This is part two of Cyndi’s story. Cyndi traveled to Chapel Hill Tubal Reversal Center for reversal of tubal ligation after discovering IVF for unmarried couples was illegal in Arkansas (AR). Part one of Cyndi’s story is Pregnancy After Tubal Ligation: IVF or Tubal Reversal?
Specializing in tubal surgery and the treatment of infertility in women who have had tubal ligations (tubes tied), we meet many patients who share many different stories with us. In the fall of 2008, I was conducting a preoperative evaluation with a patient for a tubal ligation reversal after she had an unsuccessful IVF treatment cycle. Here is her story.
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Chapel Hill Tubal Reversal Center offers an excellent alternative to in vitro fertilization (IVF) – namely, tubal surgery to untie tubes and correct tubal blockage. If you have had your fallopian tubes tied (tubal ligation) or have blocked tubes and want to become pregnant, then tubal surgery may be the best treatment for you.
Tubal blockage or tubal occlusion (the medical term) is the reason that tubal ligation prevents pregnancy. The blockage of the fallopian tube prevents joining of the sperm and egg and prevents eggs from being able to reach the uterine cavity. In the case of tubal sterilization, tubal blockage is intentional. Tubal blockage may also occur due to disease conditions and result in involuntary infertility. Tubal blockage, whether intentional or from disease, can be corrected with reconstructive tubal surgery.
Tubal blockage affects millions of women in the US and hundreds of millions worldwide. More than 10 million women in the US, and more than 100 million worldwide, have had a tubal sterilization. There are approximately 6 million infertile couples in the US. It is estimated that 10-20% (600,000 to 1.2 million) cases of infertility may be due to tubal disease. In the majority of cases, tubal occlusion due to disease is caused by pelvic inflammatory disease (PID), an infection of the fallopian tubes (salpingitis) and sometimes the ovaries and pelvic cavity. PID is “silent”, unrecognized, or misdiagnosed in many and perhaps in the majority of cases.
Tubal ligation reversal at Chapel Hill Tubal Reversal Center is a simple and safe outpatient operation for reversing tubal sterilization through a small incision that results in minimal discomfort and recovery time.
Dr. Gary Berger and Dr. Charles Monteith specialize in untying tubes. Women travel to Chapel Hill, NC from all over the United States and other parts of the world to have their tubes repaired after a previous tubal ligation. Over 7000 women have chosen to come here for their reversal procedures because we specialize exclusively in tubal ligation reversal, have perfected the outpatient approach to reversal surgery, and have the best success in terms of pregnancies after tubal reversal surgery.
This article profiles a patient who came to Chapel Hill Tubal Reversal Center for reversing tubal ligation at which time she was found to have ovarian endometriosis.
The patient and her husband traveled from Monterrey, California for tubal ligation reversal. She is 44 years old and is a banker. She has two children from previous marriage, ages 12 and 15. Her husband is a meteorologist. He has two children from a previous marriage, ages 16 and 18. They moved from Texas to California and have been married together for 1 year and 3 months. Together, they desire a child of their own.
Prior to traveling to visit us, they had a consultation with a reproductive endocrinologist near where they live. They expressed dissatisfaction with their consultation because they felt the doctor only wanted to offer them in-vitro fertilization (IVF). They did consider IVF but decided the procedure was not for them. During the preoperative consultation they specifically stated:
“We wanted to have a baby as God intended it.”
They did their own search for tubal reversal doctors and chose to come to Chapel Hill Tubal Reversal Center because we specialize exclusively in reversing tubal ligation. They felt their chance for a successful reversal procedure would be best at our center.
She was a healthy person and denied any known preexisting problems or menstrual abnormalities. We reviewed her tubal ligation operative and pathology reports that described at least 3 cm removed from each fallopian tube. We discussed their expectations and the risks and benefits of tubal reparative surgery.
During her surgical procedure and upon entering the abdominal cavity, we discovered brown fluid suggesting the presence of endometriosis. Close inspection of the right ovary revealed endometriosis inside of it and partially involving the right tube.
We removed the endometriosis and repaired the right tube. The left tube and ovary were normal. The left tube was repaired without difficulty.
She did well during the surgery. In the recovery room, we informed her and her husband of the unexpected endometriosis and the successful repair of both fallopian tubes.
Endometriosis can be suspected in most patients based on a careful evaluation of a menstrual history. Many women with endometriosis will have extremely painful menstrual periods. Menstruation can be so painful patients may require large amounts of pain medications, miss time from work, or will have pelvic pain which drastically affects their personal lives. Many women give a history of severe pelvic pain, especially with intercourse and will plan their sexual activity based on their menstrual cycles. Many patients, like this one, can have minimal or no symptoms of endometriosis.
We could not have predicted this patient’s endometriosis in advance because of her absence of preexisting symptoms. Fortunately, we were able to successfully reverse her tubal ligation and remove the endometriosis at the same time.
We wish her well on her trip back to Monterrey California and hope a healthy pregnancy will be in her near future.
The tubal ligation reversal experts of Chapel Hill Tubal Reversal Center are experienced at sterilization reversal. Many women who have had their ‘tubes tied’ will come to our center to have their ‘tubes untied’. Unfortunately, a ligation reversal is not as easy as ‘untying’ the tubes- we wish the process was that simple.
We employ a microsurgical approach to repair and reattach the ends of the tubes. This process is called tubotubal anastamosis, and provides a patient with an excellent chance of becoming pregnant naturally. We specialize in ligation reversal and in reversal of difficult tubal ligation procedures.
We would like to present the story of one of our patients who had an atypical sterilization procedure.
The patient’s name is Ofralinda. She and her husband, Juan, came to us from Texas. Ofralinda is 35 and she works as an OSHA compliance officer. Her husband is in construction. Ofralinda desired a tubal ligation reversal in order to have more children. She had a rare and atypical sterilization procedure termed the Uchida procedure.
A Japanese physician, Dr. Uchida, first described this method of sterilization in 1961. This method involves removing a large segment of the fallopian tube and suturing (sewing) the cut end of the fallopian tube into the wall of the uterus. Dr. Uchida first published information about his method of sterilization after having performed over 50,000 procedures without any pregnancy failures. This is an effective but also complicated method of surgical sterilization. Most modern physicians have never performed or seen a Uchida sterilization. We have seen several patients who have presented with a Uchida sterilization procedure and we have had success with reversal of this method.
Ofralinda had a 60-minute outpatient tubal ligation reversal. Her surgery went well. We found her tubes to be short (due to the large amount of tube removed with her initial Uchida sterilization) but otherwise healthy. We were able to successfully repair both of her fallopian tubes. She has since been discharged back to her home and we wish her well. We would like to hear a report of a successful pregnancy from her within the year.
We specialize in tubal ligation reversal. Our tubal ligation reversal specialists perform over 800 reversal procedures every year on women from across the world. We regularly have patients from as far away as Hawaii, Alaska, and the Caribbean. Occasionally, we will have patients from Australia, Asia, and Europe. 
Most tubal ligation procedures are reversible. The pregnancy rates after reversal are generally higher than after in vitro fertilization (IVF) and we specialize in difficult tubal reversal procedures.
In the spring of 2007, I had a chance encounter with an individual, which started me along a new career path. This path has led me to a specialization in tubal ligation reversal. In the summer of 2008, I joined Dr. Gary Berger at Chapel Hill Tubal Reversal Center as a ligation reversal specialist.
Many people have asked me why I decided to leave my practice of obstetrics and gynecology. To understand my reasons for leaving, one has to understand my reasons for entering the practice of medicine.
I entered the field of medicine with the very simple ideals of sacrifice, hard work, and self-determination to improve the human condition. These ideals were based on observations I had of my grandfather, who was a general medical practitioner.
My grandfather graduated from Meharry Medical School in 1932. He had two black bags, an office, and a red Studebaker sedan for house calls and visits to the hospital. He worked long hours and helped many people in the African-American community. His patients were his patients and he was their doctor. And, there simply were very few doctors who would see them during the times of racial segregation. They needed and depended on him and he needed them as well. He needed them to carry out his vision of what medicine was truly about – caring for those in need and significantly improving the human condition. He and two other independent physicians personally took care of patients for a five county area around Columbia, South Carolina. His patients loved and respected him. These three doctors worked hard for their community. If they were not there, then no one else would have been. My grandfather was a critical component of wellness for his patients.
As a young boy, I would go to work with my grandfather every Saturday. I would observe him working in his black and white checkerboard tiled office. I would sit behind his desk as he examined patients. I vividly remember the smell of alcohol, moldy penicillin- the sight of cotton balls in glass jars, scary metal syringes clanking inside metal trays, and the sounds of coughing coming from the waiting room. For the most part, I did not comprehend any of what occurred there, but I always remembered a good warm feeling. These Saturdays created many, many memories for me.
My grandfather shared many stories with me from his early days of being a healer. The practice of medicine for him was more of an art and less of a science. The only science at the time was anatomy and surgery. Penicillin had not yet been invented! My grandfather worked during the Great Depression, made house calls, and performed home births. There was no such thing as health insurance for any his patients. Many times he was paid in produce, livestock, and quite often nothing was paid to him. He did his job as a service to the people of South Carolina who would otherwise have no one else to turn to. He worked extremely hard because he was needed. And, because he saw the patients others doctors would not even touch, he was irreplaceable. As I grew older, I realized I admired his position as an irreplaceable caretaker who made a significant impact upon the lives of those he touched. To some extent, I chose this aspect of him as the most important quality I wanted to emulate.
As young man, I entered medicine with some of the romantic ideals I observed as a child. More specifically, I chose obstetrics and gynecology because it was one of the last remaining areas of medicine where you could be a complete physician. It was a discipline of medicine where you can treat illness, perform surgery and have long-standing relationships with patients and family members. Since finishing medical school, I have come to realize many things have changed since my grandfather practiced medicine. Many things have occurred which have made the field of medicine a very different entity from the vision I observed through my grandfather as a child.
Several aspects of modern medicine disturb me.
Patients no longer have their doctor. Instead, they go to a doctor who is allowed by their medical insurance. We live in a mobile society. Many patients change jobs, move and are never seen again. The sam
e is true of mobile physicians.
Many doctors are controlled by either insurance companies, hospital administration, or by malpractice insurance companies. Medicine has become less of an art between two people and more of a business interaction. Medical practice decisions are not always made with patient’s best interest, but instead based on market share and the activities of the competition and capitalism.
Malpractice lawsuits and the threat of legal action are at the top of physicians’ concerns. Many treatment or diagnostic recommendations are not made for medical reasons, but more because of liability concerns. Often we order tests not to detect physical ailments, but rather to avoid liability problems.
Declining reimbursements and rising malpractice insurance costs have also created situations where doctors have to see larger number of patients in shorter periods of time. Seeing larger numbers of patients leads to quicker and less fulfilling relationships.
Patients’ concerns and questions do not always get addressed in the haste. Many times this can result in quick, impersonal physician patient interactions, which can sometimes lead to resentment and discontent.
Having to see larger numbers patients in stressful medical situations will sometimes creates interpersonal friction between nurses, staff, doctors and patients. Unfortunately, the interpersonal friction of the modern hospital environment has become commonplace and, in many instances, is considered both normal and acceptable. I always detested this last, unfortunate reality of modern medicine.
Over the last several years, I have found myself gradually growing despondent because of the realizations I have outline above. I am not saying what I did while practicing obstetrics and gynecology was insignificant, but I began to feel as if I were not making the significant difference in patients’ lives I had envisioned. I was not the vision of my grandfather.
Relationships between caregivers and patients are strained today. In my past practice, if I did not show up for work one day, then one of my eight partners would have covered for me. When I left at 5PM, then one of my partners would deliver the baby. If I did not do a patient’s surgery, then someone else would have. Many patients would leave in the middle of their prenatal care and resume care somewhere else never to be seen again. I felt as if I was a replaceable cog in the modern machine of medicine. These were not observations and feelings I had when I spent Saturdays with my grandfather.
I decided to join the surgical center because it rekindled intense feelings in me about why I wanted to be a physician like my grandfather. In working at this surgical center, I am able to do very important things for patients and to significantly impact upon their lives. I am able to perform surgical techniques, which are gradually being forgotten by the medical world. I have a sense of being both critical and irreplaceable.
Most people do not realize how important a medical facility Chapel Hill Tubal Reversal Center is. The center is the only facility in the United States, which specializes in the reversal of tubal ligations. There are several reversal providers scattered around the states; however, they mostly do in-vitro fertilization (IVF) and very few reversal surgeries.
Tubal ligation reversal is becoming a dying surgical art – not because the surgery is ineffective (it is far more successful than IVF), but because current reproductive endocrinologist are not getting trained in ligation reversal. Current endocrinology fellows leave their training programs with little or no experience in tubal ligation reversal. The infertility specialist of tomorrow is not getting the ligation reversal training they need today. Why? Insurance plans will not pay for the surgery and the procedures are too costly if done in hospitals and training centers.
Many patients come to Chapel Hill Tubal Reversal Center from all over the world pursuing dreams of more children or feeling more complete through reversal of their sterilization. Many women have regret over their prior decisions and want to be made whole again. Many women undergo sterilization only to have extreme psychological distress, as events unfold in the future over which they have no control. Many women chose sterilization because they were in terrible relationships only to find a loving partner with whom they want more kids. Some patients have religious conversions and want to be as God intended them to be. Sadly, some women have had children die and they long to replace that missing face. For me, there is a greater sense of purpose in using my skills as a physician.
Dr. Berger has been the sole provider of ligation reversal at Chapel Hill Tubal Reversal Center and has done over 7,000 reversal surgeries. He has pioneered a surgical technique, which allows the surgery to be done quickly on an outpatient basis. As a result, tubal ligation reversal at the center is far less costly than hospital provided ligation reversal. Many women have benefited from his tireless work over the last twenty years. If Dr. Berger did not come to work, then many women would not have the option of sterilization reversal.
One can easily see when Dr. Berger offered to train me, I would have been a fool to decline his offer.
When I came to understand the important nature of the work, which was done at the center, I began to remember what my core values were. I felt like I could be a real doctor again. Using my talents, I could help individuals who would have nowhere else to turn. I can make a significant impact upon both my life and the lives of the patients and families I treat. These were feelings I had regarding the work of my grandfather.
I have had many fond memories of working as an academic generalist obstetrician and gynecologist. I have great memories of working with many bright and talented residents and medical students- many humorous stories from many late night experiences. I have had wonderful relationships with nursing and support staff and will miss them dearly. I have been privileged to bring many beautiful babies into this world. Mostly, I will miss the patients who chose me as their physician and allowed me to walk them through the problems of their lives.
We periodically write case reports on patients who undergo tubal ligation reversal at Chapel Hill Tubal Reversal Center. The patient we will profile today had a ligation reversal procedure at our center last month.
She and her husband traveled to Chapel Hill from West Virginia. She is 34 years old and previously was an in-vitro fertilization (IVF) nurse. She is the mother of two children (ages 5 and 2). Her husband works as an engineer and is the father of both of their children. She had a tubal ligation after her second child because of two difficult, high-risk pregnancies.
Her first pregnancy was a vaginal birth complicated by heavy post-partum bleeding. Her heavy bleeding required a dilation and curettage (D and C) and emergency abdominal surgery to control the blood loss. She was diagnosed as having a placenta accreta. This is a condition where the placenta has invaded into the uterus too deeply and does not separate normally from the uterus at the time of delivery. She recovered from this surgery and eventually had a second pregnancy. This child was delivered by C-section and she had a Pomeroy tubal ligation done during the C-section. The operative report described tying and cutting the tubes as well as burning the ends. The pathology report described 1.5 cm tubal segments as being removed.
She explained to us, “My decision to have a tubal ligation was not done prayerfully but was more of a medically made decision.” She and her husband now desire more children in their life, and they traveled to Chapel Hill Tubal Reversal Center to have her tubal ligation reversed.
We were concerned that her doctor described in the operative report the tubal cauterization (burning) after tying and cutting the tubes. Since the mention of the cauterization was vague (we had no idea if a small segment was burned or the entire tube was burned) we discussed starting with a screening laparoscopy. Our patient was able to talk to her doctor who performed the tubal ligation. The doctor assured her only the ends of the tubes were burned. Since this can be a common practice and seemed minimal, the decision was made to proceed with ligation reversal without starting with a screening laparoscopy.
During her operation we found the right fallopian tube was abnormal. The right tube was long and healthy appearing, but there was no fimbriated end of the tube. This area is one of the most critical areas of the tube. The fimbriated ends act like millions of small fingers, which pick up the egg and direct the egg down the tube. The repair of this tube would require a more difficult microsurgical salpingostomy and creation of a ‘neo-fimbriated’ end of tube.
A microsurgical salpingosotomy was performed on her right tube. The left side was more normal- we had two tubal segments that we repaired with the usual anastomosis procedure. The entire operation was about one hour and fifteen minutes.
The story of this patient illustrates several important concepts:
1. She was a knowledgeable medical professional. She understood what it meant to have a tubal ligation. Many patients of all walks of life will have changes of heart as their lives change. Even medical professionals will make health care decisions for themselves, which later turn out to not be right for them. None of us can predict the future.
2. She was an IVF nurse and was aware of the pros and cons of tubal ligation reversal vs IVF. She and her husband decided ligation reversal was a more appropriate path for them.
3. Operative and pathology reports provide helpful information in planning for tubal repair, but they can sometimes be misleading.
4. The right tube was very difficult to repair. Often we will question ourselves as to whether a difficult tube should be repaired or should we just focus on the ‘better’ tube. We can never predict with 100% certain what will or will not work to help get a patient pregnant, so we like to give all patients the benefit of the doubt and try at all costs to open all the tubes we operate on.
We wish her and her husband a successful outcome of her tubal reversal operation and hope their prayerful decision will be soon rewarded.
Submitted by Dr. Charles Monteith
Many women who have had a tubal ligation find themselves considering tubal ligation reversal. We have patients who come to Chapel Hill Tubal Reversal Center from all areas of the United States, Europe and Asia for ligation reversal procedures. They come to have their tubes untied for a variety of reasons. Many patients have told us about the frustration they felt when talking to their ob/gyn doctors about tubal ligation reversal or to a reproductive specialist who recommended only in-vitro fertilization (IVF). Many patients have also said their doctors minimize their concerns about symptoms they developed after having their tubes tied.
We recently published a blog about why some doctors may have negative opinions regarding ligation reversal surgery: Why your doctor may be cold to the idea of tubal ligation reversal. We also went to our message board and asked our patients and prospective patients about personal experiences with their physicians when talking about ligation reversal surgery. There we found out that many doctors were very supportive of their patient’s desire to have reversal surgery. The responses can be read under the message board topic: Share your doctors’ attitudes about tubal ligation reversal. Please feel free to leave your story about your experience when seeking reversal surgery or your doctor’s attitude toward the surgery. To leave comments on the Tubal Reversal Doctors Blog, please register and then log in (right hand column). Alternatively, you can add posts to the message board topics shown above.
At Chapel Hill Tubal Reversal Center, we are committed to providing you with the information you want to know about. That’s why the Chapel Hill Tubal Reversal team welcome your ideas, questions and comments. Whether you’re wondering about tubal reversal pregnancy rates, PTLS or how to talk to your doctor about having your tubes untied, we want to be able to address your concerns about tubal ligation reversal.
Submitted by Dr. Charles Monteith
DrMonteith@tubal-reversal.net
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Gary S. Berger, M.D. |
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Charles Monteith, M.D. |
Tubal Ligation Reversal News
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