Dr. Shane Russell

THE MIDWEST'S ONLY FELLOWSHIP-TRAINED BOARD CERTIFIED UROLOGIST FOCUSING 100% ON VASECTOMY REVERSALS AND SPERM EXTRACTION PROCEDURES

Complete Guide to Choosing Your Vasectomy Reversal Doctor - North Carolina

Your choice of which vasectomy reversal doctor to work with is the single most important factor in determining your chances of fertility success. We therefore strongly recommend that you invest some time, call around (yes, you absolutely should talk directly with any surgeon you are considering before scheduling a procedure), and do your research! A large number of reversal sites on the internet try very hard to give the impression that all vasectomy reversal procedures are essentially the same in terms of outcomes- in reality, nothing could be further from the truth. You would not know if from a quick glance at their websites, but many (if not the majority) of reversal doctors who advertise extensively on the internet are performing vasectomy reversals using very old and outdated surgical techniques. Of course, any doctor offering reversals is going to strenuously deny that they are offering their patients anything but the best procedures, and all reversal websites are designed to support this impression as well. The good news is that for couples who are trying to find a true microsurgical specialist to work with, it is quite easy to identify which doctors are using these older and much less successful techniques by learning what to look for and being willing to ask (and expect direct answers to) a few simple questions.

There is plentiful research data showing that the latest most advanced microsurgical vasectomy reversals have far superior fertility outcomes as compared to the older simpler techniques. So why would a doctor choose to offer reversals which are known to have much lower success rates? The answer is “time” (the effort and time commitment needed to learn advanced fertility microsurgery) and “money” (the ability to makes lots of it with a business model of performing many quick procedures each day).

Besides offering a very cheap price, “bargain” reversal doctors generally attempt to convince couples to let them perform their procedure in one of two ways. The first is to try and claim that their quick (60-90 minute) reversals under local anesthesia are the same as the 2.5 to 3 hour precision microsurgical procedures offered by fellowship-trained specialists. Some websites of “bargain” doctors go so far as to explicitly state that the procedures that they offer are identical. As we will discuss in more detail later, these “bargain” doctors are asking you to believe that a physician with no formal training in microsurgery (and who is not even a urologist) is providing the same meticulous microsurgery as a fellowship-trained urologic specialist, and in addition they can complete these identical procedures (and achieve the same outcomes) in about one half to 1/3rd the time. The same procedure in less than half the time by someone with a fraction of the training- this really just defies logic. The other approach that “bargain” doctors can take is to give the impression that they have developed an exciting “new” option for couples who are looking for a cheaper alternative to the gold standard vasectomy reversals performed by fellowship trained urologic specialists. What all “bargain” doctors have in common, though, is that the type of reversals that they offer are really just the outdated techniques used (with relatively poor pregnancy rates) in decades past, but which were abandoned by urologist specialists long ago once the much more successful modern microsurgical approaches were developed. However, the recycling of the old reversal techniques from the 1980’s presents “bargain” doctors with several advantages which they have been able to successfully turn into a very lucrative business model. These advantages which “bargain” doctors are able to capitalize on include:

1) Bargain reversals are easy to learn.

“Bargain” reversal doctors are almost always physicians who did their medical training in a field other than urology, and who decided mid-career that offering cheap vasectomy reversals would be a good way boost their income. The short quick bargain reversal procedures are quite simple and easy to learn, which is great for a doctor with no formal urology training who wants to rebrand their medical practice as a vasectomy reversal center. The bargain doctors know that the most advanced reversal techniques are only able to be learned and mastered by physicians willing to dedicate at least 5 years to basic Urologic instruction and then another 1 or 2 years of advanced fellowship training to become true specialists in fertility microsurgery. This type of intensive education and practice is just not possible for the non-urologist reversal doctors who instead learn how to perform reversals through either a week-long educational seminar or by watching other “bargain” doctors who themselves had no formal training. The good news for these “bargain” doctors, however, is that the majority of couples seeking reversals do not know the important differences between reversal techniques (and the huge difference in success rates). Instead, many couples focus primary on just the cost of the procedure and believe (without further scrutiny) the “bargain” doctor’s website claims that they offer state-of-the-art procedures.

2) Bargain reversals can be performed under local anesthesia.

The latest most successful vasectomy reversal techniques take about 2.5 to 3 hours of meticulous microsurgery to complete. Most all fellowship-trained specialists perform their procedures either under general anesthesia or heavy sedation- either way the man is completely asleep and not moving. This is very important as any movement of the patient while the doctor is working under the operating microscope looks like a magnitude 7.0 earthquake, which is definitely not conducive to precision microsurgery. The key to “bargain” doctors being able to even offer vasectomy reversals is the fact that the outdated bargain techniques they use are so simple and quick to complete that they can be performed under local anesthesia in the doctor’s own office. Many “bargain” reversal websites talk about the big advantage of avoiding the “dangers” of general anesthesia. The fact is that outpatient general anesthesia provided by a licensed highly trained anesthesia specialist is extremely safe, and significant complications are fleetingly rare in the relatively healthy men of reproductive age who are typically undergoing scrotal microsurgery. All “bargain” doctor’s websites also claim that their procedures under local anesthesia are an almost uniformly comfortable experience for the man. In my experience, however, most all of my patients on whom I have performed a redo vasectomy reversal after a failed initial reversal attempt by a “bargain” doctor under local anesthesia have told me afterwards that it was definitely a much more pleasant overall experience to be asleep during their procedure.

The importance of being able to perform the old quick reversal techniques under local anesthesia cannot be understated in terms of being absolutely necessary for the business model for “bargain” doctors. A non-urologist performing a vasectomy reversal is basically the equivalent of an ophthalmologist offering to take out a patient’s gallbladder. Neither have had any training in that surgical field and therefore have no business performing these procedures on unsuspecting patients. Hospitals and surgery centers protect themselves from the huge liability risk of having doctors perform procedures for which they have not undergone formal training by having an extensive credentialling process for any physician offering procedures at their facility. There is no way that a hospital or surgery center would allow a non-urologist “bargain” doctor to perform a vasectomy reversal at their facility, and no anesthesia group would put a patient asleep for such a procedure either as the liability risk would be just too high. Crucially for the “bargain” doctors there is a legal loophole which allows doctors to perform basically any procedure that they want with minimal regulation so long as that procedure can be completed under local anesthesia in their own office. So, if you go in for procedure at a surgery center or hospital, you can feel relatively assured that your surgeon at least has the experience and credentials that document that he has had extensive training in performing your procedure. However, if you travel to a doctor’s own office, it is entirely up to you to do your research and make sure that your doctor is actually trained in the surgical procedures that they are marketing. “Bargain” doctors like to give the impression that they have made the decision to not offer the latest microsurgical vasectomy reversal techniques, but instead have chosen to perform their quick cheap reversals in order to save couples money. In reality, they do not have the training or credentials to offer anything but the outdated reversal techniques of decades past in their own office.

3) Bargain reversals are very quick to perform.

This is where the business model really comes into full view. It may seem like a lot of trouble for a doctor who is not even a urologist to reinvent himself mid-career into a so-called “microsurgical specialist” offering vasectomy reversals. So, what is the incentive for such a big career change? The “bargain” doctors often say that they experienced a “calling” to help patients and decided that they would accomplish this by offering a cheaper but equally effective alternative to reversals by fellowship trained urologists. It just seems that if these doctors had a “calling” to actually help patients, that they would follow this within the field of medicine in which they had actually spent years of training and had some expertise. More likely, their decision to abruptly switch to the completely different field of urologic microsurgery was helped along by the fact that offering cheap quick reversals represents a potentially very lucrative business opportunity. This is how it works: take a week-long seminar or purchase the practice of another retiring “bargain” doctor who you shadow for week or two to learn his technique. Set up a nice website with lots of testimonials and baby pictures. Getting these testimonials is generally not a problem- some percentage of couples who undergo “bargain” reversals are inevitably successful in having children- and the sheer volume of these assembly line procedures performed every year ensures a steady stream of success story testimonials despite the overall low rates of success. Nowadays, you can even pay for an internet service (such as “Best Local Reviews”) which sends out review requests to all of your patients and then screens out only the “5 Star” replies to put on your website (and excludes all of the other less favorable reviews). As for success rates to put on your website, you have two options. One is just to make up the numbers or manipulate your own outcomes data- no one can actually check their accuracy (tip: the more detailed information you include, the more convincing it looks). An even easier approach is to just quote the medical literature data on the well-documented outcomes of fellowship-trained specialists using the latest techniques, and just imply that these are your success rates as well.

Now here comes the crucial part where not being able to perform the most advanced 2.5 to 3 hour reversals under anesthesia at a surgery center actually presents a huge financial advantage. The short (60-90 minute) procedure times of bargain reversals allows you to easily perform at least 3 of these procedures each day. Even better, by eliminating the anesthesia and surgery center fees, your overall vasectomy reversal price is dramatically lower which is a home run from a marketing standpoint. At the same time, you can still charge the exact same doctors fee ($2,000-$3000) that a fellowship-trained specialist charges for their much more technically advanced procedures that take about 3 times longer to complete. With this model in place, you have just set yourself up to make 3 times as much money as a fellowship trained microsurgical specialists each and every day while performing essentially the same amount of work. Definitely a very clever and attractive business plan and a win-win situation for providers willing to overlook the fact that they are offering substandard care to patients without telling them about the substantial trade-offs in fertility success rates. Unfortunately, from the standpoint of the couples, bargain reversals on the internet represent a lose-lose situation- outdated techniques performed by providers with minimal to no actual training in the latest microsurgical reversal techniques that invariably lead to significantly decreased success rates. The problem is not that a cheap alternative is available for couples who cannot afford anything more than a $2000-$3000 procedure and who understand that they have a substantially lower (but not 0%) chance of it being successful. Rather, the problem is that the websites of doctors offering “bargain” reversals work very hard to give the impression that their quick outdated procedures offer results that are just as good as the latest techniques offered by fellowship trained specialists in the field.

Optimizing Vasectomy Reversal Success

It is truly up to couples to do their research- the key to fertility success is to find a vasectomy reversal doctor who provides the latest, most successful microsurgical techniques at an affordable price. In addition, finding a reversal doctor who is responsive to your questions and will partner with you on every step of the reversal process (both before, during, and after your procedure) is extremely important to optimizing your chances of a successful post-reversal pregnancy. Also, be sure to confirm that your chosen doctor personally performs 100% of the reversal procedure themselves and does not delegate any part of the procedure to someone else, like a PA or student doctor. You may think that this is not a particularly important question to ask, but some (even fellowship trained) reversal doctors lower their fees using a “high volume” business model in which they have their assistants perform parts of their reversal procedures for them (or in some circumstances the entire procedure for an even larger discount). No part of a vasectomy reversal (except the 5-minute skin closure at the very end) is unimportant and not technically demanding, so do not believe reversal doctors who try to tell you that a PA “helps out” but the surgeon comes in for the “important” parts of the procedure. A fellowship-trained specialist has devoted at minimum 10 years to medical training (4 years of medical school, 5 to 6 years of Urology residency, and 1 to 2 years of infertility microsurgical fellowship)- they should be performing your entire vasectomy reversal case for the best outcomes possible. Is a discount really worth having a PA (physician assistant) with only 2 total years of medical training perform all or part of what is supposed to be extremely sophisticated and demanding microsurgery?

Choosing your vasectomy reversal doctor is the most important decision you are going to make during your post-vasectomy fertility journey- investing some time in making this choice and making sure that they perform the entire procedure from start to finish is well worth the effort. Click on the following link for a comprehensive review of how to identify which vasectomy reversal doctors are true specialists and have the skills and training to provide you with your best chances of achieving your dreams of parenthood.

Vasectomy Reversal Cost- North Carolina

Whenever someone buys a product or service, there are always choices which must be made balancing between the cost and quality of what is being purchased. On the one hand, everyone likes to find a bargain and not have to pay more for a product or service than is absolutely necessary. On the flip side, the cheapest options generally cost less for a reason. If you were on the internet and saw a 2020 Mercedes SUV being sold for $12,000, your first thought would invariably be: “ok, so what is wrong with this car that it is being sold so cheaply”. The same concept holds true for vasectomy reversals. The average price for a vasectomy reversal in the United States is currently around $10,000, with some regional variation. So, when you see reversals available on the internet for $2000-$3000, your first question should be “ok, so what corners are being cut to provide such a large discount in price”.

Affordable Vasectomy Reversals - Helping North Carolina Couples Find A Microsurgical Expert

The key to choosing a vasectomy reversal doctor is to find a fellowship-trained specialist who offers the latest most advanced microsurgical techniques at a reasonable price. The comprehensive guide mentioned above reviews a few simple questions that you should ask any prospective vasectomy reversal surgeon who you are considering working with to make sure that they provide the most technically advanced modern reversal techniques which provide the highest chances of fertility success.

Dr. Russell’s complete price for a vasectomy reversal (including anesthesia, surgery center and the procedure itself) is:

$6,300.00

This is the complete price with no hidden fees or additional costs (for example, if a vas-to-epididymis connection is necessary). Click on the following link for more information on vasectomy reversal pricing and financing options.

Vasectomy Reversal Doctor – North Carolina

If the latest most advanced techniques are being utilized, the vasectomy reversal procedure is one of the most demanding microsurgeries performed in medicine today. Decades of innovation and advancements in microsurgical instrumentation and optical visualization have led to the high success rates currently achievable today if the latest techniques are used. When performing a vasectomy reversal, there are 2 different types of connections which can be utilized when re-establishing the connection within the genital duct system: vas-to-vas (vasovasostomy) and vas-to-epididymis (vasoepididymostomy) connections. It is extremely important for any couple looking into getting a vasectomy reversal to understand the differences between these 2 connections, and to make sure that their vasectomy reversal doctor performs vas-to-epididymis connections when needed on a regular basis. The epididymal tubules are much smaller than the vas deferens, so a vas-to-vas connection is always preferred since it has a higher success rate, but it is very important to know that every patient has a chance of needing either type of connection. It is not known until the time of the vasectomy reversal (when the vasal fluid is examined microscopically) whether a vas-to-vas or vas-to-epididymis connection will be needed, with the chances of requiring a vas-to-epididymis connection increasing with the numbers of years which have passed since the original vasectomy. During the reversal procedure, if the vasal fluid is considered “favorable” upon microscopic examination (i.e. contains sperm or sperm parts), then a vas-to-vas connection can be performed. However, if the vasal fluid is “unfavorable” (e.g. thick creamy fluid with no sperm), then a vas-to-epididymis connection is required to have any chance of success. In circumstances where the vasal fluid is “unfavorable” and the reversal doctor only knows how to perform a vas-to-vas connection, then that side of the reversal is guaranteed to be a failed procedure.

Almost all “bargain” doctors and general urologists (without fellowship training in microsurgery) only offer vas-to-vas connections regardless of what the vasal fluid shows at the time of the reversal. Some “bargain” doctors include information on vas-to-epididymis connections on their websites as a way to try and imply that they offer this connection to patients, something which they invariably do not since modern vas-to-epididymis techniques are only learned through 1 to 2 years of advanced fellowship microsurgical training. The ability to perform an expert vas-to-epididymis connection when necessary is crucial to optimizing a couple’s chances of a successful reversal. Couples who are truly interested in good success rates really have to do their own research and talk with potential vasectomy reversal doctors directly to ask them these two very important questions:

1) Are they a board-certified urologist who has undergone fellowship training in infertility microsurgery?

2) Do they regularly perform vas-to-epididymis connections if needed?

There are plenty of vasectomy reversal specialists in the country who meet these minimal requirements, but unfortunately, the majority of vasectomy reversals in this country are currently performed by doctors who cannot answer “yes” to both of the above questions. Many general urologists and “bargain” doctors work hard to obscure their training backgrounds and avoid these uncomfortable topics on their websites, so it is extremely important for couples to directly ask these questions to anyone who they are considering performing their vasectomy reversal. Don’t be shy! Your first attempt at a vasectomy reversal has been clearly shown to have the highest chance of success so make sure that you are working with a doctor with the skills and training to offer you your best opportunity for a successful outcome. Redo vasectomy reversals are possible but are always associated with significantly lower pregnancy rates- you only get one first best chance at vasectomy reversal success so make it count. Be sure to talk directly to the reversal surgeon yourself before scheduling any procedure and not just a staff member at their office. The websites of many “bargain” doctors state that talking with the physician directly beforehand is not necessary, or sometimes they charge patients for a consultation as a way to dissuade them from such a conversation. This should be a big warning sign that these doctors are trying to discourage any pre-procedure scrutiny of their training and qualifications and to avoid any uncomfortable questions. Their websites are designed to lure couples in with low prices and get them to quickly sign up for a reversal slot and lock them in with a deposit before they ask too many questions. I encourage people to take their time and do their research. Any true microsurgical expert should be happy to talk with you (for no charge) before any procedure as many times as necessary to discuss all of your options and get all of your questions answered in detail. A surgeon’s wiliness to spend time with you beforehand is also a good reflection of their willingness to continue working closely with you after your reversal and helping you with all of the post-procedure steps and recommendations which can help with the healing process and make an important difference in successfully establishing a pregnancy.

Click below for more detailed information on the importance of being able to perform both vas-to-vas and vas-to-epididymis connections.

Vasectomy Reversal Success Rates - North Carolina

One of the keys to evaluating the success rates of different vasectomy reversal doctors is to look closely at how they define “success”. Some reversal doctors define success as the return of any sperm to the ejaculate- this definition is not particularly helpful since the presence of only a small number of sperm is going to make establishing a natural pregnancy difficult, if not impossible. Other doctors define success only by post-reversal sperm counts (e.g. “5 million sperm per cc or above”) while not mentioning sperm motility. The problem which this definition is that partial blockages following a reversal often lead to relatively high sperm counts but little to no motility. If the sperm are not moving, then they are not going to be able to swim up the fallopian tubes to find an egg to fertilize regardless of how high the sperm count is. At the Vasectomy Reversal Center of Ohio, we define success in terms of total motile sperm counts which evaluates both sperm numbers and motility- in other words, the total number of swimming sperm in the ejaculate, which is the best predictor of successfully establishing a pregnancy. By our definition, success is getting the total number of swimming sperm to a level where you would expect to have a good chance of establishing a pregnancy naturally, usually defined as a total motile count of at least 10 million sperm, and ideally 20 million or above. Based on this definition, our success rates based on the types of connections needed at your reversal are:

Vas-to-vas connections on both sides: 90-95%

Vas-to-vas on one side, vas-to-epididymis on the other 80-85%

Vas-to-epididymis connections on both sides: 55-60%

Click below for more detailed information on Dr. Russell’s success rates

Dr. Shane Russell

Only urologists who have completed a fellowship in infertility microsurgery have the training to offer the most advanced and successful vasectomy reversal techniques.  However, the surgical practice of even most fellowship-trained urologists consists mainly of other procedures, such as surgery of of the prostate, repair of varicoceles, and the treatment of erection problems.

Dr Russell's approach is different.  His surgical practice focuses exclusively on vasectomy reversals and sperm extraction procedures. This specialization allows him to concentrate on one goal only- to provide the absolutely best post-vasectomy fertility outcomes possible.

Click below to learn more about Dr. Russell and the training he has pursued to offer the latest most successful vasectomy reversal techniques for his patients.

TRAVEL TO OHIO

The driving time to Dr. Russell's surgery center for most North Carolina residents is between 7 hours (Charlotte) to 8 hours (Raleigh).  Some couples also choose to fly in for their procedures with the nearest airport being the Dayton International Airport (DAY) which is about 15 minutes from the surgery center. Another option is the Cincinnati/Northern Kentucky International Airport (CVG) which is about a 1 hour drive from the surgery center. Couples traveling from North Carolina generally come in the night before the procedure (we provide information on local hotel accommodations) and return back home the next day.