Tubal Reversal Blog December, 2007

Patient’s History

Ana G. was one of the 4 patients I operated on today at Chapel Hill Tubal Reversal Center. She is a 28 year old woman from Angola, the mother of 3 children - ages 9, 8, and 6. She married when she was 15 and was in an abusive marriage. To keep from becoming pregnant again, she had a tubal ligation. When she had this done, all she could think about was not becoming pregnant again.

Ana eventually ran away and divorced her husband. Several years later she met a man who she fell in love with and who has treated her very well. He has no children. Now remarried, Ana feels that her second husband will want children in the future, so she decided to have a tubal ligation reversal. Although she doesn’t intend to become pregnant soon, she says that if it happens that would be fine.

Ana’s Tubal Reversal Procedure

Ana’s tubal reversal was performed by the technique of tubotubal anastomosis. Her fallopian tubes were in excellent health, with no fibrosis and with normal fimbriae and tubal endothelium. The anastomoses were isthmic-ampullary on the right and isthmic-isthmic anastomosis on the left. The tubal lengths after repair were 6.5 cm on the right and 8 cm on the left side.

Dr. Berger’s Comments

Every patient who comes to Chapel Hill Tubal Reversal Center has a unique story to tell that led up to the decision for a tubal reversal procedure. Divorce and remarriage is a common theme, and a history of abuse in the prior marriage is often one of the reasons given for the divorce.

Ana’s story is unusual in that she married at age 15 and had her tubal ligation by age 21. This may be due to the cultural differences in some African countries from the US. Although most of our patients come from the United States, couples come from many other countries to have me perform their tubal reversal surgery.

Although Ana’s operative report stated that Filshie clips had been applied to her tubes, no clips were found during surgery. It is not clear whether the operative report was incorrect, or whether the clips migrated to other locations in the abdominal cavity. This can occur if the pressure from the closed clips causes necrosis or death of the tissue within the clip. I have seen this occasionally in other patients.

Predicted Outcome After Ana’s Tubal Reversal

Based on her age and tubal lengths, Ana’s probability of becoming pregnant is 90% as documented in the post tubal reversal pregnancy statistics among patients at Chapel Hill Tubal Reversal Center.

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 Sterilization For Young Women With No Children

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).

I have encountered other cases like this in the past. I wonder if the doctor who performed her tubal ligation considered the possibility that the patient might change her mind, and therefore it would be preferable to perform a tubal ligation better suited to reversing at a later time, should the need arise.

Comments Welcome

I am interested in what other people think about this.

See Tubal Ligation Ethics - Part 2. There are also more pages about the Ethics of Tubal Ligation on the Chapel Hill Tubal Reversal Center web site.

Tubal Anastomosis at the Uterine Cornua

Tubouterine anastomosis is a tubal reversal procedure that is intermediate between tubotubal anastomosis and tubouterine implantation. It is also called cornual anastomosis because the tube is joined to the cornual area of the uterus with this operation. The cornu is the area where the fallopian tube normally emerges from the the uterus.

When Is Tubouterine Anastomosis Performed?

Tubouterine anastomosis is performed when there is a healthy tubal segment near the ovary, but no segment remains attached to the uterus, following a tubal ligation procedure. It is also performed when a tubal segment attached to the uterus is scarred and has no open lumen.

An incision is made into the uterus at the cornu to find the opening of the fallopian tube tube as it passes through the uterine muscle. If an opening is found, the tubal segment that remains is rejoined to the uterus at this site.

Case Histories

The topic of tubouterine anastomosis is a timely one. During the past week, 2 patients undergoing tubal reversal surgery at Chapel Hill Tubal Reversal Center required this operative procedure. In one case, each fallopian tube had been coagulated or burned next to the uterine cornu, leaving no segment attached to the uterus. The other patient had developed the condition known as salpingitis isthmica nodosa in the portion of the fallopian tube between the uterus and the a Falope ring. In both cases, tubal reversal was able to performed with the technique of tubouterine anastomosis.

Dr. Berger’s Comment

Frequently, patients have been informed by doctors who are not specialists in tubal ligation reversal that their fallopian tubes cannot be repaired after a tubal ligation. This is especially true when the proximal segments of the fallopian tubes are missing or diseased. But there are a variety of surgical techniques that can be used during tubal reversal surgery by a doctor who is an experienced tubal reversal surgeon. This is one of the advantages patients have when they come to Chapel Hill Tubal Reversal Center for their tubal reversal procedures.

Salpingitis Isthmica Nodosa

Salpingitis isthmica nodosa is a nodular swelling of the isthmic segment of the fallopian tube. This fallopian tube abnormality is sometimes encountered at the time of tubal reversal surgery. It often involves the interstitial portion of tube that is within the uterine muscle. The nodule is due to thickening of the muscular wall of the tube around ingrowths or projections of the inner mucus membrane tubal layer into the muscle.

History of Salpingitis Isthmica Nodosa: Scholarly Publications

This tubal abnormality was first described and named by Chiari in 1887 .⁽¹⁾ The name he gave it reflected his belief this was an inflammatory condition. (Salpingitis means inflammation of the fallopian tube.) His contemporary, Kossman, also thought this was an inflammatory condition.⁽²⁾ An alternate theory of causation was suggested by Recklinghausen in 1896 who believed it to be a congenital abnormality.⁽³⁾ A third possibility, suggested by Benjamin and Beaver in 1951, is that SIN is an acquired, noninflammatory condition.⁽⁴⁾ They believed that the lesion begins as an overgrowth of the inner tubal lining that penetrates into the tubal muscular wall. Then cysts form and the tubal muscular wall becomes enlarged and fibrotic. This has also been termed endosalpingosis, a condition closely related to uterine adenomyosis (a form of endometriosis in which the uterine endometrium grows into the uterine muscle).

HSG Diagnostic Findings

Salpingitis isthmica nodosa can be diagnosed radiographically. A hysterosalpingogram or HSG shows multiple small diverticuli or outpouchings of of x-ray dye protruding from the tubal lumen into the wall of the isthmic portion of the fallopian tubes. Because of its appearance at HSG, radiologists call it tubal diverticulosis.⁽⁵⁾

Clinical Implications

Salpingitis isthmica nodosa is associated with increased rates of infertility by interfering with upward sperm migration and ectopic pregnancy by trapping the fertilized egg within the tube.

Treatment During Tubal Reversal

Salpingitis isthmica nodosa may be encountered at the time of tubal reversal surgery. Because of the dense abnormality of the fallopian tube at its connection with the uterus, tubotubal anastomosis is not possible. In this situation, tubouterine anastomosis or tubouterine implantation can be performed.

Tubal Reversal Scholarly Publications

Early Experimental Studies in Animals

In 1969, David, Brackett and Garcia ⁽¹⁾ reported using microsurgical techniques for uterotubal anastomosis after removing the uterotubal junction from one side in 25 rabbits. Among 11 (44%) of the animals that became pregnant, fewer implantations occurred on the operated side than on the unoperated side. This showed that the uterotubal junction has a role, but is not absolutely required, in transferring embryos from the fallopian tube into the uterus for implantation.

In 1974, Paterson and Wood ⁽²⁾ divided the isthmic segment of one fallopian tube and then performed tubal anastomosis in 10 rabbits. They removed the fallopian tube and ovary on the other side so that any pregnancies that followed could be attributed to the repaired fallopian tube. The pregnancy rate was 60%. These investigators suggested that tubal anastomosis could be applied successfully to humans for reversal of tubal sterilization.

Hulka and Ulberg ⁽³⁾ in 1975 were the first to perform a successful reversal of tubal sterilization under experimental conditions. Six weeks after applying Hulka clips to the isthmic portion of fallopian tubes in 8 pigs, they removed the clipped portion of tubes and performed tubal anastomosis using an absorbable, multifilament suture (6-0 Dexon). Six (75%) of the animals subsequently became pregnant.

In 1975 Winston ⁽⁴⁾ reported an experiment in rabbits in which the experimental variables were different suture materials and duration of tubal splinting. In one group of 25 rabbits, he removed a portion of the tubal isthmus or ampulla and then performed tubotubal anastomosis with a nonabsorbable, nonreactive, monofilament suture (10-0 nylon). Using microsurgical technique, Winston took special care to include only the 2 outer layers (muscularis and serosa) of the fallopian tube in the suture line, avoiding the inner tubal layer (endothelium). He stabilized the anastomotic sites with polyethylene splints that were removed before closure of the abdominal cavity. Twenty-three (92%) of the animals became pregnant. This was the highest pregnancy rate reported so far after tubal anastomosis in animal studies. When either 8-0 catgut was used as the suture material or the tubal splint was left in place for 1 week after surgery, the pregnancy rate dropped in half.

Winston’s results were subsequently corroborated using microsurgical tubal anastomosis with 11-0 nylon, intraoperative splinting, and avoiding mucosal trauma from suture in the reconstruction of rabbit oviducts six weeks after application of Falope rings. Eighteen (82%) of 22 rabbits became pregnant after two matings.

Comment

Experimental studies in animals demonstrated excellent pregnancy rates following reconstruction of the fallopian tube by tubal anastomosis. They provided the basis for tubal reversal surgery as a clinical treatment. The best results came using microsurgical techniques with non-reactive, monofilament suture material, intraoperative tubal splints, and avoiding the introduction of suture in the inner layer of the tube.

Dr. Berger uses these surgical techniques in his tubal reversal procedures. For a more complete description of the early history of tubal reversal surgery, read Dr. Berger’s book chapter, Reversal of Female Sterilization: An Evaluation of Results ⁽⁵⁾.

References

1. David A, Brackett BG, Garcia CR: Effects of microsurgical removal of the rabbit uterotubal junction. Fertil Steril 20:250, 1969
2. Hulka JF, Ulberg LC: Reversibility of clip sterilization. Fertil Steril 26:1132, 1975
3. Paterson P, Wood C: The use of microsurgery in the reanastomosis of the rabbit fallopian tube. Fertil Steril 25:757, 1974
4. Winston RML: Microsurgical reanastomosis of the rabbit oviduct and its functional and pathological sequelae. Br I Obstet Gynaecol 82 :513, 1975
5. Berger GS: Reversal of female sterilization: An evaluation of results. In JM Phillips, editor, Microsurgery in Gynecology, Chapter 33. American Association of Gynecologic Laparoscopists, Downey, California, 238-243, 1977.

Gary S Berger MD, Medical Director of Chapel Hill Tubal Reversal Center, is well known for his contributions to clinical medicine as a reproductive surgeon. Patients sometimes ask about Dr. Berger’s education, training, academic credentials, scholarly research and publications.

This is a resume of Dr. Berger’s academic credentials:

ACADEMIC DEGREES

1965 A.B. with Honors
Harvard College
Boston, Massachusetts

1969 M.D.
University of Rochester
Rochester, New York

1976 M.S.P.H.
University of North Carolina
School of Public Health
Chapel Hill, North Carolina

POSTGRADUATE EDUCATION

1969 - 1970 Intern
Department of Internal Medicine
Duke University Hospital
Durham, North Carolina

1970 - 1971 Assistant Resident
Department of Gynecology and Obstetrics
Johns Hopkins Hospital
Baltimore, Maryland

1971 - 1973 Epidemic Intelligence Service Officer
Family Planning Evaluation Program
Bureau of Epidemiology
Centers for Disease Control
U.S. Public Health Service
Atlanta, Georgia

1973 - 1976 Resident
Department of Obstetrics and Gynecology
University of North Carolina
Chapel Hill, North Carolina

ACADEMIC APPOINTMENTS

1976 - 1979 Assistant Professor
Department of Obstetrics and Gynecology
University of North Carolina at Chapel Hill
Chapel Hill, NC

1980 - 2003 Adjunct Associate Professor
Department of Maternal and Child Health
School of Public Health
University of North Carolina at Chapel Hill
Chapel Hill, NC

1992 - 2003 Clinical Associate Professor
Department of Obstetrics and Gynecology
University of North Carolina
Chapel Hill, NC

SCHOLARLY PUBLICATIONS

Dr. Berger has published more than 160 peer-reviewed scientific articles in medical journals. He has also authored or edited these medical books:

D.A. Edelman, G.S. Berger and L.G. Keith. Intrauterine Devices and Their Complications. G.K. Hall, 1979.

L.G. Keith, M. Labbok, J. Petty, and G.S. Berger. Postpartum and Postabortal Contraception. Synapse Publications, 1979.

L.G. Keith, D.R. Kent, G.S. Berger, and J.R. Brittain, editors. The Safety of Feliility Control. Springer Publishing Company, 1980.

M. Jackson, G.S. Berger and L.G. Keith. Vaginal Contraception. G.K. Hall, 1980.

L.G. Keith, G.S. Berger and D.A. Edleman, editors. Infections in Reproductive Health: Common Infections. Vol. I, MTP Press Ltd., 1985.

L.G. Keith, G.S. Berger and D.A. Edelman, editors. Infections in Reproductive Health: Uncommon Infections and Special Topics. Vol. II, MTP Press, Ltd., 1986.

M. Bygdeman, G.S. Berger, L.G. Keith, editors. Prostaglandins and Their Inhibitors in Clinical Obstetrics and Gynecology. MTP Press, Ltd., 1986.

G.S. Berger, M. Goldstein and M. Fuerst. The Couple’s Guide to Fertility. Doubleday and Company, 1985.

G.S. Berger, L.V. Westrom, editors. Pelvic Inflammatory Disease. Raven Press, 1992.

C. Nezhat, G.S. Berger, V.C. Buttram, and F. Nezhat, editors. Endometriosis: Advanced Management and Surgical Techniques. Springer-Verlag, 1995.

G.S. Berger, M. Goldstein and M. Fuerst. The Couple’s Guide to Fertility, revised edition. Doubleday and Company, 1995.

G.S. Berger, M. Goldstein and M. Fuerst. The Couple’s Guide to Fertility: With the Newest Scientific Techniques to Help You Have a Baby. Broadway Books, 2001.

Dr. Berger - Clinician and Scholar

Dr. Berger’s contributions to reproductive medicine and surgery show that a clinician whose primary responsibility is in the care of individual patients can also be a scholar contributing to academic research. This is the basis of Dr. Berger’s ongoing Tubal Reversal Pregnancy Study that documents and analyzes the clinical outcomes of his patients following tubal reversal surgery.

Tubal Ligation Operations Vary

Tubal ligation operations vary in the amount of damage they cause to the fallopian tubes. Tubal coagulation (cauterization) tends to damage more of the tube than tubal ligation and resection or tubal clips/rings. Burning or cauterizing the fallopian tubes with a monopolar coagulator is more destructive than with a bipolar coagulator. With either type of coagulator, the more times the tube is burned, the greater the amount of damage that occurs.

How Much Fallopian Tube Remains After a Tubal Ligation?

The remaining amount and condition of the fallopian tubes after tubal ligation procedures varies a great deal. A patient’s tubal ligation operative report will give an indication about the remaining tubal segments that can be repaired by a tubal reversal procedure. When available, Dr. Berger always reviews the operative reports that are sent by patients to estimate the likely outcome from a tubal reversal operation.

In most cases, the tubal ligation operative report (and a pathology report if available) will help to determine if tubal reversal is possible. Until the time of surgery, the actual condition of the fallopian tubes remains unknown. This is partly because doctors differ in how they perform tubal ligation operations. With tubal coagulation procedures, for example, the coagulator can be used at different power settings and applied for varying lengths of time to the fallopian tubes. These details usually are not specified in an operative report.

Examining the Fallopian Tubes by Laparoscopy

Laparoscopy is a surgical procedure that permits viewing the fallopian tubes through a narrow telescope placed through a small incision below the belly button into the abdominal cavity. Laparoscopy can be performed for patients who want to be assured that tubal reversal is possible.

Laparoscopy is recommended in cases where the amount of tube remaining is questionable, such as after monopolar coagulation of multiple sites along the fallopian tube.

Dr. Berger performs laparoscopy under anesthesia and proceeds directly to tubal reversal, if examination shows the tubes are repairable. The patient is under anesthesia only one time. For safety reasons, screening laparoscopy is offered only to patients with a body mass index (BMI) of less than 30.

Screening Laparoscopy Cost

The additional charge for laparoscopy is $1000. If tubal reversal is not possible, the operation will end and you will receive a refund of close to 50% of the total surgery fee. The screening laparoscopy option is similar to an insurance policy. You purchase it and hope you never need it, but it is certainly nice if you do. Most patients do not elect to have the laparoscopic examination because of its additional cost and the knowledge that Dr. Berger can repair the fallopian tubes in 98% of cases, regardless of the method of tubal ligation.

People like knowing what to expect when they come to Chapel Hill Tubal Reversal Center for their tubal reversal procedure by reproductive surgeon Dr. Gary Berger, our Medical Director.

We provide a great deal of information about this on our website, in emails and letters, and by telephone.

Learn From Others on the Tubal Reversal Message Board

Another useful source of information about what to expect is the Tubal Reversal Message Board. Through the message board, women can ask questions and get responses from Dr. Berger’s staff and from others who have had their tubal reversal procedure. A message board member recently asked this question about what to expect in the Preparing for Tubal Reversal forum with the subject heading Need Details About Consultation:

“Can someone who has already had their consultation give me details about what happens at the consultation? I’m nervous ):”

She received this detailed reply from another board member:

“My wife had her tubal reversal just this week, so it is still pretty fresh for us. We went there on Monday, so the schedule of things may be different on other days.

She was very nervous; we drove down - an eleven hour drive - not sure what to expect. While there are countless messages on the board detailing great experiences, the fear of showing up and discovering either a second-rate facility or a scam were still in the back of our minds. She was also nervous about “making weight”, even though she was not even close to the BMI cutoff; my dear wife likes to fret over everything.

We met the shuttle van at the lobby of the Sheraton at 6:45; Doctor Berger’s facility is only 5 minutes down the road. When we pulled in, the courtyard gate was unlocked and open. We made our way up the stairs to the second floor, and the receptionist was ready and waiting; the waiting room up there looks like a very cozy, large, well appointed living room.

My wife got the luck of the draw and was first, so it was a very efficient, streamlined process. First up was blood pressure, height and weight. All went well, and we immediately met with Doctor Berger. He is professional, courteous, and yes, asked why we chose this. He didn’t seem judgmental about age or weight; he seemed genuinely committed to giving my wife back her reproductive rights to the best of his ability.

After that was the vaginal ultrasound. My wife preferred for me to be present; it was about 10 minutes total, minimally invasive, and yes, the nurse fine tuned the hair line for surgery.

We were immediately escorted downstairs to the surgery reception, and we were quickly greeted by one of the surgical nurses. I believe we had some very brief paperwork at that point, but we moved so efficiently, I could be wrong. We were escorted to the surgical waiting area, where she changed into a johnny and a robe, and answered some of the standard surgical questions.

My wife is no fan of needles, and we let the nurse know that previous IV experiences weren’t very good. When the nurse had trouble with the IV, she immediately called in one of the OR nurses who took over and inserted a new IV in one quick, painless hit.

They talked us through every single step, and soon, my wife was walking in to surgery. She says she climbed onto the table and doesn’t remember a darned thing until waking up! As she was waking up, the nurse went over post-op care with me in painstaking detail. What the meds are for, when to give them, what existing meds can be taken with them, etc. It was thorough, and I felt quite capable of caring for my wife when we returned to the hotel. When she was awake and lucid, and had successfully emptied her bladder, they allowed her to dress, and called for the Hotel Shuttle. 5 minutes later, it arrived, and we were back in our hotel room before 11am!

The next morning promptly at 7 am, the nurse visited our hotel room, inspected the incision, and took every bit of time we needed to feel comfortable for our trip home.

A few tips:

• An important detail is that Doctor Berger’s facility is amazingly efficient; while you don’t feel rushed, you are done before you know it. They have fine tuned the process so very little time is wasted.

• Stick to the medicine schedule! Don’t be a hero and skip your pain meds or you will regret it. My wife had a few bouts of soreness that would have been difficult in the days after surgery without meds.

• The nurses are all wonderful people; we enjoyed meeting them and letting them take care of my wife. Let them take care of you, and you will do fine.”

Support Before, During, and After Tubal Reversal

At Chapel Hill Tubal Reversal Center, our relationship with patients does not begin and end on the date of surgery.  When you choose Dr. Berger as your tubal reversal doctor, you can expect to have our support before, during, and after surgery.  We are available 24 hours a day, 7 days a week to answer questions and to provide education and information about the tubal reversal process.  Our goal is to provide you with all of the tools you will need on your tubal reversal journey.

Tubal ligation was intended to be permanent. Circumstances can change and women with tied tubes may want more children. When this happens, they often are told that treatment by in vitro fertilization (IVF) is their only option. In reality, tubal reversal is the best choice.

Comparing Tubal Reversal and IVF

Once the fallopian tubes are repaired by tubal reversal surgery, there is a chance every month for pregnancy to occur naturally. This is why tubal reversal is more successful than IVF.

IVF requires a woman to have weeks of hormone injections to produce many eggs each time pregnancy is attempted.  The pregnancy rate with IVF is approximately 25% per treatment cycle. Most women require multiple IVF treatments to become pregnant. At a cost of $12,000 per cycle, this treatment becomes expensive very quickly!

The overall pregnancy rate  among Dr. Berger’s tubal reversal patients is 70%, and the cost of a tubal reversal procedure is less than half that of a single IVF treatment cycle.  This graph shows that pregnancy rates are higher after tubal reversal performed by Dr. Berger than after IVF. This is true regardless of a woman’s age.

Pregnancy Rates by Age After Tubal Reversal vs IVF

Tubal Reversal IVF

Conclusion About Tubal Reversal vs IVF

Tubal reversal has a higher pregnancy rate then in vitro fertilization and is much less expensive when performed at Chapel Hill Tubal Reversal Center.

Are There Hidden Costs of Tubal Reversal?

The discounted fee when paying in full at the time you schedule tubal reversal at Chapel Hill Tubal Reversal Center is $5900. This is an all-inclusive fee. There are no hidden charges! The fee covers the following:

Preoperative record review and consultation
Dr. Berger’s surgical fee
Anesthesiologist’s and nurse anesthetist’s fees
Surgical supplies
Operating facility fees
Postoperative pain medication and antibiotics
Follow-up care

What To Expect at Chapel Hill Tubal Reversal Center

Most of our patients come to Chapel Hill from other states and from other countries. To minimize the time you spend here, your preoperative consultation will be scheduled for the day preceding your tubal reversal. On the day of your reversal procedure, you will spend the morning at Chapel Hill Tubal Reversal Center and the rest of the day at your hotel room at the Sheraton-Chapel Hill. The following morning, one of our nurses will visit you at your hotel for a postoperative check prior to your returning home. You will be here for two nights, on the day prior to surgery for your preoperative consultation and on the day of your tubal reversal procedure.

I Will Be Happy To Assist You

If you would like additional information or would like to schedule your tubal reversal procedure, please feel free to contact me. You can reach me from 8 am to 8 pm Eastern Time at (919) 656-8204 or by e-mail at JuliaS@tubal-reversal.net. I will be glad to answer any questions you might have!

Submitted by Julia Smith, RN
Nurse Administrator