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

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

After my first meeting with Dr. Berger, I drove home and was ecstatic our conversation went so well. I did not know what to expect when I first visited the center but my visit was everything I could have hoped for. Immediately when I got home I told my wife about my experience. I had never told her about my previous dream so I also divulged to her my vision about my visit to Chapel Hill Tubal Reversal Center. She was amazed I even had such a dream because she is aware I am not a very superstitious person. To this day we still can not believe I had a dream foretelling the start of a new career.

Dr. Berger and I had several more meetings after our initial meeting. I was able to explain to him my career frustrations and my desire to become a tubal ligation reversal specialist. I was able to learn more about him, his background in infertility and in vitro fertilization, and his evolution towards becoming an exclusive provider of tubal ligation reversal surgery. Our meetings were productive and I became even more certain I wanted to become a specialist in tubal ligation reversal.

As I began to seriously consider transitioning to become a tubal ligation reversal specialist I began to realize several things about myself:

• As a physician I want to help people. I especially enjoy helping people obtain goals which are not easily available.
• I take enjoyment in doing surgeries other doctors are either afraid of or incapable of doing.
• I value letting patients make their own informed decisions. I have never felt the need to impose my beliefs upon other people. I rarely judge the decisions of others.
• I dislike hospitals. I feel they are unhealthy (for patients and doctors) and are loud, noisy places.
• I really enjoy working in outpatient, ambulatory surgery centers. I feel less confined than in the hospital environment.
• I like to be efficient. Being idle is extremely difficult for me.
• I can not take good care of others if I can not take good care of myself and family. Long nights, weekends, and poor medical outcomes began to gnaw away at one’s humanity and compassion.

It has been almost a year since I first met Dr. Berger and the staff at the Chapel Hill Tubal Reversal Center and started my path towards becoming a reversal specialist. I have realized many things about myself and my desires. I am eagerly looking forward to a career in helping women correct the misgivings of prior decisions.

After my dream of becoming a tubal reversal specialist, I emailed Dr. Berger to ask for his assistance in teaching me his techniques of outpatient tubal reversal microsurgery. I was a little reluctant to reach out and make contact but, as I previously mentioned, email is a great way to receive rejection.

When I received his return email I was afraid to open it. I thought I would click on the reply and read the typical - “Thanks for your interest but (fill in the blank) - we are not interested at this time.” Instead, I was astounded by his response. One line of his email is still vivid in my memory. The line read,

“I always thought one day I would be approached by the right person…..”

When I read this line in his email, I was ecstatic. I thought to myself, ‘Hey, that is me. I am the right person!’ I felt as is if I were a little high school boy who had his invitation to the prom accepted by the prettiest girl at school. These kinds of things never happen to me. I could not sleep well for several days because of my inner excitement.

The day came when I went to Chapel Hill Tubal Reversal Center for my first meeting with Dr. Berger. I was extremely tired because the night prior to our meeting had been a sleepless one since I had been on call in the hospital delivering babies.

I approached the building and entered through a passageway which led me into a courtyard. The first thing I remember was hearing the sound of a fountain echoing in the courtyard walls. It invoked a soothing feeling. The fountain was placed next to a set of stairs and was standing on a bed of small, rounded river rock. The stairs led up to the second level. I ascended the stairs to the second floor. I was extremely tired but I could not but help feel a sense of calmness within the courtyard. The experience brought back memories of being in church as a child. There was an overwhelming sense of peacefulness.

I entered the office and was seated by the receptionist. While I waited for Dr. Berger, I read through several of the photo albums in the waiting room. There were pictures of many tubal reversal babies and letters of thanks and encouragement. These photo albums seemed like the fruit of a fulfilling and successful career.

Dr. Berger came out to meet me and we went into his office and talked for about 45 minutes. I explained my desire to become a tubal ligation reversal specialist. He told me about his background and how he had come to specialize in tubal ligation reversal. His training, history, and career development were very interesting. I was especially interested in how he had evolved to solely provide such a specialized service. Although we were very different people, it became clear to me that we shared many common fundamental beliefs. Overall, I thought our meeting was very productive. At the conclusion, I shook his hand and thanked him for meeting with me. Since I knew he was busy (and I was tired) I expected to make a quick exit. As I was about to leave, Dr. Berger said, “Let me show you around.”

A strange feeling came over me. I quickly dismissed my strange feeling but readily took him up on the offer. He showed me the top office and waiting room. We then went outside, down the stairs, and past the fountain and decorative rocks. Again another strange feeling went through me- a sense of deja vu. He then showed me the break room with tables for eating, the operative rooms and the recovery room.

I was extremely impressed by two things. First, the entire place was absolutely the cleanest health care facility I had ever been in - I literally felt I could eat off the floor. Second, it was the quietest health care facility I had ever been in. I am used to noise, commotion, screaming, and yelling. I had never been in such a calm health care setting before.

At the conclusion of our tour, I shook his hand again and thanked him again for his time. I left and went to my car. As I started to put the keys into the ignition, I had to pause. I began to process what had happened. I began to investigate my sense of deja vu. I had been here before. I had seen this. I had done this before. It all began to come to me. This was the dream I had several weeks prior!

Then it all began to make sense. The two levels. The water and the fountain. The boulders. The table. The sense of happiness and calm……….these things never happen to me. I quickly suppressed these feelings. Why? I don’t know. I think I was afraid I was building this up to be more than it was or would ever be. I started the car and drove away.

Posted by Charles Monteith, MD

Divine Revelation and My Dream

A good idea, especially a really good idea, will make sense in every way. I began to analyze what a career as a tubal reversal specialist could mean for me. I could learn the surgical technique of tubal ligation reversal, which is gradually becoming a dying science and a lost art. In this process, I could help a large group of women regain both their fertility and wellness through tubal reversal. I could do all of the above and, at the same time, create a better, more fulfilling life for myself and my family. Once you examine all the angles and curves of a good idea and determine the piece fits perfectly within the puzzle of one’s life, then you begin to fill a sense of becoming more complete.

There was one problem. I had no way to credibly learn the techniques of tubal ligation reversal. I could apply for a fellowship in Reproductive Endocrinology (REI). This would mean three more years of training, mostly in In Vitro Fertilization (IVF) and I probably would not get any tubal ligation reversal surgical experience. A close friend of mine recently finished a fellowship in REI and he had done many rounds of IVF but only three tubal ligation reversals over three years time- that’s one per year! He now is a reproductive endocrinologist who expected to adequately counsel patients about reversal surgery and perform these surgeries on patients. Many patients wonder why their REI doctors advise IVF and not tubal ligation reversal. I quickly determined returning for a REI fellowship was not a good idea for me for many different reasons.

I put my idea of becoming a tubal ligation reversal specialist to rest for several weeks. My idea was never fully resting and was still evolving in the background of my mind. It still would not let me go.

What I am going to share next you will probably never hear from me again. Most people reading this have little idea who I am. I am not a superstitious person, nor am I an overly religious person. I can not explain what happened to me next in any way other than divine revelation.

I rarely remember my dreams; however, this one I will never forget. I went to bed thinking about a career in tubal ligation reversal and I had a dream which, I now realize, would foretell my future………

In my dream I met an older, somewhat chubby man with grayish hair. He was slightly balding and seemed content. He greeted me in front of his building which was partly his home and partly his office. He appeared proud of his creation. It was a two story building- split level. He took me on a tour. The top level appeared to be regular, albeit nice living quarters. The home was gorgeous and I don’t remember many details but I do remember a feeling of contentment and completeness. This gentleman then took me outside of the top level and down and across a courtyard. I remember several large boulders and a fountain with water. We crossed over the courtyard and entered the bottom level of the building which was large and appeared like a wine cellar cave. There was a large, rectangular wooden table with candlelight. A large group of people, approximately 10-20 people, were eating and appeared to be having a good time. I was not sure if they were friends or family but they seemed to all be getting along well. They looked up, acknowledged me, but kept on with their festivities………

The dream then came to and end. This was it, I had to leave, and this is what I vaguely remembered the next morning when I awoke.

Again, I am not much for dream interpretation so the next morning I put this dream to rest and continued with my daily life.

Several days later I decided to contact Dr. Berger at Chapel Hill Tubal Reversal Center. I called his office and asked for his email address. I was a little afraid to contact him but email is a good way to receive rejection.

I emailed him and his response floored me.

More to be continued……..

My path has taken me through four hard, long years of residency training- many days and nights in the hospital. My training can be summed up into two words- extreme exhaustion. As an attending physician, I had practiced high risk obstetrics and gynecology and had experienced many joyous and difficult moments. I have seen beautiful births and happy families, but I have also seen many seriously devastating events- one mother die and many babies die. The experience of many good things will lay over you like a warm blanket but the experience of any one, seriously bad event can deeply wound you. After ten years, the stressful events and long hours away from my growing children were beginning to take toll on me. I began to grow increasingly despondent. I began to feel both overwhelmed and unhappy.

Then a close friend was diagnosed with advanced breast cancer. Suddenly and within months, she was unable to work and was on a ventilator. Within two months she went from vibrant to not being able to hold a pen. She was a person I admired, looked up to and respected. She was a successful business woman and had influenced many lives by her work and her example. I was devastated and forced to reevaluate my path in life.

I found myself thinking, “You can work as hard as you want and be a successful as you can but it can all be taken away from you within moments- and without notice- and without any say from you.” It was then I decided I should do what I wanted to be happy and begin to work on a new formula that would redefine my personal sense of success. The only problem was I did not know what the formula would be.

During this same time, I had a chance encounter with a staff member of Chapel Hill Tubal Reversal Center. This was a totally random encounter that could have just as easily not occurred. During my training, I had periodically heard about Dr. Berger and his practice of tubal ligation reversal - but I never new much about the man and his practice. For ten years, I worked within twenty miles of Chapel Hill Tubal Reversal Center and had even referred patients to Dr. Berger but I really knew nothing about his work and his center.

During my brief conversations with the staff member, I was able to find out about the important work of tubal ligation reversal, the high quality of the tubal ligation reversal center, and that Dr. Berger was both an upstanding individual and a gentleman surgeon. I will admit these brief conversations were very interesting and amusing. They provided me information about a local doctor, whom I had heard about yet really new nothing about. These conversations were fun, but I really did not think any more about or discussions.

Good ideas are infectious. They get into your head and they will not leave. They eat at you until you deal with them. They stay with you and circulate in your head until you either act on them or let time gradually absolve them. This good idea was what happened to me after my chance encounter. This good idea was to think I could become a tubal ligation reversal physician.

I began to wonder if I could do tubal ligation reversals. I thought it could provide a new career path and a greater sense of personal fulfillment by helping others in need. This good idea began to breath life into me and it would not let me go……I had no idea of how much greater this idea would become and the divine revelation which I would later experience on my path to a career as a tubal ligation reversal specialist.

More to be continued……..

Greetings from Dr. Monteith

My name is Dr. Charles W. Monteith and I am happy to formally introduce myself as a tubal reversal physician. I will be joining Dr. Gary Berger in practice at Chapel Hill Tubal Reversal Center as a certified tubal ligation reversal specialist in the summer of 2008. I am currently undergoing certification in tubal ligation reversal under the careful guidance of Dr. Berger. My training began in January of 2008 and I am well underway. After two months of training, I have assisted Dr. Berger in more tubal ligation reversals than many infertility specialists have seen in a lifetime!

I am originally from Columbia, South Carolina. I attended college at Xavier University of Louisiana, where I graduated Summa Cum Laude in Chemistry Pre-med. I attended medical school at the University of California at San Francisco which was ranked as one of the top three medical schools in the United States when I was accepted. During medical school, I received a Howard Hughes research fellowship and conducted research in molecular genetics at the University of California at San Francisco.

I completed my residency in Obstetrics and Gynecology at the University of North Carolina at Chapel Hill. During residency, I was inducted into the Alpha Omega Alpha honor society and was the recipient of many different awards for resident and medical student teaching. I had the reputation as the resident who was the easiest to get along with, had the best rapport with patients, and was the overall most patient and best teacher.

After finishing residency, I accepted a Clinical Assistant Professor position with the Department of Obstetrics and Gynecology at the University of Chapel Hill in 2001. I worked as a Professor in Obstetrics and Gynecology at Wake Medical Hospital in Raleigh, N.C. for seven years. I practiced high risk obstetrics and advanced surgical gynecology. I delivered many babies and performed many surgeries while an Assistant Professor. My specialty was advanced laparoscopy and the performance of surgical procedures in the medically challenging patient. A significant amount of my time has been spent with the training and teaching of both medical students and residents.

Despite all of the above, my most important success has been the marriage to my wife, Mary, who has been the key element of support in all my endeavors. We married shortly after graduation from medical school in 1997, and she has been my constant support ever since. Together we have three beautiful children: Charles III (5yrs), Jordan (3yrs), and Madison (18months).

With my above training and family as support I look forward to a successful career in tubal reversal surgery. It is with special gratitude that I thank Dr. Berger and the staff at the Chapel Hill Tubal Reversal Center for accepting me with open arms and training me in both the science and art of tubal ligation reversal.

Women who are seeking the best tubal ligation reversal physicians come to Chapel Hill Tubal Reversal Center. It is the only medical practice or facility dedicated exclusively to repairing fallopian tubes after tubal ligations. Chapel Hill Tubal Reversal Center is widely recognized as the tubal reversal facility that has the best patient care and the highest documented pregnancy and birth rates, while offering low cost outpatient tubal reversals.

Tubal Reversal Physicians at Chapel Hill Tubal Reversal Center

Our Medical Director, Dr. Gary Berger, has specialized in tubal reversals for 30 years. He is now in the process of training Dr. Charles Monteith as a tubal reversal physician. Dr. Monteith will join the practice in July 2008, at which time he will offer low cost tubal reversals of tubal ligation. During July and August 2008, a special discounted fee of $4900 will be available to patients who schedule their tubal reversal procedures with Dr. Monteith.

Dr. Charles Monteith graduated Summa Cum Laude from Xavier University and received his Medical Degree from the University of California at San Francisco. Following a Howard Hughes Research Fellowship in molecular biology, he completed his residency in obstetrics and gynecology at the University of North Carolina at Chapel Hill in 2001. Since then he has been a Clinical Assistant Professor of Obstetrics and Gynecology at the University of North Carolina Medical School. Dr. Monteith is board certified in obstetrics and gynecology and has extensive experience in laparoscopic surgery and high risk obstetrics.

Explaining his decision to join Dr. Berger in practice, Dr. Monteith says, “My interest in tubal ligation reversal comes from my love of outpatient surgery and the desire to learn skills which are becoming a dying art. My hope is to be able to continue to practice tubal reversal surgery and to keep it as an option for patients who have had prior tubal ligation and desire to become pregnant.”

Low Cost Reversals of Tubal Ligation

A special discounted fee of $4900 will be available to patients who schedule their tubal reversal procedures with Dr. Monteith for July and August 2008. If you have questions or would like further information about scheduling your tubal reversal procedure with Dr. Monteith, please contact Julia Smith, RN at (919) 656-8204.

Dr. Berger’s Comment

It is truly a pleasure to be working with Dr. Monteith, who has already established a reputation as an outstanding ob/gyn physician. By the time he completes his 6 month fellowship in tubal reversal surgery with me, he will be well qualified and certified as a Tubal Reversal Physician.

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.

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.