20 Questions to Ask When Choosing Your Reversal Doctor
These 20 questions will help you to find the best doctor to give you the very best chances for success. Listen what they say. Even more important, listen to what they don’t say or how they avoid the answer. Whether your vasectomy reversal works and your dream of a family will likely depend on the doctor you select.
Of course, the answers will only be helpful if the doctor is honest and answers the questions truthfully. Be cautious.
Questions About the Doctor
1. Are you a urologist?
The answer should be an absolute yes! Urologists are the only specialists trained with years of residency in complex aspects of male reproduction and reconstructive fertility microsurgery. Many patients do not realize that many “self-proclaimed” reversal doctors are not even urologists. These doctors believe that whatever knowledge or skills they have from other specialties or from watching someone else perform a few reversals combined with a desire or calling to do reversals is good enough. At ICVR, both Dr. Marks and Dr. Burrows are trained, experienced urologists who offer you the very highest chances for a successful reversal, and so the best chances for having a child!
2. Are you full-time, reversal only specialist?
(A sneaky way of getting this answer is to ask “what other surgeries do you do?”) Your best results will always be with urologists where reversals are all they do or at least a large part of the surgeries that they perform. Most general urologists rarely perform reversals and so their success will be much lower that the busy true urologic experts. ICVR has been a full-time, reversal only center for decades. The entire staff is here for one purpose – to give you the very best reversal and care anywhere.
3. How long does your average reversal take?
In skilled and experienced hands, a correctly performed vasectomy reversal takes about 2 to 2 1/2 hours. You should wonder about the doctors that brag about performing 45 to 60 minute reversals. Just as bad are the doctors that take 4 to 6 hours or more to do a reversal. Drs. Marks and Burrows take about 2 to 2 1/2 hours for most routine and even many redo reversals.
4. How many reversals do you perform each week?
Top reversal experts perform up to 2 to 5 reversals every week. It is smart to avoid the doctor that does only an occasional reversal. Just as bad is the high volume, factory doctor that crams in 10 to 20 or more “quickie” reversals every week. Drs. Marks and Burrows together perform on average 4 to 7 reversals every week.
5. Do you limit your practice to just one reversal a day?
Almost all of the world’s true experts never do more than one reversal a day. Be wary of the doctors that advertise that they do multiple reversals in a day, as if this is something to be proud of. By limiting ourselves to only one reversal a day, you know that you will get the doctor’s full and undivided attention-to-detail. You know he is not pressured to rush to the second or third case, nor is he fatigued from earlier reversals. ICVR’s doctors each limit their practice to only one reversal each day- always have, always will.
6. How many years have you been performing reversals?
Ideally you want a urologic microsurgeon that has been performing reversals for several years or more so that they have had enough experience to perfect their skills and judgment. Some doctors are new and may not have the experience to perfect their skills. Dr. Marks has been performing reversals for 35 years and Dr. Burrows for more than 25 years.
7. How many reversals have you performed as the surgeon (not as an assist)?
There are only a handful of true experts who have performed many thousands of reversals. Of course, numbers alone are not important if they don’t perform reversals correctly. It is important for your doctor to have performed a significant number of reversals to have developed critical judgment and mastered the necessary microsurgical skills. Drs. Marks and Burrows have performed almost 6000 reversals with proven, published success up to 99.5% here at ICVR.
8. Do you publish papers, present your results at leading specialty urology conferences, write textbook chapters and teach other reversal doctors about new reversal techniques?
The answer should be yes. Many doctors only do an occasional reversal and are not experts. Others want you to think they are top experts when they really are not. When a doctor presents his results to his colleagues, he is opening up his practice and his results for all to see. The doctors of ICVR have published important papers and presented about vasectomy reversals at many international meetings, as well as writing textbook chapters. We are just a few of the true experts that continue to be invited to teach the courses to other urologists on how to perform state-of-the-art reversals.
Questions About the Procedure
9. What is your success rate for a vas-to-vas connection?
Top experts achieve up to a 99.5% reversal success using the new Marks Vas Cutting Forceps and a multilayer microsurgical technique. How did the doctor come up with his success numbers? Did the doctor make up his success rates or are they published? Many doctors do not know their actual success rate or instead quote published articles of top experts as if these were their own results. There are even others that make up a high success rates to draw patients into their practice. The doctors of ICVR have a published a proven success of 99.5% for vas-to-vas connections in a leading fertility journal.
10. Do you perform microscopic analysis of the fluid from the vas to look for sperm and then do a Vas-to-Epididymal (VE) bypass if none are seen?
The answer should be an absolute yes, every time. Knowing whether sperm are present in the fluid is the only way to know if the system is open and so a vas-to-vas (VV) connection is correct or if there is deeper blockage and so a vas-to-epididymal (VE) bypass is needed. Many doctors don’t do a microscopic analysis of the vasal fluid, mistakenly believing that the number of years from vasectomy or the way the fluid looks tells them what technique they need to do. This is just wrong. Others only perform a vas-to-vas connection on every patient, even when they know there is deeper blockage and so a zero percent chance for success. Analyzing the vasal fluid is critical at ICVR to decide what correct procedure is needed – a vas-to-vas or vas-to-epididymal bypass.
11. Does the number of years out from vasectomy determine what technique you will perform or if the reversal can work?
The correct answer is no. Despite what many may tell you, there is no magic number of years when a reversal will or will not be successful. Watch out for the doctor that tells you a reversal will not be successful because of the number of years from vasectomy. Some men at 3 years need a bypass, while others at 32 don’t. Just as bad is the doctor who claims to know before surgery that you will need a vas-to-vas connection or a bypass. ICVR doctors are ready to perform whatever your body says is the right procedure, whether a vas-to-vas (VV) or vas-to-epididymal (VE) bypass.
12. Do you perform the entire reversal, from start to finish?
(or do you use medical students, residents or fellows-in-training to participate in any part of my surgery or care?) Your best results will be when the doctor you select performs the entire reversal himself, from start to finish. ICVR does not allow doctors-in-training to perform or even participate in your reversal. You get the doctor you choose to do your surgery so you get the very best chances for success.
13. Do you use intravenous conscious sedation to keep your patients comfortable and pain-free?
Mild sedation gives you all the benefits of the sedation using only what you need with none of the rare but serious risks seen with deeper general anesthesia medications. Sedation is so much safer and more comfortable that the opposite where some doctors simply give you a “handful of pills” approach which is inconsistent and risky. ICVR’s doctors developed a mild sedation technique so you are so relaxed and you sleep comfortably and safely throughout your reversal, waking up feeling great and pain-free. In fact, most of our patients don’t even take a single Tylenol afterwards.
14. What are your thoughts on sperm antibodies?
The correct answer is they are not usually an issue and rarely impact on fertility. Many doctors still believe wrong ideas or misinterpret old studies and think that antibodies play a role. Study after study shows that antibodies after reversals are not relevant to male fertility in the vast majority of men and play no role in conception and pregnancy. Doctors that say otherwise are misinformed or are selling something. At ICVR, we rarely see any issues from sperm antibodies. We even looked at many patients with and without and found no difference in fertility between the two groups. One patient even had 100% antibodies and still fathered several children.
15. What magnification and reversal technique do you use?
The best answer should be they use a high power surgical microscope with 40X power to perform a multi-layer (3 to 4 layer) connection. True experts realize that patients will achieve the highest success up to 99.5 % with the more precise, anatomically correct multi-layer alignment of the layers of the vas. This can only be done using a high power surgical microscope as compared to the lower success 1 or 2 layer closure. Watch out for doctors that use older or faster techniques with lower success. Drs. Marks and Burrows will only perform the more precise multilayer closure under the surgical microscope, every time.
16. What size sutures do you use for the inner layer?
The correct technique is to use six to eight stitches of the tiniest 10-0 (the bigger the number, the thinner the sutures) Nylon micro sutures on the innermost layer. Watch out for doctors that use thicker 9-0, 8-0 or even 7-0 on the inner layer simply because it is easier or cheaper. ICVR’s doctors will only us the most delicate 10-0 microsutures to give you the very best chances for success. The suture size is critical as you want the smallest suture that will do the job.
Questions About the Program and Facility
17. Do you offer a fixed, all-inclusive, “no surprise” price package with the option for an in-house, no interest payment plan?
You want an all-inclusive, fixed “no surprise” fee that includes most everything related to your vasectomy reversal. There are many patients that think they are getting a cheaper reversal only to be surprised by thousands of dollars of unexpected charges later on. Many doctors can’t even quote you a total cost, because it can vary widely. Just as bad, many doctor charge you hundreds to thousands more if they have to do a VE bypass. Even if they offer a cheap price, it is smart to find out what is and is not included. What if you have questions or issues weeks or months later? Do they offer sperm banking or andrology services? Usually not. ICVR has always offered a fixed, no-surprise cost with no hidden fees and sperm banking at no charge. So whether we do a vas-to-vas connection or a more challenging bypass that takes an hour or two more, your costs are always the same.
18. Do you offer continued care after the reversal at no additional cost and give all your patients your personal cell number?
The answer should be yes. Look for doctors that provide direct access to the doctor and continued care relating to your vasectomy reversal for as long as needed. Many doctors think that as soon as the reversal is over that they are done with you, when this is not good care. What they don’t understand is that the aftercare is just as important as the reversal. The doctors of ICVR have always given our patients our cell phone numbers for direct evening and weekend access, and care for as long as you need it.
19. Do you offer all patients sperm banking, at no charge?
It’s smart to find a doctor that says yes. Only a few top centers have a state-of-the-art federally certified andrology lab affiliated with their reversal program. Look for a doctor where you have the option to bank sperm at no charge and where the andrologist works with you as long as needed to ensure the very best results. ICVR’s lab provides the option for free sperm banking, just in case, and the first year of storage at no additional cost. This can save you thousands of dollars for sperm retrieval.
20. When do you recommend we check a semen analysis?
It is critical to check your first semen analysis starting at 4 to 6 weeks after your reversal, and then regularly to be sure that you are achieving normal counts and are staying open. There are many doctors that don’t understand the importance of close monitoring of your counts and mistakenly tell patients they don’t need to check a semen analysis for many months or longer. This suggests that they really don’t know or understand. Close and regular monitoring of your sperm counts for many months after your reversal always gives you the very best success.
We are here to answer your questions or set up a no-cost consultation, phone, in office, Skype or faceTime, with either of our doctors. Call 888-722-2929 or email firstname.lastname@example.org