GIMMICKS & GUARANTEES TO AVOID

Unfortunately, too many doctors and clinics feel that they must resort to using some sort of gimmick or guarantee to attract patients and increase their business. They do this in the hopes that most prospective patients will know little about vasectomy reversals and will be drawn to them by attractive marketing. What is a bit frightening is that a large number of patients don’t see through these marketing ploys. It is amazing how many urologists have begun advertising reversal services on the Internet or offering “money-back guarantees” in the last seven years since we went on-line with one of the original reversal websites (we were one of the first clinics to educate patients via the web). Clearly, a busy reversal practice can be lucrative, and urologists who have no training in microsurgery have posted websites claiming to be experts.

We have decided to include a section to inform and educate patients on what to look for, and what is fact and medicine, versus misleading marketing. We will give you some insight on how to read between the lines. There are no governing bodies that insure that websites adhere to high ethical standards or demonstrate integrity, and no medical societies police the Internet for incorrect medical information. Anybody can make any claim on a website! One phrase that has come up from misled patients is “but it must be true, I read it on the net.” Remember that physicians are supposed to be dedicated, highly-educated, and skilled professionals who keep the patient’s interest above all else; they are not supposed to seem like used car salesmen.

First off, every patient should know that there is more than one expert doctor in the United States that can reverse a vasectomy and do a great job. There is no single best doctor who is above all the others, and there is no one doctor that can perform a certain procedure and magically get better results than all of the other experts in the field. There are no contests or polls that have voted or chosen the best reversal doctors. If your doctor says he is the best in the world, or the only one who can do a reversal, then you must question their ego and integrity. There is a top tier of reversal surgeons who have recognized superior skill and training and have dedicated their careers to performing microsurgical reversals. The criteria and characteristics that enable a physician to be a top-tier microsurgeon are simple:

1. Training
You can’t learn microsurgery on your own and there are a limited number of fellowships in the country that teach the basics. Very few urologists each year go through and finish a one-year microsurgical fellowship. This is the first criterion to start with.
 
2. Experience
The surgeon must constantly practice and improve on the basic skills acquired during the fellowship and become comfortable doing the surgery on his own. During the fellowship, microsurgical skills are learned through assisting another “mentoring” surgeon. Doctors in fellowship training don’t perform surgery by themselves. To get the needed experience and know how to handle all the different scenarios that can arise during a reversal, the surgeon needs to have performed hundreds of reversals. Then to maintain skills the surgeon needs to perform at minimum several microsurgical procedures every week. This is the thing that separates the experts from those that just dabble, even if they are fellowship-trained. The number of surgeons in the top tier with both the training and experience is probably less than ten in the United States. The reason that there are only a few top-level surgeons is that there just are not that many patients who need reversals to keep all the doctors who want to do reversals busy enough to limit their practice to just microsurgery. The busy reversal doctors get a good reputation, and they continue to get busier. There is then a second and third tier of surgeons that probably numbers ten to twenty. The goal here is not to publicize or list specific doctors, but rather to give you the tools and insight to help you educate yourselves. Please do the research so you can make a decision about the doctors you choose. Be skeptical, ask questions and get referrals from satisfied patients, other doctors or nurses. Check reputations and do your homework!
 
3. Talent
Microsurgery is a skill, an art form and a talent. Some people are more talented and skilled then others. No matter how much training they have they just can’t get it. Why do some musicians or artists become masters and others with the same level of training and dedication not reach the same heights professionally? Talent – it is something a person is born with.
 
4. Integrity
This is something to be demanded of from anyone you entrust to care for your health and reproductive future, certainly from anyone you will let perform surgery on you.

Things to ask yourself when evaluating information:

1. Does the surgeon claim he is the best or only one who can do a certain procedure?
 
2. Can the doctor perform a vasoepididymostomy? If he can’t, you shouldn’t use him.
 
3. Does the surgeon practice in a small city/ small market? Much like plastic surgeons and other highly skilled professionals, the best microsurgeons will probably be found in big cities and large markets. This does not mean that if your doctor isn’t in a big city he isn’t very good, it is just a rule of thumb that makes common sense. In order to hone skills, a microsurgeon needs to do a lot of surgeries and there are more potential patients desiring reversals in large cities.
 
4. Is the doctor a General Urologist who dabbles in vasectomy reversals or is this the focus of the practice?
 
5. Does the doctor advocate Laser reversals? This is a pure gimmick and potentially damaging to the vas deferens. (See the section dedicated to laser reversals).
 
6. Is the surgery performed in an office operating room? Office operating rooms are convenient for the surgeon and patient. The problem with office operating rooms is that they can be dangerous if not accredited. Add to that the fact that the surgeon has to worry about both your surgery, and running the operating room --involving more distractions and less focus on the patient. They only benefit to the patient is a slight cost savings, but you must decide if it is worth the drawbacks.
 
7. Does the doctor use local anesthesia to do the reversal? 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 vasoepidydymostomy under  a local, as the local can wear off during the longer procedure. From a patient perspective, the thought of lying still for 2-3 hours also seems unappealing. We therefore discourage patients from having the surgery just under local anesthetic even though it reduces the costs somewhat. This is not an area where you would want to skimp to save several hundred dollars.
 
8. “Discount” reversals:  Reversal is one of the most delicate surgical procedures in a very sensitive area; surgery of this sort is not something you want to look for a “discount.” Doctors offer discounts to jump-start a practice or attract naïve patients. The best surgeons in their fields don’t work on a discount basis. You wouldn’t have discount heart surgery or discount brain surgery. Why would you have a discount microsurgical reversal?
 
9. Fibrin Glue Reversals:  Fibrin glue is a substance that is used in other areas of surgery to seal off blood vessels and has been used “off-label” for other procedures as well. Fibrin glue has recently been applied, on an experimental basis, to vasectomy reversal to help seal the connection of the two ends of the vas. The results of this technique show promise but it has only been studied in about 40-50 human subjects with no long-tern follow-up. These data have been presented but not yet published in a scientific journal. At this time fibrin glue has no indication for vasectomy reversal and its use is considered “off-label”. The apparent advantage to this technique is that it may be quicker to perform and thereby reduce the cost of the reversal somewhat. It is up to each patient to decide if this new procedure is the right choice for them after they have been fully informed of all potential risks.
 
10. Does the doctor offer misleading guarantees or use marketing ploys to attract patients? Clearly, integrity is the first thing to look for in the person to whom you will entrust your body and reproductive future.

Money-Back Guarantees

Some centers are now offering money-back guarantees for vasectomy reversals.  We have decided to address this issue because patients have asked us about our policy. Upon closer examination of guarantees offered by others, we have found that what is offered is actually not a guarantee at all. Let’s critically examine the most commonly offered guarantee. The patient is placed in a risk category based on the:

The older the vasectomy or the worse the fluid, the higher the patient-risk category and the lower amount of money available for refund. Some centers that offer the guarantee clearly state that they do not perform vasoepididymostomy when it is indicated and needed. What this amounts to is for an “easy” vasectomy reversal, meaning the greatest chance of success (where an expert surgeon should have a 98% plus success rate), and the patient can get the highest amount of refund for failure.

For the hardest cases where the patient should have a vasoepididymostomy, a vasovasostomy is still performed, even it is the wrong procedure. When the reversal fails there is very little money refunded because the patient was in the high-risk group. In essence, what they do is only give a refund when surgery fails for patients in the low risk group knowing they will rarely have to do this. When you are in the poor risk group they will perform the wrong operation.  In such cases they don’t have to refund much money because they expect the reversal to fail, and set the system up for a very small refund. Bottom-line, the patient may get the wrong procedure, and only a small refund, but where does that leave them in terms of getting pregnant? These centers then recommend that you go somewhere else to get a vasoepididymostomy or IVF. We believe this type of money-back guarantee is a deceptive marketing ploy designed to attract patients who don’t understand what is really being offered.

A center is advertising the only guarantee for the vasoepididymostomy procedure. Once again, when examined closely, this turns out to be a marketing ploy to attract patients. The guarantee only applies to men whose vasectomy is less then ten years old. From experience we know that most men will not need that operation before 12 –15 years after the vasectomy. This guarantee only kicks in if there are no sperm by two years after the surgery. Most patients will not wait 2 years to see if the operation was successful, and move on to some other form of conception or adoption and do not come back to claim their money back. Once again….this is good for the doctor to attract patients, but bad for the patient!

There is another clinic that offers a “certificate of guarantee” if the patients fail to get pregnant after 2 years following the procedure. Sounds great! Doesn’t it? Why not consider going to a doctor who guarantees your wife will get pregnant? One thing; when you read the small print on the certificate it say the guarantee applies only if pregnancy doesn’t occur secondary to surgical failure.

What does that mean? It means that if there are ANY sperm then the surgery was considered successful because the tubes are reconnected and open. If there are sperm, and you don’t get pregnant, then no guarantee applies because the surgery was still successful by their standards. You must ask yourself if pregnancy sounds like a reasonable thing to guarantee. What if there is a problem with the female side of things?  Would any doctor in his right mind guarantee a pregnancy (only God could do that -- and he doesn’t)?

A new gimmick that has just started is clinics putting up websites and message boards, without their names on it, to make it look purely informational and unaffiliated. You can then request information that comes only from their clinic. This gives the appearance that an independent body is recommending that specific clinic. This is false and misleading advertising. If a clinic puts up a website or message board, their name should be on it, enabling to patients know the underlying sponsor so that they can evaluate and filter the information appropriately.

PLEASE - Read these guarantees carefully and make sure you understand what they really mean. Not a single respected surgeon in the community of recognized vasectomy reversal experts offers a money-back guarantee or uses deceptive marketing ploys. If your surgeon sounds more like a used car salesman than a respected professional, and uses questionable marketing techniques or makes claims that just don’t sound right, then you are in the wrong place.

Our policy is consistent with the rules and policies of the American Medical Association and the American Society for Reproductive Medicine who specifically found these types of guarantees unethical and, as such, we will not offer money-back surgery. That does not mean that we are not accountable for our work and the care we give. We could not build a practice and reputation, such as the one we have established, without many satisfied patients and word of mouth. We pride ourselves in our successes. When you succeed, we succeed, and you can be assured that we have tried everything in our power to help you achieve your goal. To that end, Dr. Werthman will redo the surgery without charging the surgeon’s fee if a patient has sperm in the vasal fluid and never has any sperm after surgery on a semen analysis after one year. IVF vs. Vas Reversal


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.