Is Your Doctor Cold on the Idea of Tubal Reversal?
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.
June 25th, 2008 at 8:12 am
It is great to be able to provide information and encouragement to women who have not received support from local doctors about having a tubal reversal procedure.
June 24th, 2008 at 9:10 am
The OB I was seeing at the time I decided to try for a reversal was very cold on the idea of having the surgury done. He did perform the surgury – he had done several himself with good results (his words) – but it was very costly and required a three day hospital stay that my insurance didn’t cover. Instead he basically tried to talk me out of it using the “You have two children and are still happily married” “You’ve had two c-sections” as the crutch.
Most often the doctors are unfamiliar but occasionally – at least in my experience – they simply don’t want to be bothered with something that isn’t necessary or necessary in their own minds.
Thank goodness that Chapel Hill, Dr.Berger and Mr.Monteith don’t regard this surgury as simply “elective”. It’s really something they believe in with their hearts and are willing to share that with all the people who seek TR’s for whatever reason or situation.
June 12th, 2008 at 7:18 pm
[...] a blog about why some doctors may have negative opinions regarding ligation reversal surgery: Why your doctor may be cold to the idea of tubal ligation reversal. We also went to our message board and asked our patients and prospective patients about personal [...]
May 30th, 2008 at 12:12 pm
Despite the fact that the computer makes available world wide informative websites, research of successful performance of certain surgical procedures may not be viewed by everyone in the medical field. Thank you, Dr. Monteith, for writing about the nearly lost of the surgical art of tubal ligation reversal available to women and your desire to carry on the procedure.
May 29th, 2008 at 12:45 pm
My doctor wasn’t necessarily “cold” on the idea – just uninformed. I was told by my doctor and a number of research sources that the success rate of a tubal reversal was “very low.” It was only when I found Dr. Berger and Chapel Hill that I saw the possibilities.
I’ve continued to met with wonder and surprise by doctors (my RE, new OB/GYN, pediatrician, etc.) when they learn that our daughter Lydia Grace was the result of a successful tubal reversal. I’ve made a point of telling all of them about Dr. Berger and the work he and his staff does at Chapel Hill.
May 29th, 2008 at 10:08 am
Dr. Monteith has given his honest assessment of how women may not always be told the real facts when it comes to their fertility issues. Women are fortunate that Dr. Berger maintains his website specifically to educate women and give them options for their care.
May 29th, 2008 at 9:39 am
Thanks for your honesty, Dr. Monteith, regarding the lack of familiarity with tubal reversal that most doctors have and the reasons for it. More and more we are having patients referred by doctors who’ve heard from former patients of Dr. Berger.
May 28th, 2008 at 7:30 am
This information is very helpful. Dr. Monteith’s explanation of lack of familiarity and training are straight forward yet comforting. This website and the blogs will allow women to make informed decisions regarding the procedure.
May 27th, 2008 at 12:44 pm
This is a very common complaint/statement that we hear from our patients on a daily basis. It does seem that there are many uninformed physicians who do not know about the possibility of tubal reversal surgery and think that IVF is the only route. Most of our patients come to Chapel Hill after having done their own research and hopefully go back home and tell their physicians about tubal reversal surgery.
May 27th, 2008 at 8:21 am
Thank goodness for Dr. Berger’s website. He offers important, factual information that women should know if contemplating tubal reversal and tubal ligation. It is nice for women to also read the experiences that Dr. Monteith brings to this blog. With all this information, women should know just how to talk with their doctors regarding tubal igations and tubal reversals. We should always be pro-active when it comes to our bodies. Dr. Berger’s and Dr. Monteith’s website and blog are great educational tools for women.
May 27th, 2008 at 6:58 am
I wish more doctors were educated about the results of tubal ligation reversal and the benefits of untying tubes. I think it’s great that Dr. Monteith is training with Dr. Berger to continue on helping families fulfill their dreams.
May 27th, 2008 at 6:41 am
Excellent! We hear this quite frequently from our patients. Most of them have found us by doing the research themselves over the internet after being dismissed by their local physician. Most finding that, including travel expenses, our price is the best value.
May 27th, 2008 at 6:18 am
Thanks Dr. Monteith. I think your points are excellent. It is our hope that OBGYNs across the country will become more familiar with tubal reversal surgery and our statistics which have a higher success rate than IVF.
May 27th, 2008 at 6:15 am
Thanks for this post Dr. Monteith. I think your points are excellent. It is our hope that OBGYNs across the country can become more familar with tubal reversal surgery and the statistics which show a higher success rate than IVF.
May 26th, 2008 at 4:47 pm
I find that doctors with patients who have had successful tubal reversals are very eager to recommend other patients for tubal reversal surgery. A lot of doctors, however, have not had patients who have undergone tubal reversal surgery and without any personal experience on the subject give negative feedback to their patients regarding pursuing a tubal reversal procedure.
May 26th, 2008 at 4:21 pm
It always amazing me to hear from patients about how negative that their local physicians are about tubal reversal surgery. I guess it is because they are not familiar with how successful it can be and that in their minds IVF is the way to go. I am glad that the patients took it upon themselves to do research and find Chapel Hill Tubal Reversal Center. I also think that it is great how the physicians at Chapel Hill Tubal Reversal Center have taken the time to put information out there so that women can make the best choice for themselves.