Tubal Reversal Blog ‘bipolar cautery’

We are interrupting our 14 part Post Tubal Ligation Syndrome (PTLS) blog series to announce the first reported Monteith tubal reversal pregnancies and the arrival of the Monteith Miracle Tubal Reversal baby shirts!

Dr. Monteith’s Success at Reversing Tied Tubes

Dr. Charles Monteith started working full time as a tubal reversal specialist on July 21st 2008 at Chapel Hill Tubal Reversal Center. We have received four pregnancy reports from patients during his first two weeks of reversing tied tubes.  His tubal reversal pregnancies have started to roll in!

The First Pregnancies

These four patients are representative of the patient population Chapel Hill Tubal Reversal Center and they come from all across the United States. They have had different types of tubal ligations and tubal lengths measuring from 3 to 8.5 cms.

Alaska (Falope ring tubal ligation)
New York (Bipolar cautery)
North Carolina (Bipolar cautery)
Idaho (Filshie clip tubal ligation)

And The Winner Is…

There has been an unofficial competition among patients of our Tubal Reversal Message Board for who would be the first patient to report a Monteith tubal reversal pregnancy. A patient from Alaska was the first to report a positive pregnancy test. She has confirmed that a first trimester ultrasound showed the pregnancy is in the uterus and is doing well. We have asked her to share her story and experience with us in a future blog article and she has said she will do this once her life calms down and her morning sickness disappears.

Why Have Pregnancies Been Reported So Soon?

These pregnancies have all occurred within the first two weeks of his reversing tied tubes. We typically ask our patients to wait a month until they try to conceive. So these patients likely started to attempt to conceive mid to end of August. They obviously had success and conceived at their first ovulation after ligation reversal!

To the patients of Dr. Monteith who have not yet conceived: keep up the faith and it should happen in due time. Most people do not realize how long it may take to become pregnant until they actually try. It can sometimes take up to 10-12 months before a successful conception can occur.

Monteith Miracle Tubal Reversal Baby Shirts

The Monteith Miracle Shirts have just arrived and are hot off the presses. They are ready to be sent out when the babies are delivered. All you have to do to receive one is:

Be a patient of Chapel Hill Tubal Reversal Center.
Be a tubal reversal patient of Dr. Montieth.
Become pregnant after tubal reversal.
Report the pregnancy to us.
Report the birth to us.

The first shirt goes out April of 2009 and the rest shortly thereafter. We wish these women good luck and all of the women who have had tubal ligation reversals by the tubal reversal doctors at Chapel Hill Tubal Reversal Center.

I started week number two at Chapel Hill Tubal Reversal Center with a beautiful ligation reversal.

Our patient was from North Carolina. She had a tubal ligation, which was done with bipolar cautery (burning) several years ago.

She went to her doctor to have her tubes tied, and after the surgery, her doctor told her, “The procedures I do are irreversible. You will never get pregnant again.” She told me she was fine with this at the time, but deep down she had feelings about why the doctor did such an aggressive procedure. She told me she thought to herself, what if she ever wanted to get pregnant again?

Well none of us can predict the future. As things so often go, she met a very special man who did not have any children. They married and together they desired a child. They came to us seeking to have her tubes untied.

I reviewed her operative note and things did not look good! Her operative note described cautery of the tube starting at the ampullary segment (the very end of the tube), and then cauterizing along the entire tube towards the side of the uterus. From the appearance of the operative note, it appeared most of the tube had been destroyed.

I recommended a screening laparoscopy to give us a quick evaluation before undergoing any surgical incisions. This would allow us to stop early if the tubes were not repairable. Unfortunately because of her Body Mass Index (BMI) issues, we were not able to proceed with a laparoscopy. Although we will perform tubal reversals for patients with BMIs up to 35, we do not perform laparoscopy for patients with a BMI over 30 due the possible increased risk of surgical complications.

This patient wanted a reversal and it was her personal decision to undergo a surgical incision so she could have an evaluation of her tubes.

As we started her surgery, we were uncertain if she would have repairable tubes. This was a wonderful patient who emanated a sense of enthusiasm and faith. She was someone you would characterize as having a beautiful personality. The entire surgical team was praying we would be able to help her.

As we started the incision, I was inwardly a little pessimistic that we would not be able to find any repairable tubes. I was afraid her doctor’s declaration about the nature of his tubal occlusions would be correct. I worried we would have to open her up, observe both her tubes having been obliterated and have to close her without doing her any good.

I was especially fearful of having to make the long surgeon’s walk. The long surgeon’s walk is the short, but measurable walk to the recovery/waiting room to give bad news to a patient’s family.

The worst thing for any tubal reversal surgeon is to have to tell a patient we could not repair their tubes. This is very comparable to a general surgeon having to tell a family their loved one did not make it through a risky surgery. To be honest, the two bad results are vastly different, but for a woman desiring tubal ligation reversal, it can feel very similar.

Things seem to happen for reasons. We found her to have good end segments and, as the operative note described, the tubes were cauterized to the very extreme side of the uterus. We were able to recover about 3cm of distal tube and found the remaining tubal lumens where they were hidden deep in the walls of the uterus. Isthmic-ampullary tubotubal anastamosis (tubal ligation reversal) was done on both sides and the average length of both tubes was about 3cm.

They ended up being short tubes. But short tubes are theoretically better than no tubes or closed tubes. We do have patients report pregnancies with tubal lengths much shorter than these.  We cannot create tubes. We can only work with what we find. Pregnancy for this patient is now very, very possible and prior to her reversal surgery, a natural pregnancy was impossible.

After the surgery, the entire team was thrilled. We never want to disappoint any patient, and we were able to give this woman both of her tubes back.

Dr. Berger and I were both very happy for this patient. We will be even happier when she reports a sticky bean to us (that’s a pregnancy for those who are not savvy to our Message Board lingo)!