Our Tubal Reversal Center is Unique

Dr. Berger is the only physician in the country with a practice that is specifically limited to tubal reversal surgery. That is the only procedure performed here with Dr. Berger performing four reversals each day, five days a week. We have a high staff/patient ratio with one or two nurses devoted specifically to your care while you are here. All of our nurses have advanced certification in cardiac life support (ACLS) and our anesthesiologists are MDs with board certification in anesthesiology. The anesthesiologists are employees here and not anesthesia staff from another hospital or anesthesia service. In other words, everyone at Chapel Hill Tubal Reversal Center has expertise in caring for tubal reversal patients and performing reversal surgery. While you are here, you will only be with other women and couples who are here specifically for the same purpose.

We Provide Accurate Tubal Reversal Statistics

We keep detailed data and statistics on each of our patients (such as age, tube length, medical history, tube of tubal ligation, pregnancy history). This is obtained by ongoing contact with our patients to ensure we have accurate information regarding their surgery and their outcome. Dr. Berger maintains and publishes data regarding pregnancy rates and pregnancy outcomes following tubal reversal surgery. We know of no other doctor or medical facility that does this.

On the Internet, claims about tubal reversal pregnancy rates are often made without supporting information or documentation - such as a description of the patient population, study method, and follow-up interval. Most Internet sites about tubal reversal do not provide any factual data at all. Any doctor may say that his patients have a particular success rate, but supporting the claim with actual data involves considerable effort. Performing a follow-up study such as this one requires keeping an accurate record of patients and their findings, as well as maintaining ongoing patient contact to determine the outcomes of treatment. That is the only way a doctor can actually know what the pregnancy and outcome statistics are for his patients. Without this detailed type of information, the accuracy of any claim of success rates should be questioned.

At Chapel Hill Tubal Reversal Center, nurses enter information into an electronic patient database at the patient’s registration, the surgical procedure, and from regular post-operative communications with our staff. If we have not heard from patients after their recovery from surgery, our nurses contact them at 6 and 12-month intervals. We know of no other doctor, hospital, or clinic that maintains such ongoing patient follow-up records after tubal reversal surgeries. I believe Dr. Berger’s commitment to providing accurate, up-to-date data is reflected in the fact that he requires this time-consuming but important procedure to be followed so that valid information can be obtained. Each year we publish the results of our follow-up study, reflecting surgical and pregnancy outcomes. This is the most comprehensive study done to date of tubal reversal surgery and its resulting outcomes, showing that for the majority of women who have undergone a tubal ligation procedure and decide later they would like to have more children, tubal reversal surgery is a better option than in vitro fertilization (IVF).

We Follow-up With Patients and Are Always Available

Another reason to choose Dr. Berger and Chapel Hill Tubal Reversal Center is the staff! We are available 24 hours a day/7 days a week to answer questions and concerns. Patients regularly express amazement at the level of care, compassion, and professionalism that they were shown before, during, and after surgery. Patients also like the fact that they receive follow-up calls on post-op day 1 and 3 and at 2 weeks, simply to see how they were doing and to have any questions answered. Our nurses follow-up with each patient again at 6 months and one year after surgery.

Submitted by Julia Smith, R.N.
Nurse Administrator

About Me

Sometimes patients ask about my background and why I became a tubal reversal doctor. (It’s a fair question, since I ask them what made them decide to have a tubal reversal.) I usually tell them about my first year after medical school when I was an intern in medicine at Duke University Hospital taking care of critically ill and dying patients. That is when I decided to devote my medical career to assisting with the beginning of life rather than its ending.

Influential Teachers

The first tubal surgery that I assisted in was during my first year of residency in obstetrics and gynecology at Johns Hopkins Hospital in 1970. At the University of North Carolina where I completed my residency, Dr. Jaroslav Hulka (the inventor of the Hulka clip) taught me the basic principles of tubal reversal surgery. In 1976, I went to Europe to learn tubal microsurgery from Dr. Robert Winston. Dr. Winston’s microsurgical method was an advancement but also a major operation of several hours duration resulting in hospitalization for 5 days or more.

My goal was to make tubal reversal easier to undergo and less costly for the patient. This was accomplished by combining the best principles of gyn surgery, microsurgery, and plastic surgery techniques. I had the great fortune of operating for many years with the renowned plastic surgeon, Dr. Erle Peacock, author of the surgical text entitled “Wound Healing”.

Outpatient Tubal Reversal

By the mid-1980s, I developed the outpatient surgical approach to tubal ligation reversal that I use - and continue to improve upon - to this day. What was a major and expensive in-hospital operation with prolonged recovery became a comfortable outpatient procedure that is affordable for most couples. It is the most gentle operation that exists for restoring tubal anatomy and has resulted in the birth of more babies in the world than any other tubal reconstructive operation.

Anyone who is interested in seeing how I perform outpatient tubal ligation reversal can watch the entire operation that was recorded on video and shown on Discovery and TLC. In this video, each step of the procedure is described as it is performed.

My Viewpoint

I have been fortunate to have had the best teachers in the world in the art of surgical technique as it applies to the fallopian tube. Specializing in tubal reversal surgery over the past 30 years has allowed me to assist more than 6000 couples in the beginning of life with the safest, most comfortable, and most successful tubal reversal operation.

The fallopian tube is an amazing and versatile reproductive organ. Its functions include capturing an egg from the ovary at the time of ovulation; nourishing the fertilized egg or zygote during its early cell divisions; and delivering the blastocyst into the uterine cavity when it is time for implantation. The different parts of the fallopian tube correspond to these various functions.

Tubal Anatomy

The end of the tube furthest from the uterus is the fimbria. The fimbrial segment is lush with cilia that beat vigorously and sweep the egg into the tube where it is fertilized. The egg is quickly moved by the bell-shaped infundibular segment into the ampullary region of the tube. Over the next several days, the combination of muscular contractions and ciliary movement move the egg toward the uterus. The ampulla provides nourishing fluid that allows repeated cell divisions. When the dividing egg (zygote) reaches the stage where the outer membrane dissolves (blastocyst), it is time to be delivered into the uterine cavity. This is the function of the muscular isthmic segment of tube closest to the uterus.

Does Anatomy Predict Function After Tubal Reversal?

Given the complexity of the functions of the fallopian tube, one might wonder if any portion is essential for pregnancy to occur. Years ago, based on the information available in medical texts, I assumed that there would be essential parts or a minimum length of tube needed to result in a normal pregnancy. However, there was little information available to answer this question. Therefore, I began recording the portions of tube removed, tubal segment lengths remaining, and other details about each patient’s reversal operation in an electronic database. Since the staff members at Chapel Hill Tubal Reversal Center follow-up with patients regarding pregnancy after tubal reversal, it has become possible to study the interaction of tubal anatomy and the tube’s ability to function normally.

A Surprising Discovery

Over the 30 years that I have been performing tubal reversal procedures, I have seen every variation of tubal ligation imaginable regarding the sections of tubes removed and lengths of tube remaining to repair. It was surprising to learn that no specific part of the fallopian tube is absolutely required for pregnancy to occur. Somehow, the fallopian is able to compensate for the loss of specific parts and still function normally! Based on this knowledge, I am optimistic in being able to repair any kind of tubal sterilization procedure with the expectation that it will allow the possibility of having more children.

Risk of Ectopic Pregnancy

Tubal surgery is associated with an increased risk of ectopic pregnancy (a pregnancy outside of the uterine cavity) . The risk of ectopic pregnancy is 2-3% in the general population. After tubal ligation and tubal ligation reversal, the risk is approximately 10%. Therefore, every woman who is pregnant following tubal reversal should be considered at risk for ectopic pregnancy until proven otherwise. This is the rationale for the early pregnancy monitoring protocol that I recommend to all of my patients.

Early pregnancy monitoring

Early pregnancy monitoring begins when a woman has a positive home pregnancy test confirming that she is pregnant. Following this, serum quantitative HCG assays should be performed twice a week. These measure the blood levels of the pregnancy hormone, human chorionic gonadotropin. The HCG doubling time in early pregnancy is normally 2-3 days. In a healthy pregnancy, the HCG level will double with each successive blood test.

When the HCG level reaches 1500 mIU/dL, a vaginal ultrasound exam should be performed to identify an intrauterine gestation sac. The gestation sac appears as a black circle or oval surrounded by a bright white “halo”.

If no gestation sac is seen, the HCG assay and ultrasound should be repeated 1 or 2 days later. If the HCG is rising and still no gestation sac is seen, the pregnancy is progressing - but not normally - and is either an intrauterine pregnancy that will miscarry (a “blighted ovum”) or is outside of the uterus. In either case, we recommend ending such a pregnancy with an injection of methotrexate in order to prevent the possible complication of tubal rupture.

Tubal rupture occurs when an ectopic pregnancy grows through and tears the fallopian tube. When this happens, intra-abdominal bleeding is likely to occur. A ruptured ectopic pregnancy is considered a surgical emergency and often results in removal of the ruptured tube. Fortunately, tubal rupture can be prevented by adhering to our early pregnancy monitoring protocol.

What To Do When You Become Pregnant

When you have a positive pregnancy test, please alert us and complete the Pregnancy Report Form that is shown as a link at the bottom of the I’m Pregnant page. We will follow your testing with you to be sure you are having the proper tests done at the right time and that they are being interpreted correctly. We follow-up on all pregnancies with each of our tubal reversal patients.

An easy way to remember the early pregnancy monitoring testing protocol is to read the I’m Pregnant page on the Chapel Hill Tubal Reversal Center website when you become pregnant. This page can be printed and taken to your local doctor. If your doctor has any questions about my recommendations, please give the doctor my pager number. I am available at all times by pager for urgent medical concerns and/or communication with your doctor.

People often wonder “If I do get the tubal reversal procedure done, what are the chances I’ll conceive?”

Dr. Berger is the only doctor who tracks his specific success rate - others doctors will just quote what has been published elsewhere or what they think the success rate should be. Dr. Berger has taken the time and the expense to meticulously keep track of his patients’ pregnancies needed to determine the success rate of the tubal reversal procedures he has performed.

Success Rates

One way to estimate your probability of success after a tubal reversal procedure is from the operative report from your tubal ligation. This can be obtained from the doctor who performed the surgery or from the medical records department of the hospital where your procedure was performed.

If you would like to forward this information to us, Dr. Berger will review the operative report at no charge and we can contact you regarding possible outcomes for you following reversal surgery. You may fax the records to us at 870-934-9211. Please include all contact information (phone and e-mail) when faxing your records.

If you have questions about your chances to get pregnant after a tubal reversal, please feel free to contact me.

Julia Smith, RN
Nurse Administrator
Chapel Hill Tubal Reversal Center
Phone: (919) 656-8204
Fax: 870-934-9211

Have you seen my tubal reversal lens on Squidoo.com? It has key information about tubal reversal. Here are some excerpts.

Tubal Reversal Success

There is just one way to know what the success after tubal reversal surgery is - and that is by documenting pregnancy and birth rates. This requires long term patient follow-up. Our ongoing follow-up system records the outcomes of every reversal procedure and provides the results for all to see. We are the only medical facility that does this! Chapel Hill Tubal Reversal Center publishes weekly pregnancy reports and pregnancy statistics that include pregnancy rates and pregnancy outcomes for my patients.

Making Surgery Comfortable for the Patient

Tubal reversal surgery traditionally has been a major operation with several days of recovery in a hospital due to postoperative pain and disability. These can be avoided.

Postoperative pain following abdominal surgery comes mainly from muscle and connective tissue injury. Abdominal retractors (metal instruments that pull back on the skin, connective tissues, and muscles) are traditionally used to give wide exposure to the pelvic organs during surgery. Pressure from abdominal retractors causes reduced blood flow to the retracted tissues, resulting in postoperative pain. The operation is best performed without retractors.

Surgical packs (large gauze pads) traditionally are placed into the abdomen to push the intestines away from the pelvic organs during surgery. Packs cause postoperative bloating due to intestinal irritation. These can be avoided also.

Injecting a local anesthetic where surgery is performed - even though the patient is asleep during the procedure - further minimizes postoperative pain. (This is called preemptive analgesia.) These are some of the ways I make tubal reversal surgery comfortable for patients. Making surgery comfortable improves recovery, avoids the need for hospitalization, and results in a low cost tubal reversal procedure.

An Excellent Reference Source

At Chapel Hill Tubal Reversal Center, we provide complete and accurate information about tubal ligation reversal. Here are some starting places:

VIP Questions
Pregnancy Testimonials
Tubal Reversal Illustrations

Tubal Reversal or IVF

Our follow-up pregnancy statistics from over 5000 tubal reversal patients show that tubal reversal is more successful than IVF. This is because once the tubes are repaired, there is a chance every month of conceiving naturally. The pregnancy rate is higher after tubal reversal than after IVF for women iof all ages. Furthermore, the cost is much less than a single IVF treatment cycle.

Pregnancy Rates After Tubal Reversal vs IVF

Tubal Reversal IVF