Ask Your Vasectomy Reversal Surgeon
Once you have educated yourself on the vasectomy reversal procedure and the decision-making process therein, it's important to have some questions outlined to ask your prospective surgeon relative to his/her qualifications in performing your operation.
We have provided 21 questions to ask when selecting a microsurgeon and
vasectomy reversal center:
Please also see our 8 Myths about Vasectomy Reversal >
- Is your Center accredited by a nationally recognized accreditation organization? And why is this important?
- Are you certified by the American Board of Urology?
- Are you a member of the Society of Reproductive Surgeons?
- Do you perform a microsurgical vasectomy reversal with six sutures of 10-0 (ten-0) or 11-0 (eleven-0) to reconnect the inner lumen (tube where the sperm travel)?
- Do you personally perform the entire surgery, from the beginning to the end?
- Do you have your own dedicated operating suite, microsurgical instruments and personal surgical staff?
- Do you use a high-powered surgical microscope to place and tie the stitches?
- Do you use a formal multi-layer (microdot) microsurgical technique every time?
- What about laser reversals?
- Do you use conscious sedation in an outpatient setting?
- Do you offer a fixed price, "all-inclusive" package?
- Do you offer the ability to retrieve sperm intraoperatively for freezing and sperm banking in a state-of-the-art andrology lab?
- Do you limit your practice to no more than one reversal in a day?
- Do you provide your patients with your personal cell phone number so they can have access to you any time, any day or night, before or after the surgery?
- How long should an uneventful vas-to-vas (VV) reversal take?
- Do you perform more reversals than any other major procedure in your practice?
- Do you routinely perform vas-to-epididymis (VE) connections if necessary?
- Do you help with local accommodations and travel arrangements?
- Do you have patients come to see you for a reversal from all over the United States...From all over the world?
- Do you have successful reversals on men as far out as 30 and 42 years from the vasectomy?
- Do you routinely perform re-do and re-do -- re-do microsurgical vasectomy reversals?
1. Is your Center accredited by a nationally recognized accreditation organization? And why is this important?
"Accreditation is a voluntary process through which an ambulatory health care organization is able to measure the quality of its services and performance against nationally recognized standards. The accreditation process involves self-assessment by the organization, as well as a thorough review by the Accreditation Association's expert surveyors, who themselves have extensive experience in the ambulatory environment.
The accreditation certificate is a symbol to others that an organization has committed to providing high-quality care and that it has demonstrated its commitment by measuring up to the Accreditation Association's high standards. The real value of accreditation, however, lies in the consultative and educational process that precedes the awarding of the certificate. It is this self-analysis, peer review and consultation that ultimately helps an organization improve its care and services." [Accreditation Association for Ambulatory Health Care]
In a continuing effort to elevate the standards of care in the field of microsurgical vasectomy reversal, the International Center for Vasectomy Reversal voluntarily submitted to the long and arduous process of accreditation through the AAAHC in late 2003. After nearly 9 months of completing the application process, our site was surveyed and received full accreditation for 3 years, the longest time permitted. We strongly support the concept that all microsurgical programs should meet the high standards established by the AAAHC in all aspects of their Practices as a commitment to their patients to maintain the highest level of care in regards to Patient Rights, Governance, Administration, Quality of Care, Quality Management and Improvement, Clinical Records and Health Information, Professional Improvement, and Facilities and Environment.
The Internet has made it possible for many people to make claims that are not necessarily supported by facts. There are many "programs" advertising themselves as "world renowned" and many surgeons claiming to be "microsurgical experts" that have not submitted to the objective and rigorous review of an accreditation organization. We made the decision to become an accredited program to substantiate for our patients that what we claim to be is what we are. We will always deliver the highest level of care to our patients, from the first phone call forward.
The answer should be yes. Dr. Marks is a Diplomat of the American Board of Urology, passing his re-certification exam and now re-certified until 2009. Dr. Burrows after completing his fellowship in microsurgery became board certified by the American Board of Urology. Not everyone is certified. This doesn't mean they are not qualified, but being certified means that your doctor has passed a rigorous two-day written and oral exam testing key points, felt to be essential by the leaders in urology, to maintain high practice standards.
Dr. Marks is one of only a handful of urologic micro surgeons who is a member in good standing of the Society of Reproductive Surgeons. This elite society requires letters of recommendation from established and respected specialists. Dr. Marks' letters of support came from three of the country's leaders in male infertility and microsurgical surgery. In addition, acceptance requires a detailed review of an 18-month surgical log of fertility related cases (vasectomy reversals) and their outcomes. When you ask around, most offices will tell you that their doctor is a member of all societies...but only a few are members of the Society of Reproductive Surgeons.
4. Do you perform a microsurgical vasectomy reversal with six sutures of 10-0 (ten-0) or 11-0 (eleven-0) to reconnect tissue-paper thin lining of the inner lumen (tube where the sperm travel)?
Dr. Marks and Dr. Burrows perform each multi-layer vasectomy reversal using only the most advanced and proven technique - the formal multi-layer (Microdot) microsurgical closure, using the tiniest 10-0 or 11-0 Nylon sutures. This technique provides the most accurate and natural repositioning of the two cut edges of the tube (lumen) where the sperm must pass. This technique offers the best chances for success with the least risk for scarring or leakage. Some doctors still use older techniques with more sutures or thicker sutures (lower numbers), which can reduce success rates.
Doctors Marks and Burrows personally perform the entire vasectomy reversal operation, from start to finish. There are no hidden assistants or residents, fellows or medical students in training doing any of the surgery or learning their skills during your reversal. This ensures that you receive the absolute best operation, each suture is placed precisely by your microsurgeon, therefore assuring you the best chances for success.
6. Do you have your own dedicated operating suite, microsurgical instruments and personal surgical staff?
Drs. Marks and Burrows are very proud of their dedicated operating suite, designed and built for one purpose - microsurgical vasectomy reversals. No one else uses the exclusive surgical suite, which guarantees a peak state of readiness and sterility for reversals. Likewise Dr. Marks has put together an elaborate assortment of the finest titanium microsurgical instruments, again only for each doctor's use during reversals. Drs. Marks and Burrows' surgical staff assists them with every case, and together they have been performing reversals for many years. This consistency and stability of staff, equipment and supplies guarantees a smooth, efficient and harmonious operating suite.
Drs. Marks and Burrows only perform microsurgical vasectomy reversals, using a new top-of-the-line Leica/Wild high-power surgical microscope with Swiss optics. This provides the best visualization possible, improving the accuracy and precision of each suture placed. Others that use lesser magnification, as with "loupes" or magnifying glasses know that studies prove the best successes are with the use of a high-powered surgical microscope.
Drs. Marks and Burrows believe that they can achieve the highest success rates using the formal multi-layer technique. With continual improvements, consistency and outcomes are the best ever using this refined technique. Through the formal multi-layer using 10-0 or 11-0 suture is more challenging and time consuming, experts will tell you that it is better operation, providing far better results than older less precise techniques. Older techniques using stents or larger sutures (lower numbers, such as 7-0 or 8-0) may work on occasion but have been abandoned by true vasectomy reversal experts.
Laser Reversals were a great idea back in the late 1980's. Then the world's top microsurgery researchers investigated and experimented with lasers to see if this would improve the results of a reversal. Over a decade ago, each researcher independently came to the same conclusion - the laser caused more injury in critical areas and reduced success of the reversal. It appears that while the laser might offer short-term success it leads to scarring in the long run and ultimate failure of the reversal. They felt that nothing was better than well-placed microsutures by an experienced microsurgeon. Using the laser allows the doctor to go faster, but that really wasn't and shouldn't be the goal. This is why every single leading true expert in vasectomy reversal has abandoned this idea and recommends not using laser.
Drs. Marks and Burrows have used all techniques over the years but believe that their patients feel better and have a more uneventful recovery when they have mild conscious sedation to relax them and keep them comfortable during the reversal. There are occasions where general anesthesia or a deeper sedation is preferred by the patient or Drs. Marks and Burrows, but these are relatively infrequent. If you desire a deeper level of anesthesia, this can be arranged as well. An additional benefit for mild conscious sedation is the dramatically reduced cost to the patient, not having to pay for an anesthesiologist to be in attendance and the very expensive medications. Throughout the procedure, while receiving conscious sedation you can direct the level of relaxation you prefer, with most men simply falling asleep and remaining asleep throughout the procedure. If you wish, you can choose to watch the procedure on your video monitor. And after the surgery is over, you are ready to go home or back to the hotel, feeling good (though perhaps a bit woozy).
Drs. Marks and Burrows have established a fixed, "all-inclusive price" so there are no hidden or unexpected surprises later on. They have seen men who were told the facility fee would be about $2,000, only to receive a bill for over $12,000! There are also some doctors that come out after surgery and surprise their patients with the news that additional surgery was performed and the patients must now pay an additional hundreds to many thousands of dollars. We have a fixed price for a first-time vasectomy reversal which is all-inclusive of consultations and support before, during and after surgery all surgery related facility fees, nursing expenses, surgeon's fees, sedation and medications--regardless of whether it is a vas-to-vas or vas-to-epididymis procedure. For those patients that have had a failed vasectomy reversal by another surgeon, we have a slightly higher fee due to the generally more complicated nature of a re-do or re-do, re-do vasectomy reversal.
Our center also does not use pricing, discounts, or money-back guarantees as a means of soliciting business and advertising. We feel that it is demeaning of us and disrespectful of our potential patients. The one promise we will make is this: we guarantee the absolute best medical and surgical experience available anywhere in the world today for the fairest price we can afford without compromising any aspect of the services we provide to our patients. We do not need to offer a money-back guarantee because our care does not end after surgery - we are here to work with and support our patients for as long as they need us to achieve the best possible outcome of their surgery. We are always available and happy to discuss the financial aspects of the surgery with our patients personally.
12. Do you offer the ability to retrieve sperm intraoperatively for freezing and sperm banking in a state-of-the-art andrology lab?
Drs. Marks and Burrows are very fortunate to have their own state-of-the-art and high-complexity certified Andrology Lab and CryoBank, coordinated by Stan Grossman. Formerly from Baylor, where he worked in one of the country's leading male infertility labs, Stan provides world-class services on-site. With Stan's experience and expertise we can secure and preserve sperm obtained at the time of the reversal.
Drs. Marks and Burrows are committed to perform only one reversal per day. This way, they can take the time to do their very best, and focus all of their energy and concentration on your vasectomy reversal without being preoccupied about finishing up and getting on to the next surgery, nor are they fatigued from earlier cases.
14. Do you provide your patients with your personal cell phone number so they can have access to you any time, any day or night, before or after the surgery?
Drs. Marks and Burrows believe that if you are going to trust them with such an important operation, they want to hear directly from you if you have any questions, concerns or potential problems. For this reason, all of their reversal patients are given their personal cell phone numbers, so they can reach them directly day or night.
An uneventful microsurgical vasectomy reversal, connecting vas to vas, takes an average of two and one half to three hours. More complicated reversal can obviously take longer. Be wary of the one hour reversals or, just as bad, the routine 5 or 6 hour or even 8 to 10 hour (yes 8 to 10 hours!) reversals.
Drs. Marks and Burrows are true microsurgical specialists, focusing their surgical practice on vasectomy reversals. It is the only major procedure that Dr. Marks performs and far and away the most common operation that Dr. Burrows performs, in addition to the other male fertility-related surgeries, TESE and MESA. Be wary of the "expert" who actually is a general urologist that may do an occasional reversal as well. Studies looking at other technically challenging surgical specialists such as heart and brain surgeons clearly demonstrate that the true experts achieve far better successes than the 'jack-of-all-trades'.
Drs. Marks and Burrows have focused their surgical practice on one thing - reversing vasectomies for the purpose of return to fertility. Therefore, just as each patient is different, each surgical procedure (and even each side) is different. When it appears that a vas-to-vas (VV) connection will not allow the passage of healthy sperm, Drs. Marks and Burrows will locate the best possible spot in the epididymis to connect the vas (VE). The VE is commonly performed, and depends on how each patient presents intraoperatively.
We understand that it's a bit more challenging to have to travel somewhere to have your surgery. So, we do everything we can on our end to make your stay in Tucson easy and comfortable. We have established great relationships with many hotel and resort properties that give our patients commercial discounts and treat them like VIPs. We will also arrange all of your ground travel - pick you up at the airport, bring you to surgery and back to your hotel afterwards, and then take you to the airport when you leave. Our goal is to make the entire experience a positive one.
19. Do you have patients come to see you for a reversal from all over the United States...From all over the world?
Our patients have traveled from every state in the U.S. - including Washington, Oregon, Florida, Missouri, Georgia, New York, Massachusetts, Idaho, California, Minnesota, Maryland, Michigan, Maine, New Hampshire, Pennsylvania, Texas, Tennessee and Alabama. Internationally, patients have traveled to the International Center for Vasectomy Reversal from Portugal, Hungary, Australia, China, Russia, the Philippines, Canada, Mexico, Venezuela, Hong Kong, South Korea, Saudi Arabia and Qatar.
Dr. Marks and Burrows have successful reversals on men as far out as 29, 30, 35 and 42 years from their vasectomy. Recently we have had many successful re-do reversals for men that had failed reversals by other non-specialists around the U.S. and men that other doctors had told they "couldn't possibly have success."
21. Do you perform re-do vasectomy reversals on men who have had a failed reversal attempt elsewhere?
Yes, we routinely provide re-do and even re-do, re-do vasectomy reversals on men from around the world who have had an unsuccessful attempt at reversal elsewhere. Though more challenging because of scarring from prior attempts, we have excellent results with many children from these re-do vasectomy reversals.