The Challenge

Vasectomy reversal surgery has become, since 2006, a highly competitive area of private practice but not always for the right reasons. Prior to this date, there was a monopoly of this type of surgery. Around this time, several surgeons had the same idea: to offer vasectomy reversal surgery. My challenges were:

  • A brand new business
  • Needed an online presence
  • Fierce competition

Not long after this year, Google increased the cost per click for the term “vasectomy reversal” within their Adsense program. The impact was disastrous. People intent on making money through the Adsense program abused the term “vasectomy reversal” so that legitimate search engine optimisation efforts aimed at those seeking surgery were severely hampered. A high ranking in Google was harder to achieve, although this website did keep one of the three top spots on page one of Google for “vasectomy reversal” for over 7 years. Ultimately, several times, the site was (very unfairly) penalised by Google because the site was associated in Google’s eyes with spam. This meant that there was a constant need to not just focus on SEO but to think of other ways that the practice could grow. This also meant that the top spots on Google were now occupied by large portal sites with poor or out of date information. Having completed an MPH and once been a nurse, I knew how important it was to educate patients to ensure they had accurate information. Here Google was, providing sub-standard information in the top positions: an absolute scandal to me. This only meant that the need to inform accurately was greater than ever.

DISCLAIMER: I worked with my husband in this practice but I tested and learnt everything I do today through that clinic so I see it only as highly relevant experience and an education in competitive fields.

When I was first approached to write a website for this new area of private practice, my husband, a urologist, had only performed around 19 vasectomy reversals. Within two years we had over 500 patients a year completing surgery. For many years subsequently, around 450 patients a year attended for surgery.

Google Changed the Algorithm

In 2012, whilst I was on holiday, Google changed it’s algorithm again. At that point, the website for vasectomy reversal surgery had been in either position one,  two or three on the first page of Google for many years. Using different, legitimate, SEO techniques, I had built links and ensured that the website performed well. Overnight that website disappeared onto the 112th page.

Had it not been for the comprehensive Google Ads campaigns, the practice would have stopped as quickly as Google changed the rules. Instead, the combination of content and Google Ads ensured that even if the first page had been penalised, the amount of articles and links around the web in addition to focussed Ads meant that enquiries continued as before.

Google Ads Asked to Meet With Me

Due to the spend on Google Ads, Google contacted me to arrange monthly meetings. This one-to-one contact ensured that my knowledge was kept up to date and helped generate over a 9.6 x ROAS (Return On Ad Spend). This is considerably higher than the industry usually acknowledges: spend $1 and receive $2 back.

Google Liked the New Website

Due to the manner of the algorithm change, I decided to start over with a new domain, keeping the old website intact and live, and start again with another brand new website. This led to the new site floating up to page 2 on Google, sitting behind the NHS and other very large portal websites. The old site floated up to around page 2 and many other links to content that I had posted were drifting on pages 1, 2 and 3 between the two sites. Anyone looking through the organic pages would see article after article linking back to the vasectomy reversal centre.


Percentage Increase in Reversals Performed

From around 2009 to 2019, around 450-500 vasectomy reversals were performed every year.


Of ALL Reversals performed in the BMI Group in the UK

From local, to national and then international patients booked in because of results


Return on Investment

The premise “pay some to get some” was a difficult principle to understand at first. It quickly became evident that paying for advertising raised the profile of the clinic. The return on paid advertising was an investment worth making.

“Catherine literally saved my business since she took over my marketing and internet profile.  I work as a Consultant Surgeon in Private Practice and had been relying on the outdated approach of GP referral to attract my patients.  Consequently my referrals were dwindling.  In the internet era patients have become much better informed and like to do their own research before paying to see a private doctor.  Catherine showed me how important it was to give the correct information about my business in a way that was transparent and easy to understand.  She is also very knowledgeable about strategies for acheiving front page dominance in both generic and sponsored search engine results.  She reports back regularly with data analysis on search trends with constant fine tuning of the marketing campaign.”

Duncan Harriss

Consultant Urological Surgeon

The Process

From day 1, working in the vasectomy reversal online world, it was clear that it was a very competitive market. My focus was to identify the real competition, reverse engineer what they were doing online and why, and then to work out a more effective strategy.

  • Google regularly changed their algorithm so my role was to ensure that strategies were aimed at ensuring good ranking and profitable return on Google Ad spend.

  • Competitors were competitors and so greater focus was required to ensure that ethical strategies ensured our leadership.

  • Thinking out of the box, planning new ways that would be attractive to potential patients became a way of life and in doing so, developed new strategies that I noticed, were later copied by competitors.

vasectomy reversal urologist


The key to success in competitive markets is to understand what your competitors are doing, who they are and plan ahead of their activities.

I consistently worked on these important elements and used all information received to help build the practice.

Consistently, this urologist was identified as the highest earning urologist in the UK according to Independent Practitioner magazine.

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Catherine Harriss

Marketing Consultant Expert
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