There have been many milestones in outpatient anesthesia since its inception. Imagine what the first patient was thinking when told he or she would be going home the same day after the administration of a general anesthetic! These milestones include vast improvements in patient monitoring, shorter acting anesthetics, and improved surgical techniques.

Anesthesia at Chapel Hill Tubal Reversal Center

All patients at Chapel Hill Tubal Reversal Center receive “general” anesthesia. General anesthesia for any day surgery center, but specifically for tubal reversal surgery, begins with our first phone call to prospective patients, weeks and sometime months before the actual surgical procedure. As an anesthesia provider this offers me a unique opportunity to care for patients in an outpatient, day surgery setting.

Our patients travel from all over the world to have their tubal ligation reversal performed by Dr Gary Berger. Some patients have just the basic preoperative lab work, while others have medical problems that require additional preoperative lab tests. In either case, these are done in the patient’s hometown and then faxed to our office for review.

Before Your Tubal Reversal Procedure

We conduct our anesthesia interview over the telephone at least a month before the scheduled procedure. This is the first step to providing good, comprehensive outpatient anesthesia care. Our next step is to send each patient written instructions of what to expect when they arrive in Chapel Hill.

Once our patients arrive at Chapel Hill Tubal Reversal Center we meet them personally and go over their history again. This ensures that both the patient and the anesthesiologist understand each other completely. We also review their instructions for that evening, making sure they understand completely about diet and other restrictions they will have to follow. The morning of surgery is less stressful for our patients because they have met our staff and have a full understanding of what to expect.

During And After Your Tubal Reversal Procedure

The tubal reversal procedure is short, only about an hour. We work closely with Dr. Berger to assure optimal pain control. During the surgery he injects local anesthesia into the muscles and surrounding tissues, thus decreasing the amount of general anesthesia necessary. In addition, our patients need less postoperative narcotics.

Our postoperative focus is then on nausea and pain control. Since each person is different, we monitor pain scores, and when our patients are comfortable they are discharged from our step down recovery room to their own hotel rooms.

We follow up with each patient and have an on going data base so that we may continue to improve our patient care in the area of tubal reversal anesthesia.

Anesthesia Team At Chapel Hill Tubal Reversal Center

Pam Mills CRNA Caryn Hertz MD James Split MD Chapel Hill Tubal Reversal Center Anesthesia Staff

We Will Ensure Your Comfort

Our experienced anesthesia team will ensure your comfort before, during, and after your tubal reversal surgery. Our two board certified anesthesiologists and registered nurse anesthetist (CRNA) specialize in outpatient anesthesia and have a total of more than 50 years of combined experience. We are an essential part of the medical and nursing team who will assess your medical status prior to surgery and will care for you during and after surgery. Our experience working every day with Dr. Gary Berger in the operating room and the recovery nurses in the post-anesthesia care unit results in the most effective care for each patient.

Submitted by Pam Mills, CRNA

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.

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……..

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.

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).

Women come from all over the world to Chapel Hill Tubal Reversal Center for tubal reversal surgery. It is natural, and appropriate, for them to ask what their chances will be for pregnancy after a tubal reversal procedure performed by Dr. Berger. This important question about the anticipated benefit should be asked of any doctor before undergoing elective surgery. When answering questions about pregnancy after tubal reversal, we provide detailed information including pregnancy rates and their supporting data.

What Is The Success of Tubal Reversal?

There is only one way this question can be answered, and it requires ongoing follow up with patients to learn the results of their tubal reversal procedures. At Chapel Hill Tubal Reversal Center, we take this task to heart. Our nurses contact patients repeatedly during the first year after their surgery. When a patient informs us of a new pregnancy, we ask her to complete a Pregnancy Report Form. From this information, we provide a summary on the Weekly Pregnancy Reports Forum. The Weekly Pregnancy Report lists the age, date of tubal reversal, date of positive pregnancy test, method of tubal ligation, and tubal lengths after tubal repair for each pregnant woman. Additional comments about these pregnancies are shown in the Pregnancy Announcements.

Our various pregnancy information forums allow people to see the results from tubal reversal surgery performed by Dr. Berger on an current basis. The reports are not “filtered” to show only successful pregnancies. They include information about miscarriages and ectopic pregnancies as well. We want people to be fully informed about all of the possible outcomes after tubal reversal. One of our missions at Chapel Hill Tubal Reversal Center is to provide complete and accurate information about all aspects of tubal reversal surgery!

Pregnancy and Baby Testimonials

Some patients send us messages accompanied by photos after they have delivered their babies. These are spontaneous reports. Although we don’t ask patients to send us testimonials, we love receiving and reading them! They are added to the Testimonials section of our site for others to enjoy as well. Currently there are about 700 testimonial pages.

Testimonials Pages

When a patient sends us a birth announcement and photo to be added to Pregnancy and Baby Testimonials, we update an index page so that there is a link at the top of the page to the newest baby testimonial. The index page is what visitors see first when they click on any link to Testimonials. This page has brief quotes with a link to the full testimonial for each patient. We limit the index page to about 30 summaries. To see previous testimonial index pages, click the “Next” link at the bottom of the page. This will show the immediate prior group of testimonial quotes and links. Currently there are 48 testimonial index pages. To see a listing of all the testimonials, look at the Testimonials Site Map.

Our patients share so many different stories about their pregnancies and deliveries after their tubal reversal procedures. Most people don’t realize how many testimonials there are (689 as of January 13th, 2008. The testimonial number is shown in the “bread crumb” at the top left hand side of the page.) To protect patients’ privacy, only the first initial of the last name is shown. Many women include their email addresses and are happy to correspond with others about their experience here.

Pregnancy and Birth Statistics After Tubal Reversal

Since pregnancy and its outcome are the primary concerns of most women who come here for a reversal procedure, we do everything possible to obtain and report this information on an ongoing basis. This keeps us informed about the number of pregnancies and what their outcomes were after tubal reversal. It also allows us to answer questions and guide patients who are waiting to become pregnant. This takes the efforts of a dozen nurses each day, in addition to their care of patients who are preparing for and undergoing surgery. No other medical facility has undertaken this effort.

As a result of the efforts of our staff and patients, we are able to perform careful analysis and report accurate statistics regarding pregnancy rates and births rates after tubal reversal procedures performed by Dr. Berger. This is referred to as “evidence based medicine”. It is consistent with our mission, and is one of the many reasons why Chapel Hill Tubal Reversal Center has become known as the best place to have tubal reversal surgery.

Exchanging Information About Tubal Reversal

The Tubal Reversal Message Board is provided by Chapel Hill Tubal Reversal Center to allow women to communicate with each other about tubal ligation reversal. Members of Dr. Berger’s staff also contribute their insights in the message posts. Here is an example of how members help and support each other on the message board in response to a post by a new member. There are many abbreviations members use in their posts. These are explained on our website page Message Board Abbreviations.

Hello, my name Heather Jo and I live in Southern Oregon. I am 28 and already have three great kids - Chris 14, Emily 7 and Bradley 5. I am getting married on 2/29/08 to my soon to be DH Justin (who has no children yet). I had my TL on 5/9/02 after the birth of my youngest son. I hope to have more babies after my TR, which we hope to have done by the end of summer 08. I look forward to being on here and having my questions answered.

Welcome Heather Jo! We look forward to seeing you in the future. Don’t hesitate to ask any questions.    Lori RN

Welcome Heather Jo! You are in the right place to have your TR done!! Dr. Berger and the Staff at Chapel Hill Tubal Reversal Center are the best.    Veronica

Nice to meet you Heather Jo. I wish you all the best.
ME-27
DH-21
DS-7
DD-4
TL-10/20/03
TR- shooting for March of 2008    Miranda

Hi, Heather! I hope that all goes well. We are all embarking on a wonderful journey! I am also new and am on the board looking for answers, comfort and support. Take Care,     Cora

Welcome to the board, Heather Jo! Congratulations on your upcoming wedding. Let me know if you need assistance with the scheduling process. Feel free to ask all the quetions you have….we are all family and the Tr sisters are great at answering questions or just making you feel welcomed.     Ericka Pamplin

Thank You for the warm welcomes. I am a little scared about the whole TR surgery. I know in my heart that I want more children. I know I’m not “done” yet. But being put under and the actual surgery scares me. I know it is worth it, and that’s why I try not to think about all that stuff. I already had my post op report sent to Dr Berger back in 2005, so this has been a couple years in the making for me. I hope to be on the post TR side of things by this time next year! Well again, THANK YOU and best wishes!    Heather Jo

It’s normal to be scared…I think we are all a little scared about the surgery and about what happens next. I’m more terrified of not conceiving than the actual surgery. I know that Dr. Berger and his staff will take excellent care of me. It’s what I have to do on my own that haunts me!!! Good luck,    Cora

Heather- I was scared about getting the TR done. Not just the surgery but everything that went with this major decision. But I am so glad that I did…I had my TR 11/19/07 and I just found out that we are pregnant! We couldn’t be more thrilled!    Jenn
TR-11/19/07
BFP-12/30/07

Congratulations. That means a lot to hear about someone having a BFP so soon after their TR. Please keep me updated! TR: March/April…I hope.    Cora

Heather Jo - Hi! My name is Jeannine. I live in Salem, OR and just had my TR last month. It was a great experience. Even my DH had nothing but good things to say about our trip, Dr. Berger and his staff and the whole surgical process. It is worth traveling across the country to do! Good luck with your journey.    Jeannine
TL 4-28-01
TR 11-16-07

It does help to hear about others having a great trip when they got their TR. I am hoping for one in March of 2008.    Miranda

CONGRATS ON BFP! Im so excited for you! I think I am going to lose my mind in this process. I know that I want this done but it seems like I’m trying to convince everyone else around me why I should. A lot of people think that it will be a big waste of money especially since I have had my tubes cut, tied, and burned. I’m sure that I’m not the only person who has had this done and that there are plenty of women who have gotten a BFP after reversing this type of TL. I’m going to plan on the end of this year for my TR. How do you send your reports to CH? What do I send exactly? You gals are great supporters by the way.   Patiently Waiting
ME-27
DH-34
DS-4
DS-3
TL-12/04

I went to the hospital where they did my TL and got a copy of what they did and then my mom faxed it over to CH. It is that easy. Some hospitals will fax it for you if you take and print out the CH release form and take it with you so they know where to send it. It does not take long before you hear back from them with where you stand. I hope this helps. I got the ok from CH. I am going to set my TR up for March 08. Hope to hear how things go with you.    Miranda

Dr. Berger’s staff is great about reviewing your records and getting back with you on your chances for success. They won’t tell you to go ahead with it if there’s no chance of a BFP.   Cora

Welcome Heather- you have made the best decision with Dr Berger. He is truly a blessing and a miracle worker. We are all for you. My surgery was quick- I was in and out of CHTRC in a matter of hours. Good luck with your upcoming marriage.   Melissa
Me: 38
TL: 10/97
TR: 1/12/06
BFP: 2/12/06
EDD: 10/25/06
DS, Brady, our miracle baby, born 10/21/06
8 pounds, 5.8 ounces
21 inches long

Thanks Miranda and Cora - you ladies have been a Godsend. I really appreciate it. I have 2 DS by my husband already but I don’t know why I stopped at 2, plus this PTLS is causing a lot of problems. I can’t wait to have this TR done.   Patiently Waiting

Patiently Waiting ~ I know what you mean…PTLS is cruel. I had said before that my husband keeps mentioning “how I used to be”…but I always strugged it off to him just being a man and us evolving. But, after hearing all the stories from other women, I am beginning to believe that I am suffering from it as well! I hope for a smooth surgery with lots of luck in March/April. I wish you all the best, too.   Cora

I have been wanting to have a TR for about 5 years now. I have 2 boys from a previous relationship and my husband has no children (well, he claims mine and treats them as his) I have talked about TR for years and my husband would never seem interested and then sometimes he would and I would get so frustrated with him thinking he just didn’t want kids with me. He finally started coming around and told me that he was scared and that he wanted to get financially stable before we had the surgery and tried to bring a new baby into the home. So, now I am closer than ever and our intentions are to schedule in March or April this year. I am working on my weight loss now as I have to lose 20 lbs to be under BMI for surgery. I know I can do it within the next 3-4 months and I am trying hard so I can have my TR and start TTC!!!!   Stephcave

Dr. Berger’s Comment

This excerpt is a good example of how women support and inform each other on the Tubal Reversal Message Board regardless of where they are from. Many women might feel they are alone in their desire to have another baby after a previous tubal ligation, but when they participate in the message board they realize that they are not alone at all.

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 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.