Reversión Essure y Adiana: Reporte de estado

Gary S. Berger, M.D.
Director Médico

Cirujanos

Essure y Adiana se conocen como procedimientos de esterilización trascervical histeroscópica porque se realizan con un histeroscopio (una pequeña cámara) que se pasa a través del canal cervical dentro de la cavidad uterina.

Durante el procedimiento de Essure se coloca un pequeño DIU de metal en cada trompa y durante el procedimiento de Adiana se coloca una pequeña matriz de silicona en cada una de ellas. La esterilización Adiana incluye un paso adicional mediante el cual se aplica energía en forma de microondas al interior de las trompas y esta energía contribuye a bloquearlas.

Los procedimientos de esterilización histeroscópica provocan que las trompas de falopio cicatricen formando un tejido cicatricial que crea una obstrucción en el interior de las trompas. El DIU Essure y la inserción Adiana tienen como objetivo permanecer en las trompas de falopio cerradas luego que el tejido cicatrizal se haya formado.

Estos procedimientos se consideran permanentes por los doctores y los productores de los estos implementos, pero pueden ser revertidos quirúrgicamente en Chapel Hill Tubal Reversal Center.

Reversiones de Essure y Adiana

El Dr. Charles Monteith y el Dr. Gary Berger, cirujanos expertos en reversión de trompas en el Chapel Hill Tubal Reversal Center, publicaron los primeros informes de reversiones exitosas y de embarazos luego de hacer la reversión de los procedimientos Adiana y Essure en publicaciones de literatura médica.1-2 Essure y Adiana pueden ser revertidos en el Chapel Hill Tubal Reversal Center mediante una operación ambulatoria de 90 minutos, llamada implantación tubouterina.

La implantación tubouterina ha sido el patrón oro para la reversión de la oclusión de trompas (ístmica) por otras vías. Hemos desarrollado nuevas técnicas para el procedimiento tubouterino, más allá de lo tradicional, al crear técnicas especiales que permiten que este sea un procedimiento que se pueda realizar con seguridad para las pacientes y de forma ambulatoria.

Durante el procedimiento, las partes sanas de las trompas se separan del útero. El DIU metálico Essure se retira para prevenir posibles complicaciones para futuros embarazos. Las inserciones Adiana son extremadamente pequeñas y puede que no se puedan extraer en su totalidad pero a diferencia de Essure, no se extienden a la cavidad uterina.

Entonces se hace una incisión a través del músculo uterino y la porción sana de cada trompa se inserta en la cavidad uterina. Luego se cierra la incisión uterina alrededor de las trompas implantadas. El procedimiento de implantación tubouterina es necesario para hacer un puente con la porción cicatrizada de las trompas de falopio resultantes de los procedimientos Essure y Adiana.

El embarazo después de las reversiones de Essure y Adiana

Hicimos 23 cirugías de reversión de esterilización histeroscópica (Essure y Adiana) entre enero de 2009 y diciembre de 2010.

De estas 23 mujeres, 19 deseaban quedar embarazadas y sólo 4 deseaban la reversión de Essure y no intentaban quedarse embarazadas. De las 19 mujeres que deseaban quedarse embarazadas, hasta ahora 5 reportaron embarazo y 3 reportaron nacimientos. Durante este mismo período, la tasa de embarazo luego de la reversión de la esterilización histeroscópica era del 26% y la de nacimientos del 16%.

Durante el 2011 se practicaron 19 reversiones de esterilizaciones histeroscópicas. De estas 19 mujeres, 18 deseaban quedar embarazadas y sólo una deseaba nada más la reversión de Essure.

De estas 18 mujeres de 2011, hasta ahora 3 han reportado embarazos y todos están en proceso (aún no han dado a luz). El seguimiento del 2011 no está completo aún pero la tasa de embarazo del 2011 para la reversión de la esterilización histeroscópica es hasta ahora del 17%.

En comparación, el éxito de un ciclo sencillo de fertilización in vitro utilizando óvulos frescos es de aproximadamente el 36% para cada ciclo de fertilización in vitro.3

Reversión de esterilización histeroscópica o REH?

La fertilización in vitro puede ofrecer una tasa de éxito de embarazo más alta si se compara con la reversión de la esterilización histeroscópica; sin embargo, cuando se compara el éxito de la fertilización in vitro con el éxito de la reversión de esterilización histeroscópica los lectores deben comprender que:

Las pacientes de la fertilización in vitro como grupo tienen razones diferentes para su infertilidad con relación a las pacientes de oclusión de trompas

Los datos de la fertilización in vitro no incluyen los abortos

La edad de nuestras pacientes oscila entre los 26 y los 44 años

Con un tiempo adicional el embarazo a través de la reversión de la esterilización pudiera ser más alto a medida en que más pacientes queden embarazadas

Para una mayor comprensión de lo que la tasa promedio de éxito de la fertilización in vitro significa visite el artículo complementario: Essure Reversal Or In Vitro Fertilization?

No se ha determinado aún si los implementos de Essure deberían retirarse antes de la fertilización in vitro para incrementar la posibilidad de éxito y minimizar los riesgos de complicaciones en el embarazo. Existen muchos informes de casos de fertilizaciones in vitro que han sido exitosas con DIU Essure que no han sido retirados.4,5

Costo de las reversiones de Essure y Adiana

El costo de ambas es de $7500. Esta tarifa incluye todo y cubre las consultas pre-operatorias, cirugía, anestesia, y la recuperación postoperatoria. En comparación el costo promedio del ciclo de fertilización in vitro en los Estados Unidos es de $12,000.

La mayoría de los seguros no cubren el costo de la fertilización in vitro o la reversión de la esterilización. Nosotros ofrecemos una opción de prepago que da la posibilidad a las pacientes de no tener que pagar toda la cirugía a la misma vez. Nosotros no participamos en la financiación de las cirugías de reversión debido a los costos adicionales de las mismas.

Efectos secundarios de Essure y su extracción

Algunas mujeres experimentan efectos secundarios después de haberse colocado un DIU Essure y desean extraerlo.

Entre enero de 2009 y enero de 2012, hemos realizado 5 extracciones de Essure en mujeres que manifestaban sufrir efectos secundarios luego del procedimiento Essure.

Cuatro de estas pacientes han reportado mejoras en sus síntomas luego de que se les extrajera el dispositivo Essure.

Nosotros les ofertamos una tarifa reducida a las mujeres que solo desean que se les retire el dispositivo Essure sin desear futuros embarazos. Si sólo estás interesada en que se retire el Essure llama al (919) 968-4656 para que preguntes sobre la extracción del dispositivo Essure.

Seguridad de la reversión de Essure y Adiana

La implantación tubouterina puede llevarse a cabo de manera segura como un procedimiento ambulatorio pero puede incrementar el riesgo de ruptura uterina durante la operación.

En las 42 reversiones de esterilización histeroscópica y 5 reversiones de Essure que hemos realizado, no ha ocurrido ninguna complicación inmediata y ninguna paciente ha presentado ruptura uterina.

Para mayor seguridad para la madre y el bebé, aconsejamos a nuestras pacientes de reversión de Essure y Adiana luego de las implantaciones tubouterinas que hagan un parto por cesárea en todos sus embarazos para evitar el riesgo de una posible ruptura uterina.

Source: http://espanol.tubal-reversal.net/reversion-de-essure-y-adiana.htm

Tubal Reversal Pregnancy Report

A new study has just been published by Chapel Hill Tubal Reversal Center. This report presents detailed statistics about pregnancies, both numbers and percentages, from approximately 10,000 patients at Chapel Hill Tubal Reversal Center. It is the largest and most definitive study ever reported about pregnancies and their outcomes after tubal reversal surgery.

This report comes in the following sections:

• Tubal Reversal Pregnancy Study Report 2011 - Overview
• Study Methodology
• Where Patients Come From
• Patients Ages and Tubal Ligation Procedures
• Pregnancies by Age and Tubal Ligation Procedures
• Pregnancies by Tubal Lengths
• Births, Miscarriages, Ectopic Pregnancies
• Tubal Reversal Pregnancy Statistics – What You Should Know

These results from the Tubal Reversal Pregnancy Study show that tubal ligation reversal at Chapel Hill Tubal Reversal Center is the most successful option for most women with tied tubes who want to become pregnant again.

More Information on this reprt can be seen at
http://tubal-ligation-reversal-by-dr-berger.blogspot.com.au/2012/08/how-successful-is-tubal-ligation.html

Living Proof Children After Tubal Reversal Possible

“I’m living proof having children after a tubal reversal is possible… we have 4 reversal children ages 8, 3, 2, and 2 months! Dr. Berger is the best!” Diana M., Fort Polk, Louisiana

In 2005 Diana wrote a book called "Tubal Reversal - Our Journeys" this was not long after the birth of her first TR baby. Now another 7 years later her journey continues with the arrival of her 4th Tubal Reversal Baby.

Restoring the ability to conceive naturally is the main benefit of Tubal Reversal when compared to the alternative treatment IVF TR patients continue to have the chance of becoming pregnant over time.

Discount on Surgery To Untie Fallopian Tubes

 Chapel Hill Tubal Reversal Center is offering a 10% discount for those scheduling surgery before January 1, 2011.

Women who wish to schedule surgery to have their tubes untied can now receive an additional 10% discount on top of the the already discounted all-inclusive cost for tubal reversal surgery performed by Dr. Berger $5900 and $54000 for surgery performed by Dr. Monteith. For a limited time only, Chapel Hill Tubal Reversal Center has announced a special 10% off coupon on Google Maps. For women looking to have their tubal ligation reversed in 2010, this coupon will allow them to save 10% off of their reversal surgery fee. Call (919) 968-4656 for more details about this special discount.

Chapel Hill Tubal Reversal Center is offering a 10% discount on the tubal reversal procedure if scheduling before January 1, 2011. Julia Smith Nurse administrator says Often women and couples will inquire when the discounted rate will be so that they are able to save on the expense.

Tubal ligation reversal does not have to be so expensive that the average couple cannot afford to have
fertility restored. Many who research the procedure are shocked in the variations in price between surgeons and centers.

Chapel Hill Tubal Reversal Center is able to offer this outpatient procedure at the lowest of cost all throughout the year. This is because this unique Center performs only tubal ligation reversal surgery and the repair of blocked fallopian tubes.

The Center performs surgery four days a week. Staff to patient ratio is kept high so that the patent is well taken care of. CHTRC makes it known that patient care and safety is the top priority.

Dr. Berger and Dr. Monteith not only perform the ligation reversals that are more common but also the Essure as well as Adiana reversal. This has been a blessing to those women who are having physical discomfort and do not want a full hysterectomy.

Chapel Hill Tubal Reversal Center offers a variety of payment arrangements, including a pre-payment plan, for women who come to have their tubes untied by Dr. Gary Berger and Dr. Charles Monteith. Dr. Berger and Dr. Monteith are well-known as the doctors with the most experience in repairing tied tubes. Their low-cost, one-hour operation has resulted in the birth of the most tubal reversal babies worldwide.

Over 8000 couples have traveled to Chapel Hill, North Carolina to have fertility restored and their tubes untied with the tubal ligation reversal procedure. The surgeons have a 98% repair rate and 2/3 of patients are pregnant within the first 12 months.The nurses and doctors of Chapel Hill Tubal Reversal Center make it simple for women wanting tubal ligation reversals.

Women who are interested in having another baby after a tubal ligation should have their tubal ligation operative reports sent to Dr. Berger or Dr. Monteith for review. At Chapel Hill Tubal Reversal Center, the tubal reversal doctors and nurses will contact patients within 24-48 hours of receiving these medical records. Even if someone is unable get a copy of their tubal ligation operative record, they can still schedule ligation reversal surgery. They can choose to have a diagnostic laparoscopy to make sure the tubes are reversible or they can rely on the fact the tubal reversal specialists are able to repair the fallopian tubes in over 98% of patients.

To inquire if you are a candidate for tubal reversal surgery, call a Tubal Reversal Nurse for a free telephone consultation at 919-968-4656.

How to conceive after tubal ligation?

Deciding to have children is a big step just as the decision not to have them also is.  Most times women will take precautions to prevent further pregnancies- including tubal ligation, which is when the fallopian tube is cut to prevent an egg from becoming fertilized. This is generally the most popular method and is considered to be a permanent form of female sterilization.

So, what happens when a woman changes her mind and decides she wants another child?  The first question they want to know is how to conceive after tubal ligation?

Even though this is meant to be a permanent procedure it doesn't mean that the future is set in stone. In fact, a woman can opt to have it reversed. It is a procedure called tubal ligation reversal and it has proven to have a high success rate. The doctor usually performs them in the office in less than an hour.  

Many women choose to have this procedure when they have changed their mind about more children, or if it has been changed for them. Sometimes this decision is their own doing and sometimes it is strictly based on life circumstances. Divorce, death and remarriage of a spouse or something as simple as just changing their mind can all lead to making this monumental choice.


If you decide to go this route there are a few things that you should know about the procedure.  First of all, it is usually not covered by insurance which makes you responsible for the entire bill. Some insurance companies may cover a portion or the doctor’s office may have a payment plan of some kind. The good news is that without complications the recovery time is quick and as the months progress your chances of becoming pregnant should continue to improve.

There is another option, but it does not reverse the ligation. It is called an IVF, or in vitro fertilization. Here, a fertilized egg is placed in the woman's uterus. But it is not the preferred choice for the following reasons.  The procedure is quite expensive and must be done for each cycle where a woman wants to try to get pregnant.  If it doesn't take, which is common, then she must start over. That means more money each time she tries.  

Source: www.tubal-reversal.net

June 21st 2010 (ezinearticles) How to Conceive After Tubal Ligation - What a Woman Must Know

Chances of Getting Pregnant After Tubal Ligation Reversal

When a woman wants to have a baby, she can have the most emotional and gut wrenching feelings in her heart day after day. However, when a woman has had her tubes tied and then realizes that she made a big mistake, the overwhelming sense of guilt and anguish can be too much to bear. She may have changed her mind due to a life change such as the loss of another child or even a new marriage. No matter what the reason, her primary goal becomes how to improve her chances of getting pregnant after having a tubal ligation.

She might go to her gynecologist who would possibly give her incorrect information that the only way she could get pregnant is by having an in vitro fertilization. Anyone who has ever checked into IVF knows that it's extremely expensive and it does not have an overly high success rate. In fact, women who have experienced infertility and have done IVF treatments will often tell you that they spent their life savings doing these treatments month after month. Some women are successful and end up having children. However, there are many others who spent tens of thousands of dollars only to end up with no baby.

It should be good news for women who have had a tubal ligation to know that there is a procedure called a tubal ligation reversal. This procedure is similar to a man's vasectomy reversal as the tubes are reattached so that in an egg can move down the fallopian tubes. Although they are not always successful, nothing is. However, once a woman has a tubal ligation reversal procedure, she has the ability to get pregnant each month which is unlike IVF. With IVF, a woman would only have the chance to get pregnant at the time she has the procedure. Once that month has passed, unless she wants to pay more money, her chances of getting pregnant are eliminated.

During a recent 8 year study conducted by the Chapel Hill Tubal Reversal Center, it was found that the pregnancy rate after having tubal reversal was much higher than that of IVF in every age group. Because a woman can get pregnant month after month once having had a reversal, the chances of getting pregnant continue to increase over time. Therefore, the chances of getting pregnant with a tubal ligation reversal surgery are much higher and more stable than those of IVF. If a woman wants to continue trying to have a child, it would be best for her to invest her money in having a tubal reversal surgery rather than repeated IVF unless there is some other medical reason why her doctor thinks she should do so.

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.

IVF or Tubal Reversal?

Pregnancy After Tubal Ligation: IVF or Tubal Reversal?

A Chapel Hill Tubal Reversal patient, Cyndi, describes to Dr. Monteith how she was trapped in an abusive marriage and had a tubal ligation. After divorcing and meeting her current partner, Steven, she wanted to have another child with him. She then describes being talked out of tubal ligation reversal and into IVF by an infertility specialist, only to discover that IVF is illegal for unmarried couples in the state of Arkansas.

The following replies are from those posted at IVF or Tubal Reversal in forum After Tubal Reversal at Tubal Reversal Message Board:

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Posted by cindy0714 (Member # 13204) on January 06, 2009 08:13 PM:

This story is so familiar. My husband and I were also told our chances would be better through IVF than tubal reversal. IVF failed and broke our hearts. Now here we are 4 years later at CHTRC. I will be having my TR in March. Good Luck to you Cyndi.

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Posted by magdvn (Member # 12680) on January 06, 2009 11:30 PM:

I was told by a fertility specialist that IVF was a better option for us since I was almost 40 and would most likely only want one more child. My husband and I were led to believe that since I had had no problem getting pregnant in the past and he had no abnormal tests that we were almost assured to get pregnant. After $15,000 and no pregnancy (and no frozen embryos to try again) we were very disappointed.

We decide to have TR done because at least then we could try every month instead of a one time deal. I wish we would have done the TR much earlier and instead of IVF.

Merill

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Posted by pam mills (Member # 617) on January 07, 2009 05:32 AM:

Thank you ladies for your input. As your stories confirm, this issue is more common than we like to think. Many people are not even aware that tubal reversal is an alternative to IVF. I am so happy that you have found your way to Chapel Hill Tubal Reversal Center and I look forward to meeting you when you arrive in Chapel Hill.

Pam Mills, CRNA

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Posted by Martha, LPN (Member # 12781) on January 07, 2009 09:03 AM:

Thank you for this blog Dr. Monteith. We get frequent calls where we explain to women that with tubal reversal surgery, once the tubes are repaired, the chance of pregnancy can occur each month naturally. With IVF, medications must be administered by injection and a minor surgical procedure is performed each time pregnancy is attempted. Compared with current national IVF statistics, tubal reversal surgery at Chapel Hill Tubal Reversal Center has a higher pregnancy rate and it is more affordable than IVF.
Martha
Martha

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Posted by BirthdayBaker Judy (Member # 10176) on January 07, 2009 05:13 PM:

Just wanted to add a bit of my story for those over 40. I was 41 when I had my TR and 42 with my perfectly normal PG and delivery.
Judy
TR 10/16/2006
PG --1st try BFP 2/22/07
Delivery 11/2/07 baby boy 10# 7oz and 22.5 inches.
Vaginal delivery -- no pain meds.

Baby Joey is approx. 27# and 33" today at 14 months old. He's walking, reading words, knows colors, and numbers but isn't forming and using words just yet. He was tongue tied at birth and it took us 6 months to find a DR that would fix the issue. (This is a common family birth defect for me.)
I wish you all our same success.

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Posted by mommeeof3 (Member # 11929) on January 07, 2009 06:33 PM:

I think tr and ivf are both wonderful. I did tr first to end up with ectopic and after months of ttc that's all I got. To me with ivf you have 2 be a good candidate 4 it. I did it once transferred 2 eggs and I am currently 15weeks pregnant with twins.I don't regret either decision that I made cause the tr was about being whole again and that's how I feel WHOLE! We try and we get errors. I wish you all happiness with your decisions.

More information about IVF vs Tubal Reversal

National Infertility Week - What About Infertility Because of a Tubal Ligation?

During National Infertility Week, starting today October 20th, a lot of attention in the media will be given to the treatment of In Vitro Fertilitzation (IVF). This is a technologically advanced treatment for most causes of infertility. But what about those couples who want to have a baby but can't because of a previous tubal ligation? There are hundreds of thousands of infertile couples in this group in the US. Is IVF the best treatment for them? Let's compare the two treatments to see which might be the best one for women whose tubes have been tied.

Tubal reversal is a method of rejoining the fallopian tubes where they were cut. The preparation is minimal for the surgery and includes reviewing your tubal ligation operative records. The operation takes about an hour and is done as outpatient surgery at Chapel Hill Tubal Reversal Center. This cuts the cost in half or less than if done as an in-hospital operation.

Now let's look at IVF in comparison. There are hormonal shots that you have to get in order to stimulate your body's egg production and also to keep it from going into ovulation prematurely. These can take from one to two weeks or longer and are just the preparation part.

Next will be the removal of your eggs. Of course, the doctor will need to be sure of the right time to do so and will do this by monitoring with hormonal blood tests and ultrasound exams to be sure to catch the eggs at the right time. Your system has been stimulated to produce many more eggs than normal. You will get another shot before ovulation is due. Then, when all is ready, the doctor will use a needle to remove the egg.

Now, comes the part you have been taking all those shots for. You will have the fertilized eggs implanted into your body. This will happen after some time in the lab where the fertilization and the beginning development of the embryo takes place. You will most likely get several fertilized eggs, which actually have begun developing into embryos, placed back into your uterus. You will get more injections at this point as well.

This is when you hold your breath hoping everything will go OK. Of course,this will depend upon things like how skilled your doctor is and how careful he was in implanting the embryos among other things. If it doesn't work, you may have had some extra embryos frozen.

Before you make a decision to have IVF done, you should probably take a look at the success rates. Most commonly the success rates of any one cycle are given as 20 - 30% that you will be successful. You have a higher likelihood of success with more eggs implanted but don't want to go overboard as that could lead to some problems as well. You will find that three embryos is about the most any doctor will implant. Still, one in every three pregnancies that occur after IVF is a multiple pregnancy. Babies conceived as a result of IVF are more likely to be born prematurely and have health problems later in life.

Getting back to the option of tubal reversal, the success rates will vary depending upon your chosen surgeon. This makes choosing the best tubal reversal doctor and center a matter of utmost importance. At the Chapel Hill Tubal Reversal Center - the only facility where they publish their specific pregnancy rates after a tubal reversal, you will see that it is an overall 70%. Your potential success rate will depend upon several things including your age, tube lengths left for repairing, and type of ligation procedure used. The good news is that once the surgery is done, you get to try over and over again to "make a baby" every month without having to pay any more money.

And that's the last thing to cover. One session, or cycle, of IVF will cost on average $10,000 to $12,000 with most patients being told to expect to undergo at least three cycles. That's $30,000 or more for most couples who start treatment by IVF. The average cost of a tubal reversal varies widely, but at Chapel Hill Tubal Reversal Center it ranges between $5400 and $6900 depending upon which option you choose. So with a higher success rate, lower cost, and the opportunity to become pregnant month after month, what do you think tubal reversal now? It may not be as well known or advertised as IVF, but during National Infertility Week, it should certainly be recognized as the best treatment for women wanting to become pregnant again but who are infertile because they had their tubes tied in the past.

Should You Have an HSG after Tubal Ligation Reversal?

The Chapel Hill Tubal Reversal Center gets asked a lot about HSG by women after tubal reversal surgery. They are questioning whether their tubes are really open, regardless of the checking Dr. Berger does during the surgery, and want to do this procedure. However, there are concerns about this being done too quickly.

First off, you may be wondering just what a HSG or hysterosalpingogram is. Maybe your doctor mentioned getting it done or you have heard of it elsewhere. An HSG is essentially a real time x-ray procedure done under a fluoroscope. It is done as an outpatient procedure that doesn't take very long.

You will lie on your back on a table. A speculum is placed into your vagina. If you have had a pap smear done, you are familiar with this type of device. Your cervix is cleaned and then opened slightly. A cannula, or flexible tube, that is inserted through the cervix is used to introduce an iodine based "contrast" material which will show up on the x-ray. As this contrast material shows up as an opaque material, the doctor can watch the flow as it moves through your uterus, up through your fallopian tubes and spills out of them into the abdominal cavity.

Your doctor may have you move from your back to one side and then to the other in order to get the "dye" to flow into your fallopian tubes. Some doctors may even try to force the material past any blockages by adding a lot of the material into your uterus.

Some women experience only very mild cramping during the HSG whereas others say it very painful. Some have also reported feeling as if they were going to pass out. It is highly suggested you take at least 600mg of ibuprofen one hour before the procedure is done. If you do have problems with pain, it is also highly suggested you discuss this with your doctor before the procedure is done.

One suggested reason for the pain by women who have had this done is due to "debris" being within your uterus. This is why you should have this done after menstruation but before ovulation. This allows most of the debris from a cycle to be removed first. You do not want it done after ovulation as it is possible it could interfere with potential pregnancy.

Some possible risks include a risk of infection which might damage your tubes requiring removal, fainting (as mentioned above), iodine allergic reaction or spotting. If the spotting continues past one or two after the procedure or becomes heavy, the patient should notify her doctor. If you have an allergy to iodine or seafood, a non-iodine version of the procedure should be done. Be sure to tell your doctor if you are allergic.

As for minimizing the risk of infection from the procedure, Dr. Berger of Chapel Hill Tubal Reversal Center says you should use a betadine vaginal douche the evening before and the morning of the procedure. You should also get a prophylactic antibiotic prescription from your doctor.

If you want to do this procedure after tubal reversal, Dr. Berger recommends waiting at least six to 12 months. Using his own tubal reversal statistics, he has found that 70% of women will conceive within 12 months of having the surgery. The mean time to conception is 10 months.

Too often, however, even given all the above, he finds the procedure does not give conclusive results. The dye may not make it into the fallopian tubes because of a spasm or mucus or calcium deposits. Or not enough dye is used meaning it will not spill into the abdominal cavity even if it makes it past the tubal anastomosis site. The radiologist, however, may mistakenly interpret this as meaning there is a blockage.

So if you are considering doing a HSG after tubal reversal, it is much better to wait till at least a year past your tubal reversal surgery. Most of Dr. Berger's patients will conceive in less than a year proving that the tubes are open. That means you don't have to go through a potentially risky, expensive, and painful procedure that may be inconclusive.

Reversing tied tubes - YouTube Videos

Reversing Tied Tubes
Tubal reversal doctors are reproductive surgeons who specialize in reversing tied tubes. There are few such specialists available in the US or other countries because of the lack of advanced training programs in reverse tubal ligation surgery. Fortunately, Chapel Hill Tubal Reversal Center has two tubal reversal doctors with the most experience in the operation called tubal anastomosis and who limit their practice to reversing tied tubes.

Chapel Hill Tubal Reversal Center has a YouTube channel with informative videos about tubal ligation reversal. These include the actual tubal anastomosis operation, facts about tubal ligation and reversing tied tubes, cost, a virtual tour of Chapel Hill Tubal Reversal Center, meeting the nurses and surgical technicians, and discussions by Dr. Gary Berger about why he specializes as a tubal reversal doctor and the reality of hope that he offers couples wanting to have children. These are "must watch" videos for anyone thinking about having their tubes untied.

Tubal Reversal You Tube Channel

YouTube Videos from Chapel Hill Tubal Reversal Center

Tubal Ligation Reversal "The Operation"

Dr. Gary Berger is the leading authority on tubal reversal. His technique of outpatient tubal ligation reversal has been featured on Discovery and other television networks. Watch how Dr. Berger restores fertility after a tubal ligation through a comfortable and affordable one-hour outpatient procedure. Order the free full-length video of The Operation.

Tubal Ligation and Reversal Facts

Chapel Hill Tubal Reversal Center nurses discuss important facts regarding reverse tubal surgery with Dr. Gary Berger and Dr. Charles Monteith. These include how to determine if reversing tied tubes is the best option, success rates following tubal reversal surgery, and the fact that Chapel Hill Tubal Reversal Center is the only facility dedicated solely to the practice of tubal ligation reversal.

Virtual Tour of Chapel Hill Tubal Reversal Center

Dr. Gary Berger discusses the mission of Chapel Hill Tubal Reversal Center during this virtual tour of the world's first and only Tubal Reversal Center. Educating patients about the benefits, risks, and success rates of reversing tubal ligations allows patients to informed decisions. Chapel Hill Tubal Reversal Center is the only facility where collecting and providing detailed, accurate information with prospective patients is part of the mission.

Is Tubal Reversal Right For You?

Tubal Reversal Center Patient Care Coordinator – Jennifer Okun, RN - answers important questions that will help you decide if reversing tubal ligation is right for you. Tubal anastomosis is the most effective option for most women who desire more children after a previous sterilization. Although untying tied tubes may not be right for everyone, listen as Jennifer Okun, RN, provides information you can use to help determine if tubal reversal surgery is the best option in your situation.

Why Chapel Hill Tubal Reversal Center?

Tubal Reversal nurses explain what sets them apart from other facilities, and why choosing Chapel Hill Tubal Reversal Center means choosing the best medical facility in the world for repairing tubes that have been tied. Chapel Hill Tubal Reversal Center is dedicated exclusively to performing tubal reversal surgery. Medical Director, Dr. Gary Berger is widely recognized as the tubal reversal doctor with the most experience. Exceptional patient care, complete and accurate pregnancy statistics, and a low cost outpatient procedure that has produced the most tubal reversal babies born worldwide are just a few of the reasons that patients travel from all over the world to have Dr. Berger perform their sterilization reversal.

Why Tubal Reversal?

Dr. Gary Berger specializes in helping families have children after a tubal ligation. He is the only doctor with a practice limited to reversing tied tubes. Dr. Berger has dedicated his career to repairing tubes that have been tied, clipped, and/or burned. Listen as Dr. Berger discusses why this special branch of reproductive surgery is important to him and how he restores fertility through his one-hour, outpatient microsurgical tubal anastomosis procedure.

Tubal Reversal Cost

Chapel Hill Tubal Reversal Center Business Office Manager, Ericka Pamplin, explains the fee options available to women who are interested in surgery at the only center dedicated to tubal reversal surgery. Three fee options, including a pre-payment plan and financing options, make the outpatient procedure affordable and available to women interested in having children after a previous tubal ligation.

Meet Our Staff

Staff members at Chapel Hill Tubal Reversal Center introduce themselves and explain their roles in the tubal reversal process. Each member of Dr. Gary Berger’s team has expertise in caring for and performing outpatient tubes reversal. A high staff/patient ratio with one or two nurses devoted specifically to each patient’s care means women receive safe, personalized, professional care and are joined by other couples who are there specifically for the same purpose.

Tubal Reversal Surgical Techs

Two surgical technicians at Chapel Hill Surgical Center describe what they do that makes tubal sterilization reversal safe and effective. Listen as they describe the benefits of working with Dr. Gary Berger where personalized care is easier to ensure in the small, private, outpatient setting than in a large hospital and how a higher clinical staff to patient ratio than in a hospital allows staff to concentrate all of their attention on the safety and comfort of tubal reversal patients.

The Reality of Hope

Meet Dr. Gary Berger and listen as he discusses his belief that tubal reversal surgery provides hope to women who have changed their mind after a tubal ligation and now desire to have more children. Dr. Berger and his team at Chapel Hill Tubal Reversal Center understand that reversing tied tubes is more than just surgery; it is hope for a new beginning. Providing hope – realistic hope – is part of the philosophy Dr. Berger brings to his patients.

Order Your Free Full Length Video of Tubal Ligation Reversal "The Operation"

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.

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!!"

Why Women Get Tied Tubes Untied

Some women seek to have their tubes untied for many reasons other than to have another child after tubal ligation. Some of the reasons are to: relieve symptoms associated with a tubal ligation (PTLS), feel whole again, be like God intended them to be, comply with their religious tenants, relieve regret of a prior mistake, correct a decision made during a past and difficult relationship, or fill the emptiness from the loss of a child or another loved one.

Over a year ago, I approached Dr. Berger at Chapel Hill Tubal Reversal Center to start a new career as a tubal ligation reversal specialist. When I started to pursue my interest and training in tubal reversal surgery, I naively thought that only women who wanted to have another child had their tied tubes untied. I have come to realize that some women seek to have their tubes untied for many reasons other than to have another child after tubal ligation.

Of course the number one reason is to have more children, but there are many more and equally important reasons patients give. Some common reasons patients come for tubal ligation reversal are to:

• relieve symptoms associated with a tubal ligation (PTLS)
• feel whole again
• be like God intended them to be
• comply with their religious tenants
• feel more like a woman
• relieve regret of a prior mistake
• correct a decision made during a bad relationship
• fill the emptiness from the loss of a child or another loved one

As a generalist ob/gyn, I was always keenly aware of how many women bore both the burden of having children and the burden of sterilization. It was only after I became a ligation reversal specialist I saw how heavy the burden of tubal ligation could be. Now I have the opportunity to help in these situations and feel gratified that my training as a tubal reversal surgeon is progressing nicely under Dr. Berger’s mentorship.

Submitted by Dr. Charles Monteith
Tubal Reversal Specialist in Training
Chapel Hill Tubal Reversal Center

2 Responses to “Why Women Get Tied Tubes Untied

1. Joy Bryant Says:
   June 21st, 2008 at 2:33 pm
   There are a few good reasons I chose to have a tubal reversal. The main reason is because my husband now forced the issue since he doesn’t have children of his own. My kids who are older now (13 and 11) would love to have a new sibling who is part of me as well as their stepfather. It is a HUGE decision that needs a lot of thought and time put into it. I will be 32 tomorrow and I had been thinking of doing it since I was 28. I am happy to say we are going to TTC later this summer. Many thanks to Chapel Hill staff. Thanks a bunch for giving me this wonderful opportunity to be a new mother again.
   Joy


2. Dr. Berger Says:
   June 21st, 2008 at 3:52 pm I find this to be a most interesting topic. Dr. Monteith’s comments update a previous blog topic that I wrote about Why Tubal Reversal.

####

This is topic Why Women Get Tied Tubes Untied in forum After Tubal Reversal at Tubal Reversal Message Board.

Posted by Gary S Berger MD (Member # 3) June 21, 2008 01:55 PM:
Dr. Monteith just posted a new topic on the Doctors Blog section of our website about the reasons women have given to the question why tubal reversal? I thought that this topic may be of interest to some of the members of the message board. You are welcome to post comments on the blog.
Here is a link to his post:
http://www.tubal-reversal.net/blog/2008/tubal-ligation-reversal/why-tied-tubes-untied.html

Posted by jarz (Member # 9286) June 21, 2008 02:38 PM:
It is so true. I did get a TR to have another child but throughout the journey as a matter of fact just soon after my TR I felt like "myself" again, I felt something more was fixed or returned to me that had been taken away without me even really knowing it. I even told my husband a few months after that even if we did not ever have another child, it was money well spent for the what it had given back to my life. Jo

Posted by karend (Member # 10442) June 21, 2008 05:42 PM:
We are so thankful to Dr. B and staff for the chance of becoming new parents again has been a great journey and such a miracle for us!!

Blog Topics Suggested by Tubal Reversal Patients

Chapel Hill Tubal Reversal Center recently asked Tubal Reversal Message Board members to submit ideas for future topics to be addressed in the Doctors Blog.

Here are some of the topics that have been suggested so far:
• Tubal ligation effects on a woman’s body
• Tubal ligation risks
• Pregnancy outcomes and other issues for older women
• Information to help educate other doctors

If you would like to add suggestions for other topics, please post on the Doctor’s Blog Suggestions thread on the Message Board.

At Chapel Hill Tubal Reversal Center, we are dedicated to patient education about all aspects of tubal ligation reversal. We welcome your ideas and want to address your questions and concerns about tubal ligation, tubal reversal, or pregnancy after a tubal ligation reversal.
Submitted by Dr. Charles Monteith
Chapel Hill Tubal Reversal Center
DrMonteith@tubal-reversal.net
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Posted by brenda0704
What I would like to see discussed is the effects of TL on a woman's body and how much TR helps to correct these things. My main concern is how much damage is done to the ovaries and can that function be restored. I am very concerned about early menopause, because I am only 36 and not ready for that. I also would like to know exactly what causes sexual dysfunction after TL and if I will get my function back if I get a TR, because right now it almost feels like castration!
Thanks,
Brenda
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Posted by Rhonda Brown, RN
Dear Brenda,
Thank you for your suggestions. Keep your eye on the blog for new information.
Rhonda
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Posted by Scarlet04
I know you asked for the girls to let you know the responses their getting when dealing with their Dr.'s about TR but what about a blog that helps us explain to our Dr.'s what they need to know in dealing with us as TR patients that have become pregnant and some of the misconceptions that doctors have about the success rate of TR's with pregnancy. It took me calling 6 different OB doctors offices to finally get someone to take me seriously. I kept referring them to your website. The doctor I did find, sees a TR patient of yours and she is currently 7 months pregnant. She was totally excited to have me as a 2nd TR patient of yours. Dr. Berger, do you do very many public forums or conferences for Dr.'s to attend? I know you have patients from all over the world come to see you and that would be a big audience to try to get your message out to but I don't think many Dr.'s are doing their research on the internet or they just don't know to look for you. Trisha
ME-37
DH-32
DS-12
DS-10
DS-8
DS-3
TR- 5/22
L-5.5, R-7
Denver, CO
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Posted by Gary S Berger MD
Thanks, Brenda and Trisha. Dr. Monteith and I will address these issues in future blog topics.
I think that Trisha is right about needing to get the message to other doctors at conferences and public forums. Until now, I have been concentrating on developing our website as the primary way to communicate all of the information we have. In the future, I will plan to devote more time to providing information to doctors through publications in medical journals and presentations at medical conferences.
--------------------------------------------------------------------------------
Posted by Blessings
I think that is a awesome idea Dr. Berger. So many, if not 99% of doctors are ignorant to fact that there are risks with having a TL. If I had known the risks before hand and could have made an intelligent decision knowing all the pros and cons then I would have never had the TL to begin with. But, I spent 7 months talking with my DR. about the TL with my concerns and worries and he assured me that it would not effect anything except I would not have to worry about BC.
I am grateful, if for nothing else that I feel normal again.
I am truly grateful for all that you do and I am so happy that Dr. M will be doing these TR's too. We need more Dr.s doing these out there.
Blessings,
Christie
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Posted by Gary S Berger MD
Dr. Monteith has just posted on the Doctors Blog asking for others to add their suggestions on this message thread. The blog topic is entitled Blog Topics Suggested by Patients. Here is a summary:
"We recently asked Tubal Reversal Message Board members to submit ideas for future topics to be addressed in the Doctors Blog.
Here are some of the topics that have been suggested so far:
• Tubal ligation effects on a woman’s body
• Tubal ligation risks
• Pregnancy outcomes and other issues for older women
• Information to help educate other doctors
If you would like to add suggestions for other topics, please post on the Doctor’s Blog Suggestions thread on the Message Board."
--------------------------------------------------------------------------------
Posted by Jennifer Okun, R.N.
Please continue to write in with any ideas you have. This really helps us to be able to provide our patients and potential patients with information on topics they are most interested in.
Thank you,
--------------------------------------------------------------------------------
Posted by PaulnJenn
Here are some more suggestions....
http://forums.tubal-reversal.net/ubb/ultimatebb.php/topic/6/3186.html#000000
Jenn
--------------------------------------------------------------------------------
Posted by momto10
How about a blog about the effect hormones have on a woman's daily life?
OR
The signs of a hormonal imbalance.
Gwen
--------------------------------------------------------------------------------
Rhonda Brown RN Says:
I think that this is a great idea. It is always nice to know what women are looking for as far as information in regarding to tubal reversal surgery. Information can help a women make the best decision for herself as well as her family. Putting patients first, just another example of exceptional patient care.
Donna Sisson, ST Says:
Another great way for Dr. Berger and Dr.Monteith to be sensitive to women’s needs. Your thoughts and suggestions are very important to Chapel Hill Tubal Reversal Center.
Ericka Says:
Understanding what questions patients have allows us to focus on their specific concerns. Feedback is always welcome!
Stephanie Duncan Says:
We always like questions! I think it is great that women are responding and letting us know what topics are of interest to them.
Jennifer Okun Says:
Asking patients directly to inquire about what topics they are interested in and need more information about is a great idea. This really facilitates meeting the needs of patients when they are able to directly communicate which information they are most in need of.
Pamfmills Says:
Patient education is so important, especially in a field like tubal reversal. Informed patients make better decisions for themselves and can truly participate in their care. I just love the fact that I work at a facility that promotes patient knowledge
Kathy Sronce ST Says:
This helpful idea just opens the door for patient - physician communication. I think it helps patients feel that they are a part of their tubal reversal process. Chapel Hill Surgery Center helps to educate their patients as well as care for them.

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.