My First Day at Nourishing Hopes and Dreams

My first day as a tubal ligation reversal specialist will always be remembered. I began my training with Dr. Berger during the first week of January 2008. We started the day off by meeting the patients who would be undergoing tubal ligation reversal at Chapel Hill Tubal Reversal Center.

I met four patients of different ages, backgrounds, and ethnicities . They were all very different people who all desired the same thing: reversal of their tubal ligation.

• The first patient was in her forties, she had emigrated from Ethiopia, her last child was more than twelve years ago, and she desired a chance to have another child.
• The second patient was in her thirties and her previous husband had died unexpectedly. She had children but her fiancé did not have any children. Together, they desired a child.
• The third patient,in her late twenties, had two children and a tubal ligation. Several years later she subsequently found a new partner and he desired a child with her. So while he was deployed overseas, she came for a tubal ligation and a chance for a new future when he returned from his military deployment.
• The fourth patient was in her late twenties and had several children. When she and her partner were in their early twenties they were financially maxed out and she had her tubes tied as an act of desperation. Several years later, she and her husband subsequently became financially stable and they wanted another child. They considered IVF but decided that a reversal was a better option for them. We also learned of an extremely sad story from this patient. She had a friend who had a tubal ligation. This friend had all of her four children die overnight in a house fire. This friend desperately has hope for a future reversal of her tubal ligation and was hoping to obtain a tubal reversal in the future.

All of the tubal reversal surgeries went well that day. The patients all did well and had technically excellent tubotubal reanastamosis (tubal ligation reversal) procedures. They all recovered well and went home to pursue their quest to add to their families.

For as long as a live, I will never be able to forget these women, their partners and the stories they told. I can never forget their quest to add children to their lives. For them I hope they attain what they desire.

My first lesson as a Tubal Reversal Specialist was that no one can predict the future, but if you always look hard enough you can always find a way - and someone to help- to correct prior mistakes.

Greetings from Dr. Monteith

My name is Dr. Charles W. Monteith and I am happy to formally introduce myself as a tubal reversal physician. I will be joining Dr. Gary Berger in practice at Chapel Hill Tubal Reversal Center as a certified tubal ligation reversal specialist in the summer of 2008. I am currently undergoing certification in tubal ligation reversal under the careful guidance of Dr. Berger. My training began in January of 2008 and I am well underway. After two months of training, I have assisted Dr. Berger in more tubal ligation reversals than many infertility specialists have seen in a lifetime!

I am originally from Columbia, South Carolina. I attended college at Xavier University of Louisiana, where I graduated Summa Cum Laude in Chemistry Pre-med. I attended medical school at the University of California at San Francisco which was ranked as one of the top three medical schools in the United States when I was accepted. During medical school, I received a Howard Hughes research fellowship and conducted research in molecular genetics at the University of California at San Francisco.

I completed my residency in Obstetrics and Gynecology at the University of North Carolina at Chapel Hill. During residency, I was inducted into the Alpha Omega Alpha honor society and was the recipient of many different awards for resident and medical student teaching. I had the reputation as the resident who was the easiest to get along with, had the best rapport with patients, and was the overall most patient and best teacher.

After finishing residency, I accepted a Clinical Assistant Professor position with the Department of Obstetrics and Gynecology at the University of Chapel Hill in 2001. I worked as a Professor in Obstetrics and Gynecology at Wake Medical Hospital in Raleigh, N.C. for seven years. I practiced high risk obstetrics and advanced surgical gynecology. I delivered many babies and performed many surgeries while an Assistant Professor. My specialty was advanced laparoscopy and the performance of surgical procedures in the medically challenging patient. A significant amount of my time has been spent with the training and teaching of both medical students and residents.

Despite all of the above, my most important success has been the marriage to my wife, Mary, who has been the key element of support in all my endeavors. We married shortly after graduation from medical school in 1997, and she has been my constant support ever since. Together we have three beautiful children: Charles III (5yrs), Jordan (3yrs), and Madison (18months).

With my above training and family as support I look forward to a successful career in tubal reversal surgery. It is with special gratitude that I thank Dr. Berger and the staff at the Chapel Hill Tubal Reversal Center for accepting me with open arms and training me in both the science and art of tubal ligation reversal.

Tubal reversal surgery is becoming a lost skill among doctors in training, according to an article in the January 2008 issue of Fertility and Sterility, the most influential medical journal for reproductive specialists. The article states, “The future for tubal anastomosis seems grim…and, like the Roman Empire, may be lost in Antiquity.”

The thesis of the article was that almost exclusive concentration on IVF and related reproductive technologies has decreased the training of reproductive specialists in tubal reparative surgery.

“The success of surgical tubal anastomosis is directly linked to surgical experience. With the advent of ART, surgical training has markedly declined, and there remain few fellowship programs with meaningful numbers of surgical cases. One study reported that most of the current Reproductive Endocrinology and Infertility fellows performed less than 10 procedures and 35% of program graduates performed no surgical tubal reversals in the previous year.”

Chapel Hill Tubal Reversal Center is for Patient Care

Patients have occasionally asked me if, with the experience I have had performing tubal reversals, I was teaching other physicians to perform this kind of surgery. Since Chapel Hill Tubal Reversal Center is a private practice dedicated to patient care - not a training institution - I have not previously taught other physicians the skills acquired over the 30 years I have been practicing as a reproductive surgeon. Having residents or RE fellows coming here for brief periods would allow only an introduction to the techniques of tubal reparative surgery. This would be insufficient for them to acquire all of the skills necessary to perform tubal reversals.

Introducing Dr. Charles Monteith

Recently, Dr. Charles Monteith, an Assistant Professor of Obstetrics and Gynecology at the UNC School of Medicine, requested a mentoring relationship with me to learn the techniques of tubal reversal surgery. Dr. Monteith is a board certified obstetrician-gynecologist with 6 years of surgical experience subsequent to completing his residency at the UCSF Medical Center. He has begun assisting me in surgery and will continue to do so on selected dates during the next 6 months. Some of the patients who have come here since January 1st have already met him. With his prior surgical experience, and after an extended training period, Dr. Monteith will become certified as a Tubal Reversal Specialist and join our staff in July 2008.

Dr. Berger’s Comment

My response, therefore, to the Fertility and Sterility article is that tubal anastomosis will not become “lost in Antiquity”. Perhaps in the future, other physicians will follow the path that Dr. Monteith has chosen to learn the skills and techniques required for successful tubal reversal operations. More information about Dr. Monteith will be available in forthcoming blog posts and on the Chapel Hill Tubal Reversal Center website.