Tubal Reversal Blog May, 2008

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