The tubal reversal doctors at Chapel Hill Tubal Reversal Center performed the first reversal procedure after Adiana tubal sterilization on February 6, 2009. Today they report the success of the operation as confirmed by a positive pregnancy test submitted by the patient,Tina D., via her Pregnancy Report Form. Read the rest of this article and comment on it. »
The staff of Chapel Hill Tubal Reversal Center is pleased to announce the arrival of Dr. Monteith’s first tubal ligation reversal baby.
The first Monteith Miracle T-Shirt was mailed to Alaska the first week of April. The pregnancies assisted by Dr. Monteith are beginning to roll in and the ‘Montieth Miracle’ t-shirts are starting to roll out.
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Preparation for tubal ligation reversal surgery is the same for all patients regardless of age. Any person considering ‘untying tied tubes‘ should read this article to understand how to arrange and schedule a tubal ligation reversal.
This is the sixth article in a series dedicated to women considering alternatives for pregnancy and tubal ligation reversal after the age of 40.
The previous article describes the risk of having a tubal reversal surgery and the first article of our series is Tubal Ligation Reversal After the Age 40 | Introduction.
Read the rest of this article and comment on it. »
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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The tubal reversal doctors at Chapel Hill Tubal Reversal Center perform over 800 tubal ligation reversals every year. We perform tubal reversals on patients from all over the United States and across the world. We have become experts in unblocking blocked tubes.
Every one of our patients brings with them a unique story. Periodically, we like to present their stories so readers can see the diverse walks of life from which our patients come.
On December 1st 2008, I meet Dorinda and asked her if she would participate in our Tubal Reversal Blog. She agreed and here is her story:
The tubal reversal doctors at Chapel Hill Tubal Reversal Center are specialists in fallopian tube repair. Although most of patients come to Chapel Hill Tubal Reversal Center for tubal ligation reversal, others come for fallopian tube repair after a tubal infection or pelvic inflammatory disease (PID), ectopic pregnancy, or previous surgery involving the fallopian tubes.
The fallopian tube begins within the muscular wall of the uterus (interstitial segment), leads away from the uterine wall (isthmic segment), becomes wider (ampulla), extends to the widest area near the end of the tube (infundibulum), and ends next to the ovary (fimbrial segment).
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.
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.
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.
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.
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
Of the many questions I receive daily from potential patients, one of the most important questions is what makes Dr. Berger the best choice to perform tubal reversal vs. another doctor. With a specialized procedure such as tubal ligation reversal, surgical experience is the most important factor in predicting success from the operation. Dr. Berger has performed more than 7000 tubal reversal operations and has the most experience of any tubal surgeon in the world.
We routinely hear from women who have gone to a nearby doctor for a tubal reversal, only to have the doctor stop the procedure before repairing the tubes because an unexpected situation was encountered during surgery. There are multiple situations where this may happen:
1. No isthmic tubal segment remains and tubouterine implantation needs to be performed.
There are few, if any, other doctors who can perform this type of operation and none could do so as outpatient surgery. At Chapel Hill Tubal Reversal Center, Dr. Berger has successfully performed this type of operation many times as a safe and effective outpatient operation.
2. A fimbriectomy has been performed.
Tubal ligation by fimbriectomy involves removing a portion (usually up to one-third) of the fallopian tube closest to the ovary. To our knowledge there are no other doctors performing fimbriectomy reversals. The pregnancy rate following fimbriectomy reversal performed by Dr. Berger is 56%.
3. The patient has only a proximal tubal segment (attached to the uterus) on one side and a distal tubal segment (near the ovary) on the other side.
This is an unusual situation, but Dr. Berger has successfully attached these two segments on opposite sides of the body to create one tube with 2/3 women becoming pregnant afterwards. This operation has not been described in the medical literature. Dr. Berger calls this operation “contralateral tubotubal anastomosis”.
4. The patient is found at the time of surgery to have inherent disease of the fallopian tubes due to tubal endometriosis, salpingitis isthmica nodosa, or pelvic inflammatory disease. In these situations, Dr. Berger removes the diseased tubal segment and repairs the fallopian tube with the most appropriate reversal operation.
Experience is the most important indicator of whether successful tubal reversal surgery can be performed when a woman has a difficult tubal reversal situation due to short tubes, missing tubal segments, fimbriectomy, or inherent diseases of the tubes. While most doctors would be unwilling – or unable – to perform a reversal procedure in one of these situations, Dr. Gary Berger is able to repair the tubes in 98% of cases, regardless of the type of sterilization that has been performed or whether difficult situations are encountered.
Submitted by Julia Smith, R.N.
Nurse Administrator
If you have questions or would like assistance scheduling your surgery, please contact me.
JuliaS@tubal-reversal.net
(919) 656-8204
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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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