET). After hours, please leave a message and we will return your call on the next business day.
Dr. Stein answers e-mail from home and can usually respond within 24 hours.