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Vasectomy Reversal Frequently Asked Questions Why do you offer a money back guarantee on the surgeon's fee portion of the total cost on your vasectomy reversals? Dr. Buch is confident because of the excellent success rates his patients have experienced. His experience includes the simpler straightforward first time attempts at vasectomy reversal in Dallas, as well as the more complicated "redo" cases of previously failed vasectomy reversal by other surgeons. We have learned that many patients will only make the commitment to reverse their vasectomy when they are reassured by the statement of confidence along with the offer of a money back vasectomy reversal guarantee. In order to benefit this large group of patients, Dr. Buch became the first nationally recognized expert in performing both simple microsurgical vasectomy reversal called vasovasostomy (VV) and complicated vasectomy reversals called vasoepididymostomy (VE) to offer a money back guarantee. Our guarantee assures that you will get the vasectomy reversal procedure needed for the best chance to return sperm to your ejaculation, which is why patients come to us for vasectomy reversal from Florida and other states. Are there any restrictions on your money back guarantee? A complete and straight-forward description of the money back guarantee can be obtained from our office at the time you schedule an initial consultation visit.Briefly, a full refund on the surgeon’s portion of the total cost of the vasectomy reversal will be given in cases of first time vasectomy reversals 9 years or less from the time of the vasectomy that fail to return sperm to the ejaculate by one year after reversal. A 50 % refund of the surgeon’s fee portion of the total cost will be refunded if we fail to return your sperm to your ejaculation on a second (“redo”) vasectomy reversal or if it has been 10 years or more since the time of your vasectomy. Please note that this money back guarantee program may be terminated at any time. What is your success rate? The success rate varies depending on the type of reconnection (vasovasostomy or epididymovasostomy) that is required. This can only be determined at the time of surgery. However, where a straight forward vasectomy reversal (VV) can be performed on both sides, regardless of the number of years since the vasectomy, sperm return in 95 % of our cases, with a corresponding 65 % pregnancy rate. (Please note that of all couples trying to conceive, only 85 % will achieve a natural conception at the end of one year). When a bypass to the epididymis (EV) is required on both sides due to a secondary blockage or “epididymis blow-out,” we still achieve return of sperm in 80 % of such cases, with a corresponding 50 % pregnancy rate. Since nearly one half of our cases are complicated redo cases of previously failed vasectomy reversals from other surgeons, our overall statistics are 89 % for return of sperm and 55 % pregnancy rate, with an average of 11.5 years from time of vasectomy to time of reversal. How much will it cost? Dr. Buch has arranged for 2 comprehensive packages depending on your choice of anesthesia. Package A includes his surgical fee, the anesthesiologist and the facility fees with a price of $8,300. Package B includes his surgical fee, local anesthesia and facility fees with a price of $7,300. This pricing is comparable with that of similarly trained and experienced microsurgeons who perform vasectomy reversals on a routine basis. Beginning January 1, 2008 all redo vasectomy reversal cases will be charged an additional $400 to cover the increased costs of anesthesia and facility required for these lengthier cases. We appreciate your understanding. Please contact us ahead of time to be sure that our prices have not changed. How can I pay for the procedure? Rarely will your insurance cover the cost of a vasectomy reversal, and therefore it is considered a cash pre-paid procedure much like plastic surgery for face lifts, etc. An increasing number of clients who have payroll deductions or contributions by employer into medical saving accounts or flex accounts (cafeteria plans) are positioning these tax advantaged funds to pay for their surgery. Several independent companies offer low cost independent medical financing programs that are available to qualifying clients. Although our office does not recommend any particular company, we have established relationships with Capital One and the Reliance Finance Corporation. You can apply online at www.amerifee.com or www.reliancemedicalfinance.com. How long is the procedure? Please understand that when it comes to successful microsurgery, we are not running a race with the clock. A simple reversal (vasovasostomy, or VV) may take only 3 hours of surgery time, whereas the more complicated cases requiring an epididymovasostomy (EV or VE) may require 4 hours. What type of anesthesia is used for the surgery? Dr. Buch prefers to use a light general anesthetic (we put you to sleep) combined with the use of a local anesthetic to "numb" the area where the surgery is occurring, much like at the time of the original vasectomy. Our patients wake up promptly after vasectomy reversal with no immediate discomfort, and there is minimal nausea or hangover feeling. Why not use local anesthesia only? Many men undergoing vasectomy reversal are psychologically sensitive about the procedure, and the drifting in and out of consciousness with IV sedation plus local anesthesia can be unsettling during the surgery. Also there is a tendency toward unpredictable patient movements under sedation with local that can cause problems with the accuracy of the reconnection during a microsurgical vasectomy reversal. Where is the procedure performed? The vasectomy reversal microsurgery is performed at the Legacy Surgery Center of Frisco, a state-of-the-art day surgery facility providing you with the latest technology, microsurgical equipment, and fully trained health care professionals.  You will receive the highest level of care, and the comfort of knowing that there is consistency in support personnel and professionalism at every step of your care. The facility is conveniently located next door to our office. Why not do it in your own office? Doctors who perform microsurgical vasectomy reversal in their own office provide what seems like convenience at a price. The price for this seeming convenience is loss of the doctor’s attention on purely performing an excellent vasectomy reversal, since the doctor must also spend his time and attention on the details of running his "in-office" surgery center. Dr. Buch prefers to be focused purely in giving his patients the best possible surgical outcome. What about sperm granulomas? A sperm granuloma forms when sperm leaks out slightly from the testicle side of the vasectomy in some men, resulting in a nodular area that you may be able to feel on your own. This is often a positive sign that sperm will be present on the testicle side of the vasectomy at the time of reversal, and allow a straight forward vasovasostomy. However, the granulomas are an unreliable indicator of level of repair needed for a successful microsurgical vasectomy reversal. Therefore, all men considering vasectomy reversal should pursue their surgery with a microsurgeon such as Dr. Buch who is proficient at performing epididymovasostomy as well as vasovasostomy. What about sperm freezing at the time of a vasectomy reversal? Dr. Buch was one of the first microsurgical vasectomy reversal specialists in the world to offer the option of freezing sperm at the time of the reversal. His early results were published in the medical journal Fertility and Sterility in 1994. Sperm cryopreservation offers another option for conception to our few couples who fail to return sperm to the ejaculate after what appears to be a technically successful vasectomy reversal at the time of surgery. The frozen sperm from behind the vasectomy can only achieve reliable pregnancy rates when used for in vitro fertilization (IVF) with intracellular sperm injection (ICSI) which bypasses the inability of the immature sperm from behind the vasectomy to penetrate the egg on their own. Are there any reasonable alternatives to vasectomy reversal? As mentioned above, the sperm behind the vasectomy (i.e. in the testicle or epididymis) are unable to fertilize eggs on their own. They can be used in IVF-ICSI to achieve reliable pregnancy rates of approximately 50 % per try at a cost of $12,000 (relative average success rates and costs in Dallas/Ft. Worth). A sperm retrieval procedure the day of the IVF-ICSI has an average cost of $3,000. The combined costs of these two procedures as an alternative to vasectomy reversal nearly doubles the cost to the couple without doubling the pregnancy rate. This alternative is only chosen by a small number of our clients who typically have unique reasons for choosing this option. What about sperm antibodies? Sperm antibodies are immune reactions against one's own sperm. They are found in the blood and on sperm of many men after a routine vasectomy, and they can impair sperm movement and function. Fortunately these antibodies disappear in the majority of men who undergo a successful vasectomy reversal, and there is no reason to check for antibodies prior to performing the vasectomy reversal. If antibodies do persist after surgery, they can be successfully treated with medication. Why should the microsurgeon also be a fully trained specialist in Male Fertility? Your goal is to achieve a pregnancy, not simply to get sperm back to your ejaculate. In many cases the sperm count and quality may not return to the original pre-vasectomy levels. This cannot be predicted prior to the vasectomy reversal. Only a Male Fertility Specialist can provide the comprehensive approach needed to maximize a couple's chance to conceive after a successful vasectomy reversal.

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