Tubal Reversal Blog ‘ligation reversal specialist’

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.

The practice of modern medicine

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 same 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.

Why did I decide to join Dr. Berger at Chapel Hill Tubal Reversal Center?

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.

As I depart….

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.

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 in Training
Chapel Hill Tubal Reversal Center

Dr. Gary Berger is leading the way in the specialty of tubal ligation reversal. Performing over 7,000 tubal reversals, Dr. Berger developed and refined the only one-hour, outpatient tubal reversal surgery using microsurgical techniques.

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At Chapel Hill Tubal Reversal Center, we want to maximize the chances for pregnancy after tubal ligation reversal for all of our patients. One step that is helpful in planning for a tubal reversal procedure is examining the pathology report from a patient’s medical record. Pathology reports can provide critical information to a tubal reversal specialist since they convey additional information beyond what is contained in the operative report describing the tubal ligation.

What is a pathology report?

A pathology report- sometimes shortened to ‘path report’- is a typed report from a pathologist (doctor who studies healthy and diseased tissue) that describes the removed tubal segments. Usually when tissue is removed by a surgical operation, it is sent to a pathologist for examination. After this examination, a pathologist will create a typed report describing what was observed.

When a tubal ligation and resection procedure has been performed, a segment of fallopian tube was removed and most likely sent to a pathologist. Therefore, a pathology report should exist in the patient’s medical record. When a sterilization has been performed by tubal electrocautery or with tubal clips or rings, there will not be a pathology report because no tubal tissue is removed with these tubal ligation methods.

A pathology report will help our tubal reversal doctors determine exactly what was done during a ligation and resection procedure and what your chances of tubal reversal success will be.

Examples of Pathology Reports After Tubal Ligation

Here are some examples of what the pathology reports may show after a tubal ligation and resection:

Scenario 1
Operative note states, “A standard ligation and resection was done.” Pathology report states, “Two 1.5 cm isthmic sections of fallopian tube were examined.” In this case, the pathology report confirms that small amounts of isthmic tubal segments were removed and the chance of successful ligation reversal is very good.

Scenario 2

Operative note states, “A bilateral ligation was done…tubes were resected.” Pathology report states, “Two 4 cm sections of fallopian tube were examined and fimbrial ends were present on both sections.” In this case, the pathology report demonstrates that the patient has had a fimbriectomy. We would advise the patient that fimbrectomy reversal will be the appropriate procedure to reverse this type of tubal ligation.

Scenario 3
Operative note states, “A typical bilateral tubal ligation was done.” Pathology report states, “Two 7 cm section of fallopian tubes were examined.” In this case, the pathology report shows that large amounts of tubal length were removed. This is not a typical bilateral tubal ligation, and the chance of a reversing tubal ligation is remote. In this case, we would advise the patient that IVF would be a better treatment option for her than tubal reversal surgery.

Get Expert Opinion

As tubal reversal experts who specialize in ‘untying tied tubes’,  we have found that most tubal ligations are reversible. Any patient considering ligation reversal should send us a copy of their operative report and, if ligation and resection was done, a copy of the pathology report. We will review these reports, without charge, and provide the best recommendation for becoming pregnant after tubal ligation.

Submitted by Dr. Charles Monteith
Chapel Hill Tubal Reversal Center