My first day back at work was the beginning of my second week of recovery.
I work as a receptionist so I have somewhat of a desk job, but I do have to get up and down to get files, answer phones, and assist clients. I took my heating pad to work with me those first few days.
I only worked half a day Friday and I was exhausted by the end of the half day shift.
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
Women who want more children after tubal ligation must decide between two treatment options: In-vitro fertilization (IVF) and tubal ligation reversal.
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).
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).
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.
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.
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.
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.
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.
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.
The Doctor Who Unties TubesDr. Gary Berger is a tubal reversal doctor who specializes exclusively in procedures to untie tubes. Dr. Berger created the first and only tubal reversal clinic – Chapel Hill Tubal Reversal Center. This is the best place to get tubes untied for women who want another baby after tubal ligation.
One of the questions Dr. Berger asks his patients is what made them decide to have their tubes untied. In answering this question, women describe the circumstances which led them to want another child after tubal ligation. Most cases involve divorce and remarriage. Often the husband has no children, and the couple would like to have a family of their own. Some couples already have children together but realize that having a tubal ligation was a decision that they regret. Death of a child, religious considerations, and the desire to relieve symptoms of “Post Tubal Ligation Syndrome” are other reasons for wanting to get tubes untied.
Although there are many websites that discuss reverse tubal ligation, information about success rates is often lacking or stated in general terms. To make a fully informed decision about tubal reversal, women should have specific and accurate statistics about pregnancies regarding a doctor’s own patients rather than a general statistic taken from some other source. Otherwise, it has little meaning.
Chapel Hill Tubal Reversal Center provides information each week about pregnancies after tubal reversal procedures performed by Dr. Berger. Whenever one of Dr. Berger’s patients becomes pregnant, they can submit a Pregnancy Report Form to alert the Tubal Reversal Center staff of their pregnancy. This enables Dr. Berger and his nurses to monitor the results of the Early Pregnancy Protocol that is recommend by Dr. Berger. Each week, the new pregnancy reports are tabulated and listed in the Weekly Pregnancy Reports forum on the Tubal Reversal Message Board. During this past week, there were 20 new pregnancies reported by Dr. Berger’s tubal reversal patients. This is more than reported in a year by most doctors who perform tubal reversal procedures! Additional information about the new pregnancies is shown in the Pregnancy Announcements section of the Chapel Hill Tubal Reversal Center website. A complete statistical analysis of the outcome of all tubal reversals is published as the Tubal Reversal Study Report each year.
By establishing a medical facility exclusively for tubal reversal procedures that untie tubes, following up on all patients who have had a reverse tubal ligation, and publishing their pregnancy statistics, Chapel Hill Tubal Reversal Center has set a new standard for other doctors who provide tubal reversal services to follow.
Reverse tubal ligation – or more properly, tubal ligation reversal – is a procedure to get tubes untied for women who desire a pregnancy after tubal ligation. There are actually several procedures that can be used to untie tubes after the tubes have been tied.
There are 3 main techniques that can be used for reversing tubal ligation.
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The most common method for untying tubes is the reverse tubal ligation procedure of tubal anastomosis. Anastomosis refers to joining two body parts, and tubotubal anastomosis is joining two tubal segments together. Most techniques that tie tubes result in two separate tubal segments, so the simplest way to get tubes untied in these cases is with the anastomosis procedure.
For more details about untying tubes via tubal anastomosis, see the topic on Tubal Reversal by Tubal Anastomosis on the Tubal Reversal Blog and the description of Microsurgical Tubal Anastomosis on the Chapel Hill Tubal Reversal Center website.
Reverse tubal ligation is usually described as extremely expensive, ranging from $10,000 to $30,000. The tubal anastomosis procedure to untie tubes costs $5900 at Chapel Hill Tubal Reversal Center. Because it is done as outpatient surgery and performed four times a day, the cost savings is passed on to the women who want kids after tubal ligation.
The tubal reversal operation by Dr. Berger has been featured on television – this video clip on YouTube is 3 minutes long. To watch the entire operation, you can order a free video or DVD of tubes untied.
Tubal implantation and salpingostomy are less frequent techniques to untie the tubes after a tubal ligation. For descriptions of these techniques, see the topic on Tubal Reversal by Tubal Implantation and Tubal Reversal by Salpingostomy on the Tubal Reversal Blog or Read the section on Reversal Illustrations on the Chapel Hill Tubal Reversal Center website.
Women who have had their tubes tied and then want to get tubes untied often ask if there is a simple procedure that permits pregnancy after tubes tied. Often they envision a tubal ligation as if there is a bow tied around the tubes that can be simply untied, like one unties a shoelace. This is actually not the case. The common term “tying tubes” simplifies what is a tubal ligation – or tubal sterilization – is.
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| Tied and Cut |
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| Final Result |
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The most common type of tubal ligation involves putting a surgical ligature (or tie) around a loop of the fallopian tube and then cutting off the segment that has been ligated. The two tubal segments separate from each other. This is the Pomeroy technique, first describe by Dr. Ralph Pomery. Some doctors burn the ends of the tubes that have been cut and may use the term “modified” Pomeroy procedure in their operative report.
Another common type of ligation/resection procedure is the Parkland tubal ligation. With this techniqe, two ligatures are placed around the tube at a distance from each other and the portion of the fallopian tube in between the ligatures is resected (cut out). There are many other variations of the ligation and resection method of tubal ligation.
Tubal sterilization can also be performed by burning the tubes. This may be done with electocoagulation (coagulation, cautery, or cauterization) or with thermal coagulation. There are also variations with the coagulation methods of tubal ligation, such as the use of monopolar or bipolar coagulators, and the number of sites burned and for how long they are burned. The greater the number and the longer coagulator is applied to the tube, the greater the amount of damage.
A third method of female sterilization involves simply blocking or obstructing the tube with clips or rings. In general, these tend to cause the least amount of damage to the tube. Of all tubal ligation techniques, the tubal clip (Filshie clip or Hulka clip) is the least damaging and the one that consistenly gives the best results when the tubes are “untied” or repaired.
Essure is another new tubal sterilization procedure. This does not require surgery, but it is the least reversible method for women wanting kids after tubal ligation.
This summary is to help women who want to get their tubes untied. The first thing to know is what tying tubes actually means. It is not as simple as placing a string around the tube that can later be untied. Contrary to what some people think, tubes don’t become untied by themselves after a certain length of time. With this basic information about the fallopian tube and tubal ligation methods in mind, I will explain how reversal of tubal ligation is done in the next topic Tubal Reversal Blog – How to Get Tubes Untied: Reverse Tubal Ligation.
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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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