Tubal surgery for blocked fallopian tubes

With the invention of in vitro fertilization many years ago, some doctors are no longer performing tubal surgery on a regular basis. In fact, doctors are being trained and taught to do IVF but not getting information on how to do to tubal surgery. For women who have blocked fallopian tubes, this type of surgery can often be the only way that they can get pregnant. Because IVF is an expensive procedure that has a lower success rate than tubal surgery, women have a limit as to how many times they can attempt pregnancy with it.

However, tubal surgery provides a permanent fix for the problem of blocked fallopian tubes. This means that women can pay to have the surgery one time and continue to try to get pregnant each and every month. The cost of tubal surgery is considerably less than IVF also on average. Unless there are problems with scarring or adhesions after tubal surgery, women should continue to have open tubes and the ability to get pregnant.

This, of course, assumes that the woman and her doctor find the cause of her blockage and treat it so it will cause no further blockage. Since most often it is caused by a disease, and a sexually transmitted disease at that, taking care of the cause is usually done with a full antibiotic treatment.

Then, too, a woman needs to find a doctor who is experienced and knows what he is doing with regards to the surgical alternative. As training in this field is not a top priority these days, it is important to be selective in your choice.

If both of the fallopian tubes are blocked, the only way that a woman will get pregnant is either with IVF or tubal surgery. Finding a good doctor who understands and does tubal surgery on a regular basis is important because they can assess your particular situation to see if you would be a good candidate for the surgery.

For women who have blocked fallopian tubes, tubal surgery is a great option due to its relatively inexpensive price and its long-term potential to allow the woman to get pregnant. Blocked fallopian tubes do not always get symptoms, so if a woman is experiencing infertility for no known reason then she should see her doctor to have the situation assessed. The cause needs to be determined so that it can be treated appropriately and so there are no further episodes.

Tubal Reversal Pregnancy Study Report 2009

Study Shows Tubal Reversal Surgery is the Best Treatment to Have More Children After a Tubal Ligation

Dr. Gary S. Berger today reported the results of the largest study ever performed of tubal reversal surgery, involving over 5000 women. The prospective study concludes that tubal ligation reversal is more successful than IVF for couples wanting more children after a tubal ligation.

“A simple one-hour outpatient tubal reversal procedure is more successful and costs less than half than the widely used and more complex IVF treatment,” said Dr. Berger, Medical Director of Chapel Hill Tubal Reversal Center.

“With increasing divorce and remarriage rates, many couples want to start second families, even after women’s tubes have been tied. Most people, including infertility specialists, think of tubal ligation as a permanent method of birth control,” continued Dr. Berger. Tubal ligation reversal repairs the fallopian tubes to allow pregnancies to occur naturally again.

The Tubal Reversal Pregnancy Report 2009 compared pregnancy statistics from Chapel Hill Tubal Reversal Center with the latest IVF statistics in the US. Pregnancy and birth rates were higher after tubal reversal than after IVF for every age group.

The study involved 5,046 women who had tubal reversal surgery performed by Dr. Berger between July 2000 and June 2008. This is the largest and most detailed long-term study ever performed regarding tubal reversal surgery results.

At the conclusion of the study interval, 66 percent of the tubal reversal patients had reported pregnancies. The pregnancy rate ranged from 80 percent for women under 30 to 31 percent for women 40 and older. The highest pregnancy rate (90 percent) was among women under age 30 following reversal of a clip method of sterilization.

Dr. Berger, one of the pioneers of tubal reversal surgery, is a reproductive surgeon who specializes in and limits his practice to outpatient tubal ligation reversal. Eliminating the need for hospitalization was one of the main factors in the lower cost of the surgical procedure.

Tubal Reversal Pregnancy Study Report 2009

Tubal Reversal Informed Decision And Recovery

Chapel Hill Tubal Reversal Center (http://www.tubal-reversal.net) -- Dr. Berger discusses the issue of informed decision about tubal ligation reversal with his patient during her recovery just after her tubal reversal surgery. As a nurse herself, she points out how helpful it is to have a full understanding of the tubal reversal process to make an informed decision about it and why she chose tubal reversal vs IVF

Transcript of Video Interview With Dr. Berger

Dr. Berger: And briefly because of their ages they were told no you can’t and that was really not their place. That is not a decision that a doctor makes for somebody else. I mean that is a personal decision based on the concept of informed consent. Then I suggested we talk a little bit about it because to me that is a really important issue. And informed consent is not just the signing of a piece of paper where someone just sticks a piece of paper in front of you. It is a process of when someone calls or starts to seek information. We try to provide very comprehensive information about everything that we can think of that is related to tubal ligation reversal. All of the pros and cons, how it’s done, what are the various options. I mean in the terms of surgery the various types of surgical procedures, alternative treatments which involves in vitro fertilization or some variation of that.

Tubal Reversal Patient: Your website is excellent as far as finding out. I mean, I am a researcher. I will read something to death before I make a decision. And you do offer a lot of information on your website. And everyone was so knowledgeable too. I mean, I did have questions pop up and it was very easy to have questions answered. Even at home if I did think of something it was easy enough to find it on the website or to find someone that could answer it. And that is being accessible too and that is a really good thing.

Dr. Berger: That’s right it is pretty important and we have nurses generally we have two nurses. Well, during working hours we have a lot of nurses who work here. But, outside of work hours we have two nurses carrying cell phones and myself. And I try to be readily available by email. I check email everyday even multiple times throughout the day. But it’s interesting to me too like you are here this is now and we are sitting in the second stage recovery room. And I think I finished your operation around 11:00am.

Nurse: 11:07am

Dr. Berger: And it is now 12; 35pm, so this is within an hour and a half of surgery. I think one of the things that is important to me that I really try to ensure for patients is that not only is the surgery safe but I do everything I possibly can to make sure it is comfortable.

Tubal Reversal Patient: Nods head and answers yes.

Dr. Berger: Because one of the worst things about surgery is that it can be real painful and that’s one of the disadvantages of a surgical procedure and the recovery time it takes. I find it interesting and the reason I asked if you’d be will to talk about it because as a neonatal intensive care nurse you see things from both the patients perspective and as a nursing professional.

Tubal Reversal Patient: Some of the wonderful things you have are the pictures you have and the books in the waiting room and there are people who are wondering are really real and yes they are they are right in the books and that is a wonderful thing. And it really boosts you up a bit.

Dr. Berger: And that is the joy of the whole thing. And obviously, I want know I mean there are various reasons for it. And when it comes back to the issue of informed consent frankly I don’t see how anyone could undergo tubal reversal surgery unless they have a realistic idea of that the success is going to be. That is in the potential benefits and the potential risks. Well if we do not follow up on all the patients that have surgery and find out what the outcomes are how can provide that information? And I don’t know how to say it the sad thing or kind of disgraceful thing is that no one else does this. It does take a lot of effort admittedly. You have to be committed to maintaining that contact which is different then most surgical procedures where once the patient is recovered from surgery and they are no longer a patient. But, to me it’s the only sensible thing to do. It’s exciting to know what is happening. Intellectually, it is gratifying. And it adds useful information to the medical field but it’s absolutely essential for the patients when they are trying to decide what to do. If they don’t have that how could they really decide between IVF or tubal reversal or to go to this place or have a tubal reversal someplace else? These things seem just common sense.

Tubal Reversal Patient: And they are able to decide what to do. When I went to work and told them what I was going to do and they asked if it was going to work and I was able to give them that information because it was right there on the website and plus in speaking with you. I know everyone’s situation is different and every patient that comes through your door has a little bit of a different scenario why they chosen this and what’s going on in their lives and you are right in what you said informed consent is a very personal thing. But the question is will it work for me? And what are the benefits and what are the risks involved to me is I do this? Not just physically but emotionally and it is a big undertaking for anybody. And I really do feel like I was very prepared by you the staff and your website.

Dr. Berger: (To partner) And how about you? How do you feel about it?

Tubal Reversal Patients Partner: The full disclosure of knowing both sides of it it is not a used car sales pitch. It’s here what we offer and here’s the good, here’s the bad and you make the decision on your own. There’s no sugarcoating of anything to get business. You definitely give out the impression of you want people to come in knowing what they are getting into and that they are completely aware of every aspect and every side of it.

The Cost Of Tubal Reversal Surgery

For many women and couples who are looking into tubal reversal surgery the cost is a big issue. In these hard economical times everyone is trying to cut corners. There are some surgeons that are very expensive and some do charge less for the tubal reversal surgery.

One of the biggest things to watch for when comparing the prices for surgery is that the price may be lower until you add in the other expenses. What many have been doing is stating a low price and then after adding in the price of the anesthesiologist and the hospital stay, which ends up being very expensive. Many do not realize this until they think they have all the money saved for the surgery and then go to a consult with the surgeon who will be performing the tubal reversal surgery and then are told the added in charges.

Read the rest of this article

Good Financial News for Tubal Reversal Surgery
Women desiring tubal reversal often find themselves being financially creative. The cost of tubal ligation reversal can range from $5400 to over $25,000, depending on where the operation is perform. Chapel Hill Tubal Reversal Center keeps the cost for tubal reversal to the absolute minimum to help women be able to afford the operation that will allow them to have more children. Many women wanting a baby after a tubal ligation share their ideas on the Tubal Reversal Message Board for overcoming the financial obstacles to having this life-giving procedure.

Chapel Hill Tubal Reversal Patients Discuss Relief From PTLS

Chapel Hill Tubal Reversal Message Board offers a forum for TR patients to discuss how TR has helped relieve the symptoms of Post Tubal Ligation Syndrome. Many patients notice relief even with the first menstrual cycle after TR. Often, patients note even greater improvements over time. Chapel Hill Tubal Reversal Center hosts a PTLS blog as well as information on the condition on their website.

---

This is topic Best period ever! in forum Post Tubal Ligation Syndrome on the Tubal Reversal Message Board:

Posted by Flutist29 (Member # 12785) on October 18, 2008 10:12 AM :
This seems strange to write about, but I can't help it! I had my TL on 1/10/05 and have had horrible, horrible periods ever since then. So many things changed in my life, I can't believe it. Anyways...I had TR surgery on 10/8 and am now going through my first period since the TR. It is amazing how much better I feel already. My DH said to me this morning, "WOW, your skin looks so much better." I have had basically no cramping and my right hip isn't killing me like it used to. My bleeding is actually at a normal flow! The only thing I could complain about if I wanted to was that I had a headache Thursday and Friday. That's it! I still can't believe! I should have had this surgery 3 years ago! I would have saved myself a bunch of pain and sorrow.

---

Posted by MS_LICIA (Member # 9456) on October 18, 2008 12:36 PM :
lol....good for you !!! I myself, have found relief in many ways after having my TR, so I'm w/ya !!!

---

Posted by justnotme (Member # 12842) on October 18, 2008 04:05 PM :
flutist29- thanks sooo much for posting this. I just got over a 7 day AF!!!ugh!!! I also get wicked pains shooting down my legs and lots of other PTLS symptoms. I'm scheduled for Oct 29th. I can't wait to report the same things. My and my DH were just talking earlier today that we sure hope and pray that this helps me. I can't help but feel so optimistic, which I am generally anyways, that this IS going work. Thanks again for even more hope for me and other women that this will erradiacate our PTLS!! So happy for you.

---

Posted by MOMZILLA (Member # 12256) on October 18, 2008 07:12 PM :
I have had one period after another since the TR that is better, less crampy, lighter and I no longer have that crazy flooding....I was even late this month and even though my cycle was longer..it was not heavier when it arrived...what a great relief it has been to have normal periods again...

---

Posted by momto10 (Member # 11808) on October 18, 2008 07:32 PM :
I know what you mean. My PTLS didn't go fully away until last month, 9 months post TR. I finally had a FULL cycle that was 100% normal!!! YEAH!!! Now time to get down to business, TCC.... LOL Gwen

---

Posted by Ericka Pamplin (Member # 1953) on October 19, 2008 12:00 PM:
It's always great to hear the relief of PTLS that our patients experience after having the tubal reversal. I'm sure your stories will be encouraging to others that are feeling the same way!

---

Dr. Monteith's Blog on PTLS (Post Tubal Ligation Syndrome)

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

Frequently asked questions regarding operative reports

Operative Reports Before Ligation Reversal Surgery

Undergoing a tubal ligation reversal at Chapel Hill Tubal Reversal Center is an important endeavor and we want to maximize every patient's chance of ligation reversal success. Operative reports are important because they allow us to determine the likely success of tubal ligation reversal surgery. When the operative report is not available, we offer the option of starting with a screening laparoscopy. The choice of whether to start with screening laparoscopy is up to the individual patient. Since most tubal ligation procedures are reversible, it is an option, and not a requirement at Chapel Hill Tubal Reversal Center.

What is an operative report?

An operative report is a typed report describing exactly what the doctor saw and did during your tubal ligation procedure.

Where can tubal ligation operative reports be obtained?

Tubal ligation operative reports can be obtained from the hospital or health care facility where you had your tubal ligation surgery. Your doctor may have a copy of your operative report in their office. The hospital will have a copy of the report in your hospital record and will keep them on file for a limited time.

How long does the hospital keep my operative report?

The time a health care facility will keep records will vary by state. Most states have laws specifying how long records must be kept. If a state does not have laws regarding keeping medical records, then the state medical board will have guidelines which the board encourages physicians to follow. North Carolina, for instance, has no state laws mandating how long medical records will be kept. The North Carolina State Medical Boards recommends physicians keep records for a minimum of 10 years. Medicare and Medicaid records are recommended to be kept for a minimum of five years.

The physician’s office or hospital will typically keep records in their file room for a limited time and then transfer the files to another storage area for several years. Some facilities will create digital records of your health care information and store this information indefinitely.

How can I obtain an operative report?

Contact the medical records department of the hospital where your tubal ligation was performed. You will have to fill out a medical records release form. The operative report can be mailed or faxed to you and to our facility. Please be aware some medical facilities are very busy and have limited medical record personnel. This means they may take some time to send records and you might have to keep a close watch to make sure the records are actually sent in a timely fashion. Chapel Hill Tubal Reversal Center has instructions and a form you can use to obtain a copy of your operative report.

What happens if I can not get my operative report?

If you can not get your operative report you can try to get your doctor to give you more information about the type of ligation surgery you had. Although this is not as accurate as an operative report, this can provide some information. Many doctors will do their tubal ligation surgeries the same way over many years and they should be able to tell you how your procedure was done.

Your best option is to consider a screening laparoscopy. This involves placing a small telescope under your umbilicus (belly button) and looking at the fallopian tubes. This provide quick and accurate information about the condition of your fallopian tubes. When the screening laparoscopy is performed here, we proceed immediately with the tubal repair. If the laparoscopy shows that the tubes cannot be repaired, the procedure is ended without the laparotomy incision and a partial refund is given to the patient.

Will Chapel Hill Tubal Reversal do my reversal surgery if I do not have an operative report?

Yes. We frequently encounter many patients who are unable to obtain their operative report. The choice of whether to start with screening laparoscopy is up to the individual patient. Since most tubal ligation procedures are reversible, it is an option, and not a requirement.

Read More about Operative Reports Before Ligation Reversal Surgery

Tubal Ligation Reversal - Untying Tied Tubes

Untying Tied Tubes: Bipolar Electrocoagulation

History of Tubal Sterilization

The first tubal sterilization procedure, reported in 1881, was tubal ligation and resection. Ligation and resection - or ‘tying tubes’ was the most common surgery for sterilization until the advent of laparoscopic surgery in the mid 1900’s. As laparoscopic surgery became more popular, electrocoagulation (electrical burning) of the fallopian tubes became an additional method of surgical sterilization. Tubal sterilization by electrocoagulation uses electric current to cut and destroy the portion of the tube that is exposed to the electric current. These portions of the tube eventually heal and close.

Monopolar Tubal Coagulation

The initial method of laparoscopic tubal coagulation, in 1962, used a type of electrical current termed monopolar current. Monopolar tubal electrocoagulation was a popular type of laparoscopic sterilization through the 1970’s and 1980’s. The medical community began to realize that the complication rate from this form of electric surgery was higher than for other electric surgical methods of tubal sterilization. Sterilization procedures done by monopolar current have gradually been replaced with bipolar current.

Bipolar Electrocoagulation of the Fallopian Tubes

The first reported sterilization using bipolar electrocoagulation was in 1972. This was done via a laparoscope inserted just under the belly button. During bipolar coagulation, the electrical current can be more precisely controlled, resulting in less tubal damage than monopolar coagulation. This sterilization procedure results in higher reversal success rates than monopolar electrocoagulation.

Reversing Tubal Sterilization

Many people, including doctors, mistakenly believe that tubal sterilization is permanent and irreversible. Although bipolar coagulation sterilization is intended to be permanent, this procedure can be reversed successfully in almost all cases. The success rates depend on how many different areas of the tube were damaged with electrocautery. Approximately 60- 70% of patients at Chapel Hill Tubal Reversal Center become pregnant after a reversal of a bipolar coagulation sterilization procedure. Chapel Hill Tubal Reversal Center is the only medical facility that specializes exclusively in reversal of tubal ligation. We perform tubal ligation reversals every day, and our tubal reversal doctors are experts in reversing all types of tubal ligations- or ‘untying’ tubes that have been ‘tied’!

Untying Tied Tubes: Falope Ring Sterilization

Falope Ring Sterilization

The Yoon Falope rings were developed in the 1960’s as a safer alternative to laparoscopic monopolar cautery tubal sterilization. This procedure is performed by inserting a laparoscope just under the belly button. The fallopian tube is then identified and a device holds the tube while the silastic ring is slid over a 2-3 cm ’knuckle’ of tube that is kinked off by the ring. This is done once for each side.

The common misperception is that the Falope ring is what prevents pregnancy and that reversal of the procedure simply requires removal of the ring. The Falope ring causes the squeezed ’knuckle’ of tube to undergo avascular necrosis (to die and become absorbed by the body). After this happens the ends of the tubal segments outside the ring close up, thereby preventing sperm from reaching the egg.

Falope Ring Sterilization Reversal

Reversing Falope ring sterilization is not as easy as just removing the ring. The closed ends of the tubes must be opened and the tubal segments must be rejoined.

Falope rings cause destruction of a minimal length of fallopian tube and reversal of this type of tubal ligation gives excellent results. Approximately 75% of patients at Chapel Hill Tubal Reversal Center become pregnant after a reversal of a Falope ring sterilization procedure.

Many people believe tubal sterilization is permanent and irreversible. Although tubal sterilization with Falope rings is intended to be permanent, this procedure can be reversed. Chapel Hill Tubal Reversal Center is the only medical facility that specializes exclusively in reversal of tubal ligation.

Untying tied tubes: Hulka clips

Hulka Clip Sterilization

One common form of female sterilization is the use of Hulka clips to block the fallopian tubes. The Hulka clip was approved for use in the United States in the 1970’s and was invented in Chapel Hill, North Carolina by Dr. Jaroslav Hulka at the University of North Carolina at Chapel Hill.

The Hulka clip is a small, gold plated stainless steel spring loaded clip. The clip in introduced into the abdominal cavity via a laparoscopic clip applicator. This image shows the open clip in the applicator and the tip of the laparoscope with its fiber optic lighted end. When the clip is placed across the fallopian tube, it is closed and a small spring holds the clip firmly across the tube. The Hulka clip has the advantage of damaging only a very small portion of the fallopian tube- approximately 7mm (the thickness of three quarters stacked on each other).

The Hulka clip causes bilateral tubal occlusion by squeezing a very small portion of the tube. The squeezed portion is deprived of its blood supply and eventually undergoes avascular necrosis (dies and is absorbed by the body). This causes the fallopian tube to be divided in half and the two ends to close up. The Hulka clip is held in place between the two divided tubal segments by a small amount of scar tissue which forms within the clip.

Hulka Clip Reversal

A common misconception is that the Hulka clips can simply be opened to reverse the sterilization process - that the tubes can be unclipped. Unfortunately, tubal ligation reversal for Hulka clips is not as simple as opening the clips. Hulka clip tubal occlusion is reversed by removing the section of the tube with the clip across it and then, using microsurgical techniques, joining the remaining tube segments back together in perfect alignment.

Tubal reversal of Hulka clip tubal occlusion is better than for most other methods of sterilization because such a minimal amount of tube is destroyed in the occlusion process. Approximately 76% of patients at Chapel Hill Tubal Reversal Center become pregnant after a reversal of a Hulka clip sterilization procedure.

Common Misconception About Tied Tubes

Many patients seem to imagine the fallopian tube is like a shoe lace which is tied up like a bow to prevent pregnancy. As tubal ligation reversal specialists, we wish it were that easy- then untying tied tubes would be easier!

‘Tying ones fallopian tubes’ is a common language phrase used to describe several different surgical procedures which result in sterilization (a procedure intended to permanently prevent pregnancy). The more correct medical term is bilateral (both sides) tubal occlusion (closure of the fallopian tube).

There are many different ways to occlude (close) the fallopian tubes: ligation and resection (tying and cutting), clips and rings, and coagulation (burning). No matter how the procedure is done the end result causes the tube to close, heal shut, and prevent sperm from fertilizing an egg.

Tubal Sterilization is Reversible

Many people believe tubal sterilization is permanent and irreversible. Although Hulka clip sterilization is intended to be permanent, this procedure is ideal for tubal reversal. The Chapel Hill Tubal Reversal Center is the one medical facility which specializes in tubal ligation reversal.

We have become experts in reversing all types of tubal ligations- or ‘untying’ tubes that have been ‘tied’!

Untying Tied Tubes: Filshie Clip Sterilization

Tying Tubes is Not Like Tying a Shoe Lace

Many patients seem to imagine the fallopian tube is like a shoe lace which is tied up like a bow to prevent pregnancy. As tubal ligation reversal specialists, we wish it were that easy- then untying tied tubes would be easier!

‘Tying fallopian tubes’ is a common language phrase used to describe several different surgical procedures that result in tubal sterilization (a procedure intended to permanently prevent pregnancy). The more correct medical term is bilateral (both sides) tubal occlusion (closure of the fallopian tube).

Tubal Ligation Methods

There are many different ways to occlude (close) the fallopian tubes: ligation and resection (tying and cutting), clips and rings, and coagulation (burning). No matter how the procedure is done the end result causes the tube to close, heal shut, and prevent sperm from fertilizing an egg.

Filshie Clip Tubal Ligation

One common form of laparoscopic (camera) sterilization is the use of Filshie clips to occlude both fallopian tubes. The Filshie clip was approved for use in the United States in the mid 1990’s. The Filshie clip is a small titanium clip which is lined with a thin silicone cushion. The clip was an improvement over the Yoon Falope Ring and the Hulka Clip because it was as easy to apply with less risk of operative complications. The clip also has the advantage of destroying only a very small portion of the fallopian tube- approximately 4mm (approximately the thickness of two quarters stacked on each other). The adjacent tube is not affected. The majority of Filshie clips placed in the United States are done by laparoscopic surgery; however, there is a growing trend to use them for tubal occlusion at the time of cesarean delivery (c-section).

The Filshie clip causes bilateral tubal occlusion by squeezing a very small portion of the tube. The squeezed portion is deprived of its blood supply and eventually undergoes avascular necrosis (dies and is absorbed by the body). This causes the fallopian tube to be divided in half and the two ends to close up. The Filshie clip is held in place (in between the two divided ends) by a small amount of scar tissue which forms over the clip.

A common misconception is that the Filshie clips can simply be removed to reverse the sterilization process- that the tubes can be unclipped. Unfortunately, tubal ligation reversal for Filshie clips is not as simple as just opening the clips. Filshie clip tubal occlusion is reversed by removing the clips and using microsurgical techniques to open the closed ends and join the tubal segments back together in perfect alignment.

The reversal of Filshie clip tubal occlusion is usually technically easier than some other methods of sterilization because such a minimal amount of tube is destroyed in the occlusion process.

Approximately 76% of patients at Chapel Hill Tubal Reversal Center become pregnant after a reversal of a Filshie clip sterilization procedure.

Tubal Sterilization Can Be Reversed

Many people believe tubal sterilization is permanent and irreversible. Although Filshie clip sterilization is intended to be permanent, this procedure can be reversed. Chapel Hill Tubal Reversal Center is the one medical facility that specializes in tubal ligation reversal.

We have become experts in reversing all types of tubal ligations- or ‘untying’ tubes that have been ‘tied’!

Untying Tied Tubes

Tying Tubes

Many people seem to imagine the fallopian tube is like a shoe lace that is tied in a bow to prevent pregnancy. As a tubal ligation reversal specialist, I wish it were that simple- then reversing tied tubes would be a whole lot easier!

Perhaps a well meaning doctor may have told a patient one day, “I am going to tie your tubes so you don’t get pregnant.” Maybe the doctor wrote a letter to a medical journal explaining the procedure and then the terminology stuck. More likely, a reporter may have simplified the terminology for the surgical procedure of tubal ligation to make a catchy title for an article. Others may then have started using the term “tying tubes” to quickly explain a complex procedure. These explanations often have a long life span and make their way into common language.

The more accurate terminology is bilateral tubal occlusion (closure of both fallopian tubes) which results in sterilization (not being able to conceive). There are many ways to perform bilateral tubal occlusion. The most common tubal sterilization procedure is performed at the time of cesearean delivery (c-section) or immediately after having a baby. It does involve tying the tubes with a suture - but then also cutting out a segment of healthy tube, resulting in closure of the tube as it heals. The suture then dissolves. The intial suture tying is most likely where the phrase ‘tying tubes’ came from.

Another common method is to burn the tubes with electrical energy (electrocoagulation). This is usually done by laparoscopic surgery and is usually done remote from pregnancy. Lastly, there are many devices- clips and bands - which can close off the tubes and cause a portion of the tube to be destroyed.

No matter how the procedure is done, the end result is obstruction of the fallopian tube that prevents pregnancy.

Many people believe that tubal sterilization is irreversible. Although bilateral tubal occlusion is intended to be permanent, the procedure can be reversed. Chapel Hill Tubal Reversal Center is the one medical facility that specializes exclusively in reversal of tubal ligation. We have become tubal ligation reversal experts………experts at untying tied tubes!

Tubal Reversal Information

Tubal reversal information is plentiful on the internet, but not everything that you read is accurate or factual. Of the websites that provide information about tubal ligation reversal, the one from Chapel Hill Tubal Reversal Center is most complete and accurate. It describes the various types of tubal ligation procedures and the different tubal reversal procedures that can be used. If you are interested in learning about tubal reversal, spend some time looking at the different pages on this extensive site. There is a search box at the top of every page that can direct you to specific information about any issues relating to tubal ligation reversal. Take a look also through the many topics of information on the Tubal Reversal Blog.

Tubal Reversal Surgery

Tubal ligation reversal is usually considered to be a major operation, taking several hours and requiring a hospital stay of 1 to 5 days. Complete recovery is often described as taking 4 to 6 weeks. However, the tubal reversal procedure that Dr. Berger has developed is performed as outpatient surgery with no hospital stay required and with complete recovery generally within 5 to 10 days. Since hospitalization is not required, the cost of the tubal reversal procedure is reduced by half or two-thirds of the cost when performed in a hospital. Patients are more comfortable during their post operative recovery and are able to return to work and other normal activities much faster. A free video or DVD of Dr. Berger’s tubal reversal procedure is available on the Chapel Hill Tubal Reversal Center website.

Risks of Tubal Reversal

As with any surgery, complications are always a possibility. Although rare, these may include bleeding, infection, damage to other organs, or complications of anesthesia. The most significant risk associated with tubal ligation reversal is the long term risk of having an ectopic pregnancy. This risk is increased from approximately 2% of pregnancies in the general population to approximately 10% after tubal reversal. Fortunately, the medical problem of a ruptured tubal pregnancy can be prevented by following an early pregnancy monitoring protocol that has been described by Dr. Berger and is recommended to all women after a tubal reversal procedure.

Alternative Treatment

Rather than “untying” their tubes, some women are advised to be treated by in vitro fertilization (IVF). However, IVF is more complicated and expensive, the pregnancy rate after IVF is not as high as after tubal reversal, and there is a very high incidence of multiple births (approximately 30%) after IVF. Further, there is concern about the possible long term effect of the use of potent hormones to stimulate the ovaries to produce many eggs (called “super-ovulation”) and the suspicion that it might increase the risk of ovarian cancer later in life.

Am I a Candidate for Tubal Reversal?

Although most women have been told that tubal ligation is permanent, in fact, the vast majority of tubal ligation procedures are reversible. The operative report from your tubal ligation will give a good indication if the procedure can be reversed. When there is any doubt about this, diagnostic laparoscopy can be performed to examine the fallopian tubes and then decide whether to proceed with the reversal operation.

Pregnancy Rates After Tubal Reversal

Pregnancy and birth rates after a tubal reversal are significantly better than after IVF. Neither procedure, however, can guarantee that pregnancy leading to birth will occur. Even when the fallopian tubes have been repaired, other factors – such as age, menstrual cycle regularity, ovulation or other hormonal disorders, and the fertility of the male partner - may determine when, or whether, conception will occur.

Women under the age of 30 who have a tubal reversal have an 82% pregnancy success rate; between 30-34 the pregnancy rate is 76% and for women ages 35-39, the pregnancy rate is 67%. The pregnancy rate declines for women 40 and older in accordance with the natural decline in fertility with age. However, pregnancy rates are higher for women of any age following tubal reversal than after IVF.

More Tubal Reversal Information

If you would like to discuss your individual situation with a Tubal Reversal Nurse, call (919) 968-4656. The experienced nurses at Chapel Hill Tubal Reversal Center are always happy to provide information about tubal ligation reversal. You can also exchange information with other women on the Tubal Reversal Message Board.

Tubal Ligation and Tubal Reversal News: 2007

Past topics in the Tubal Reversal Blog include posts and comments about patient care at Chapel Hill Tubal Reversal Center. This topic summarizes important articles about tubal ligation and tubal reversal reported in the news during 2007.

Sterilization is Most Popular Family Planning Method
Approximately 10 million American women use the pill for contraception, while sterilization has been chosen by 15 million men and women.

One In Five Women Regret Decision For Tubal Ligation
One in five women under age 30 who undergo tubal sterilization later regret the procedure, despite the number of children they have.

Is Sterilization the Best Contraception Choice?
Women requesting a tubal ligation should be counseled regarding other long-term, reversible methods of contraception and informed that vasectomy is safer and more effective than tubal ligation.

Tubal Ligation Counseling Issues
Counseling about tubal ligation should include permanence of the method, possibility of future regret, and information about the specific techniques of tubal sterilization.

Relationship Conflict Before Sterilization
Women whose relationship was marked by substantial conflict before they underwent tubal ligation were most likely to regret the decision.

Young Age, Prodding Partner and Sterilization Regret
Young age and a prodding partner are risk factors indicating that a woman undergoing sterilization may later regret her decision.

Tubal Reversal Among Overweight Women
Overweight women’s chances of becoming pregnant after tubal reversal improve when they lose weight.

Dr. Berger’s Comment

These news reports touch on some of the issues patients talk about when they come to Chapel Hill Tubal Reversal Center for tubal sterilization reversal. The popularity of tubal ligation, and the fact that many women regret their decision to have a tubal ligation, are well documented. Young age and marital conflict are risk indicators for subsequent regret. Before performing a tubal ligation, doctors should ensure that the implications of ending childbearing potential are clearly understood and discuss vasectomy as an alternative permanent method of birth control. Women undergoing tubal reversal who are overweight should be aware that losing weight will improve their chances of becoming pregnant again.

Consenting to Tubal Ligation During Childbirth

I received an email message today from a patient that prompted me to write about informed consent for tubal ligation. (See my previous blog about informed consent for tubal reversal.) Here is the message that was sent to me.

Hello, Dr. Berger,

You performed tubal reversal surgery on me on 10/29/07, and I just found out that I’m pregnant. Thank you so much! This is such a blessing. I filled out the report and have heard back from Sarah Meacham. I’ll make sure to follow her instructions.

I’m writing because I have a friend named Samantha who wants to get reversal surgery, but she would like to make sure she’s a candidate based on the information in her operative report. I told her that I would send it to you so you can look it over, so it’s attached. She and her husband have two cute little girls, but she agreed to the tubal ligation on the operating table after she gave birth to her youngest at the prodding of her doctor. She said that she made a terrible mistake and wants more children. And like me, no one she’s asked in south Florida will even consider the procedure that you do. When I told her about you, she was ecstatic. And now that I’m pregnant, she knows that it works!

Thank you again for the miracles you work for so many women. God bless you and your staff!

Sincerely,
Amy P.

I was glad to hear that Amy was pregnant and had recommended to Samantha that she come here for her tubal reversal procedure, but this part of the message caught my attention:

“…she agreed to the tubal ligation on the operating table after she gave birth to her youngest at the prodding of her doctor. She said that she made a terrible mistake…”

What Is Informed Consent?

Before performing a tubal ligation - an elective operation - a doctor should always obtain the patient’s informed consent. Informed consent is the process through which the patient becomes educated about the procedure - including its benefits, risks and alternatives - and makes the decision to have the procedure performed. Informed consent implies that the patient fully understands the issues, has asked any questions she has, had her questions answered, and makes her decision under no duress. Adequate time should be allowed for a patient to think about all of the issues before consenting to the operation.

Should Consent For Tubal Ligation be Made During Childbirth?

Many tubal reversal patients have told me that the first time they discussed a tubal ligation with their doctor while they were on their way to the operating room for a C-section. Some regretted their decision while they were on the operating table or when they awoke in the recovery room. Other patients have said they had a tubal ligation in response to pressure from their spouse, parents, or their doctor. Labor and delivery is not the best time to think about an issue with such profound and lasting results as surgical sterilization. This should be discussed and thought about at leisure, not during the stress of childbirth.

Dr. Berger’s Comment

Besides the doctor’s responsibilities in obtaining informed consent, the patient also has a responsibility when giving it. A tubal ligation is not an emergency operation. Having a tubal ligation is a decision that should be carefully considered and not made in haste. There is adequate time during the pregnancy for a doctor and patient to discuss the issue of sterilization. Bringing this up for the first time on the way to the delivery room is a mistake, in my opinion. A more deliberate approach to the process of informed consent by both doctor and patient would help avoid mistaken decisions, such as in Samantha’s case.

Is Tubal Ligation Regret A Big Problem?

At Chapel Hill Tubal Reversal Center, we receive requests 7 days a week, 365 days a year, for information about tubal ligation reversal. These requests come from women who regret having a tubal ligation. A staff member recently asked me how big a problem this is throughout the country. The following is in response to this question.

How Many Women Have Had A Tubal Ligation?

There is no single data source reporting the number of surgical sterilizations performed in the United States. Based on multiple sources of information, it is likely that 650,000 to 700,000 tubal sterilizations are performed each year, and more than 11 million American women have had a sterilization operation. The latest study, conducted in 2002 by the US Department of Health and Human Services, indicates that between one in four to one in five of adult, sexually active women have had a tubal ligation.⁽¹⁾

How Common Is Tubal Ligation Regret?

Many factors can affect a woman’s likelihood to regret sterilization. Among women who had a tubal ligation, risk factors for regret include young age, less education, and a husband or partner who wanted the woman to have a tubal ligation.

In 1999, a study called the Collaborative Review of Sterilization (CREST) found that 20% of women who were sterilized before the age of 30 regretted their decision. Women who were sterilized at a young age had a higher chance of requesting information about reversal, regardless of their number of living children. Also, women who reported conflict with their husbands or partners before tubal sterilization were more than three times as likely to regret their decision and more than five times as likely to request a reversal than women who did not report such conflict. ⁽²⁾

Dr. Berger’s Comment

This statistical information helps give a broader picture to the significance of the issues and comments raised in the previous blog topic - Ethics of Tubal Ligation. Additional comments on this issue are welcome from all readers.

References

1. MMWR Surveillance Summary, “Contraceptive Use — United States and Territories, Behavioral Risk Factor Surveillance System, 2002.
2. Mosher WD, Martinez GM, Chandra A, Abma JC, Wilson SJ. Use of contraception and use of family planning services in the United States: 1982–2002. Hyattsville, MD: US Department of Health and Human Services, National Center for Health Statistics, 2004. Advance Data from Vital and Health: no. 350.

Tubal Reversal After Fimbriectomy Tubal Ligation

Tubal Ligation by Fimbriectomy

Fimbriectomy is an infrequent type of tubal ligation in the United States. This female sterilization method is performed by removing the fimbrial end of the fallopian tube. At the fimbrial end of the tube, the inner tubal lining faces outward towards the ovary. The tubal lining is rich in cilia that beat in coordinated waves to pull the egg into the tubal opening.

Many doctors think that tubal reversal cannot be successful following a fimbriectomy because of the loss of the egg-capturing fimbria. This is a mistaken notion. Cilia are abundant in the ampullary segment of the fallopian tube. The inner lining of the remaining ampullary tubal segment can be folded outward after opening the tube and can function as a new fimbrial end. The tubal reversal procedure for fimbriectomy reversal is called ampullary salpingostomy.

Fimbriectomy Reversal Pregnancy Rates

Chapel Hill Tubal Reversal Center publishes statistics updated annually regarding pregnancy rates and pregnancy outcomes for all of the women who have had tubal reversal procedures performed by Dr. Berger. The data for women who had tubal ligation procedures by fimbriectomy are from our Tubal Reversal Pregnancy Study Report 2007.

The overall pregnancy rate after fimbriectomy tubal reversal is 56% for patients at Chapel Hill Tubal Reversal Center. The following table shows the numbers and pregnancy rates according to womens’ ages at the time of their tubal reversal procedure.

Pregnancy Rates After Fimbriectomy Reversal

Age	All Women	Pregnant (#)	Pregnant (%)
<30	29	20	69%
30-34	82	52	63%
35-39	131	81	62%
40+	70	22	31%

Recommendations for Fimbriectomy Reversal

The success of fimbriectomy reversal depends upon having an adequate length of ampullary segment of the fallopian tube. The length of the remaining ampullary tubal segment can be determined from a hysterosalpingogram (HSG) or from diagnostic laparoscopy.

I recommend having an HSG or choosing the screening laparoscopy option when tubal ligation has been performed by fimbriectomy. An HSG can be ordered by the patient’s local doctor and the x-ray films sent to me for examination prior to scheduling tubal reversal surgery. Alternatively, patients can omit having an HSG and schedule their reversal surgery to start with screening laparoscopy. This will show if ampullary salpingostomy will be effective. If so, the tubal reversal procedure will be performed at the same time while the patient is under anesthesia.

Chapel Hill Tubal Reversal Center Welcomes Dr. Split

Dr. James Split, a board certified anesthesiologist, is the newest member of the Chapel Hill Tubal Reversal Center staff. Although only 4 tubal reversal surgeries are performed each day at Chapel Hill Tubal Reversal Center, there are 2 anesthesiologists and a nurse anesthetist on staff. The primary responsibility of the anesthesia department is to ensure patients' safety during surgery and comfort during recovery. Many of Dr. Berger's patients who are having their tubes untied will be speaking with Dr. Split as a part of their preoperative evaluation and will meet him on the day prior to or on the day of their tubal ligation reversals.

In the Chapel Hill Tubal Reversal Center Blog Dr. Berger welcomes Dr. Split.

It is a happy occasion to introduce another new member of the staff of Chapel Hill Surgical Center. Dr. James Split is a Board Certified Anesthesiologist. He has worked at Chapel Hill Surgical Center since December 2007. He previously lived and worked in Greensboro, North Carolina for the last 18 months. Before moving to North Carolina, Dr. Split practiced medicine in Michigan for 25 years. He obtained his medical degree at the University of Michigan in 1979 and practiced Emergency Medicine for the first 11 years of his career. He both practiced and taught Emergency medicine in an Emergency Medicine Residency and held a clinical faculty position at Michigan State University. In 1990, he returned to the University of Michigan to train in anesthesiology. He completed his anesthesiology residency in 1993 and has been in the full time practice of anesthesiology since then. Dr. Split is a member of the American Society of Anesthesiologists and The Society for Ambulatory Anesthesia.

Dr. Split will be speaking with many of you as part of your pre-operative evaluation. If you have any general questions about anesthesia, you can add comments to this blog or post them on the Tubal Reversal Message Board and he will to answer them. If you have specific questions that require privacy, or that may not be of interest to others, please send Dr. Split an e-mail to DrSplit@tubal-reversal.net and he will respond.

Dr. Berger’s Comment

The highest priority for patients who come to me for tubal reversal surgery to untie tubes is patient safety during and after surgery. This is ensured by the involvement of medical professionals who are the most highly trained and qualified specialists. Our two anesthesiologists are certified by the American Board of Anesthesiology. The anesthesiologist is the physician responsible for the monitoring and care of patients while they are asleep during their tubal reversal procedure and for their safe and comfortable recovery in the post anesthesia care unit (PACU). Dr. Split’s background in Emergency Medicine gives him an added dimension of knowledge and experience. On behalf of all of our staff, I am very pleased to welcome Dr. Split to Chapel Hill Surgical Center and Chapel Hill Tubal Reversal Center.

1. Rhonda Brown RN Says:
   
   April 18th, 2008 at 9:37 pm
   

   Dr. Split is a positive addition to the anesthesia team at Chapel Hill Tubal Reversal Center. His interaction with the patients during their preop consultation has made it obvious of his desire for optimal patient care.



2. Stephanie Duncan RN Says:
   
   April 19th, 2008 at 8:58 am
   

   It is a pleasure to work with Dr. Split in the operating room each and every day! He goes the extra mile to make patients feel safe and well cared for before going to sleep. His experience and background makes him a good fit for Chapel Hill Tubal Reversal Center.



3. Julia Smith RN Says:
   
   April 20th, 2008 at 9:15 am
   

   We are excited to have Dr. Split with us. I know that our patients will appreciate his skill as an anesthesiologist as well as his professional and compassionate bedside manner.



4. Ericka Pamplin Says:
   
   April 21st, 2008 at 6:20 am
   

   It is a pleasure to work with you, Dr. Split!



5. Pamela Mills CRNA Says:
   
   April 21st, 2008 at 6:29 am
   

   It is a pleasure to work with Dr. Split; he is a terrific addition to our team!



6. Matt Murphy ST Says:
   
   April 21st, 2008 at 6:52 am
   

   I’m so glad to have him on our team! He is an excellent anesthesiologist and is great with the patients.



7. jgokun Says:
   
   April 21st, 2008 at 9:24 am
   

   Patients are often very apprehensive about their anesthesia for the tubal reversal surgery. Dr. Split is extremely friendly and I think he does a great job of putting patients fears aside and helping them to feel comfortable about their upcoming procedure.



8. Kathy Scrone ST Says:
   
   April 21st, 2008 at 11:36 am
   

   Patients at Chapel Hill Surgery Center feel reassured and comfortable that they are taken care of in such a professional and caring manner by Dr. Split. I enjoy working with him.



9. Sarah Meachem RN Says:
   
   April 21st, 2008 at 2:44 pm
   

   It has been a pleasure to work with Dr. Split - he has been a great addition to our staff!

Pregnancy and Birth Testimonials March 2008

“Thank you for giving my husband his first child and making me a new mother again.” LaCrecia and Tafuma A.

---

“I thought I would never give birth to my own child again. Today I’m looking at my 5 week old baby.” Amber and Emma Grace

---

“If it wasn’t for Chapel Hill Tubal Reversal Center, we would not have these two beautiful children.” Colin, Amber, Colin Jr, and Dee

---

“We are most excited to announce to you the birth of our son. He’s our first post-TR baby.” Ellen & Jim W.

---

“Thank you for our miracle baby. Thank you so much for our Angel.” Jill and John P.

---

“I had my tubal reversal surgery on December 22nd, 2006. Thank you so much. Everyone at Chapel Hill tubal Reversal Center are truly angels in disguise” Mohsen and Kim F.

---

“We were fortunate to find Dr Berger’s tubal reversal website - we had been told by several doctors that in-vitro was the only option for us to conceive.” Nicole and Family

---

“I just wanted to send you some pictures of our TR baby. I love this little guy so much.” James and Holly W.

---

“We have finally had success with our tubal reversal. Thank you all so much for your help to bring these beautiful bundles of joy into our life. We couldn’t be happier.” Rod and Kathy L.

---

“Thank you Dr. Berger for giving me the chance to experience this again. We are eternally grateful to you and your staff.” Jennifer D.

Tubal Reversal in Canada

This is topic New with questions on the Tubal Reversal Message Board.

Posted by hopefulforfour (Member # 12046) on February 11, 2008 10:00 AM:

I am new here, well I have been reading for a while but just registered. I got a tubal (the rings, but not cut and burnt) in November 2005. The reason was that I had had 6 miscarriages. The last was at 3 months. Found out that it was low progesterone. But, my emotions got the best of me and I decided a few days after my last miscarriage to get a tubal. My miscarriage was on Sept 18, 2005 and I was getting my tubal on November 24, 2005. I regret it with every inch of my being. I would love to have one more baby. I have three ages 8,7 and 4. I should also say that I just turned 27 so age is in my favor I imagine.
My questions:
I am in Canada and was wondering why people are choosing to see Dr. Berger instead of getting it done in Canada. I am definitely getting the reversal but I am investigating the best options before I decide where to go.
Cost: For those in Canada, is it not cheaper to get it done here instead of with Dr. Berger? I am just wanting to know why you chose to go to the states as I will get a better idea of where I would like to go.
I just got the clamps (rings) so are there quite a few success stories with getting pregnant after? I know that if they are cut and burnt I am sure that the chances are not as great as the rings.
Also, my specialist that did the tubal told me that the rings would cut off circulation and would eventually make my tubes split apart. Is this true? Or has anyone heard of this?
Ever since my tubal I have had wicked pain at ovulation and right before my monthly. I am sure it is because of the clamps. My regular doc says he thinks I have endometreosis. I am actually going for an ultrasound today to check for that. I am sure that it is just the clamps. I wonder if surgery cost would be covered if the clamps are being a problem. Probably not!
Also, I have been reading about bmi. That is not a problem for me as mine is aroud 30. But, I am curious as to why that matters.
Thanks for taking the time to read.


Posted by in-Gods-hands (Member # 11795) on February 11, 2008 10:49 AM:

Well I do not live in Canada but the reason we choice to look to Dr.Berger for a TR is because of his studies in to this, his care of every woman that goes to him, and the fact that he is well known and only does TR's. I did not have the rings but I too have had the pain right before my AF and it is all because of the blood flow being cut off my doctor told me. So getting the TR would restore that. The getting pregnant after a TR if you had the rings I can not tell you. Our bodies are all different so it all depends on what your tubes are like after the TR I would think. Dr.B has things posted about this on his site. The BMI is important when it comes to putting someone to sleep and how much body fat the doctor has to go through to get to the tubes to repair them. This is what my doctor told me. I hope I was at lest a little help. If you want to come in to the waiting room part 42 and jump in and start asking ?'s the lady's will gladly answer. I will be praying for you. Miranda


Posted by Dr. Monteith (Member # 11996) on February 13, 2008 11:10 AM:

Hi- I thought i would jump in quickly.

The Chapel Hill Tubal Reversal Center is the only center in the United States which specializes in the reversal of tubal ligation. They don't do them periodically or on the third Thursday of every fourth month- instead every day, 5 days a week and every month of the year. The center keeps comprehensive statistics and follow-ups on patients for at least 12 months after the surgery so the success numbers are real and verified.

Also people really love to come to Chapel Hill to experience Tar Heel basket ball and to see the birth place of Air - his Highness- Micheal Jordan!

To have any permanent sterilization the tube must be separated. They can be ligated (tied), cut, and then they can be cauterized (fancy medical way of saying burnt)- this causes the tubes to close and separate. The rings and clips achieve the same result but through different mechanisms. These devices put so much pressure on the tube in a small area which causes the blood supply to stop to that area. This causes - avascular necrosis- or more simply, causes the tissue to that area to die and the tube separates and heals itself over. The benefit to the rings and clips is they are both very effective (low rates of failure and ectopic pregnancy) and minimal amounts of tubes are destroyed and reversal is theoretically easier.

Pain after ligation. Rarely do the devices cause pain after ligation. I have occasionally seen a rare patient in which the actual clips were the cause of the pain which resolved when the clips were removed.

It is possible you could have endometriosis but more commonly pain and cramps are due to other conditions such as adenomyosis- or just worsening periods as you get older (I am not calling you old-okay!). Patients after tubal ligation stop hormonal methods which usually make cramps and pain better- this is why some people have the perception that things got wore after the ligation. Some of the patients at the center have post tubal ligation syndrome and seek reversal for this reason.

More Information on Tubal Reversal in Canada

Dr. Charles Monteith to Become Certified as Tubal Reversal Surgeon.

Press Release February 18, 2008 - Physician joins practice of Gary S. Berger, M.D. at Chapel Hill Tubal Reversal Center.

(CHAPEL HILL, NC) - Dr. Gary S. Berger, Medical Director of Chapel Hill Tubal Reversal Center in Chapel Hill, North Carolina, today announced the association of Dr. Charles W. Monteith as a certified tubal reversal surgeon beginning in July of 2008.

Dr. Monteith attended college at Xavier University of Louisiana, where he graduated Summa Cum Laude. He attended medical school at the University of California at San Francisco where he received a Howard Hughes research fellowship and conducted research in molecular genetics.

After completing his residency in Obstetrics and Gynecology at the University of North Carolina at Chapel Hill, Dr. Monteith accepted a Clinical Assistant Professor position with the Department of Obstetrics and Gynecology at the University of North Carolina in 2001. He worked as a Professor in Obstetrics and Gynecology at Wake Medical Hospital in Raleigh, N.C. for seven years where he practiced high-risk obstetrics and advanced surgical gynecology. Dr. Monteith spent a significant amount of time with the training and teaching of both medical students and residents.

Under the guidance of Dr. Berger, Dr. Monteith is currently undergoing certification in tubal ligation reversal surgery and will have assisted on more than a hundred reversal procedures before he begins accepting patients in July.

Dr. Berger has been performing tubal reversal surgery for more than 30 years and has performed more than 6000 reversal procedures during his career. Chapel Hill Tubal Reversal Center is the only facility in the United States that is limited specifically to the practice of tubal reversal surgery.

Dr. Gary S. Berger
(919) 656-8204

More information on Charles Monteith, Tubal Reversal Surgeon.

Dr. Charles Monteith to Become a Certified Tubal Reversal Surgeon - Free-Press-Release.com

Informed Consent For Tubal Reversal Surgery

Informed consent means a person has access to and understands all relevant information about a medical or surgical treatment necessary to make an informed decision about it. With regard to tubal reversal surgery, informed consent means that a woman understands how the surgery is performed, the alternative treatment of in vitro fertilization, and the potential benefits, risks, and likelihood of success from these treatments.

When Dr. Gary Berger meets with his patients pre-operatively, he thoroughly explains the outpatient tubal reversal procedure he performs. Well before the patient arrives at Dr. Berger's office or meets the staff, she has had access to extensive information and statistics on the Chapel Hill Tubal Reversal website, has received printed materials about what to expect before, during, and after the surgery, and can watch a DVD or video showing each step in the tubal reversal operation. With this detailed information and pre-operative education, it becomes possible to make a fully informed decision about tubal reversal surgery.

Tubal Reversal Information

How Do I Determine Which Tubal Reversal Information Is Accurate?
A member of The Chapel Hill Tubal Reversal Center Message Board posts her concerns that she has read a lot of conflicting information about the best tubal reversal techniques. Members of Dr. Gary Berger's staff - as well as other patients - offer information and encouragement. 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. Most Internet sites about tubal reversal do not provide any factual data at all. Any doctor may say that his patients have a particular success rate, but supporting the claim with actual data involves considerable effort. Performing a follow-up study such as the one Dr. Berger compiles requires keeping an accurate record of patients and their findings, as well as maintaining ongoing patient contact to determine the outcomes of treatment. Without this detailed type of information, the accuracy of any claim of success rates should be questioned.

The following is topic Other websites in forum Preparing for Tubal Reversal from the Tubal Reversal Message Board:
--------------------------------------------------------------------------------
Posted by Impatient (Member # 5526) on November 27, 2007 03:00 PM:
I have been looking at this board and other TR sites for a long time and wonder why their seem to be so many difrent stories on the best way to do the surgery, dye tests, no dye tests, 3 layers or 2. Honestly, it seems that some people are just trying to throw out stuff to run people off or to be misleading. How should me and my dh know what is right?
Carrie
--------------------------------------------
Posted by CarlaJo (Member # 10380) on November 27, 2007 03:04 PM:
By the statistics of pregnancy and the recovery time. Dr. Berger and his staff are awesome! I did my research also, and he had the best stats for my age and type of ligation.
--------------------------------------------
Posted by Julia Smith, RN (Member # 10) on November 27, 2007 03:07 PM:
Hi, Carrie. I was asked this same question just a few days ago and do have e-mail requests with this same question fairly frequently. I usually respond that the "three layers are better than two" theory is just the opinion of one doctor on the internet!
Dr. Berger sews the muscular and outer serosal layers together but not the inner endothelial layer as this may increase the risk of scar formation within the tubal lumen. In his opinion, this is the best approach. The suggestion I always make is to read through the testimonials from our patients. All of those women had surgery performed by Dr. Berger using the microsurgical techniques he pioneered -- with pregnancy rates near 80% in our latest follow-up survey. This is a clear indication that his techniques are successful and result in pregnancies!
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. Most Internet sites about tubal reversal do not provide any factual data at all. Any doctor may say that his patients have a particular success rate, but supporting the claim with actual data involves considerable effort. Performing a follow-up study such as the one Dr. Berger compiles requires keeping an accurate record of patients and their findings, as well as maintaining ongoing patient contact to determine the outcomes of treatment. Without this detailed type of information, the accuracy of any claim of success rates should be questioned.
I hope this is helpful!
Julia Smith, RN
--------------------------------------------
Posted by Sarah Meacham, RN (Member # 9766) on November 27, 2007 03:16 PM:
Hi Carrie,
We keep very detailed data and statistics on each of our patients (age, tube length, medical history, tube of tubal ligation, pregnancy history, etc.). This is obtained by daily contact with our patients to ensure we have accurate information regarding their surgery and their outcome. To the best of my knowledge, Dr. Berger is the only doctor with published data regarding outcomes following reversal surgery.
Please contact me (SarahM@tubal-reversal.net) with any other questions you may have and we look forward to having you as a future patient!
Sarah
--------------------------------------------
Posted by Jennifer Okun, R.N. (Member # 1806) on November 27, 2007 03:17 PM:
Hi Carrie,
What Julia answered is exactly right! Dr. Berger has been performing the reversal surgery for over 30 years, has performed over 6,000 reversals and has the most tubal reversal babies born world-wide. So, obviously Dr. Berger's technique is the best and he is doing it the best way possible.
I have worked for Dr. Berger for nearly 10 years and I can assure you - he is an amazing surgeon!
You will have the best outcome possible if you decide to undergo reversal surgery at our facility with Dr. Berger.
You may email me anytime with questions: Jennifer O@tubal-reversal.net
Best wishes!
--------------------------------------------
Posted by Jennifer Okun, R.N. (Member # 1806) on November 27, 2007 03:20 PM:
I should also add that Dr. Berger is the only physician in the country with a practice that is specifically limited to tubal reversal surgery. That is the only procedure we perform here with Dr. Berger performing four reversals each day, five days a week. We have a high staff/patient ratio with one or two nurses devoted specifically to your care while you are here. All of our nurses have advanced certification in cardiac life support (ACLS) and our anesthesiologists are MD's with board certification in anesthesia. The anesthesiologists are employees here and not anesthesia staff from another hospital or anesthesia service. So everyone here has expertise in caring for and performing reversal surgery. While you are here, you will only be with other women and couples who are here specifically for the same purpose.
--------------------------------------------
Posted by Rhonda Brown, RN (Member # 9485) on November 27, 2007 03:36 PM:
Dear Carrie,What a good question. We get asked this question quite a bit. The best tool that any patient can have is information. I do not know of any other physician that puts out the information that Dr. Berger provides. We encourage patients to check his credentials and to ask as many questions as they need to. We provide 24/7 coverage seven days a week not only to our patients that have had surgery, but to patients that are thinking of having tubal reversal surgery.
As you browse the message board and read all the posts you will see that experience is a factor with tubal reversal surgery We have had many patients come to Dr. Berger after they had been told that tubal reversal could not be done in their case and then Dr. Berger was able to successfully repair the tubes as he is able to do in 98% of the cases.
I do not think that you will find a more caring physician who is truely devoted to the procedure that he performs as well as patient care. We as staff members feel very fortunate to be a part of this experience and would love to meet you in the near future. Please contact us if you have any questions.
Rhonda

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

Obtaining Medical Records For Tubal Reversal Surgery

Dr. Berger has performed nearly 6000 tubal ligation reversal procedures. The success of the procedure depends on several factors, including a woman's age, the type of sterilization performed and the length of healthy tube remaining following surgery.

One way to determine what your success rate may be is with the operative report from your tubal ligation. This can be obtained from the doctor who performed the surgery or from the medical records department of the hospital where your procedure was performed. When patients forward their records, Dr. Berger reviews the operative report at no charge and provides input regarding possible outcomes following reversal surgery. If patients are unable to get the records, Dr. Berger can proceed without them or can perform a screening laparoscopy to assess the overall condition of the tubes if your body mass index (BMI) is less than 30.

Fortunately, Dr. Berger is able to repair the tubes in 98% of situations, including those cases where the tubes have been cut and burned.