Tubal Ligation Reversal

Chapel Hill Tubal Reversal Center.

Wednesday, July 23, 2008

New Specialist Surgeon Joins Chapel Hill Tubal Reversal Center

Dr. Gary S. Berger, world-renowned tubal reversal surgeon, welcomes Dr. Charles W. Monteith to the Chapel Hill Tubal Reversal Center surgical team.

Dr. Monteith is the first tubal reversal surgeon to join the practice since the initial tubal reversal microsurgery performed by Dr. Berger in 1982.

Monteith began his fellowship training with the center in January 2008, and has assisted in more than 100 reversal procedures under the guidance of Dr. Berger.

According to Dr. Monteith, his plan is to keep tubal reversal surgery a viable option for women wanting to have children after tubal ligation surgery.

“My interest in becoming a tubal reversal surgeon began when I realized that tubal reversal surgery was gradually becoming less available to patients because of limited training opportunities for younger physicians,” said Monteith.

Dr. Monteith graduated summa cum laude from Xavier University in Louisiana. He attended medical school at the University of California at San Francisco where he received a Howard Hughes Medical Research Fellowship used to conduct research in molecular genetics.

After completing his residency in obstetrics and gynecology at the University of North Carolina at Chapel Hill, he accepted a clinical assistant professor position with the department of obstetrics and gynecology in 2001. He also served as assistant professor in obstetrics and gynecology at Wake Medical Hospital in Raleigh for seven years where he practiced high-risk obstetrics and advanced surgical gynecology.

Chapel Hill Tubal Reversal Center is the only facility in the United States dedicated exclusively to tubal reversal surgery. Dr. Gary Berger has successfully performed over 7,000 tubal reversals using the one-hour outpatient microsurgical technique he developed and refined. His technique has been featured on The Learning Channel and Discovery Health.

References:
http://www.tubal-reversal.net/doctor-monteith.htm
Tubal Reversal Blog

Saturday, July 19, 2008

Choose the Best Tubal Reversal Doctor

If you're considering having your tubes untied, knowing what questions to ask is key. Dr. Berger and the staff at Chapel Hill Tubal Reversal Center have put together some frequently asked questions to help you make the right tubal reversal decision. Reversing your tubal ligation is an important decision. Why trust anyone but the best with your health?

When women begin researching tubal reversal surgery, there are several questions that are frequently asked. These questions are typically based on the differences that become apparent when they compare various facilities and doctors.

“How do I choose a doctor?” Considering the number of choices, it is one of the most important questions to consider before a woman moves forward with planning her tubal reversal procedure. Training, experience, availability, and patient support can vary greatly between doctors and facilities.

Most women who research the option of tubal reversal surgery after a tubal ligation are interested in how many reversal procedures the doctor has performed. Many reproductive surgeons have performed a tubal reversal procedure, but few perform the procedure routinely and even fewer limit their practice to this specialty. In the case of tubal reversal surgery, experience is an important factor in predicting the outcome of the procedure. Chapel Hill Tubal Reversal Center is the only medical facility specifically for tubal ligation reversal surgery. Dr. Gary Berger performs 4 reversals a day and has performed more than 7000 reversal procedures in his career.

Another question women frequently ask is whether the doctor uses the dye technique or a stent to ensure the tubes are open following surgery. The use of the dye technique is not the most accurate indicator regarding whether the tubes are open following tubal repair to allow conception. The stent technique is the better approach in our opinion to avoid any doubt. The stent is sterile and does not pass through the cervix. The stent not damage the tubes, and it ensures that they are open so a dye test is not necessary. With the stent technique used by Dr. Berger, there is no question regarding tubal patency following surgery, which puts the woman in a much better position for achieving pregnancy following surgery.

A common question during the process of researching tubal reversal facilities is whether the doctor uses permanent or absorbable suture to repair the fallopian tubes and whether he or she reconnects each of the tubal layers. While some doctors may suture all of the tubal layers, Dr. Berger uses permanent suture and sews the muscular and outer serosal layers together. He does not place suture in the inner endothelial layer as this may increase the risk of scar formation within the tubal lumen. In Dr. Berger’s opinion, this is the best approach. Comparing doctors’ data regarding pregnancy outcomes is the best way to assess their techniques since high pregnancy rates are a clear indication that the techniques are successful.

Ultimately, the most frequently asked – and most important - question regarding tubal reversal surgery is, “What are the doctor’s success rates”. Since pregnancy and its outcome are the primary concerns of most women who choose the reversal procedure, the answer to this question should be based on accurate statistical data. On the Internet, claims about tubal reversal pregnancy rates are often made without supporting information or documentation - such as a description of the patient population, study method, and follow-up interval. At Chapel Hill Tubal Reversal Center, Dr. Berger and his staff do everything possible to obtain and report this information on an ongoing basis. This allows them to remain informed about the number of pregnancies achieved and what their outcomes were after tubal reversal and to answer questions and guide patients who are waiting to become pregnant.

The decision to undergo surgery to restore fertility after a previous sterilization is a serious one for any couple. Where to go for surgery and with whom care will be entrusted is an important part of that decision. Potential patients should expect that they have been given detailed, accurate information regarding costs and recovery times, as well as careful analysis and reporting of accurate statistics regarding pregnancy and birth rates. This is referred to as “evidence based medicine” and is consistent with the mission of Chapel Hill Tubal Reversal Center. It is one of the many reasons why the facility has become known as the best place to have tubal reversal surgery.

Friday, July 11, 2008

The Ethics of Tubal Ligation

Dr Berger has posted to his tubal reversal blog about the Ethics of Tubal Ligation. He says Doctors who perform tubal ligations should consider the possibility that the patient might in the furure change her mind, and therefore it is preferable to perform a type of tubal ligation better suited to reversing at a later time, should the need arise.

"One of today’s patients at Chapel Hill Surgical Center was a woman in her thirties who recently become married and had a tubal ligation at age 24 years when she had no children. Her tubal ligation had been performed by a tubal coagulation procedure in which the fallopian tubes were burned at the junction of her uterus. The tubal lumen or opening within the uterine wall was scarred completely on both the right and left sides from the burning procedure. Therefore, the only way to perform a tubal reversal was through the technique of tubouterine implantation.

I mention this case because it was unnecessarily destructive, especially when performed for a young woman with no children. Many studies show that these are women who are most likely to change their minds later on and want to be able to have children. In this case, almost any other tubal ligation procedure would have been preferable. In my view, the best choice of a tubal ligation for a young woman with no children is the clip method (either Hulka clip or Filshie clip)."

In a follow up post the question is raised, since there are tubal ligation methods that can be reversed, is it ethical for a doctor to destroy the tubes in a young woman with no children?

Dr Berger writes "One of today’s patients is a 26 year old who had a tubal ligation at age 22 and had never had children. The doctor who performed her tubal ligation first applied Falope rings to the tubes, then proceeded to burn them in several locations. In her case, tubal reversal was not possible at all. During her operation, I wondered why any doctor would perform such a destructive type of tubal ligation for a young woman with no children. The Falope ring alone would have been sufficient to prevent pregnancy, yet allow reversal at a later time if she changed her mind about having children. Fortunately, she has the option of treatment by IVF. Still, why would a doctor perform an operation that essentially destroyed the tubes in such a young woman when there are a variety of other less destructive procedures for performing a tubal ligation? Is this ethical medical treatment?

I am very interested in what others think about this issue. Please leave your comments!!"