| 1. |
Do you have a better than 98%
success rate if sperm were present in the vas at the time of
reversal?
From a patient’s perspective this is the most important
piece of information to know, the doctor’s success rate.
Dr. Werthman’s patency rate for those men who have sperm
in the vas and undergo vasovasostomy is higher than 98%. Bottm
line-Only few other experts can obtain this consistent result.
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| 2. |
Are you fellowship-trained in microsurgery?
Dr. Werthman completed a microsurgical fellowship at UCLA and
was a visiting fellow at the Baylor College of Medicine, one
of few surgeons to obtain fellowship training at 2 institutions.
By training with a variety of specialists including Dr. Rothman,
Dr Werthman has been able to synthesize the best techniques
possible for reversal and can integrate different surgical principles
rather than being able to do a reversal only one way as learned
from one teacher. Fellowship training confers another level
of knowledge and commitment to the surgeon. It is important
to find a reversal surgeon who is fellowship trained. |
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| 3. |
Are you Board Certified by the American
Board of Urology?
The answer must be yes. Being board certified doesn’t
mean the doctor is a great doctor nor does it mean he can perform
microsurgery, but it is a minimum criterion one should look
for in a surgeon. It means the doctor has passed the basic requirements
specified by the American Board of Urology. Dr. Werthman is
a Diplomat of the American Board of Urology and a Fellow of
the American College of Surgeons. If a doctor is not board-certified
then you should be curious as to why they are not? |
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| 4. |
Are you a member of the Society for
Reproductive Surgeons?
Dr. Werthman is a member of the Society as are most of the top
male infertility specialists. In order to become a member, the
surgeon must submit a case log of 18 months of surgery to assure
that the majority of his practice is dedicated to fertility
and reproductive medicine. This certification does mean that
a substantial portion of the doctor’s practice is devoted
to treating infertility patients. |
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| 5. |
Do you perform reversal with 10-0 sutures
to reconnect the inner channel of the vas?
Most fellowship trained microsurgeons perform a standard 2 layer
closure of the vas with 10-0 nylon suture (half the thickness
of a hair). Use of this technique is one way that usually allows
one to distinguish between the trained microsurgeons versus
the general urologists performing reversals. This technique
appears to be most precise and allows for the best results. |
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| 6. |
Do you personally perform the entire
surgery from beginning to end?
Dr. Werthman precisely places every suture himself. He does
not train residents or junior associates. He is in your surgery
from the moment it starts until the moment it finishes. |
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| 7. |
Do you have your own dedicated
operating suite, microsurgical instruments and personal surgical
staff?
Dr. Werthman performs all reversal surgeries at Specialty
Surgical Center in Beverly Hills and is a partner. Specialty
is a high end, state-of-the-art ambulatory surgical center
that provides the highest quality preoperative, anesthesia
and postoperative care to Dr. Werthman’s patients.
Dr. Werthman has an operating room set aside for him to use
specifically for reversal surgery that includes 2 of the newest
Zeiss operating microscopes as well as a Nikon light microscope
and Dr. Werthman’s personal microsurgical instruments
(some of which Dr.Werthman helped design). The staff including
Dr. Werthman’s assistant have worked with Dr. Werthman
for many years specifically doing reversals. We have received
many compliments from patients who were impressed with the
level of care and compassion they received at the center.
For a virtual tour of the facility you can visit our website
www.specialtysurgical.com.
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| 8. |
Do you use a high-powered
surgical microscope to perform the reversal?
Specialty Surgical Center has invested over $100,000 to obtain
the finest quality microscopes and microsurgical instruments
for Dr. Werthman’s use. The better the vas can be visualized
the more precisely the sutures can be placed and the more
accurate a reconnection can be performed and all this means
better success rates and chances of pregnancy and that is
what we are all about. |
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| 9. |
Do you use a 2-layer closure for the
vas connection?
We perform the 2 layer anastamosis using 10-0 double armed,
nylon sutures. Each microsuture is hand-made and specifically
designed for reversal surgery. Each suture is placed in an inside-out
fashion so there is less chance of accidentally misplacing the
suture. Once again we perform the reversal in a way that ensures
the greatest chances of success. |
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| 10. |
Do you perform laser reversals or
use fibrin glue?
Laser reversals actually can cause harm to the vas and lower
the chances for a successful reversal. The energy from the laser
damages the tissue around the vas and the small blood vessels.
No respected reversal surgeon performs laser reversals. This
falls into the category of gimmick along with fibrin glue. The
best way of reconnecting the vas is with precisely placed microsutures.
In our hands this gives a better than 98% success rate for those
men with sperm in the vas at the time of reversal. No other
techniques come close to these chances of success so why look
for something that is less successful and possibly harmful just
because it sounds high-tech and new? |
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| 11. |
Do you use conscious sedation in
an outpatient setting?
Surgery is performed on an outpatient basis but under general
anesthesia. We do not recommend local anesthesia with conscious
sedation for several reasons. Microsurgical reconnection of
the vas is an extremely technical and precise surgery. It would
be very difficult to perform and results may be compromised
if the patient was able to move around. Think of how hard it
would be to hit a moving target the size of a pen dot with a
needle. The other significant issue is that it is very difficult
to perform a vasoepididymostomy under local as the local can
wear off during the longer procedure. From a patient perspective,
the thought of lying still for 2+ hours also seems unappealing.
We therefore discourage patients from having the surgery under
local anesthetic/sedation even though it reduces the costs somewhat.
This is not an area where you would want to skimp to save several
hundred dollars. Our anesthesia team is expert in providing
general anesthesia in the outpatient setting so you wake up
quicker and feel better after surgery than with general anesthesia
many patients have had in hospital settings. Very few patients
have requested a local or wanted to be awake for the procedure.
We keep it simple, come in, take a snooze, wake up and go home
an hour later. |
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| 12. |
Do you offer a fixed price package?
Yes. We charge the same fee for an uncomplicated vasovasostomy
as for a harder vasoepididymostomy. This means that you will
know all costs up-front and will not get a “surprise”
bill after surgery from the facility because the surgery took
longer as sometimes happens with patients who have procedures
in hospital or non cost controlled settings. Once again, our
goal is to make it as easy as possible for you to have the procedure.
We want to give you information in a strait forward and forthright
manner. Re-do reversals and sperm harvesting do cost more. For
cost information please contact the Center for Male Reproductive
Medicine at 310-277-2873. |
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| 13. |
Do you offer the ability to retrieve
sperm for freezing and sperm banking in a state-of-the-art andrology
lab?
We offer sperm harvesting and freezing at the time of reversal
for those patients’ considering In-Vitro Fertilization
as a back-up plan should the reversal fail. We recommend it
in cases where there is a high likelihood of having to perform
a vasoepididymostomy. Our Center is equipped with a complete
COLA-certified andrology lab. Dr. Rothman is the founder and
owner of the California Cryobank, the world’s largest,
oldest and most reputable sperm bank. Patients’ samples
are stored at the Cryobank facility. For mare information regarding
the sperm bank visit them at www.cryobank.com. |
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| 14. |
Do you limit your practice to no
more than one reversal in a day?
Dr. Werthman will only perform one reversal in a day so as to
give that patient his complete attention. Reversals are technically
challenging and require a great deal of concentration. Dr. Werthman
feels that it would be unfair to perform a second reversal in
a day and wants to perform every patient’s surgery at
his best. |
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| 15. |
Do you provide your patients with
your personal cell phone number so they can have access to you
any time?
Dr. Werthman or Phil as he prefers to be called by patients
is always accessible and available to patients and prospective
patients. He does not carry a beeper so all patients get his
cell phone and direct home phone numbers and be reached anytime. |
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| 16. |
Does an uneventful vas to vas reversal
take about two and a half to three hours?
No, an uneventful vasovasostomy takes Dr. Werrthman between
one and a half to two hours. The reason Dr. Werthman can perform
the surgery a bit faster than most surgeons is simple. He has
streamlined the surgery. Microsurgery is an art form and Dr.
Werthman has choreographed every movement so there is no wasted
motion. Making the incision and isolation and preparation of
the vas takes 15-20 minutes, collecting and checking the vasal
fluid for sperm takes 5 minutes, performing the microsurgical
reconnection takes 20-25minutes and closing the incision takes
5 minutes for each side. Dr. Werthman is a highly skilled and
talented surgeon who constantly assesses every portion of the
surgery looking for ways to improve the process and increase
success. A vasoepididymostomy takes between two and two and
a half hours and a re-do reversal takes about two and a half
hours. Anesthesia and patient preparation time is another half
hour to forty-five minutes |
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| 17. |
Do you perform more reversals than
any other major procedure in your practice?
Yes, vasectomy reversal is the most common procedure that Dr.
Werthman performs and is one of only several surgeons in the
United States who truly specialize in male reproductive surgery
and have limited their practice to helping infertile patients.
This is in contradistinction to general urologists who do a
bit of everything including reversals and those urologists who
are fellowship trained but are not busy enough to limit their
practice to fertility treatments. Dr. Werthman has performed
over 1700 microsurgical procedures. |
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| 18. |
Do you routinely perform vasoepididymostomies?
Dr. Werthman performs vasoepididymotomy when it is indicated
and it appears that a vas-to-vas connection will not give the
best results. Please watch the video of Dr. Werthman performing
the procedure to see exactly how it is done. Dr. Werthman’s
success rate for patients requiring vasoepididymostomy on both
sides runs between 60-70% patency. |
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| 19. |
Do you help with local accommodations
and travel arrangements?
The office staff at the Center for Male Reproductive Medicine
and Vasectomy Reversal can help you with local accommodations.
There are several hotels in the Century City and Beverly Hills
area that our patients routinely stay at. We can recommend to
you certain pleasantries such as limousine upon request but
the Center can not provide these to patients directly or offer
any “percs” that could be misconstrued as an enticement
to come to us to have surgery. This would be unethical and raises
liability and legal issues with the office of The Inspector
General. We will do everything possible to help you within ethical
and legal limits. |
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| 20. |
Do you have patients come to see
you for reversals from all over the US and the world?
The Center for Male Reproductive Medicine and Drs. Werthman
and Rothman established a world-wide reputation as extraordinary
microsurgeons and male fertility experts. They are the experts
often called upon by the media for who seek expert opinion and
interviews with the doctors (see Center in the News). Patients
travel from all over the US and the world to have their surgery
with Dr. Werthman. Please see the map to view countries and
states of origin of our patients around the world. |
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| 21. |
Do you have reversals on men as far
out as 30 and 42 years from vasectomy?
We frequently perform reversals on men whose vasectomies are
25-30 years old. Dr. Werthman has the distinction of helping
a man father a child 52 years after his vasectomy, performed
at the end of World War II. This proves that men can still produce
sperm half a century after their vasectomy. |
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| 22. |
Do you have an andrologist and anesthesiologist
on staff?
The Center has a full time andrologist who has worked with us
for over twenty years and is an expert on sperm preparation
techniques and cryopreservation, working with Dr, Rothman since
he first started the California Cryobank out of the office twenty
plus years ago. Specialty Surgical Center has a staff of anesthesiologist
that work with Dr. Werthman on a daily basis. |
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| 23. |
Do you routinely perform re-do and
re-do-re-do reversals?
Dr. Werthman routinely and successfully performs re-do reversals.
Several years ago he performed a reversal on the Tribal King
of an Island Nation who flew a great distance to see Dr. Werthman
after he failed two reversals performed in his county.
There is a relatively small group of surgeons in the country
who fulfill the above criteria and are excellent reversal surgeons.
There are some other achievements that distinguish Dr. Werthman
and the Center from among other terrific reversal experts. |
| |
| 24. |
Did the surgeon graduate from medical
school as the number one student in his class and receive the
highest scores on the National Boards Medical Exam?
Dr. Werthman graduated as the Valedictorian of his Medical School
class and achieved the highest scores on the medical licensing
exam. These accomplishments serve to illustrate Dr. Werthman’s
commitment to medicine and the care of his patients by always
striving to do the best he can and not settling for less. |
| |
| 25. |
Have you edited a medical
textbook on male infertility and microsurgery?
Dr. Werthman, as a world recognized expert in male reproductive
medicine and microsurgery was asked to assemble and edit a medical
textbook on the latest advances in male infertility by publisher
W. B Saunders. This book was completed in 1999 and is available
from the publisher. |
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| 26. |
Were you chosen to perform a vasectomy
reversal on national “prime-time” network television
by "Extreme Makeover?"
Dr. Werthman was recently chosen by the producers of ABC’s
prime time TV show Extreme Makeover to perform a reversal on
one of their patients on national TV. The show searched out
reversal specialists and, after doing background checks and
checking with other physicians, they came to Dr. Werthman and
trusted him to perform the reversal when they had to have it
succeed.
Tune in to Extreme Makeover next September (2006) to see the
Season premier reversal episode and Dr. Werthman.
Schedule an appointment - If you'd like to request information about reversals or make an appointment,
you can call us or complete our online Action
Request Form and we will then contact you. |
Dr. Werthman was chosen as the 2008 American Fertility Association's
Illuminations award recipient for his more than decade-long
accomplishments in the field of male reproductive medicine and success
in helping couples conceive. This is the highest award a fertility
doctor can receive 
Dr. Werthman was featured on ABC's Prime Time TV show "Extreme Makeover" where he joined a team of world-class reconstructive surgeons. Dr. Werthman was carefully chosen by the show's producers as their vasectomy reversal expert and fertility specialist. He performs a vasectomy reversal on the season's premier episode.
"...this book is dedicated to my patients who have allowed me the privilege of touching their lives by helping them start families." - Dr. Philip Werthman