Tubal Reversal Blog ‘dr berger’

Our first patient of the day came to us from New Jersey. Her last child was born 10 years ago and she had a tubal ligation five years after the birth of her last child.

She eventually met a new partner who did not have any children. Together they wanted to have a child. Our patient began researching tubal ligation reversal. She eventually found Chapel Hill Tubal Reversal Center on the Internet and decided to proceed with plans for a tubal ligation reversal.

Her partner was unable to attend the surgery because he had to stay behind and work, but our patient was able to travel with a close friend in attendance. Dr. Berger and I met both of them the morning of the surgery and we were able to explain the surgical procedure of tubal ligation reversal, the risks involved and the post procedure recovery. We answered all their questions and the patient went down for her surgery while her friend waited in the waiting room.

Her surgery went well. During the surgery we found both tubes had good lengths and were easily repairable. She had a successful bilateral tubal ligation and reversal. The incision was about three inches long and the blood loss was minimal. The surgery was without problems and we were quickly in the recovery room.

We discharged the patient with her friend to stay in town overnight. She was doing well the next day and went back to New Jersey to pursue her dream of giving her partner a child. We wish her well and we want her to keep in touch.

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)!

To the patients of the Chapel Hill Tubal Reversal Center message board, sorry. It has been a long time since I last posted a blog. I have worked six to seven days a week for the last eight years and sometimes 36-hour shifts in the hospital. Needless to say, many sleepless nights and long hours. Recently, I completed a six-month training period with Dr. Gary Berger while at the same time, working in the hospital and delivering babies. Before starting my new career at Chapel Hill Tubal Reversal Center, I took some time off to be with my family and now I am back!

It has been a long process to become a tubal ligation reversal specialist, but well worth it.

My path to become a specialist in tubal ligation reversal actually started 18 months ago when I first made contact with Dr. Berger. Six months of meetings, followed by six months of tubal ligation reversal training has gone by quite fast. This week has gone by even faster. Monday, July 21 was my first ‘official’ day with Chapel Hill Tubal Reversal Center. As I write this blog, this is my fourth day of surgery and we have completed 16 tubal ligation reversals thus far. So far, we have had nothing but success. All patients this week have had at least one tube opened or successfully reversed. I hope they will all become pregnant.

My first day untying tubes was wonderful, and all of the surgeries went well. Each day has been both a challenge and a joy. Dr. Berger and I are doing four reversal surgeries a day. I help him with his two patients and he helps me with my two patients. We have been working very well together and the staff at the center have been great and very accommodating.

The best thing about my new career has been the patients. The patients have been wonderful people to work with. I have the opportunity to meet patients from all over the United States and from all walks of life. They each have a unique story to tell. They have been wonderful individuals and couples who desire either more children or improvement in their menstrual symptoms. In the first three days of my new job I received more ‘Thank you Doctor….’ than I did in eight years as a general Ob/Gyn.

I think this will be the beginning of a long and lovely career…..

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.

Sally Muncy, R.N.
Chapel Hill Tubal Reversal Center

Introducing Myself

Dr. Berger has asked me to give a short description of what I do as an Operating Room Nurse so that you will feel that you know me when you come here for your tubal reversal surgery. I am a nurse who accompanies you to the operating room once the preoperative nurses have admitted you and taken care of all your physical as well as emotional needs. I am there for you to make sure that you are comfortable and have no last minute questions or misgivings.

One more time I will check your name on your name band and ask you about allergies and if you have eaten. I will ask you to use the rest room to empty your bladder as Dr. Berger does not use any bladder catheter in your bladder during surgery. I’m not asking these same questions that the other nurses have ask you because I don’t know the answers, but ask them only as one more opportunity to avoid a mistake about something you may have forgotten to mention.

In The Operating Room

In operating room, you will be made comfortable and warm and everything that is being done will be explained to you. I realize this is a little frightening since everyone in the operating room wears a mask, gloves and gown for your protection. This brings up another point about who will be in the operating room with you. As I said I will be at your side the whole time. There will also be an anesthesiologist or anesthetist, a surgical assistant, and a surgical scrub technician (the person who is responsible for all the sterility of the surgical equipment and for seeing that Dr. Berger has the instruments as he needs them when he is concentrating on surgery). The only other person present is Dr. Berger.

For those of you (and there are many) who have a concern for modesty in the operating room, you really have nothing to worry about. After the surgical area is cleansed you are covered from head to toe. There is only about an 8 inch by 3 inch window of skin exposed on your abdomen. Many ladies also come for surgery while having their menstrual period. This also is handled very discreetly. You will keep your underwear and pad on until the last minute and then you can remove them in the bathroom and we will have a pad on the bed for you. I really want to impress upon you that from the time you walk in the front door to when you leave after surgery you will be treated with the utmost respect and dignity.

Once you are settled in the operating room you go off to sleep fairly quickly after being attached to heart monitors and a final safety check being done. One more time every staff person in the room checks your name, allergies, and other important data regarding your health. At this point everyone takes their designated position in the room and like a finely choreographed dance surgery begins. Because of keeping sterility in the room, no one can touch another person so each one has to know exactly what they are doing and where the other four people are.
I am the one who keeps computer records of anything pertinent to your surgery while Dr. Berger dictates in detail. I am also responsible to see that everyone has the sterile equipment, medications, irrigating fluids, or anything else that needs to be brought in to the operating room. And finally I perform, with the scrub technician, a counting of all the instruments and dressings that are used during surgery. This count is also done before you enter the room and two more times. The final count must match exactly. This avoids any concern of a lost instrument or dressing. This is to insure absolute safety.

On To The Recovery Room

When Dr. Berger finishes surgery I will put a small dressing on your abdomen. Surgical time will be recorded and you will soon wake up and move back to your original bed. It is then my pleasure to return you to the recovery room where your nurse will greet you and I will bring your family member in to sit with you.

I just want to assure you once again that you will be in good, safe hands throughout your tubal reversal surgery. Every staff member at Chapel Hill Tubal Reversal Center and Chapel Hill Surgical Center is there to meet your needs and we are honored that you have put your trust, first in Dr. Berger, and then in everyone else who has any part in your care.

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
Chapel Hill Tubal Reversal Center

One of yesterday’s patients is a 33 year old from West Virginia. She works as a facilities assistant in a maximum-security prison. She has three children ages 15, 11, and 10. After her last child she had her tubes tied. She was previously married but now has a new partner. Her partner does not have any children and together they desire a child.

She found Chapel Hill Tubal Reversal Center by researching tubal ligation reversal on the Internet. She says it took some time for them to decide and make up their mind where to have her tubal reversal operation performed. They decided to come to us because of our reputation and informative website.

Dr. Berger and I meet with her and her husband the morning of surgery. We discussed her medical history, risks of surgery and expected recovery. After our pre-operative evaluation, she and her husband met the anesthesiologist, Dr. Caryn Hertz, and within one hour she was in the operating suite.

She underwent general anesthesia without any difficulty. She had a small 3-inch incision just about the pubic hairline. Both tubes were easily identified and repaired. The tubal lengths after the tubal reapproximation were good. The entire surgical procedure was one hour. Her surgery went extremely well.

After her stay in the recovery room, we discussed the operative results with her and her husband and the recovery room nurses reviewed the postoperative instructions with them. They were discharged to stay at a local hotel where one of the Tubal Reversal Nurses visited her this morning. She was found to be recovering well and she was discharged to return home to West Virginia.

We wish her and her husband well and that they will have the baby soon they are hoping for!

Submitted by Dr. Charles Monteith
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 versus 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.