Tubal Reversal Blog ‘clips’

Katherine is planning to be a future reversal patient of Chapel Hill Tubal Reversal Center in the fall of 2008. She discovered us while searching the Internet.

Here Katharine tells her story in her own words…

My ligation was two years ago. A month later, while getting ready for a wedding, I destroyed my bathroom upstairs in my home!

My boyfriend was in total shock! He flew up the stairs to see what in the world was going on up there. I had a “fit of rage”. It was awful. It is still very embarrassing to talk about. I do not have a history of mental illness or mood disorders. This ‘fit’ was extremely terrifying for me and for my boyfriend. After calming myself enough to grab the phone, I called my gynecologist. It was a Saturday and the Doctor on call suggested I seek psychiatric help.

Still shaking, and holding the phone in my lap…I thought for a moment…”Maybe I am crazy.”
Needless to say I never made it to the wedding, as I was afraid that I might have another “episode”. A few months later…my boyfriend moved out because he never knew what kind of woman he would come home to. The sad part is I’d wake up and wonder what kind of woman I would be that day. My instinct told me the tubal ligation was the cause of my emotional instability. I just knew it. It was intuition.

I made an appointment with the Doctor who performed the ligation (Filshie clips). When my name was called, I was ushered into the Nurse’s office instead of my Doctor’s office. The nurse explained the Doctor heard I was there to talk about a reversal and wanted to relay to me he “does not do reversals and is not aware of any post ligation symptoms and that I should seek professional psychiatric help.” I left crying.

I then called a psychiatrist who put me on Depakote, Lamectil and Klonopin. I informed her I have Post Tubal Ligation Syndrome (PTLS) symptoms PTLS, but I think she feels I’m bi-polar. The medication does help with the violent mood swings and depression.

The main symptoms are:

daily headaches
2-week PMS
7-8 day HEAVY periods (pass clots the size of walnuts)
anxiety, panic attacks, depression
pitting edema in ankles
fits of rage
uncontrollable crying spells
during ovulation..I have to sit on a pillow while driving and can’t sit flat on my chair at work. Pain with walking
sharp pains in my right side
pain during and after sex (especially after…I curl up in ball and suffer)

I have a small 10-acre farm with horses, dogs, and cats and soon…pigs! I don’t have time to be a pain ridden Tasmanian devil. I love my job, my family, my farm and it is so hard to enjoy it all when PTLS rules my life. I feel all of this is about to change now that I have found Chapel Hill Tubal Reversal Center!

Most importantly…My boyfriend and I have started dating again after a year apart. I showed him all of the emails, websites, etc that explain why I am the way I am…

A complete discussion of Post Tubal Ligation Syndrome and the stories of other PTLS patients who have undergone tubal reversal can be seen in our blog series on PTLS. The first of fourteen articles is Pain After Tubal Ligation: A Symptom of Post Tubal Ligation Syndrome? .

Readers can also view other patient submitted stories about their menstrual symptoms, reasons for reversing tubal ligation, and outcomes after reversal reversal surgery. Each patient’s story is listed below:

Meet Momzilla
Meet Andrea
Meet Rebecca
Meet Praybelieving

We invite readers to join our Tubal Reversal Message board and discuss and share personal experiences with tubal ligation. We also have a dedicated PTLS forum for readers to share experiences of worsening symptoms after tubal ligation procedures.

My name is Andrea, and I’m a 31 year-old home schooling mother to four children.

I’m married to my partner in Christ, Jeff, who is 36. Jeff has his own CPA practice here near our home. We live in beautiful Coeur d’ Alene Idaho, where we are a very close knit Christian family.

In 2005, against the advice of my doctor and with my husband cautioning against it, I had a Filshie clip tubal ligation at the planned c-section birth of my daughter. My doctor used clips because of my age at the time of tubal ligation, as well as the fact that he believed I would want more kids based on my nature.

Soon after the birth of my daughter, I began experiencing symptoms that independently wouldn’t have been alarming, but when gathered together, had me very worried and feeling terrible. Early after the birth, I felt very sad about not having more children. At times I thought the symptoms were just because I was sad about ending my fertility. Now I know they are separate, as well as the desire to continue to have more children, even if you already have “more than normal”, is a God given desire, and NOT something BAD.As my symptoms began to mount, I began a journal of NEW symptoms for me. While one or two of these may not be abnormal, each one of these was new for me, and together made a host of symptoms.

· Period returned 3 weeks after post-partum bleeding, despite breastfeeding full time.    The earliest I had a period while breastfeeding before was 8 months!

· Cyclical migraines or cluster headaches. Typically, one in the week before my period, one upon my period leaving, and one mid-cycle. Each took up to 4 days to clear completely, and each required prescription medication. Nausea and vomiting would accompany without treatment.

· First time I couldn’t lose my baby weight through breastfeeding, diet and exercise.

· Highly emotional, and easily brought to tears or sadness.

· Extremely dry skin.

· Mid-cycle cramping and breast tenderness.

· Terrible cramping for 1-2 days of menstruation, with moderate cramping before bleeding starts, with light cramping entire period. I’m a very active woman with high pain tolerance. This cramping was enough to nearly bring me to tears.

· Bleeding so severely, I would soak a pad in an hour. My doctor suspected menstrual anemia.

· Bleeding sometimes mid-cycle. Spotting would begin on CD 23-24 and continue through 28 when heavy period would start. Bleeding would last 7 full days, with spotting another 2-3 at the end.

· Persistent yeast infections, presumably from being “damp” due to having to wear pads much of the month to catch unexpected flow.

When looking at this journal, I sought the advice of my OB/Gyn and family physician. Both doctors acknowledged tubal ligation can and often does cause painful and heavy periods. However, my family physician went a step further. She conveyed that she had heard numerous cases of women having severe problems following tubal ligation, and was fully on board in my seeking a reversal. She did hormone screening and other blood work, and my OB/Gyn performed a pelvic ultrasound to rule out endometriosis, infections, fibroids, cancers and cysts. Both doctors gave me a clean bill of health, with no other cause for my new problems. Both doctors wrote to my insurance company, requesting payment for a tubal reversal on the sole basis of Post Tubal Ligation Syndrome (PTLS).

The insurance company, a national and well-known provider, wrote back these words:

“Although a tubal ligation reversal is medically necessary for the health of the insured, tubal reversals are not covered as the code falls under fertility treatment which is excluded. *Named insurance company* will authorize payment for treatments of hormone therapy, ablation, D&C and hysterectomy.”

Obviously, at 29 years old and also seriously mourning the loss of my fertility, these were not acceptable treatments for the physical manifestations of my tubal ligation.

We began the process of searching out the best doctor to perform a tubal ligation reversal, and saving the funds to do so. Some local physician’s, including my own, perform tubal ligation reversal. However, I was unable to feel satisfied about the outcome since none maintained accurate PTLS relief and pregnancy statistics based on their own work. Doctor’s in the Seattle area also do tubal ligation reversal, as well as many other cities in the nation. The local doctor’s were going to cost us about $12,000. Even with travel from Northern Idaho, Chapel Hill Tubal Reversal Center was a more affordable, and a more highly skilled facility.

Post Tubal Ligation Syndrome Series

This is the ninth article in our fourteen part series on PTLS and associated medical conditions. The first article, Pain After Tubes Tied: A Symptom of Post Tubal Ligation Syndrome?, introduces the most common symptoms some women attribute to their tubal ligation.

Readers can also read Andrea’s after surgery follow-up story: Andrea After Tubal Ligation Reversal Surgery. In addition to telling us how she has done after her tubal ligation reversal, she also has some exciting news to share!

Our next several articles will present personal stories of some of our patients who have suffered from worsening menstrual, physical, and emotional symptoms after surgical sterilization procedures ( women who had their tubes tied).

We invite readers to join our Tubal Reversal Message board and discuss and share personal experiences with tubal ligation. We also have a dedicated PTLS forum for readers to share experiences of worsening symptoms after tubal ligation procedures.

Hulka Clip Sterilization

One common form of female sterilization is the use of Hulka clips to block the fallopian tubes. The Hulka clip was approved for use in the United States in the 1970’s and was invented in Chapel Hill, North Carolina by Dr. Jaroslav Hulka at the University of North Carolina at Chapel Hill.

The Hulka clip is a small, gold plated stainless steel spring loaded clip. The clip in introduced into the abdominal cavity via a laparoscopic clip applicator. This image shows the open clip in the applicator and the tip of the laparoscope with its fiber optic lighted end. When the clip is placed across the fallopian tube, it is closed and a small spring holds the clip firmly across the tube. The Hulka clip has the advantage of damaging only a very small portion of the fallopian tube- approximately 7mm (the thickness of three quarters stacked on each other).

The Hulka clip causes bilateral tubal occlusion by squeezing a very small portion of the tube. The squeezed portion is deprived of its blood supply and eventually undergoes avascular necrosis (dies and is absorbed by the body). This causes the fallopian tube to be divided in half and the two ends to close up. The Hulka clip is held in place between the two divided tubal segments by a small amount of scar tissue which forms within the clip.

Hulka Clip Reversal

A common misconception is that the Hulka clips can simply be opened to reverse the sterilization process – that the tubes can be unclipped. Unfortunately, tubal ligation reversal for Hulka clips is not as simple as opening the clips. Hulka clip tubal occlusion is reversed by removing the section of the tube with the clip across it and then, using microsurgical techniques, joining the remaining tube segments back together in perfect alignment.

Tubal reversal of Hulka clip tubal occlusion is better than for most other methods of sterilization because such a minimal amount of tube is destroyed in the occlusion process. Approximately 76% of patients at Chapel Hill Tubal Reversal Center become pregnant after a reversal of a Hulka clip sterilization procedure.

Common Misconception About Tied Tubes

Many patients seem to imagine the fallopian tube is like a shoe lace which is tied up like a bow to prevent pregnancy. As tubal ligation reversal specialists, we wish it were that easy- then untying tied tubes would be easier!

‘Tying ones fallopian tubes’ is a common language phrase used to describe several different surgical procedures which result in sterilization (a procedure intended to permanently prevent pregnancy). The more correct medical term is bilateral (both sides) tubal occlusion (closure of the fallopian tube).

There are many different ways to occlude (close) the fallopian tubes: ligation and resection (tying and cutting), clips and rings, and coagulation (burning). No matter how the procedure is done the end result causes the tube to close, heal shut, and prevent sperm from fertilizing an egg.

Tubal Sterilization is Reversible

Many people believe tubal sterilization is permanent and irreversible. Although Hulka clip sterilization is intended to be permanent, this procedure is ideal for tubal reversal. The Chapel Hill Tubal Reversal Center is the one medical facility which specializes in tubal ligation reversal.

We have become experts in reversing all types of tubal ligations- or ‘untying’ tubes that have been ‘tied’!

Submitted by Dr. Charles Monteith

Tying Tubes is Not Like Tying a Shoe Lace

Many patients seem to imagine the fallopian tube is like a shoe lace which is tied up like a bow to prevent pregnancy. As tubal ligation reversal specialists, we wish it were that easy- then untying tied tubes would be easier!

‘Tying fallopian tubes’ is a common language phrase used to describe several different surgical procedures that result in tubal sterilization (a procedure intended to permanently prevent pregnancy). The more correct medical term is bilateral (both sides) tubal occlusion (closure of the fallopian tube).

Tubal Ligation Methods

There are many different ways to occlude (close) the fallopian tubes: ligation and resection (tying and cutting), clips and rings, and coagulation (burning). No matter how the procedure is done the end result causes the tube to close, heal shut, and prevent sperm from fertilizing an egg.

Filshie Clip Tubal Ligation

One common form of laparoscopic (camera) sterilization is the use of Filshie clips to occlude both fallopian tubes. The Filshie clip was approved for use in the United States in the mid 1990’s. The Filshie clip is a small titanium clip which is lined with a thin silicone cushion. The clip was an improvement over the Yoon Falope Ring and the Hulka Clip because it was as easy to apply with less risk of operative complications. The clip also has the advantage of destroying only a very small portion of the fallopian tube- approximately 4mm (approximately the thickness of two quarters stacked on each other). The adjacent tube is not affected. The majority of Filshie clips placed in the United States are done by laparoscopic surgery; however, there is a growing trend to use them for tubal occlusion at the time of cesarean delivery (c-section).

The Filshie clip causes bilateral tubal occlusion by squeezing a very small portion of the tube. The squeezed portion is deprived of its blood supply and eventually undergoes avascular necrosis (dies and is absorbed by the body). This causes the fallopian tube to be divided in half and the two ends to close up. The Filshie clip is held in place (in between the two divided ends) by a small amount of scar tissue which forms over the clip.

A common misconception is that the Filshie clips can simply be removed to reverse the sterilization process- that the tubes can be unclipped. Unfortunately, tubal ligation reversal for Filshie clips is not as simple as just opening the clips. Filshie clip tubal occlusion is reversed by removing the clips and using microsurgical techniques to open the closed ends and join the tubal segments back together in perfect alignment.

The reversal of Filshie clip tubal occlusion is usually technically easier than some other methods of sterilization because such a minimal amount of tube is destroyed in the occlusion process.

Approximately 76% of patients at Chapel Hill Tubal Reversal Center become pregnant after a reversal of a Filshie clip sterilization procedure.

Tubal Sterilization Can Be Reversed

Many people believe tubal sterilization is permanent and irreversible. Although Filshie clip sterilization is intended to be permanent, this procedure can be reversed. Chapel Hill Tubal Reversal Center is the one medical facility that specializes in tubal ligation reversal.

We have become experts in reversing all types of tubal ligations- or ‘untying’ tubes that have been ‘tied’!

Submitted by Dr. Charles Monteith