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……..

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.

In a recent email inquiry, someone asked if it would be safer to have tubal reversal surgery in a hospital. My response - “It is much safer to have tubal reversal surgery performed at Chapel Hill Tubal Reversal Center than in a hospital.”

Infection and Medication Error Risks in Hospitals

Roughly 100,000 people wind up with a potentially deadly infection during hospital treatment in the US each year, according to the Centers for Disease Control. Hospital-acquired infections (also called “nosocomial” infections) are particularly dangerous, since hospital germs are especially resistant to antibiotics. One example in the news recently is the bacteria called methicillin-resistant staphylococcus aureus (MRSA). Most of these dangerous bacteria are transmitted by hospital staff from other patients. In addition, hospital patients get the wrong drug one time out of five, according to a study by Auburn University.

Patient-safety incidents continue to rise in American hospitals. The largest increases involve hospital-acquired infections and post operative sepsis (overwhelming infection).

A Chicago Tribune study revealed that serious violations of infection-control standards have been found in the vast majority of hospitals nationally. Since 1995, more than 75 percent of all hospitals have been cited for significant cleanliness and sanitation violations. This report says:

A hidden epidemic of life-threatening infections is contaminating America’s hospitals, needlessly killing tens of thousands of patients each year. Nearly three-quarters of the deadly infections are preventable, the result of unsanitary facilities, germ-laden instruments, unwashed hands and other lapses.

Deaths linked to hospital germs represent the fourth leading cause of mortality among Americans, behind heart disease, cancer and strokes, according to the federal Centers for Disease Control and Prevention. These infections kill more people each year than car accidents, fires and drowning combined.

“The number of people needlessly killed by hospital infections is unbelievable, but the public doesn’t know anything about it,” said Dr. Barry Farr, a leading infection-control expert and president of the Society for Healthcare Epidemiology of America.

Dr. Berger’s Comment

When it comes to cleanliness and strict adherence to infection control procedures, there is no medical or surgical facility better than Chapel Hill Tubal Reversal Center. Our patients often comment about the meticulous nature of our facility. It is clean, orderly, and uncluttered. We are obsessive about this.

The idea that it may be safer to have elective surgery in a hospital is wrong. Hospitals are the right place for treating complicated medical or surgical problems, but they are not the best place for healthy people to have tubal reversal surgery!

Note

Dr. Berger was an Epidemic Intelligence Service Officer at the Centers for Disease Control (CDC).

Patients often ask when they should have a hysterosalpingogram (HSG) to see if their fallopian tubes are open after tubal reversal surgery.

When to Have an HSG

Wait for at least 6 to 12 months after a tubal reversal procedure for this test of tubal patency. An HSG carries a risk of infection and often does not give conclusive results. It is best to give yourself a chance to become pregnant rather than rushing to have an HSG. Most patients conceive within this time frame and will avoid the need for an unnecessary and possibly misleading or harmful procedure.

Preparing for an HSG

To avoid unnecessary risks, an HSG should be performed only after menstruation is over and before ovulation occurs. Having an HSG after the time of ovulation may interfere with a pregnancy - before a pregnancy test can detect that conception has occurred. To minimize the risk of infection, use a betadine vaginal douche the evening before and the morning of the scheduled procedure and ask your doctor for a prophylactic antibiotic prescription. 600 mg of ibuprofen taken one hour before the HSG will minimize its discomfort.

What to Look For in an HSG

You can ask to watch the results on the fluoroscopy screen while the dye is being injected into the uterus.

At first, the dye will fill the uterine cavity. It is essential that the dye actually enter the fallopian tubes up to the point where the anastomosis was performed. Often, this does not occur due to spasm of the sphincter between the uterus and tubes (shown by the arrows) or from mucus or calcium deposits in the proximal tubal segments.

If the dye passes through the anastomosis sites, the fallopian tubes are open. Most radiologists do not consider the x-ray to show tubal patency (openness) unless dye spills into the abdominal cavity. When this happens, the diagnosis of tubal patency is conclusive.

We often see x-rays where dye has passed through the tubal  anastomosis site, but has not yet spilled into the abdominal cavity. This is due to an insufficient amount of dye being injected into the tubes. The radiologist may mistakenly believe the tube is blocked when in reality it is open.

Send Your X-Rays To Me

In order to be certain about whether an HSG demonstrates tubal patency, tubal occlusion, or is inconclusive, please instruct the radiologist to send the x-ray films to me to interpret. Having documented the anatomy and measurements of the fallopian tube segments during tubal reversal surgery, I can compare the x-ray findings with each patient’s operative report. This allows me to give the most accurate interpretation of HSG results.

Dr. Berger’s Comment

Hysterosalpingography is a widely available procedure to examine tubal anatomy. Unfortunately, it is often performed or interpreted inaccurately. An HSG also has risks as well as discomfort and cost. It is best to wait for at least 6-12 months after a tubal reversal procedure to have an HSG. Most patients will become pregnant after tubal reversal within a year and can avoid the problems associated with HSGs. Preparing properly for an HSG and sending the x-ray images to me will minimize the risks and errors associated with a hysterosalpingram.

New patients may want to learn about the relationship between Chapel Hill Tubal Reversal Center and Chapel Hill Surgical Center. They are interrelated health care organizations exclusively for the benefit of patients undergoing tubal reversal surgery.

Chapel Hill Tubal Reversal Center

Chapel Hill Tubal Reversal Center is the name of my private practice. It is located on the second floor of a 2 story building at 109 Conner Drive in Chapel Hill, North Carolina. Prior to 1997, Chapel Hill Tubal Reversal Center was known as Chapel Hill Fertility Center. During earlier years, complete diagnostic and treatment services were provided for all causes of infertility. Because it has always been my primary interest and special skill, I decided to limit my practice to tubal reparative surgery. I am the the only reproductive surgeon who performs tubal reversal surgery exclusively.

Chapel Hill Surgical Center

Chapel Hill Surgical Center is a licensed ambulatory surgical facility that occupies the first floor of 109 Conner Drive in Chapel Hill. This is where the tubal reversal procedures are performed. The facility has 3 operating rooms, a two-stage recovery room, and is staffed by a team of anesthesiologists, a nurse anesthetist, operating room nurses, recovery room nurses, surgical technologists, and an administrative staff. In the past, it was operated as a general ambulatory surgical center that included other doctors from many other surgical specialties. The facility was reorganized to provide tubal reconstructive surgery alone to allow all of the professional staff to concentrate on tubal reversal patients. This has led to the best medical care for women having a tubal reversal procedure.

A Unique Medical Organization

As the Medical Director of both facilities, I am assisted by a dedicated and highly trained staff of over 20 people who devote all of their efforts to caring for 4 couples a day having tubal reversal surgery. The staff to patient ratio (5:1) is higher than found in any other surgical center or hospital. This permits the most attentive and personalized medical care possible. There is no other medical organization like this anywhere else. Most patients learn about us from the Chapel Hill Tubal Reversal Center website, while others are referred by their doctors or previous patients. Couples come here from all 50 states in the US and from every continent around the world.

Our Mission

We take pride in being the premier medical facility for tubal ligation reversal. Our mission for 2008 is to restore hope, fertility, and the opportunity to have children for 800 more couples, as we have done each year in the past.

Tubal Anastomosis at the Uterine Cornua

Tubouterine anastomosis is a tubal reversal procedure that is intermediate between tubotubal anastomosis and tubouterine implantation. It is also called cornual anastomosis because the tube is joined to the cornual area of the uterus with this operation. The cornu is the area where the fallopian tube normally emerges from the the uterus.

When Is Tubouterine Anastomosis Performed?

Tubouterine anastomosis is performed when there is a healthy tubal segment near the ovary, but no segment remains attached to the uterus, following a tubal ligation procedure. It is also performed when a tubal segment attached to the uterus is scarred and has no open lumen.

An incision is made into the uterus at the cornu to find the opening of the fallopian tube tube as it passes through the uterine muscle. If an opening is found, the tubal segment that remains is rejoined to the uterus at this site.

Case Histories

The topic of tubouterine anastomosis is a timely one. During the past week, 2 patients undergoing tubal reversal surgery at Chapel Hill Tubal Reversal Center required this operative procedure. In one case, each fallopian tube had been coagulated or burned next to the uterine cornu, leaving no segment attached to the uterus. The other patient had developed the condition known as salpingitis isthmica nodosa in the portion of the fallopian tube between the uterus and the a Falope ring. In both cases, tubal reversal was able to performed with the technique of tubouterine anastomosis.

Dr. Berger’s Comment

Frequently, patients have been informed by doctors who are not specialists in tubal ligation reversal that their fallopian tubes cannot be repaired after a tubal ligation. This is especially true when the proximal segments of the fallopian tubes are missing or diseased. But there are a variety of surgical techniques that can be used during tubal reversal surgery by a doctor who is an experienced tubal reversal surgeon. This is one of the advantages patients have when they come to Chapel Hill Tubal Reversal Center for their tubal reversal procedures.

Salpingitis Isthmica Nodosa

Salpingitis isthmica nodosa is a nodular swelling of the isthmic segment of the fallopian tube. This fallopian tube abnormality is sometimes encountered at the time of tubal reversal surgery. It often involves the interstitial portion of tube that is within the uterine muscle. The nodule is due to thickening of the muscular wall of the tube around ingrowths or projections of the inner mucus membrane tubal layer into the muscle.

History of Salpingitis Isthmica Nodosa: Scholarly Publications

This tubal abnormality was first described and named by Chiari in 1887 .⁽¹⁾ The name he gave it reflected his belief this was an inflammatory condition. (Salpingitis means inflammation of the fallopian tube.) His contemporary, Kossman, also thought this was an inflammatory condition.⁽²⁾ An alternate theory of causation was suggested by Recklinghausen in 1896 who believed it to be a congenital abnormality.⁽³⁾ A third possibility, suggested by Benjamin and Beaver in 1951, is that SIN is an acquired, noninflammatory condition.⁽⁴⁾ They believed that the lesion begins as an overgrowth of the inner tubal lining that penetrates into the tubal muscular wall. Then cysts form and the tubal muscular wall becomes enlarged and fibrotic. This has also been termed endosalpingosis, a condition closely related to uterine adenomyosis (a form of endometriosis in which the uterine endometrium grows into the uterine muscle).

HSG Diagnostic Findings

Salpingitis isthmica nodosa can be diagnosed radiographically. A hysterosalpingogram or HSG shows multiple small diverticuli or outpouchings of of x-ray dye protruding from the tubal lumen into the wall of the isthmic portion of the fallopian tubes. Because of its appearance at HSG, radiologists call it tubal diverticulosis.⁽⁵⁾

Clinical Implications

Salpingitis isthmica nodosa is associated with increased rates of infertility by interfering with upward sperm migration and ectopic pregnancy by trapping the fertilized egg within the tube.

Treatment During Tubal Reversal

Salpingitis isthmica nodosa may be encountered at the time of tubal reversal surgery. Because of the dense abnormality of the fallopian tube at its connection with the uterus, tubotubal anastomosis is not possible. In this situation, tubouterine anastomosis or tubouterine implantation can be performed.

Tubal Reversal Scholarly Publications

Early Experimental Studies in Animals

In 1969, David, Brackett and Garcia ⁽¹⁾ reported using microsurgical techniques for uterotubal anastomosis after removing the uterotubal junction from one side in 25 rabbits. Among 11 (44%) of the animals that became pregnant, fewer implantations occurred on the operated side than on the unoperated side. This showed that the uterotubal junction has a role, but is not absolutely required, in transferring embryos from the fallopian tube into the uterus for implantation.

In 1974, Paterson and Wood ⁽²⁾ divided the isthmic segment of one fallopian tube and then performed tubal anastomosis in 10 rabbits. They removed the fallopian tube and ovary on the other side so that any pregnancies that followed could be attributed to the repaired fallopian tube. The pregnancy rate was 60%. These investigators suggested that tubal anastomosis could be applied successfully to humans for reversal of tubal sterilization.

Hulka and Ulberg ⁽³⁾ in 1975 were the first to perform a successful reversal of tubal sterilization under experimental conditions. Six weeks after applying Hulka clips to the isthmic portion of fallopian tubes in 8 pigs, they removed the clipped portion of tubes and performed tubal anastomosis using an absorbable, multifilament suture (6-0 Dexon). Six (75%) of the animals subsequently became pregnant.

In 1975 Winston ⁽⁴⁾ reported an experiment in rabbits in which the experimental variables were different suture materials and duration of tubal splinting. In one group of 25 rabbits, he removed a portion of the tubal isthmus or ampulla and then performed tubotubal anastomosis with a nonabsorbable, nonreactive, monofilament suture (10-0 nylon). Using microsurgical technique, Winston took special care to include only the 2 outer layers (muscularis and serosa) of the fallopian tube in the suture line, avoiding the inner tubal layer (endothelium). He stabilized the anastomotic sites with polyethylene splints that were removed before closure of the abdominal cavity. Twenty-three (92%) of the animals became pregnant. This was the highest pregnancy rate reported so far after tubal anastomosis in animal studies. When either 8-0 catgut was used as the suture material or the tubal splint was left in place for 1 week after surgery, the pregnancy rate dropped in half.

Winston’s results were subsequently corroborated using microsurgical tubal anastomosis with 11-0 nylon, intraoperative splinting, and avoiding mucosal trauma from suture in the reconstruction of rabbit oviducts six weeks after application of Falope rings. Eighteen (82%) of 22 rabbits became pregnant after two matings.

Comment

Experimental studies in animals demonstrated excellent pregnancy rates following reconstruction of the fallopian tube by tubal anastomosis. They provided the basis for tubal reversal surgery as a clinical treatment. The best results came using microsurgical techniques with non-reactive, monofilament suture material, intraoperative tubal splints, and avoiding the introduction of suture in the inner layer of the tube.

Dr. Berger uses these surgical techniques in his tubal reversal procedures. For a more complete description of the early history of tubal reversal surgery, read Dr. Berger’s book chapter, Reversal of Female Sterilization: An Evaluation of Results ⁽⁵⁾.

References

1. David A, Brackett BG, Garcia CR: Effects of microsurgical removal of the rabbit uterotubal junction. Fertil Steril 20:250, 1969
2. Hulka JF, Ulberg LC: Reversibility of clip sterilization. Fertil Steril 26:1132, 1975
3. Paterson P, Wood C: The use of microsurgery in the reanastomosis of the rabbit fallopian tube. Fertil Steril 25:757, 1974
4. Winston RML: Microsurgical reanastomosis of the rabbit oviduct and its functional and pathological sequelae. Br I Obstet Gynaecol 82 :513, 1975
5. Berger GS: Reversal of female sterilization: An evaluation of results. In JM Phillips, editor, Microsurgery in Gynecology, Chapter 33. American Association of Gynecologic Laparoscopists, Downey, California, 238-243, 1977.

Tubal Ligation Operations Vary

Tubal ligation operations vary in the amount of damage they cause to the fallopian tubes. Tubal coagulation (cauterization) tends to damage more of the tube than tubal ligation and resection or tubal clips/rings. Burning or cauterizing the fallopian tubes with a monopolar coagulator is more destructive than with a bipolar coagulator. With either type of coagulator, the more times the tube is burned, the greater the amount of damage that occurs.

How Much Fallopian Tube Remains After a Tubal Ligation?

The remaining amount and condition of the fallopian tubes after tubal ligation procedures varies a great deal. A patient’s tubal ligation operative report will give an indication about the remaining tubal segments that can be repaired by a tubal reversal procedure. When available, Dr. Berger always reviews the operative reports that are sent by patients to estimate the likely outcome from a tubal reversal operation.

In most cases, the tubal ligation operative report (and a pathology report if available) will help to determine if tubal reversal is possible. Until the time of surgery, the actual condition of the fallopian tubes remains unknown. This is partly because doctors differ in how they perform tubal ligation operations. With tubal coagulation procedures, for example, the coagulator can be used at different power settings and applied for varying lengths of time to the fallopian tubes. These details usually are not specified in an operative report.

Examining the Fallopian Tubes by Laparoscopy

Laparoscopy is a surgical procedure that permits viewing the fallopian tubes through a narrow telescope placed through a small incision below the belly button into the abdominal cavity. Laparoscopy can be performed for patients who want to be assured that tubal reversal is possible.

Laparoscopy is recommended in cases where the amount of tube remaining is questionable, such as after monopolar coagulation of multiple sites along the fallopian tube.

Dr. Berger performs laparoscopy under anesthesia and proceeds directly to tubal reversal, if examination shows the tubes are repairable. The patient is under anesthesia only one time. For safety reasons, screening laparoscopy is offered only to patients with a body mass index (BMI) of less than 30.

Screening Laparoscopy Cost

The additional charge for laparoscopy is $1000. If tubal reversal is not possible, the operation will end and you will receive a refund of close to 50% of the total surgery fee. The screening laparoscopy option is similar to an insurance policy. You purchase it and hope you never need it, but it is certainly nice if you do. Most patients do not elect to have the laparoscopic examination because of its additional cost and the knowledge that Dr. Berger can repair the fallopian tubes in 98% of cases, regardless of the method of tubal ligation.

People like knowing what to expect when they come to Chapel Hill Tubal Reversal Center for their tubal reversal procedure by reproductive surgeon Dr. Gary Berger, our Medical Director.

We provide a great deal of information about this on our website, in emails and letters, and by telephone.

Learn From Others on the Tubal Reversal Message Board

Another useful source of information about what to expect is the Tubal Reversal Message Board. Through the message board, women can ask questions and get responses from Dr. Berger’s staff and from others who have had their tubal reversal procedure. A message board member recently asked this question about what to expect in the Preparing for Tubal Reversal forum with the subject heading Need Details About Consultation:

“Can someone who has already had their consultation give me details about what happens at the consultation? I’m nervous ):”

She received this detailed reply from another board member:

“My wife had her tubal reversal just this week, so it is still pretty fresh for us. We went there on Monday, so the schedule of things may be different on other days.

She was very nervous; we drove down - an eleven hour drive - not sure what to expect. While there are countless messages on the board detailing great experiences, the fear of showing up and discovering either a second-rate facility or a scam were still in the back of our minds. She was also nervous about “making weight”, even though she was not even close to the BMI cutoff; my dear wife likes to fret over everything.

We met the shuttle van at the lobby of the Sheraton at 6:45; Doctor Berger’s facility is only 5 minutes down the road. When we pulled in, the courtyard gate was unlocked and open. We made our way up the stairs to the second floor, and the receptionist was ready and waiting; the waiting room up there looks like a very cozy, large, well appointed living room.

My wife got the luck of the draw and was first, so it was a very efficient, streamlined process. First up was blood pressure, height and weight. All went well, and we immediately met with Doctor Berger. He is professional, courteous, and yes, asked why we chose this. He didn’t seem judgmental about age or weight; he seemed genuinely committed to giving my wife back her reproductive rights to the best of his ability.

After that was the vaginal ultrasound. My wife preferred for me to be present; it was about 10 minutes total, minimally invasive, and yes, the nurse fine tuned the hair line for surgery.

We were immediately escorted downstairs to the surgery reception, and we were quickly greeted by one of the surgical nurses. I believe we had some very brief paperwork at that point, but we moved so efficiently, I could be wrong. We were escorted to the surgical waiting area, where she changed into a johnny and a robe, and answered some of the standard surgical questions.

My wife is no fan of needles, and we let the nurse know that previous IV experiences weren’t very good. When the nurse had trouble with the IV, she immediately called in one of the OR nurses who took over and inserted a new IV in one quick, painless hit.

They talked us through every single step, and soon, my wife was walking in to surgery. She says she climbed onto the table and doesn’t remember a darned thing until waking up! As she was waking up, the nurse went over post-op care with me in painstaking detail. What the meds are for, when to give them, what existing meds can be taken with them, etc. It was thorough, and I felt quite capable of caring for my wife when we returned to the hotel. When she was awake and lucid, and had successfully emptied her bladder, they allowed her to dress, and called for the Hotel Shuttle. 5 minutes later, it arrived, and we were back in our hotel room before 11am!

The next morning promptly at 7 am, the nurse visited our hotel room, inspected the incision, and took every bit of time we needed to feel comfortable for our trip home.

A few tips:

• An important detail is that Doctor Berger’s facility is amazingly efficient; while you don’t feel rushed, you are done before you know it. They have fine tuned the process so very little time is wasted.

• Stick to the medicine schedule! Don’t be a hero and skip your pain meds or you will regret it. My wife had a few bouts of soreness that would have been difficult in the days after surgery without meds.

• The nurses are all wonderful people; we enjoyed meeting them and letting them take care of my wife. Let them take care of you, and you will do fine.”

Support Before, During, and After Tubal Reversal

At Chapel Hill Tubal Reversal Center, our relationship with patients does not begin and end on the date of surgery.  When you choose Dr. Berger as your tubal reversal doctor, you can expect to have our support before, during, and after surgery.  We are available 24 hours a day, 7 days a week to answer questions and to provide education and information about the tubal reversal process.  Our goal is to provide you with all of the tools you will need on your tubal reversal journey.