Cutting the vas deferens in two (a vasectomy) is easier than putting it back together (a vasectomy reversal) and is indeed a horse of a different color.

• Vasectomies are covered by insurance-vas reversals are not.
• Because the reversal is not covered by insurance the patient sees, feels, and pays the entire expense of the procedure, the surgeon, the supplies (microscopic suture) and the facility.
• The surgeon fees are relatively high because very few urologists do reversals often or often enough to do well.
• Few urologists are comfortable enough to feel they can do the procedure with a high likelihood of patency (presence of sperm after a vasectomy reversal) and this in turn also limits the number of urologists willing to perform the procedure.
• The identification of the vasectomy site and preparing it for the reversal is something that is comfortable to all urologists. Reanastamosing the inner tubule of the vas deferens by tying microscopic suture while looking through a microscope is not what most urologists are comfortable with and to do efficiently and effectively requires experience and a steep learning curve.
• Some urologists perform the procedure in an office setting with local anesthesia and because this excludes the hospital and an anesthesiologist, these physicians are able to perform a reversal at a lower price. In other words in this setting the hospital fees, which is usually the highest cost component of any surgery, does not exist.
• Some urologists work exclusively through a hospital and with general anesthesia and the fees of this physician and associated costs are the highest.
• Some urologists use general anesthesia and an independent ambulatory surgery center. In this scenario the urologist pays the center for the anesthesia, materials and staffing. The fee of the urologist then is added to this for the all inclusive cost of the procedure.
• Some urologists own their surgery center and use general anesthesia. In this scenario the surgeon has more options regarding costs. Owning the surgery center cuts out the middle man so to speak of a hospital or an independent surgery center and often results in a lower cumulative price but with the benefits of a hospital. The cost of a reversal in this scenario represents a blend of the most expensive hospital based procedure and the least expensive office based procedure.
• Just because a surgeon charges more for a reversal doesn’t mean he or she is better qualified to perform the reversal. There may be other costs involved that the surgeon must account for in his pricing that have nothing to do with his fee for the procedure, i.e the facility, the microscope, the suture, anesthesia, and the staffing.
• Because a reversal is not covered by insurance necessitates the surgeon handling all the fees associated with the procedure so that the patient only has one fee.
• The above makes the reversal procedure expense noticed more because the patient must pay out of pocket.
• This in turn highlights why urologists are hesitant to say they can do a reversal despite having little experience do the procedure because the patient and the doctor are both very disappointed when the procedure doesn’t work. It would be somewhat disingenuous for a doctor to charge a patient the fees, put him through a surgical procedure, knowing he has very little experience in the procedure. This thought process also limits urologists agreeing to do a reversal for concerns of doing the procedure poorly and with poor results. In other words, if you take out a ureteral stone, you have taken it out and it is gone.  This is considered a good surgical result. When a reversal is done, the urologist has done the procedure then there is the hopeful expectation of a result, i.e. you just don’t remove something and you are done. With a reversal there is the procedure itself and then there are functional expectations, i.e. the presence of sperm and pregnancy.
• Just with anything the due diligence and decision making is the responsibility of the patient and his family and all of the factors noted above should be taken into consideration.
• Patients need to know from the start what they are getting into and that despite everything going just right there is a percentage of patients who don’t achieve pregnancy.
• And this is why there is variance in the cost of a reversal and why it is harder to perform and more expensive than a vasectomy.