By Lisa D. Hourmouzis, RN
Tubal Reversal Nurse

It’s 7:30 am at Chapel Hill Surgical Center. In a moment of solitude, Dr. Gary Berger meticulously scrubs for the first surgery of the day. As he stands there quietly, I can’t help to wonder about the story behind the man in the surgical mask.

How did he become the surgeon he is today? What drives him to succeed?

These questions led to the following sit down with America’s leading tubal reversal surgeon, Dr. Gary Berger:

When did you decide to go into obstetrics and gynecology?
GB – When I was beginning my fourth year of medical school, during the time when we had to decide what direction we were going to go in, I felt like I wasn’t really secure enough in my basic medical foundation to want to jump into a specialty. So, I made the decision I would take a year of internship in internal medicine. But I had already made the decision that year to start my OB/GYN residency after the internship in medicine.

What led you to Duke?
GB – I was always a very hard worker. I guess I believed in the adage, “No pain, no gain.” So, I picked the hardest program in the US which was the medical internship at Duke University Medical Center. They had that reputation at the time. You were on-call five nights out of seven, and it was a very grueling program. But I thought I needed that to feel like I had a basic medical education before I proceeded.

Did anyone influence your decision to enter OB/GYN?
GB – I had been thinking about going into obstetrics and gynecology, and it just so happened that during that time we had a visit from Dr. Carl Tyler from the Centers for Disease Control. He was looking to recruit physicians into the EIS program, the Epidemic Intelligence Service. He came to the University of Rochester where I attended medical school and made contact with one of the pediatric professors there. I remember being on my pediatric rotation at that time.

Unbeknown to me, my pediatrics  professor had been an EIS officer; he also taught the courses in epidemiology and statistics, which I loved. Most of the other medical students weren’t so interested in them. Because I had done so well in those courses, he recommended that Dr. Tyler interview me. That was definitely a turning point in my life.

I was offered the opportunity to be in the U.S. Public Health Service at the CDC, but Dr. Tyler needed me to complete one year of my OB/GYN residency before I could join the program. That made my decision. I immediately started looking for residencies in OB/GYN.  And as it turned out, that two-year period was probably one of the most influential periods in my life. It was an absolute amazing experience.

What did you like most about obstetrics and gynecology?
GB – The thing I liked about obstetrics and gynecology was the obstetrics. I really did not think I would ever have an interest in performing surgery. In medical school, my surgical rotation was one of my least favorites.

What changed your view about surgery?
GB – During my third and fourth year of my OB/GYN residency, I had the good fortune of working closely with Dr. Jerry Hulka, the inventor of the Hulka clip. He made a big impression on me. His interests, aside from developing this technique in sterilization, were laparoscopic surgery and tubal surgery. So, it was during that time I became interested in tubal surgery; and what really solidified it was when I had the chance to see microsurgery performed. I knew at that point, that’s what I wanted to do.

Why did you decide to focus on tubal reversal surgery?
GB – My ideal was always to be able to do this surgery. I’ve done infertility treatment, IVF. I’ve done almost every type of GYN operation there is, with the exception of cancer surgery, but tubal microsurgery was always my special love. Fortunately, that’s where I am at this point.

What drives you?
GB – I think it’s a desire to be successful at whatever I do. If I’m doing tubal surgery, I want to be the best at doing tubal surgery. I want to know the most about it, have done the most and not just have the most experience, but intellectually, collected the most information. To me, that’s enjoyable because then I feel like it’s something that I’ve mastered. And of course, I like being able to help the couples that come here. I really feel that we can help most people. I know that  people are better off coming here than taking any other alternative that they have, in terms of having tubal reversal surgery.

What do you enjoy most about tubal reversal surgery?
GB - I like the challenge, the meticulousness about it. And I like being able to operate on patients and see them be comfortable and safe, and not dealing with complications.

I have a very idealistic view of things. If there’s a better way to do something, let’s find it and do it that way. I just think that’s a good way to practice medicine. But it’s not just about me personally; it has to do with everyone on our staff  who is involved in it.

Where do you hope to see tubal reversal surgery in the future?
GB – I don’t know if the pendulum will ever swing back to tubal reversal, it was there when I started 30 years ago. It was the new, exciting thing. And then IVF became the new and exciting thing.

Tubal surgery is quite different. I don’t think tubal surgery will ever suddenly become widely used or widely taught, but I think there is clearly a place for it. I like the fact that I’m training another doctor. And maybe in the future, one thing we might consider is becoming a training center where we could take physicians who are already at an advanced level like Dr. Monteith, and help them be able to do this type of surgery with expertise.

Tubal reversal helps a lot of patients, and there definitely should be the option for doctors to have additional education in it so that doctors don’t automatically send their patients into IVF programs when a simple tubal operation could be the solution.

Do you have a philosophy in your professional life?
GB – There’s an expression that I heard when I was in medical school, the quote was, “the secret in caring for the patient, is in caring for the patient.” And part of my philosophy is that I want to provide the exact type of medical care that I would want for myself, no less.

If I have to have a doctor, I want somebody who knows what they’re doing, is educated and a decent and kind person. Technically an expert, as knowledgeable about it as anyone, or more so than anybody else in the world. That’s the kind of doctor I would want for myself. Someone who will really take care of me if I have a problem and won’t brush it off or be too busy because it’s inconvenient for them. That’s the same thing that I want for my patients.

To learn more about Dr. Berger and Chapel Hill Tubal Reversal Center, call 919.968.4656 or contact one of our tubal reversal professionals today.

hope (hp)v.t. & i, expect or look forward to, with desire and confidence. –n. 1, confidence in a future event; expectation of something desired. 2, what is hoped for. 3, something that arouses or justifies hope.

At Chapel Hill Tubal Reversal Center, Dr. Gary Berger understands that hope is not just a word to the hundreds of women who come to his center each year. Hope is what they find in him.

When Amanda Nelson first decided to have a tubal ligation in 1997, she never imagined she would find herself in Chapel Hill, North Carolina, 4,000 miles away from her home in Cumbria, England about to undergo a tubal ligation reversal.

“I had been married for a number of years when my marriage broke down,” said Amanda. “I had two boys to look after, so I waited a year and then went ahead with my tubal ligation. At the time, the thought of having children with a different father didn’t appeal to me.”

Like Amanda, many women who come to Chapel Hill Tubal Reversal Center have faced life changes such as divorce, loss of a child or remarriage.

“Years went by, and then I met David. He had no children and happened to mention he would like one of his own some day,” said Amanda. “It took me awhile to think about it, but decided to look up having the operation.”

The couple sought the advice of Amanda’s local gynecologist. She suggested that they try in-vitro fertilization. But due to the high cost and limited chance of conceiving, the couple decided to begin researching tubal reversal surgery.

“David and I came to the conclusion that you only get one chance with IVF, and if it didn’t work, you have to start all over again,” said Amanda. “The emotional side of it and the high cost put us off.”

The Search Begins

The couple began searching online for tubal reversal specialists. Their search brought them to the Chapel Hill Tubal Reversal Center Web site and Dr. Gary Berger.

“My doctor said we would have more of a chance of getting pregnant if the surgeon had done the operation many times,” said Amanda. “ I couldn’t believe my luck when I found Dr. Berger.”

Over the past 28 years, Dr. Gary Berger has performed over 7,000 tubal reversals as a one-hour, outpatient operation. Recognized as a leader in the field, Dr. Berger has been featured on The Learning Channel and Discovery Health.

Patients come to Chapel Hill from across the United States and abroad to have him perform the procedure. Using microsurgical techniques he developed and refined, Dr. Berger can successfully repair the fallopian tubes in 98 percent of the women who want their tubes untied.

“At first it seemed silly to travel that far to have surgery,” said Amanda. “But when David and I read the Web site and learned about Dr. Berger, we knew he was the man for the job.”

On April 1, Amanda contacted the center to schedule her tubal reversal surgery. After completing the required forms and health history with a tubal reversal nurse, Amanda was ready to begin her long journey to North Carolina.

When the couple arrived at the Raleigh-Durham International Airport in late May, they were greeted by Janice Barrett of Red Carpet Coach, a transportation service that offers discounted rates to Dr. Berger’s patients.

“Janice picked us up and gave us a little tour of the town,” said Amanda. “She drove us by Dr. Berger’s office, then to the hotel. It was nice knowing we were close by.”

Dr. Berger’s patients stay at the Sheraton Chapel Hill Hotel, where they receive a discounted rate. This convenient location allows for quick and comfortable access to the hotel following surgery.

The First Meeting

On the morning of her surgery, Amanda and David arrived at the center for a patient consultation and first meeting with Dr. Berger. As Amanda describes, her first meeting with Dr. Berger was a special experience.

“I remember years ago watching a television show on the Discovery channel about a lady having the tubal reversal surgery and Dr. Berger was on it,” said Amanda. “Being on his Web site most days, I used to look at his photo and think, it won’t be long now before I’m in Chapel Hill. So when I finally met him, it just felt special…he was a star, and a humble one at that.”

Immediately following her operation, Amanda was alert and comfortable. David arrived shortly in the post-anesthesia care unit to be by her side.

“I woke up from surgery to my David, and I was in no pain,” Amanda said. “I was shocked because when I had my tubal ligation, I woke up in extreme pain, so I was really pleased. I was given time to wake up and told the good news by Dr. Berger that everything went well and my tubes were repaired.”

Most women are typically discharged from the facility within two hours after surgery. And most resume normal activities within five to 10 days. This outcome is far better for patients than the standard approach to tubal ligation reversal that requires hospitalization for several days, longer recovery times and unnecessary hospital costs.

“I didn’t experience any pain the day of my surgery,” said Amanda. “And I was able do a little sightseeing of Chapel Hill the day after my surgery.”

Home Sweet Home

After returning to England, Amanda joined the Chapel Hill Tubal Reversal Center message board. The message board is a place for patients and those interested in tubal reversal and women’s health issues to share their stories.

“The Web site is wonderful,” says Amanda. “I’ve found the message board to be very helpful, and I’ve managed to help some future patients of Dr. Berger’s that live here in the UK.”

When asked to describe her experience in Chapel Hill, Amanda gave two words…first class.

“My experience was better than I expected,” said Amanda. “David was very happy with the care I received, and I think he enjoyed the care he received, too. You don’t leave the men out, I think that’s important.”

Giving hope to patients is something Dr. Berger and his team of tubal reversal professionals doesn’t take lightly. Hope isn’t just a word; it’s their mission.

Learn More

To learn more about Dr. Gary Berger and his team at Chapel Hill Tubal Reversal Center, visit www.tubal-reversal.net or call 919.968.4656.

Submitted by Lisa Hourmouzis, RN
Tubal Reversal Nurse

My training in residency taught me that Post Tubal Ligation Syndrome (PTLS) was a dirty little phrase used by ill-informed doctors to describe the observed, normal aging process in women after a tubal ligation. No one who has taught me that concept has ever met Momzilla. Momzilla is her sign-on name, which she gave me permission to use, for the Chapel Hill Tubal Reversal Center message board.

Momzilla came to us at Chapel Hill Tubal Reversal Center seeking relief of problems that occurred after her tubal ligation. She is currently 43 years old, is happily married, and has three children. She is employed as a human resource manager and her husband is an attorney.

Momzilla had her tubal ligation three years ago and she describes the gradual onset of symptoms after her tubal ligation. I asked her if we could use her as the subject of a blog featuring our patients. She agreed and after her surgery she emailed me a comprehensive list of her physical problems. Below are her symptoms in her own words,

“Longer clotty periods with a day or so of flooding blood followed by nothing and then bleeding again. (My menstrual periods from the dawn of time prior to that had been regular and predictable to almost the day), horrible insomnia, light-headedness/dizziness (almost passing out on a few occasions), exaggerated PMS and mood swings, absence of libido and an aversion to sex, fatigue, a sense of dread or doom (not depression), withdrawal from my family (almost needing isolation from people), inability to concentrate, fogginess and an awful memory, tingling in extremities, very dry skin no matter how much I drink or how much lotion I used, more frequent headaches, bloating and GI issues, inability to lose my baby weight (I lost my waist), breaking hair that is more oily, breaking nails, changes in perspiration and body odor (sweating and smelling more easily), bad taste in my mouth, more sinusitis and allergies…I think that about covers it..”

She also had told us she had tingling in her legs, which required her to see a neurologist and have a brain MRI. She also increased sugar cravings and gained 15 lbs.

Momzilla told us her story of having a tubal ligation and then noticing the onset of these symptoms. She has seen several doctors and had a variety of inconclusive tests. She found information about PTLS on the Internet and discovered Chapel Hill Tubal Reversal Center as well. She was very clear she was not getting a ligation reversal so she could have more kids. She was trying to get her body to be like it was prior to the ligation. She desired a return to her normal state.

I am happy to report Momzilla had a successful tubal ligation reversal. Her surgery went well with Dr. Berger acting as the primary surgeon and me as the assistant. She had good tubal lengths and did well in the recovery room.

Momzilla has kept in touch with us since her surgery and we hope she has a good and speedy recovery. We hope her symptoms abate and we have asked her to keep us closely updated on her progress.

Submitted by Dr. Charles Monteith
Chapel HIll Tubal Reversal Center

Over a year ago, I approached Dr. Berger at Chapel Hill Tubal Reversal Center to start a new career as a tubal ligation reversal specialist. When I started to pursue my interest and training in tubal reversal surgery, I naively thought that only women who wanted to have another child had their tied tubes untied. I have come to realize that some women seek to have their tubes untied for many reasons other than to have another child after tubal ligation.

Of course the number one reason is to have more children, but there are many more and equally important reasons patients give. Some common reasons patients come for tubal ligation reversal are to:

• relieve symptoms associated with a tubal ligation (PTLS)
• feel whole again
• be like God intended them to be
• comply with their religious tenants
• feel more like a woman
• relieve regret of a prior mistake
• correct a decision made during a bad relationship
• fill the emptiness from the loss of a child or another loved one

As a generalist ob/gyn, I was always keenly aware of how many women bore both the burden of having children and the burden of sterilization. It was only after I became a ligation reversal specialist I saw how heavy the burden of tubal ligation could be. Now I have the opportunity to help in these situations and feel gratified that my training as a tubal reversal surgeon is progressing nicely under Dr. Berger’s mentorship.

Submitted by Dr. Charles Monteith
Tubal Reversal Specialist in Training
Chapel Hill Tubal Reversal Center

Women who want more children after tubal ligation must decide between two treatment options:  In-vitro fertilization (IVF) and tubal ligation reversal.

In-Vitro Fertilization (IVF)

This medical treatment involves controlling the woman’s natural cycle with hormone injections that stimulate the ovaries to produce a large number of eggs. The eggs are retrieved from the ovaries, combined with sperm in a laboratory and the fertilized eggs are placed inside the uterus. A single course or cycle of treatment takes three to eight weeks. The success rates are variable and depend on the reasons for infertility. In general, success rates per cycle are 10 to 30 percent.

Most IVF specialists advise patients to start the process by planning to undergo at least three cycles. The average cost of a cycle in the US is approximately $10,000 to $12,000, and can be as high as $20,000. Recently CNN and the NY Times have reported on the costs of in-vitro fertilization.

The most serious risk of IVF is ovarian hyperstimulation syndrome (OHSS). Ovarian hyperstimulation syndrome may be classified as mild, moderate or severe. The worst cases are associated with pregnancy since HCG (the pregnancy hormone) continues to stimulate the ovaries. Severe OHSS is a life threatening complication.  Despite careful monitoring, up to 33 percent of IVF treatments has been reported to be associated with mild forms of OHSS. Severe OHSS has been reported in three to eight percent of IVF cycles. Other risks of IVF are multiple gestations (30-50 percent) and ectopic pregnancy (three percent).

Tubal Ligation Reversal

This surgical treatment involves reattaching fallopian tubes that have previously undergone surgical separation (tubal occlusion or tubal ligation). The surgery time can range from one to five hours, and the average costs in the US can be $8,000 to $9,000, but can be as high as $25,000. Approximately 70 percent of patients who undergo tubal ligation reversal will become pregnant. Pregnancy rates for reversal depend on the patient’s age and the method of tubal ligation, and can range from 20 to 80 percent. The main risk of tubal ligation reversal is an increased risk of ectopic pregnancy (10 percent).

When to Choose IVF or Tubal Reversal

IVF is a good treatment for couples who have unexplained infertility, severe sperm disorders and for women with severely damaged fallopian tubes from pelvic inflammatory disease (PID).

Tubal ligation reversal is a better treatment for women who have previously had a tubal ligation and who do not have any of the above indications for IVF.

Ligation Reversal Misinformation

Misinformation regarding tubal ligation reversal exists on the Internet. Most of this misinformation centers on the success of ligation reversal when compared to IVF, the cost and the risks of the surgical procedure.

Success Rates

The success rates of ligation reversal are related to the type of sterilization procedure a patient has undergone. At Chapel Hill Tubal Reversal Center, 69 percent of patients become pregnant after reversal of ligation and resection sterilizations. Clip and band sterilization procedures have excellent reversal results with 76 percent of patients becoming pregnant.

For IVF the success rates depend on the reason for infertility and can range from 10 to 50 percent. The average success of a single cycle is approximately 30 percent. The success rates of IVF decrease with maternal age over 35 years of age. After 40 to 42 years of age, IVF specialists will advise the use of donor eggs (eggs from another woman) to increase the chances of success. Many IVF specialists will attempt to increase the pregnancy rate of IVF by transferring several embryos into the uterus. This increases the chance of multiple gestations. Sometimes high order multiple gestations (triplets or more) will occur and these pregnancies can be very high-risk pregnancies.

Tubal ligation reversal has a higher chance of success when compared to a cycle of IVF by providing the couple with multiple opportunities to become pregnant and the ability to have more than one pregnancy without the need for hormonal control of the cycle.

Chapel Hill Tubal Reversal Center has success rates that are better than the 30 percent average success rates associated with an individual cycle of IVF.

Cost

Many sources quote tubal ligation reversal as high as $25,000. This is true if reversal ligation surgery is done in a hospital-based ambulatory care center or a hospital with an overnight stay. If a patient has a laparoscopic tubal ligation reversal or robotic assisted tubal ligation reversal, then they will pay much higher costs for surgery.

When performed as an outpatient procedure through a small abdominal incision and using microsurgical technique, ligation reversal surgery can be very affordable. Many patients are mislead to believe modern technology results in better success of ligation reversal; however, current medical literature does not support increased success rates for tubal ligation reversal when these surgeries are done laparoscopically or with robotic assistance. Success rates are similar with the use of these modern technologies when compared with abdominal incisions and microsurgical operative techniques. What is very clear is the use of these modern technologies dramatically increase the cost of reversal surgery.

The medical director of Chapel Hill Tubal Reversal Center, Dr. Gary Berger, has perfected a mini-laparotomy approach (mini-abdominal incision). He has continually refined this technique over the last twenty years. It allows easy access to the fallopian tubes and a quick operation. This minimizes the amount of time a patient spends under anesthesia. The decreased anesthetic time results in faster postoperative recovery and reduces the cost and risk of being under an anesthetic. Many hospitals charge patients for anesthesia by the minute and the longer a surgery, the higher the cost. This is true even if the surgery is done in a hospital ambulatory care center. The longer a patient is exposed to anesthesia, the more difficult and longer it takes to recover from the medication effects.

Chapel Hill Tubal Reversal Center is a free standing health care facility that is licensed by the State of North Carolina as a surgical center and has been accredited by the Joint Commission on Hospital Accreditation. Our free standing center is dedicated only to ligation reversal. We do not have to charge for anesthesia by the minute to help subsidize the services of other patients. To help patients who have ligation reversal at our center have a good postoperative period, patients stay at a local hotel and are seen the day after surgery by one of our tubal reversal nurses. Mini-laparotomy surgery is extremely safe with minimal postoperative discomfort and therefore, does not require an unnecessary, overnight hospital stay. A hotel stay is far cheaper than a hospital admission. As a result, we are able to offer ligation reversal for $5,900.

Risk of Tubal Reversal Surgery

Tubal reversal surgery is extremely safe in the appropriate patient. Patients who are not morbidly obese and who do not have severe heart, lung or vascular disease are excellent candidates for outpatient reversal surgery. There is a 10 percent risk of ectopic surgery after ligation reversal; however, with close follow-up of an early pregnancy, this risk can be appropriately managed to avoid the complication of tubal rupture.

We have had excellent operative results with few adverse outcomes in our reversal patients. We advise close follow-up care of our patients. Most suspected ectopic pregnancies are diagnosed early and treated with medical management to prevent complications.

Our Goal

At Chapel Hill Tubal Reversal Center, we are tubal ligation reversal experts dedicated to providing safe and low cost tubal ligation reversal. By keeping the cost low and focusing only on tubal ligation reversal, we make reversing a tubal ligation available to women who would be unable to afford the high cost of in-vitro fertilization or tubal reversal in the hospital setting.

Dr. Montieth’s Diary on Becoming a Tubal Reversal Specialist

Today we had another successful day of untying tubes. We began the day at 7AM. Four patients were scheduled for tubal ligation reversal surgery.

I was able to first assist Dr. Berger in the first three surgeries of the day, but had to leave prior to the fourth surgery. I am becoming proficient at identifying tubal anatomy and repairing tubes that have been tied.

The first patient had her tubes tied several years ago and she was now in a new relationship. Both she and her partner desired more children. They made the decision that they would undergo tubal ligation reversal and try to pursue their dream of having children together. Her surgery went well and we were able to successfully reverse her tubal ligation.

The second patient was similar to the first and desired more children. Her surgery also went well.

The third patient had her tubes tied, but after her surgery she lost a child to Sudden Infant Death Syndrome (SIDS). We often hear stories like this from many patients who come to Chapel Hill Tubal Reversal Center. It is extremely sad to hear the stories these patients tell. My heart aches for them as they try to replace their children and add to their family. Every time I hear these stories I think of my own children and what it would be like to experience such a loss. I can not fully imagine the pain from such loss but I can understand the strong desire to replace a cherished soul. I am happy to report that her surgery went extremely well and she had an excellent operative result. I take enjoyment out of every reversal surgery I have participated in, and feel an extra sense of accomplishment when assisting in untying tubes for patients who have lost children unexpectedly.

I had to leave before the fourth patient had surgery. Fortunately, I will be back in the morning for four more reversal surgeries and to meet four more interesting people and learn about their stories.

My First Day at Nourishing Hopes and Dreams

My first day as a tubal ligation reversal specialist will always be remembered. I began my training with Dr. Berger during the first week of January 2008. We started the day off by meeting the patients who would be undergoing tubal ligation reversal at Chapel Hill Tubal Reversal Center. I met four patients of different ages, backgrounds, and ethnicities . They were all very different people who all desired the same thing: reversal of their tubal ligation.

• The first patient was in her forties, she had emigrated from Ethiopia, her last child was more than twelve years ago, and she desired a chance to have another child.
• The second patient was in her thirties and her previous husband had died unexpectedly. She had children but her fiancé did not have any children. Together, they desired a child.
• The third patient,in her late twenties, had two children and a tubal ligation. Several years later she subsequently found a new partner and he desired a child with her. So while he was deployed overseas, she came for a tubal ligation and a chance for a new future when he returned from his military deployment.
• The fourth patient was in her late twenties and had several children. When she and her partner were in their early twenties they were financially maxed out and she had her tubes tied as an act of desperation. Several years later, she and her husband subsequently became financially stable and they wanted another child. They considered IVF but decided that a reversal was a better option for them. We also learned of an extremely sad story from this patient. She had a friend who had a tubal ligation. This friend had all of her four children die overnight in a house fire. This friend desperately has hope for a future reversal of her tubal ligation and was hoping to obtain a tubal reversal in the future.

All of the tubal reversal surgeries went well that day. The patients all did well and had technically excellent tubotubal reanastamosis (tubal ligation reversal) procedures. They all recovered well and went home to pursue their quest to add to their families. For as long as a live, I will never be able to forget these women, their partners and the stories they told. I can never forget their quest to add children to their lives. For them I hope they attain what they desire. My first lesson as a Tubal Reversal Specialist was that no one can predict the future, but if you always look hard enough you can always find a way - and someone to help- to correct prior mistakes.

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……..

Past topics in the Tubal Reversal Blog include posts and comments about patient care at Chapel Hill Tubal Reversal Center. This topic summarizes important articles about tubal ligation and tubal reversal reported in the news during 2007.

Sterilization is Most Popular Family Planning Method
Approximately 10 million American women use the pill for contraception, while sterilization has been chosen by 15 million men and women.

One In Five Women Regret Decision For Tubal Ligation
One in five women under age 30 who undergo tubal sterilization later regret the procedure, despite the number of children they have.

Is Sterilization the Best Contraception Choice?
Women requesting a tubal ligation should be counseled regarding other long-term, reversible methods of contraception and informed that vasectomy is safer and more effective than tubal ligation.

Tubal Ligation Counseling Issues
Counseling about tubal ligation should include permanence of the method, possibility of future regret, and information about the specific techniques of tubal sterilization.

Relationship Conflict Before Sterilization
Women whose relationship was marked by substantial conflict before they underwent tubal ligation were most likely to regret the decision.

Young Age, Prodding Partner and Sterilization Regret
Young age and a prodding partner are risk factors indicating that a woman undergoing sterilization may later regret her decision.

Tubal Reversal Among Overweight Women
Overweight women’s chances of becoming pregnant after tubal reversal improve when they lose weight.

Dr. Berger’s Comment

These news reports touch on some of the issues patients talk about when they come to Chapel Hill Tubal Reversal Center for tubal sterilization reversal. The popularity of tubal ligation, and the fact that many women regret their decision to have a tubal ligation, are well documented. Young age and marital conflict are risk indicators for subsequent regret. Before performing a tubal ligation, doctors should ensure that the implications of ending childbearing potential are clearly understood and discuss vasectomy as an alternative permanent method of birth control. Women undergoing tubal reversal who are overweight should be aware that losing weight will improve their chances of becoming pregnant again.