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!!"

Tubal Reversal a better option than IVF

Survey finds Tubal Reversal is a better option than IVF.

AN OPERATION to reverse sterilisation of women over 40 who want another baby is significantly more successful and tens of thousands of dollars cheaper than IVF, an Australian study has found.

The study, published yesterday in the Medical Journal of Australia reports live births after tubal reanastomosis were successful in 40 per cent of women aged between 40 and 47, compared with an in vitro fertilisation (IVF) success rate of just 5 per cent for women aged 40 to 42 and 2 per cent for older women.

The direct cost of a reversal is $4850 per treatment, and $11,317 per live birth, compared with about $6940 per cycle of IVF treatment, and $97,884 per live birth for women aged 40 to 42, increasing to $182,794 for older women.

The study, titled Live birth following day surgery reversal of female sterilisation in women older than 40 years: a realistic option in Australia? said tubal surgery was a "better option" and "highly cost effective" compared with IVF for women over 40.

Source: Sydney Morning Herald More information

Wonderful Surgery Experience

Dear Dr. Berger & Staff,

Just wanted to take this opportunity while sending back my feedback sheet to thank you all so much for making our surgery experience so wonderful. I must say that when we first found the clinic the day before my surgery for my consult, we were surprised by the small appearance of the building. My husband & I expected a big sprawling clinic/hospital looking place. But once we entered into the reception area we were at ease. The receptionist was very kind & took a picture of us together so Dr. Berger would be able to “put a face with the name”. I thought that was great, that he thought enough of his patients to do that. We sat in the waiting area looking at & reading all the pictures of new babies & hundreds of thank you’s & blessings.

All the staff there at your clinic are very professional, patient & wonderfully friendly. I never spoke to one nurse who didn’t ask me if I had questions or concerns & they are all so fully capable of their jobs. Jennifer was the first one I had contact with via telephone when I first called to see about the procedure, processes & payment. She spoke with me a good while & never asked me to hold on and was very patient with all my questions. Rhonda was also when I had to call back a few days later about my blood work. My husband & I were very impressed with the whole setup of the clinic given our first outside impression. Everything was so organized, clean & efficient which made us less nervous & more comfortable. I liked the way you have the gown/robe packets put together in the bathroom where we change and the map to pin where everyone is from. That was really interesting to us to see where so many people have come from to your clinic. The recliners were comfortable to sit in & I thought it was a nice touch having the refrigerator with refreshments for the patients & partners.

When it was time for me to go back to surgery the nurses were so kind & it helped me to relax so much. I loved that the operating table was heated. Jan was with me & she massaged my arms & legs & kept me covered up so as not to “reveal” myself while I was positioning onto the table. That was very thoughtful & I barely remember anything else from then. I went right out with the ladies explaining to me what was going on..

When I woke up in recovery everyone was very attentive to myself & my husband. They even printed out some of the instructions in Spanish so my husband could read it himself & they would be sure he also knew what I needed to have for the next week or so after my surgery. We also think that the whole setup your clinic has with the hotel Sheraton was a great convenience. They were very helpful with giving me a room closest to the elevator so I would not have to walk too far after surgery & providing the shuttle bus for the drive to & from the clinic was one less thing to worry about with making sure you know how to get there & traffic. They also provided a little care package of food for after my surgery. The anesthetist’s were also very patient & informative along with Dr. Berger who was very patient with our questions & never made us feel he was rushing to get to the next patient. Laura, the nurse who came & checked on me at the hotel the day after was very nice & called to check on me at home also. Even Kathy, the nurse who did my ultrasound was great & gave me a copy picture to take to my doctor about a possible concern. All these things combined have made this a very wonderful experience & be rest assured that anyone I know who is looking to have this procedure done will be recommended to Dr. Berger & his great staff!!

I first found out about your clinic when I was researching tubal reversals via internet & came across your website. It was very straightforward, easy to understand & I liked reading some of the testimonials. Hopefully we will soon be sending out baby announcements ourselves. You will be some of the first to know. Thank you again & may God bless you all as you are blessing so many!

Sincerely,
Kathy & Joel C.