What is Reverse Tubal Ligation?

Reverse tubal ligation - or more properly, tubal ligation reversal - is a procedure to get tubes untied for women who desire a pregnancy after tubal ligation. There are actually several procedures that can be used to untie tubes after the tubes have been tied.

Techniques of Reverse Tubal Ligation

There are 3 main techniques that can be used for reversing tubal ligation.

1. Tubal anastomosis
2. Tubal implantation
3. Salpingostomy (Fimbriectomy Reversal)

Tubal Anastomosis

Tubal Anastomosis

The most common method for untying tubes is the reverse tubal ligation procedure of tubal anastomosis. Anastomosis refers to joining two body parts, and tubotubal anastomosis is joining two tubal segments together. Most techniques that tie tubes result in two separate tubal segments, so the simplest way to get tubes untied in these cases is with the anastomosis procedure. 

For more details about untying tubes via tubal anastomosis, see the topic on Tubal Reversal by Tubal Anastomosis on the Tubal Reversal Blog and the description of Microsurgical Tubal Anastomosis on the Chapel Hill Tubal Reversal Center website.

What is the Cost of Untying Tubes?

Reverse tubal ligation is usually described as extremely expensive, ranging from $10,000 to $30,000. The tubal anastomosis procedure to untie tubes costs $5900 at Chapel Hill Tubal Reversal Center. Because it is done as outpatient surgery and performed four times a day, the cost savings is passed on to the women who want kids after tubal ligation.

Watch Dr. Berger Untie Tubes

The tubal reversal operation by Dr. Berger has been featured on television - this video clip on YouTube is 3 minutes long. To watch the entire operation, you can order a free video or DVD of tubes untied.

Other Methods to Untie Tubes

Tubal implantation and salpingostomy are less frequent techniques to untie the tubes after a tubal ligation. For descriptions of these techniques, see the topic on Tubal Reversal by Tubal Implantation and Tubal Reversal by Salpingostomy on the Tubal Reversal Blog or Read the section on Reversal Illustrations on the Chapel Hill Tubal Reversal Center website.

Dr. Caryn M. Hertz - Director of Anesthesia

Caryn M. Hertz, MD is a Board Certified Anesthesiologist and has worked in the field for over 20 years. She has devoted her professional career to the subspecialty of ambulatory (outpatient) anesthesia. She has been working with Dr. Gary Berger at Chapel Hill Tubal Reversal Center since 1995.

Originally from Queens, New York, Dr. Hertz attended college at The Cooper Union for the Advancement of Science and Art, graduate school at The University of Pennsylvania, and medical school at the University of Rochester. She completed her residency in anesthesiology at Beth Israel Hospital in Boston (a Harvard affiliate) and at the University of North Carolina at Chapel Hill. After finishing her residency, she was employed at Duke University Medical Center for 5 years, specializing in preoperative assessment and ambulatory surgery. Dr Hertz has worked at Chapel Hill Surgical Center ever since.

Dr. Hertz says, “I am dedicated to making each patient’s surgery comfortable and safe. Working regularly with Dr. Berger has enabled me to truly optimize and continually improve the Tubal Ligation Reversal experience for our patients.”

Dr. Hertz and her family have lived in Chapel Hill since 1989. Having relocated from the Northeast, they very much enjoyed the mild weather, beautiful environment, and remarkable community here in Chapel Hill.

Dr. Berger’s Comment

One of the many things that makes tubal reversal surgery safe and comfortable at Chapel Hill Tubal Reversal Center is the close coordination among the professional staff who work together every day. This makes the tubal reversal procedure go smoothly and without any unnecessary waste of time for the patient who is under anesthesia. It is like a finely tuned orchestra, with each player knowing exactly what the other is doing. This coordinated team work comes only with constant repetition. The surgical and anesthesia staff at Chapel Hill Tubal Reversal Center practice together each day, and doing four procedures a day allows us to work toward the goal of perfection in patient care. It is the goal that we all strive for each day, with each patient, and each tubal ligation reversal. Other doctors and nurses who have visited our facility are amazed at how quickly patients recover from their operations.

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.

Surgical Technologists at Chapel Hill Tubal Reversal Center

Surgical technologists, also called surgical technicians, are the unsung heros of the surgical team at Chapel Hill Tubal Reversal Center. Patients have little interaction with them except when they are in the operating room. The surgical techs are not easily recognizable behind their surgical masks and during most of the time patients are in the operating room they are asleep! The surgical technicians, however, are responsible for making sure that all equipment is in perfect working order, the operating rooms are meticulous, and that all equipment and instruments are sterile. Their training and working every day with Dr. Berger ensures that tubal reversal procedures go smoothly, safely, and that patients are under anesthesia for the minimal length of time necessary. They must think and act quickly, safely, and accurately to assist the surgeon to achieve the optimal surgical technique throughout the entire operation, from the time a patient goes to sleep until she awakes.

Meet Our Surgical Technologists

Below is a brief history about our outstanding team of surgical techs introducing them from the left to the right in the photo. Here is a link to the web site page about our four surgical technologists at Chapel Hill Tubal Reversal Center.

Matt Murphy, ST underwent his training as a surgical technician at Chapel Hill Tubal Reversal Center where he has worked since 2005. During this time, Matt took a break to work abroad. He describes his time away as an enlightening, growth experience. Matt says that Dr. Berger is always encouraging him to research topics about surgical technique and to continue his education. Matt’s favorite subjects are science and medicine and he is in the process of getting his associates degree in science. Matt’s fluency in Spanish permits him to communicate easily with Spanish speaking patients.

Brandon Martin-Williams, ST also was trained at Chapel Hill Tubal Reversal Center as a surgical techician where he has worked since 2006. During his time at Chapel Hill Surgical Center Brandon has become interested in furthering his career in medicine. Even while working full-time, Brandon has been taking classes to finish his bachelor’s degree in Biology. Brandon hopes to go to medical school in the near future. With his demonstrated skills in the operating room, Dr. Berger believes that Brandon would be an excellent doctor.

Donna Sisson, ST has worked as a first assistant to Dr. Berger in surgery since 1990. Prior to coming to Chapel Hill Surgical Center, she worked as a surgical technologist at St. Francis Hospital in Greenville, SC and at Durham Ambulatory Care in Durham, NC where she specialized in gynecological and plastic surgery procedures. Donna says that working with Dr. Berger is particularly rewarding because Dr. Berger always strives to be on the leading edge of his profession. Donna was Dr. Berger’s first assistant in the Learning Channel’s documentary “The Operation” that features Dr. Berger performing Outpatient Tubal Ligation Reversal.

Kathy Scronce, ST has been a surgical technician at Chapel Hill Tubal Reversal Center since 2005. She previously worked as a surgical technologist at Durham Regional Hospital in Durham, NC. Kathy appreciates the fact that Dr. Berger and all of the staff at the Chapel Hill Tubal Reversal Center are extremely devoted to their patients. Kathy is an integral member of this caring team who work so well together and who concentrate on optimal surgical technique to ensure a successful experience for tubal reversal patients.

Dr. Berger’s Comment

Over the many years I have been performing tubal reversal surgery, I can truly say that I have never worked with a more professional, well trained, and competent surgical team than the one that currently exists at Chapel Hill Tubal Reversal Center. Not only are these individuals professionals in every sense, but also they are exceptional people who are truly dedicated to providing the best and safest care to patients that is possible. Although the patients who come to Chapel Hill Tubal Reversal Center are often unaware of the importance of these essential team members, our patients benefit everyday from the extraordinary way that our surgical technologists do their jobs. It is one of the many factors that makes Chapel Hill Tubal Reversal Center stand out for its excellence in patient care.

There have been many milestones in outpatient anesthesia since its inception. Imagine what the first patient was thinking when told he or she would be going home the same day after the administration of a general anesthetic! These milestones include vast improvements in patient monitoring, shorter acting anesthetics, and improved surgical techniques.

Anesthesia at Chapel Hill Tubal Reversal Center

All patients at Chapel Hill Tubal Reversal Center receive “general” anesthesia. General anesthesia for any day surgery center, but specifically for tubal reversal surgery, begins with our first phone call to prospective patients, weeks and sometime months before the actual surgical procedure. As an anesthesia provider this offers me a unique opportunity to care for patients in an outpatient, day surgery setting.

Our patients travel from all over the world to have their tubal ligation reversal performed by Dr Gary Berger. Some patients have just the basic preoperative lab work, while others have medical problems that require additional preoperative lab tests. In either case, these are done in the patient’s hometown and then faxed to our office for review.

Before Your Tubal Reversal Procedure

We conduct our anesthesia interview over the telephone at least a month before the scheduled procedure. This is the first step to providing good, comprehensive outpatient anesthesia care. Our next step is to send each patient written instructions of what to expect when they arrive in Chapel Hill.

Once our patients arrive at Chapel Hill Tubal Reversal Center we meet them personally and go over their history again. This ensures that both the patient and the anesthesiologist understand each other completely. We also review their instructions for that evening, making sure they understand completely about diet and other restrictions they will have to follow. The morning of surgery is less stressful for our patients because they have met our staff and have a full understanding of what to expect.

During And After Your Tubal Reversal Procedure

The tubal reversal procedure is short, only about an hour. We work closely with Dr. Berger to assure optimal pain control. During the surgery he injects local anesthesia into the muscles and surrounding tissues, thus decreasing the amount of general anesthesia necessary. In addition, our patients need less postoperative narcotics.

Our postoperative focus is then on nausea and pain control. Since each person is different, we monitor pain scores, and when our patients are comfortable they are discharged from our step down recovery room to their own hotel rooms.

We follow up with each patient and have an on going data base so that we may continue to improve our patient care in the area of tubal reversal anesthesia.

Anesthesia Team At Chapel Hill Tubal Reversal Center

Pam Mills CRNA Caryn Hertz MD James Split MD Chapel Hill Tubal Reversal Center Anesthesia Staff

We Will Ensure Your Comfort

Our experienced anesthesia team will ensure your comfort before, during, and after your tubal reversal surgery. Our two board certified anesthesiologists and registered nurse anesthetist (CRNA) specialize in outpatient anesthesia and have a total of more than 50 years of combined experience. We are an essential part of the medical and nursing team who will assess your medical status prior to surgery and will care for you during and after surgery. Our experience working every day with Dr. Gary Berger in the operating room and the recovery nurses in the post-anesthesia care unit results in the most effective care for each patient.

Submitted by Pam Mills, CRNA

Tubal reversal surgery is becoming a lost skill among doctors in training, according to an article in the January 2008 issue of Fertility and Sterility, the most influential medical journal for reproductive specialists. The article states, “The future for tubal anastomosis seems grim…and, like the Roman Empire, may be lost in Antiquity.”

The thesis of the article was that almost exclusive concentration on IVF and related reproductive technologies has decreased the training of reproductive specialists in tubal reparative surgery.

“The success of surgical tubal anastomosis is directly linked to surgical experience. With the advent of ART, surgical training has markedly declined, and there remain few fellowship programs with meaningful numbers of surgical cases. One study reported that most of the current Reproductive Endocrinology and Infertility fellows performed less than 10 procedures and 35% of program graduates performed no surgical tubal reversals in the previous year.”

Chapel Hill Tubal Reversal Center is for Patient Care

Patients have occasionally asked me if, with the experience I have had performing tubal reversals, I was teaching other physicians to perform this kind of surgery. Since Chapel Hill Tubal Reversal Center is a private practice dedicated to patient care - not a training institution - I have not previously taught other physicians the skills acquired over the 30 years I have been practicing as a reproductive surgeon. Having residents or RE fellows coming here for brief periods would allow only an introduction to the techniques of tubal reparative surgery. This would be insufficient for them to acquire all of the skills necessary to perform tubal reversals.

Introducing Dr. Charles Monteith

Recently, Dr. Charles Monteith, an Assistant Professor of Obstetrics and Gynecology at the UNC School of Medicine, requested a mentoring relationship with me to learn the techniques of tubal reversal surgery. Dr. Monteith is a board certified obstetrician-gynecologist with 6 years of surgical experience subsequent to completing his residency at the UCSF Medical Center. He has begun assisting me in surgery and will continue to do so on selected dates during the next 6 months. Some of the patients who have come here since January 1st have already met him. With his prior surgical experience, and after an extended training period, Dr. Monteith will become certified as a Tubal Reversal Specialist and join our staff in July 2008.

Dr. Berger’s Comment

My response, therefore, to the Fertility and Sterility article is that tubal anastomosis will not become “lost in Antiquity”. Perhaps in the future, other physicians will follow the path that Dr. Monteith has chosen to learn the skills and techniques required for successful tubal reversal operations. More information about Dr. Monteith will be available in forthcoming blog posts and on the Chapel Hill Tubal Reversal Center website.

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.

Chapel Hill Tubal Reversal Center Mission

Chapel Hill Tubal Reversal Center is the only medical facility specifically for tubal ligation reversal surgery. We provide the most detailed information about tubal reversal available from any doctor, hospital, or medical institution. This blog post describes how we are able to do this.

Electronic Patient Database

Keeping track of patients following surgery makes sense from a clinical point of view. Continuing follow-up after surgery helps ensure the best patient care. It also allows us to evaluate the success of tubal reversal surgery and the care we provide. Setting up and maintaining a system for ongoing patient follow-up is not usually found in a private medical practice. It is costly, time-consuming, and requires staff knowledgeable in database management. Despite the cost and time requirements, I have made it a priority because of my commitment to giving patients all of the information they should have to make informed decisions about tubal reversal surgery.

At Chapel Hill Tubal Reversal Center, we have a computer system where every nurse enters patient information before, during, and after tubal reversal procedures. All 11 of our nurses contact patients, record data, and make daily entries into computerized records. With this follow-up information, I can analyze and report accurate statistical data about the long-term outcomes of the tubal reversal procedures I have performed.

Information Sources

The patient follow-up system consists of information collected in many different ways and includes a minimum of 6 calls or e-mails to every patient in the first year following surgery:

1. Post-operative nurse visit the morning after surgery;
2. Telephone follow-up on the second postoperative day;
3. Telephone follow-up on the third postoperative day;
4. E-mail questionnaire at two weeks;
5. Telephone contact at 6 months;
6. Telephone contact at 12 months.

Other information is collected and recorded any time we communicate with patients post-operatively. These contacts are usually initiated by patients to report pregnancies and the outcomes of pregnancies. When patients report new pregnancies, we request that they complete a Pregnancy Report Form. Each week, we list the new pregnancy results in the Weekly Pregnancy Report Forum of the Tubal Reversal Message Board and also give more details in the Weekly Pregnancy Announcements.

Summary

After reading our information and statistics and comparing it to what might be available from other doctors, we believe patients will recognize that Chapel Hill Tubal Reversal Center is the only facility where accuracy of information is considered a priority and sharing it with prospective patients is considered a necessity. Providing facts, rather than offering misleading or speculative statements about tubal reversal success, is one mission of our practice. We believe this is the right thing to do.