Tubal Reversal Blog ‘dr berger’

Women who are seeking the best tubal ligation reversal physicians come to Chapel Hill Tubal Reversal Center. It is the only medical practice or facility dedicated exclusively to repairing fallopian tubes after tubal ligations. Chapel Hill Tubal Reversal Center is widely recognized as the tubal reversal facility that has the best patient care and the highest documented pregnancy and birth rates, while offering low cost outpatient tubal reversals.

Tubal Reversal Physicians at Chapel Hill Tubal Reversal Center

Our Medical Director, Dr. Gary Berger, has specialized in tubal reversals for 30 years. He is now in the process of training Dr. Charles Monteith as a tubal reversal physician. Dr. Monteith will join the practice in July 2008, at which time he will offer low cost tubal reversals of tubal ligation. During July and August 2008, a special discounted fee of $4900 will be available to patients who schedule their tubal reversal procedures with Dr. Monteith.

Dr. Charles Monteith graduated Summa Cum Laude from Xavier University and received his Medical Degree from the University of California at San Francisco. Following a Howard Hughes Research Fellowship in molecular biology, he completed his residency in obstetrics and gynecology at the University of North Carolina at Chapel Hill in 2001. Since then he has been a Clinical Assistant Professor of Obstetrics and Gynecology at the University of North Carolina Medical School. Dr. Monteith is board certified in obstetrics and gynecology and has extensive experience in laparoscopic surgery and high risk obstetrics.

Explaining his decision to join Dr. Berger in practice, Dr. Monteith says, “My interest in tubal ligation reversal comes from my love of outpatient surgery and the desire to learn skills which are becoming a dying art. My hope is to be able to continue to practice tubal reversal surgery and to keep it as an option for patients who have had prior tubal ligation and desire to become pregnant.”

Low Cost Reversals of Tubal Ligation

A special discounted fee of $4900 will be available to patients who schedule their tubal reversal procedures with Dr. Monteith for July and August 2008. If you have questions or would like further information about scheduling your tubal reversal procedure with Dr. Monteith, please contact Julia Smith, RN at (919) 656-8204.

Dr. Berger’s Comment

It is truly a pleasure to be working with Dr. Monteith, who has already established a reputation as an outstanding ob/gyn physician. By the time he completes his 6 month fellowship in tubal reversal surgery with me, he will be well qualified and certified as a Tubal Reversal Physician.

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.

Patients often ask when they should have a hysterosalpingogram (HSG) to see if their fallopian tubes are open after tubal reversal surgery.

When to Have an HSG

Wait for at least 6 to 12 months after a tubal reversal procedure for this test of tubal patency. An HSG carries a risk of infection and often does not give conclusive results. It is best to give yourself a chance to become pregnant rather than rushing to have an HSG. Most patients conceive within this time frame and will avoid the need for an unnecessary and possibly misleading or harmful procedure.

Preparing for an HSG

To avoid unnecessary risks, an HSG should be performed only after menstruation is over and before ovulation occurs. Having an HSG after the time of ovulation may interfere with a pregnancy - before a pregnancy test can detect that conception has occurred. To minimize the risk of infection, use a betadine vaginal douche the evening before and the morning of the scheduled procedure and ask your doctor for a prophylactic antibiotic prescription. 600 mg of ibuprofen taken one hour before the HSG will minimize its discomfort.

What to Look For in an HSG

You can ask to watch the results on the fluoroscopy screen while the dye is being injected into the uterus.

At first, the dye will fill the uterine cavity. It is essential that the dye actually enter the fallopian tubes up to the point where the anastomosis was performed. Often, this does not occur due to spasm of the sphincter between the uterus and tubes (shown by the arrows) or from mucus or calcium deposits in the proximal tubal segments.

If the dye passes through the anastomosis sites, the fallopian tubes are open. Most radiologists do not consider the x-ray to show tubal patency (openness) unless dye spills into the abdominal cavity. When this happens, the diagnosis of tubal patency is conclusive.

We often see x-rays where dye has passed through the tubal  anastomosis site, but has not yet spilled into the abdominal cavity. This is due to an insufficient amount of dye being injected into the tubes. The radiologist may mistakenly believe the tube is blocked when in reality it is open.

Send Your X-Rays To Me

In order to be certain about whether an HSG demonstrates tubal patency, tubal occlusion, or is inconclusive, please instruct the radiologist to send the x-ray films to me to interpret. Having documented the anatomy and measurements of the fallopian tube segments during tubal reversal surgery, I can compare the x-ray findings with each patient’s operative report. This allows me to give the most accurate interpretation of HSG results.

Dr. Berger’s Comment

Hysterosalpingography is a widely available procedure to examine tubal anatomy. Unfortunately, it is often performed or interpreted inaccurately. An HSG also has risks as well as discomfort and cost. It is best to wait for at least 6-12 months after a tubal reversal procedure to have an HSG. Most patients will become pregnant after tubal reversal within a year and can avoid the problems associated with HSGs. Preparing properly for an HSG and sending the x-ray images to me will minimize the risks and errors associated with a hysterosalpingram.

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.

Patient’s History

Ana G. was one of the 4 patients I operated on today at Chapel Hill Tubal Reversal Center. She is a 28 year old woman from Angola, the mother of 3 children - ages 9, 8, and 6. She married when she was 15 and was in an abusive marriage. To keep from becoming pregnant again, she had a tubal ligation. When she had this done, all she could think about was not becoming pregnant again.

Ana eventually ran away and divorced her husband. Several years later she met a man who she fell in love with and who has treated her very well. He has no children. Now remarried, Ana feels that her second husband will want children in the future, so she decided to have a tubal ligation reversal. Although she doesn’t intend to become pregnant soon, she says that if it happens that would be fine.

Ana’s Tubal Reversal Procedure

Ana’s tubal reversal was performed by the technique of tubotubal anastomosis. Her fallopian tubes were in excellent health, with no fibrosis and with normal fimbriae and tubal endothelium. The anastomoses were isthmic-ampullary on the right and isthmic-isthmic anastomosis on the left. The tubal lengths after repair were 6.5 cm on the right and 8 cm on the left side.

Dr. Berger’s Comments

Every patient who comes to Chapel Hill Tubal Reversal Center has a unique story to tell that led up to the decision for a tubal reversal procedure. Divorce and remarriage is a common theme, and a history of abuse in the prior marriage is often one of the reasons given for the divorce.

Ana’s story is unusual in that she married at age 15 and had her tubal ligation by age 21. This may be due to the cultural differences in some African countries from the US. Although most of our patients come from the United States, couples come from many other countries to have me perform their tubal reversal surgery.

Although Ana’s operative report stated that Filshie clips had been applied to her tubes, no clips were found during surgery. It is not clear whether the operative report was incorrect, or whether the clips migrated to other locations in the abdominal cavity. This can occur if the pressure from the closed clips causes necrosis or death of the tissue within the clip. I have seen this occasionally in other patients.

Predicted Outcome After Ana’s Tubal Reversal

Based on her age and tubal lengths, Ana’s probability of becoming pregnant is 90% as documented in the post tubal reversal pregnancy statistics among patients at Chapel Hill Tubal Reversal Center.

Tubal Anastomosis at the Uterine Cornua

Tubouterine anastomosis is a tubal reversal procedure that is intermediate between tubotubal anastomosis and tubouterine implantation. It is also called cornual anastomosis because the tube is joined to the cornual area of the uterus with this operation. The cornu is the area where the fallopian tube normally emerges from the the uterus.

When Is Tubouterine Anastomosis Performed?

Tubouterine anastomosis is performed when there is a healthy tubal segment near the ovary, but no segment remains attached to the uterus, following a tubal ligation procedure. It is also performed when a tubal segment attached to the uterus is scarred and has no open lumen.

An incision is made into the uterus at the cornu to find the opening of the fallopian tube tube as it passes through the uterine muscle. If an opening is found, the tubal segment that remains is rejoined to the uterus at this site.

Case Histories

The topic of tubouterine anastomosis is a timely one. During the past week, 2 patients undergoing tubal reversal surgery at Chapel Hill Tubal Reversal Center required this operative procedure. In one case, each fallopian tube had been coagulated or burned next to the uterine cornu, leaving no segment attached to the uterus. The other patient had developed the condition known as salpingitis isthmica nodosa in the portion of the fallopian tube between the uterus and the a Falope ring. In both cases, tubal reversal was able to performed with the technique of tubouterine anastomosis.

Dr. Berger’s Comment

Frequently, patients have been informed by doctors who are not specialists in tubal ligation reversal that their fallopian tubes cannot be repaired after a tubal ligation. This is especially true when the proximal segments of the fallopian tubes are missing or diseased. But there are a variety of surgical techniques that can be used during tubal reversal surgery by a doctor who is an experienced tubal reversal surgeon. This is one of the advantages patients have when they come to Chapel Hill Tubal Reversal Center for their tubal reversal procedures.

Salpingitis Isthmica Nodosa

Salpingitis isthmica nodosa is a nodular swelling of the isthmic segment of the fallopian tube. This fallopian tube abnormality is sometimes encountered at the time of tubal reversal surgery. It often involves the interstitial portion of tube that is within the uterine muscle. The nodule is due to thickening of the muscular wall of the tube around ingrowths or projections of the inner mucus membrane tubal layer into the muscle.

History of Salpingitis Isthmica Nodosa: Scholarly Publications

This tubal abnormality was first described and named by Chiari in 1887 .⁽¹⁾ The name he gave it reflected his belief this was an inflammatory condition. (Salpingitis means inflammation of the fallopian tube.) His contemporary, Kossman, also thought this was an inflammatory condition.⁽²⁾ An alternate theory of causation was suggested by Recklinghausen in 1896 who believed it to be a congenital abnormality.⁽³⁾ A third possibility, suggested by Benjamin and Beaver in 1951, is that SIN is an acquired, noninflammatory condition.⁽⁴⁾ They believed that the lesion begins as an overgrowth of the inner tubal lining that penetrates into the tubal muscular wall. Then cysts form and the tubal muscular wall becomes enlarged and fibrotic. This has also been termed endosalpingosis, a condition closely related to uterine adenomyosis (a form of endometriosis in which the uterine endometrium grows into the uterine muscle).

HSG Diagnostic Findings

Salpingitis isthmica nodosa can be diagnosed radiographically. A hysterosalpingogram or HSG shows multiple small diverticuli or outpouchings of of x-ray dye protruding from the tubal lumen into the wall of the isthmic portion of the fallopian tubes. Because of its appearance at HSG, radiologists call it tubal diverticulosis.⁽⁵⁾

Clinical Implications

Salpingitis isthmica nodosa is associated with increased rates of infertility by interfering with upward sperm migration and ectopic pregnancy by trapping the fertilized egg within the tube.

Treatment During Tubal Reversal

Salpingitis isthmica nodosa may be encountered at the time of tubal reversal surgery. Because of the dense abnormality of the fallopian tube at its connection with the uterus, tubotubal anastomosis is not possible. In this situation, tubouterine anastomosis or tubouterine implantation can be performed.

Gary S Berger MD, Medical Director of Chapel Hill Tubal Reversal Center, is well known for his contributions to clinical medicine as a reproductive surgeon. Patients sometimes ask about Dr. Berger’s education, training, academic credentials, scholarly research and publications.

This is a resume of Dr. Berger’s academic credentials:

ACADEMIC DEGREES

1965 A.B. with Honors
Harvard College
Boston, Massachusetts

1969 M.D.
University of Rochester
Rochester, New York

1976 M.S.P.H.
University of North Carolina
School of Public Health
Chapel Hill, North Carolina

POSTGRADUATE EDUCATION

1969 - 1970 Intern
Department of Internal Medicine
Duke University Hospital
Durham, North Carolina

1970 - 1971 Assistant Resident
Department of Gynecology and Obstetrics
Johns Hopkins Hospital
Baltimore, Maryland

1971 - 1973 Epidemic Intelligence Service Officer
Family Planning Evaluation Program
Bureau of Epidemiology
Centers for Disease Control
U.S. Public Health Service
Atlanta, Georgia

1973 - 1976 Resident
Department of Obstetrics and Gynecology
University of North Carolina
Chapel Hill, North Carolina

ACADEMIC APPOINTMENTS

1976 - 1979 Assistant Professor
Department of Obstetrics and Gynecology
University of North Carolina at Chapel Hill
Chapel Hill, NC

1980 - 2003 Adjunct Associate Professor
Department of Maternal and Child Health
School of Public Health
University of North Carolina at Chapel Hill
Chapel Hill, NC

1992 - 2003 Clinical Associate Professor
Department of Obstetrics and Gynecology
University of North Carolina
Chapel Hill, NC

SCHOLARLY PUBLICATIONS

Dr. Berger has published more than 160 peer-reviewed scientific articles in medical journals. He has also authored or edited these medical books:

D.A. Edelman, G.S. Berger and L.G. Keith. Intrauterine Devices and Their Complications. G.K. Hall, 1979.

L.G. Keith, M. Labbok, J. Petty, and G.S. Berger. Postpartum and Postabortal Contraception. Synapse Publications, 1979.

L.G. Keith, D.R. Kent, G.S. Berger, and J.R. Brittain, editors. The Safety of Feliility Control. Springer Publishing Company, 1980.

M. Jackson, G.S. Berger and L.G. Keith. Vaginal Contraception. G.K. Hall, 1980.

L.G. Keith, G.S. Berger and D.A. Edleman, editors. Infections in Reproductive Health: Common Infections. Vol. I, MTP Press Ltd., 1985.

L.G. Keith, G.S. Berger and D.A. Edelman, editors. Infections in Reproductive Health: Uncommon Infections and Special Topics. Vol. II, MTP Press, Ltd., 1986.

M. Bygdeman, G.S. Berger, L.G. Keith, editors. Prostaglandins and Their Inhibitors in Clinical Obstetrics and Gynecology. MTP Press, Ltd., 1986.

G.S. Berger, M. Goldstein and M. Fuerst. The Couple’s Guide to Fertility. Doubleday and Company, 1985.

G.S. Berger, L.V. Westrom, editors. Pelvic Inflammatory Disease. Raven Press, 1992.

C. Nezhat, G.S. Berger, V.C. Buttram, and F. Nezhat, editors. Endometriosis: Advanced Management and Surgical Techniques. Springer-Verlag, 1995.

G.S. Berger, M. Goldstein and M. Fuerst. The Couple’s Guide to Fertility, revised edition. Doubleday and Company, 1995.

G.S. Berger, M. Goldstein and M. Fuerst. The Couple’s Guide to Fertility: With the Newest Scientific Techniques to Help You Have a Baby. Broadway Books, 2001.

Dr. Berger - Clinician and Scholar

Dr. Berger’s contributions to reproductive medicine and surgery show that a clinician whose primary responsibility is in the care of individual patients can also be a scholar contributing to academic research. This is the basis of Dr. Berger’s ongoing Tubal Reversal Pregnancy Study that documents and analyzes the clinical outcomes of his patients following tubal reversal surgery.

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.