Info - Finances
The cost for a vasectomy reversal across the US ranges from under $2,000 to over $30,000. For the Male Fertility and Peyronie's Clinic price, click here. Typically, the cost depends on several factors:
- Whether the procedure is performed in the office (least expensive), in an ambulatory surgical center, or in a hospital (most expensive)
- Surgeon experience
- Surgeon subspecialty training in infertility and microsurgery
- Use of an operating microscope
- One-layer (including modified) vs two-layer anastomosis
- Use of the Reinforcing Vasal Suture (ReVas) technique
- The quality of the suture used (10-0 sutures are significantly more expensive than 7-0, 8-0, or 9-0 sutures)
- The ability to perform a complex reversal if needed (epididymovasostomy)
- The use of general anesthesia
Not necessarily. The following factors do not impact the overall success rate of the procedure:
- Location (office vs ambulatory surgical center vs hospital) - although the specific site of surgery is not critical, it may be important if the surgeon is not able to perform the more complex repair (epididymovasostomy) in that particular setting. For example, there are very few surgeons in the US who are able to do an epididymovasostomy in the clinic.
- Use of general anesthesia - the type of anesthesia does not impact success rates, unless it impacts the ability of the surgeon to perform the more complex (epididymovasostomy) repair.
In contrast, the following factors directly impact success rates:
- Greater surgeon experience leads to higher success rates
- Specialty training - surprisingly, most people who do vasectomy reversals are not fellowship (specialty) trained. The surgeons who are most specifically trained for vasectomy reversals are those who are board certified in Urology and have done a Fellowship in Male Infertility.
- The use of an operating microscope has been shown to improve outcomes compared to the use of surgical loupes or no magnification.(1)
- Use of the Reinforcing Vasal Suture (ReVas) Technique results in higher success rates and lower re-stenosis rates over time.(2)
- The ability to perform an epididymovasostomy is essential to achieving good outcomes in many cases. It is not possible to know if an epididymovasostomy is required until the time of surgery. If the surgeon is not able to perform the procedure (either because of lack of training or other reasons), and if the procedure is indicated, then the patient will not receive the correct surgery and will have a lower chance of success.
1 - Jee SH, Hong YK: One-layer vasovasostomy: microsurgical versus loupe-assisted. Fertil Steril. 2010 Nov;94(6):2308-11.
2 - Savage J, Manka M, Rindels T, Alom M, Sharma KL, Trost L: Reinforcing Vasal Suture (ReVas) technique improves sperm concentration and pregnancy rates in men undergoing vasovasostomy for vasectomy reversal. Translational Andrology and Urology 2019.
And some factors may or may not impact the success rate (debatable):
- Performance of a one-layer vs two-layer technique. Although the clinical studies have currently not shown a difference between the two techniques, these studies have not been powered sufficiently (not enough patients included) to detect smaller differences in outcomes. In general, the two-layer technique is the more traditional one with a longer track record of successful outcomes, however, it is more time consuming and challenging to perform compared to the one-layer techniques.
- Suture quality has not been investigated in any rigorous manner. It is hypothesized that one cause of vasectomy reversal failure is leakage of sperm outside of the area that was sewn back together. This may occur if too few sutures are placed to re-connect them. Typically, if you want to place more sutures to assure that the connection is water-tight, you need to use a finer suture, such as 10-0. However, these are often expensive (up to $500 per suture), which is why many practices use the less expensive (7-0, 8-0, or 9-0) options. It is also more technically challenging to use 10-0 sutures given their small size (10-0 is smaller than 9-0, which is smaller than 8-0, etc.)
The cost of in-vitro fertilization will vary across the US, but typically costs $15,000-20,000 for the first cycle and $5,000-7,000 for each additional cycle.
Vasectomy reversal is very rarely covered by insurance in the US. In most cases, this requires the patient to pay for the procedure out of pocket. In some cases, patients may have flexible spending accounts that can be used to pay for the procedure using pre-tax dollars, however, this still requires the patient to pay for the entirety of the procedure.
In some cases, providers will offer a money back guarantee to assure success rates. There are two important factors to consider whenever evaluating a guarantee. The first is, what is the definition of success that is guaranteed? As noted in the Success Rates Info Page, if the outcome is < 5 million, the chance for pregnancy is much lower than if you have 5 million or more sperm. The second factor to consider is what portion of the money will be refunded. Most providers will only refund the surgeon portion of the bill. In most cases, this is the smallest overall portion of the procedure.
In our clinic, we have chosen to offer a full money back guarantee if you have not achieved either of the following: 5 million or more sperm present at the 1 year time point on two analyses or a successful pregnancy. This guarantee does not apply to the "Vasovasostomy Only" option. We felt that this was the most accurate determination of success. We also felt that this was the most moral approach. Since vasectomy reversals are cash procedures for most people, and since you would expect to receive a refund with nearly any other purchase in life if it did not deliver as advertised, we felt that this should be the case with vasectomy reversals as well. Simply put, it just didn't feel right to do things any other way. Also, based on patient input, we have elected to make this an optional add-on in order to reduce the price for the reversal further.