Tubal Reversal Blog May, 2008

Submitted by Dr. Monteith
Chapel Hill Tubal Reversal Center

Many doctors will give you less than a warm response when you ask about tubal ligation reversal. Ever wonder why?

I would like to use myself as an example. I started my obstetrics and gynecology (ob/gyn) residency in July 1997 and finished in June 2001. I never saw a single tubal reversal operation performed at the university where I trained. Not one. I saw many unusual and rare things, but I never saw a tubal ligation reversal. I am not alone. Many other doctors would probably tell you the same thing if you asked them.

Lack of Familiarity or Training

Most doctors- especially those who have trained within the last 15 years – are unfamiliar with tubal ligation reversal. The reason is simple. Ligation reversal is considered elective surgery. As a result, these procedures are rarely done in hospitals. Therefore, doctors in training get little or no exposure to these surgical procedures. Because of this, most doctors have little knowledge about these types of operations.

Sometimes doctors in training will reason that if they never saw a particular operation, the surgery does not exist because it is not beneficial and may even be harmful. Of course, this is faulty reasoning.

I would have never thought ligation reversal is an effective surgery if it were not for a three minute experience I had when I was a second year resident doing my reproductive endocrinology rotation.

I was with a physician who was the head of our reproductive endocrinology department. We were counseling a 38-year-old patient who was married, had a tubal ligation and wanted to become pregnant again. At the conclusion of her visit, she had asked what she should do? Since I had seen every patient with fallopian tube problems treated with in-vitro fertilization (IVF), I mumbled to myself, “We are going to recommend you get IVF.” Before I could finish my mumbled response, the director said, “I recommend you get a tubal ligation reversal.” My mouth dropped open! Why did we recommend an operation that we did not perform and one I had never seen? I remember exactly what he said next, “We can do this procedure for you. The cost of tubal reversal will be $15,000 here at the hospital. I recommend you talk with Dr. Gary Berger, a tubal reversal specialist who does them for considerably less cost.”

After the conversation, I asked him why we didn’t do tubal reversal procedures at our hospital. He responded, “Charles, we have to charge patients more for this surgery in the hospital. Since patients have to pay out of pocket, most people will be unable to afford the surgery with us. This is a great procedure for her because she will have the ability to get pregnant many times.”

“But isn’t the success rate less than 50 percent?”, I asked. He dropped his glasses down, looked over the rims and told me in a very direct voice, “No! In the best of hands, the success rate is 80 percent.” Somehow he seemed offended that I thought he had recommended a bad treatment.

This conversation happened in 1998. I filed this brief exchange in my memory and mostly forgot about it for the rest of my training.

Other Mistaken Ideas Doctors May Have

Many doctors might say a general ob/gyn resident would not see any of these surgeries while training, but a doctor in training as a reproductive endocrinologist would. Unfortunately, this is not true. I had two friends who trained to be reproductive endocrinology specialists. One did two tubal reversals over a three year period of training, the other did none.

It is unfortunate that my friends, who had little or no experience with reversal surgery, are going to be the same doctors who will counsel patients about it. No wonder they routinely recommend IVF – a treatment that they received almost exclusive training in during their fellowship programs.

Why I Came to Chapel Hill Tubal Reversal Center

I hope my personal experience can illustrate why general ob/gyn doctors may not support their patients who want to have their tubal ligations reversed, and why reproductive specialists mostly do IVF. I view tubal ligation reversal as a disappearing surgical skill that may not be available to patients in the future. This is why I asked to join Dr. Berger’s staff at Chapel Hill Tubal Reversal Center. To help women with tubal ligations who want to get pregnant is the reason why I have decided to embark on the path to become a tubal ligation reversal specialist.

At Chapel Hill Tubal Reversal Center, we want to maximize the chances for pregnancy after tubal ligation reversal for all of our patients. One step that is helpful in planning for a tubal reversal procedure is examining the pathology report from a patient’s medical record. Pathology reports can provide critical information to a tubal reversal specialist since they convey additional information beyond what is contained in the operative report describing the tubal ligation.

What is a pathology report?

A pathology report- sometimes shortened to ‘path report’- is a typed report from a pathologist (doctor who studies healthy and diseased tissue) that describes the removed tubal segments. Usually when tissue is removed by a surgical operation, it is sent to a pathologist for examination. After this examination, a pathologist will create a typed report describing what was observed.

When a tubal ligation and resection procedure has been performed, a segment of fallopian tube was removed and most likely sent to a pathologist. Therefore, a pathology report should exist in the patient’s medical record. When a sterilization has been performed by tubal electrocautery or with tubal clips or rings, there will not be a pathology report because no tubal tissue is removed with these tubal ligation methods.

A pathology report will help our tubal reversal doctors determine exactly what was done during a ligation and resection procedure and what your chances of tubal reversal success will be.

Examples of Pathology Reports After Tubal Ligation

Here are some examples of what the pathology reports may show after a tubal ligation and resection:

Scenario 1
Operative note states, “A standard ligation and resection was done.” Pathology report states, “Two 1.5 cm isthmic sections of fallopian tube were examined.” In this case, the pathology report confirms that small amounts of isthmic tubal segments were removed and the chance of successful ligation reversal is very good.

Scenario 2

Operative note states, “A bilateral ligation was done…tubes were resected.” Pathology report states, “Two 4 cm sections of fallopian tube were examined and fimbrial ends were present on both sections.” In this case, the pathology report demonstrates that the patient has had a fimbriectomy. We would advise the patient that fimbrectomy reversal will be the appropriate procedure to reverse this type of tubal ligation.

Scenario 3
Operative note states, “A typical bilateral tubal ligation was done.” Pathology report states, “Two 7 cm section of fallopian tubes were examined.” In this case, the pathology report shows that large amounts of tubal length were removed. This is not a typical bilateral tubal ligation, and the chance of a reversing tubal ligation is remote. In this case, we would advise the patient that IVF would be a better treatment option for her than tubal reversal surgery.

Get Expert Opinion

As tubal reversal experts who specialize in ‘untying tied tubes’,  we have found that most tubal ligations are reversible. Any patient considering ligation reversal should send us a copy of their operative report and, if ligation and resection was done, a copy of the pathology report. We will review these reports, without charge, and provide the best recommendation for becoming pregnant after tubal ligation.

Submitted by Dr. Charles Monteith
Chapel Hill Tubal Reversal Center

Undergoing a tubal ligation reversal at Chapel Hill Tubal Reversal Center is an important endeavor and we want to maximize every patient’s chance of ligation reversal success. Operative reports are important because they allow us to determine the likely success of tubal ligation reversal surgery.

When a surgeon performs an operation on a patient they are required to keep a written record describing the entire procedure. This is an important part of patient care and many hospitals provide transcription services to assist with creating operative reports. After surgery is completed, the physician will dictate an operative report. Operative reports contain the pre-operative diagnosis, post operative diagnosis, operative procedure, surgeon’s name, findings of the surgery, and what was done during the surgery.

There are two types of operative reports: vague and detailed.

A vague operative report gives generalized information regarding your surgery. Such a report might read, for example, “The tubes were tied in a standard fashion”, or “The tubes were burned in 3 separate areas,” or “A segment of each tube was removed.” These vague reports leave much to the imagination because there is no recognized ’standard fashion’ and we do not really know how far apart ’separate’ burns are.

A detailed operative report will give very specific and easy to understand information regarding your tubal sterilization. Such a detailed report might read, for example, “The tubes were tied in the isthmic (middle) section and a 2 cm interval segment was removed.” or ” The tubes were cauterized (burned) in 3 adjacent areas in the isthmic portion.” These reports give very specific information about what was done and where it happened.

There is no substitute for a detailed operative report. A good operative report can give us enough information to formulate what the likely success of any reversal procedure will be. In general, we can give ligation reversal success based upon the type of ligation a patient has had. If an operative report is ominous, then this allows us to advise patients to consider either a screening laparoscopy or in vitro fertilization (IVF) before attempting ligation reversal. This can prevent having an operation that would have a limited chance of success.

If an operative report can not be obtained then consideration should be given to having a screening laparoscopy. Patients should also be aware that most tubal ligation procedures can be reversed and only a small minority of ligation procedures can not be reversed.

Patients with any questions regarding operative reports, tubal ligation reversal, or tubal reversal success rates should contact a nurse at Chapel Hill Tubal Ligation Reversal Center.

Frequently asked questions regarding operative reports

What is an operative report?

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

Where can tubal ligation operative reports be obtained?

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

How long does the hospital keep my operative report?

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

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

How can I obtain an operative report?

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

What happens if I can not get my operative report?

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

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

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

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

Dr. Monteith’s Diary – May 22, 2008

One of our 4 tubal reversal patients today had the following story.

She was from North Carolina and had three older children. She had her tubes tied several years ago. As time passed, she changed her mind and desired more children. She wanted a tubal ligation reversal and after searching the internet for the best tubal reversal doctor, she found out about Dr. Berger and she came to Chapel Hill Tubal Reversal Center to get her tubes untied.

Prior to her surgery, we reviewed her operative and pathology reports from her tubal ligation surgery, as we do with all patients. There was a shocking finding in her doctor’s description of her tubal ligation. Her doctor described removing 8 cm of fallopian tube on both sides! The fallopian tubes are normally about 10 cm in total length, and if 8cm of tube had been removed, there would be very little tube left to repair. Her pathology report, however, stated two separate 2 cm of tube lengths were the lengths of tubal segments sent to the pathologist for examination.

If the doctor really did remove 8cm of tube, then it might not be possible to repair her tubes successfully. If the pathology report was correct, then she should have good lengths left to reapproximate. Perhaps the pathology report was correct and the doctor did remove 2cm of fallopian tube but cauterized (burned) the rest. We were not sure. We had a dilemma.

Dr. Berger had initially recommended treatment by IVF. She did not want to do this, so the recommendation was made to start her operation with a screening laparoscopy . We were concerned if we proceeded straight to ligation reversal surgery, she may not have good fallopian tubes and she would have gone through an unnecessary operation.

The patient had a different plan. She declined both IVF and screening laparoscopy. Her desire was to have a tubal reversal no matter what. She reasoned if it was not meant to be – then it would not be. She was well informed regarding the possibility of us not being able to repair either fallopian tube. She wanted us to try to work with what she had. Her thinking was that any chance is better than no chance.

As tubal ligation reversal experts we were well aware of the possibility that this approach might lead to disappointment and unnecessary surgery and cost to the patient. We always want to maximize everyone’s chance of success. We never want a patient to undergo an unsuccessful operation. On the other hand, we recognize each patient is a unique person – a person with dreams and desires.

Our patients are well informed and understand the risks and potentially benefits of their treatment options. We do one thing very, very well at Chapel Hill Tubal Reversal Center: reversal of tubal ligation. The second thing we do well is allowing patients to make their own decisions regarding their health care. We do this by giving them the most complete and accurate information about tubal reversal surgery. We rarely say ‘No’ to patients who want to have their tubes untied.

There are some occasions where we may decline to perform surgery – if we believe that operating might be harmful or not have a possibility of being able to repair the fallopian tubes. We do realize a successful ligation reversal is important; however, equally as important, is a patient’s desire to try. For many of our patients the only thing worse than not having a successful ligaton reversal is not ever having tried.

This patient was the first patient of the day. We started the surgery with some fear that we might not see any fallopian tubes. Upon entry into the abdomen we did see good tube lengths and her repair went extremely well! She had a good surgical result and her total tubal lengths were about 4-5 cms on both sides.

We ended the surgery happy and content. As it turned out, this patient knew what she wanted and had confidence that it would work out. In the end, we were glad we did her reversal, allowing her make the decision that seemed right to her, and we were very glad that she was right!

Submitted by Dr. Charles Monteith

As my training as a Tubal Reversal Specialist continues, I would like to share the story of one of our recent patients.

This patient lives in Pennsylvania. She came to Chapel Hill Tubal Reversal Center for a ligation reversal and her story is similar to many of the women who come here to have their tubes untied.

She is 32 and had two older teenage children. She had her tubes tied after her second child. Unfortunately, her husband died after her tubal ligation, but she eventually found a new partner who did not have any children. She and her partner eventually decided they wanted a child together. They had researched the possibility of having another child and made an appointment with an infertility specialist in Pennsylvania. She considered in-vitro fertilization (IVF); however, she and her infertility specialist decided the better option for her would be tubal ligation reversal. Her infertility specialist recommended Dr. Berger as the tubal reversal expert who could give her the best tubal reversal procedure so she and her partner could pursue their desire of having more children.

When the patient came to Chapel Hill Tubal Reversal Center for her pre-operative visit, her partner was unable to travel with her for the reversal surgery; however, she did bring a close friend. We reviewed her medical history. Her tubal ligation surgery was performed many years ago and there were no operative or pathology reports available. She was able to get some information from her ob/gyn doctor who told her she had the ’standard type of tubal ligation’. She told us about her history and her dreams of having more children.

I was happy that she had excellent operative results and a successful bilateral ligation reversal. She stayed overnight at the local Sheraton Hotel where she was seen in the morning by one of the Chapel Hill Tubal Reversal Nurses. Following the postoperative check-up, she returned to her home in Pennsylvania to pursue her quest for adding more children to her family. We are eager to hear from her as soon as she has a positive pregnancy test!

Submitted by Dr. Charles Monteith
Chapel Hill Tubal Reversal Center

How Important Is a Tubal Reversal Doctor’s Experience?

Of the many questions I receive daily from potential patients, one of the most important questions is what makes Dr. Berger the best choice to perform tubal reversal vs. another doctor. With a specialized procedure such as tubal ligation reversal, surgical experience is the most important factor in predicting success from the operation. Dr. Berger has performed more than 7000 tubal reversal operations and has the most experience of any tubal surgeon in the world.

Tubal Repairs That Other Doctors Could Not Perform

We routinely hear from women who have gone to a nearby doctor for a tubal reversal, only to have the doctor stop the procedure before repairing the tubes because an unexpected situation was encountered during surgery. There are multiple situations where this may happen:

1. No isthmic tubal segment remains and tubouterine implantation needs to be performed.

There are few, if any, other doctors who can perform this type of operation and none could do so as outpatient surgery. At Chapel Hill Tubal Reversal Center, Dr. Berger has successfully performed this type of operation many times as a safe and effective outpatient operation.

2. A fimbriectomy has been performed.

Tubal ligation by fimbriectomy involves removing a portion (usually up to one-third) of the fallopian tube closest to the ovary. To our knowledge there are no other doctors performing fimbriectomy reversals. The pregnancy rate following fimbriectomy reversal performed by Dr. Berger is 56%.

3. The patient has only a proximal tubal segment (attached to the uterus) on one side and a distal tubal segment (near the ovary) on the other side.

This is an unusual situation, but Dr. Berger has successfully attached these two segments on opposite sides of the body to create one tube with 2/3 women becoming pregnant afterwards. This operation has not been described in the medical literature. Dr. Berger calls this operation “contralateral tubotubal anastomosis”.

4. The patient is found at the time of surgery to have inherent disease of the fallopian tubes due to tubal endometriosis, salpingitis isthmica nodosa, or pelvic inflammatory disease. In these situations, Dr. Berger removes the diseased tubal segment and repairs the fallopian tube with the most appropriate reversal operation.

Experience Is The Most Important Consideration

Experience is the most important indicator of whether successful tubal reversal surgery can be performed when a woman has a difficult tubal reversal situation due to short tubes, missing tubal segments, fimbriectomy, or inherent diseases of the tubes. While most doctors would be unwilling – or unable – to perform a reversal procedure in one of these situations, Dr. Gary Berger is able to repair the tubes in 98% of cases, regardless of the type of sterilization that has been performed or whether difficult situations are encountered.

Submitted by Julia Smith, R.N.
Nurse Administrator

If you have questions or would like assistance scheduling your surgery, please contact me.

JuliaS@tubal-reversal.net
(919) 656-8204

Tubal Sterilization Methods

‘Tying tubes’ is a phrase that is commonly used to refer to surgical procedures that result in tubal sterilization.

There are many different ways to block the fallopian tubes for tubal sterilization: ligation and resection (tying and cutting), tubal clips or rings, and electrocoagulation (burning). No matter how the procedure is done, the end result is closure or occlusion of the fallopian tube. This prevents sperm from reaching an egg.

Tubal Ligation and Resection

The most common female sterilization procedure is the ligation and resection method. This was the earliest reported method of sterilization, and it is still a very common and effective procedure. According to the method described by Dr. Ralph Pomeroy, an absorbable suture is tied around a “knuckle” of the fallopian tube that has been elevated and a segment is resected (cut out). The cut ends close as the tube heals. As the suture dissolves, the two tubal segments pull apart. Ligation and resection is currently the most popular form of sterilization for women. It is often performed during a cesarean delivery (C-section) or following a normal delivery.

Untying ‘Tied’ Tubes

A common misconception is that fertility can be restored by simply ‘untying’ the tubes. Tubal ligation reversal is not that simple. Tubal ligation and resection is reversed by opening the closed ends of the tubes and joining the tubal segments back together in perfect alignment using microsurgical techniques. Approximately 70% of patients at Chapel Hill Tubal Reversal Center become pregnant after a reversal of a ligation and resection procedure.

Tubal Ligation and Resection Can Be Reversed

Many people believe tubal sterilization is permanent and irreversible. Although tubal ligation and resection sterilization is intended to be permanent, this procedure can be reversed. Chapel Hill Tubal Reversal Center is the medical facility that specializes in tubal ligation reversal. We are experts in reversing tubal ligations- or ‘untying’ tubes that have been ‘tied’!

Submitted by Dr. Charles Monteith

History of Tubal Sterilization

The first tubal sterilization method was tubal ligation and resection, reported in 1881! 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 a popular method of female sterilization.

Tubal Electrocoagulation Results in Burned Tubes

The first description of laparoscopic electrocoagulation, in 1962, used a type of electrical current termed monopolar current – hence the term monopolar tubal coagulation. This sterilization procedure uses electric current to destroy part of the fallopian tube. The burned part of the tube turns into scar tissue and the remaining tubal segments are separated and blocked. This was a very popular form of laparoscopic sterilization from 1970 until the early 1980’s.

Although monopolar electrocautery is a very effective form of tubal sterilization, studies showed that it had a higher complication rate than for electrocoagulation using bipolar current, where the damage to the fallopian tube (or other structures) is more easily restricted. Sterilization procedures done by monopolar current are gradually decreasing and being replaced with bipolar current. Monopolar cautery, however, is still used for tubal sterilization by some doctors.

Can Burned Tubes Be Repaired?

Patients often ask whether burned tubes can be repaired. In most cases, monopolar electrocoagulation sterilization procedures can be reversed. The success of reversal is dependent on the amount of fallopian tube that has been damaged by the electrocautery. This information is usually available in the tubal ligation operative report. When in doubt, a screening laparoscopy can be performed. Approximately 50% of patients at Chapel Hill Tubal Reversal Center will become pregnant after a reversal of a monopolar coagulation sterilization procedure.

Many people, including doctors, have been told that tubal sterilization is permanent and irreversible. Although monopolar tubal coagulation is intended to be permanent, this procedure is usually revesible. The best place for women to have their tubes ‘untied’ when they have been burned is Chapel Hill Tubal Reversal Center – the only medical facility that specializes in reversal of tubal ligation.

Submitted by Dr. Charles Monteith

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’!

Submitted by Dr. Charles Monteith

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.