The answer is absolutely NO, there is no way that doctors should limit what they do to do only one procedure when there are various scenarios and different techniques that may be best for each patient. There is no way in any field in medicine in 2023 where it’s in the patient’s best interest to have a doctor who can’t or won’t provide the most appropriate or correct care for that individual patient.
There may be extreme variability in what vasectomy reversal doctors say they are able to do and what they actually deliver. Patients have told me that some doctors announce beforehand that they are going to perform the very same vasectomy reversal technique (vas-to-vas connection) on all patients. even if a bypass is the correct technique.
This blog, written by international authority Sheldon H.F. Marks, MD, reviews how some patients can have poorer success rates when doctors do the same vas reversal technique on every patient, whether it is the correct or wrong procedure to do. Recently Dr. Marks created educational YouTube video for other reversal doctors on how to decide what technique to perform.
When a couple wants to find the leading vas reversal expert so they can fulfill their dream of having a child together, they have a lot of choices. So how does anyone choose? Couples frequently ask: “Don’t most doctors do the same surgery to provide the highest reverse vasectomy success rate?” No! Not at all.
Some doctors incorrectly declare what vas reversal procedure they will do based on the number of years from vasectomy or the way the vas fluid appears. Most top experts would explain that this “one size fits all” may be fine for some patients but not good for others. These leading urologists understand what is best for that patients is to perform technique whichever is the most appropriate of the 2 different types of vas reversal connections based on what is seen microscopically in the vasal fluid.
Because there is no oversight as with most other surgeries, prospective patients may think that all doctors that perform vasectomy reversal are specialty trained and qualified experts, even if they are not. There are some doctors with minimal to no training that perform vas reversal microsurgery (1) while others may have decades of experience with thousands of patients.
What’s really upsetting to many vas reversal experts that I have talked with is that patients have told us that they had surgery by a doctor that would only perform the easier and faster vas-to-vas connection on each side even if that was not the correct technique for that patient’s body. Most experts would agree that it is not best for the patient to decide beforehand that they will only do the vas-to-vas technique (also called a VV, or vasovasostomy) (2). The scientific literature, professional courses and expert opinion makes it clear that the one-size-fits-all, “everyone gets the same procedure” approach may not be right for every patient.
It is a very clear and established technique in 2023 where the doctor is supposed to analyze the fluid from the vas under a microscope to determine whether sperm are present. If sperm or sperm parts are seen, then that side needs the easier vas-to-vas connection. If no sperm or perm parts are seen in the fluid from the vas, then the more challenging vas-to-epididymal bypass is the correct reverse vasectomy procedure (3) to provide the best vas reversal success rates.
Because the vas-to-epididymal bypass is technically more demanding and takes more time, there are many reasons that some may justify to the patient why they didn’t need the bypass or why the doctor did not even need to look at the fluid. Because there was no way to know if the system was open or blocked, the patient automatically received the straightforward, quicker and easier vas-to-vas reversal connection, even if this means a much lower chance for success on that side.
When each couple selects a vasectomy reversal doctor, it is smart to ask if the urologist microscopically analyzes the fluid from the vas on every patient, each side. Then ask how often they perform the epididymal bypass (VE) and also the success rate they see with their vas bypass technique. The top experts will tell each patient that even if he is just a few years from vasectomy, there is still a chance he may need a bypass on one or both sides. Ask the tough questions and take time to find the most skilled vas reversal expert, as chances are good that each couples’ ultimate results and dreams will depend on the doctor that they choose.
The “one-size-fits-all” may be good for hats, but it is not not in any patient’s best interest when performing a microsurgical precision vasectomy reversal if the patient cares about having the very best chances for having a baby.
To have any questions answered or to find out more about ICVR’s full time, vas reversal only center where we offer personalized, precision medicine, call us today! When ready, we can set up a no cost consultation by phone, in person, Skype, Zoom or Face Time with one of our two vas reversal experts, Dr. Sheldon Marks or Dr. Peter Burrows.
This page was reviewed, edited and updated June 13, 2023 by Sheldon H. F. Marks, MD.
References:
1.Akanksha Mehta, Philip S Li. Male infertility microsurgical training Asian J Androl. 2013 Jan; 15(1): 61.
2.Kirby EW, Hockenberry M, Lipshultz LI. Vasectomy reversal: decision making and technical innovations. Transl Androl Urol. 2017 Aug; 6(4): 753–760.
3.Chawla A, O’Brien J, Lisi M, Zini A, Jarvi K.Should all urologist performing vasectomy reversal be able to perform vasoepididymostomies if required? J Urol 2004;172(3):1048- 50.
4.Marks SHF. Vasectomy Reversal: Vasovasostomy and Vasoepididymostomy. New York; Springer; 2018.
