Tubal Reversal Blog ‘tubal reversal surgery’

Future Tubal Ligation Reversal Patient Georgia Peach | An Introduction

My name is Tanya (Georgia Peach) and I am a 32-year-old receptionist at a vet clinic. I had my tubes tied in May of 2000, after the birth of my fifth daughter. My doctor at the time had dire predictions of the dangers to my health if I had any more children. Concerns for my health and pressure from my family really pushed me into having a tubal ligation. I had given birth to five healthy daughters. I lost my second born to SIDS in 1995. I reluctantly agreed to a tubal ligation.

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This is the fifth article of a series dedicated to women considering alternatives for pregnancy and tubal ligation reversal after the age of 40.  The previous article provided an overview of the benefits of tubal ligation reversal at Chapel Hill Tubal Reversal Center for women in their forties. This article focuses on the surgical and early pregnancy risks for older women having their ‘tubes untied’.

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At Chapel Hill Tubal Reversal Center we perform over 800 tubal ligation reversals a year. We have patients who travel from across the United States and from around the world for tubal ligation reversal. Our patients come from many walks of life. Our current blog is about Patricia, a nearby patient from Mooresville, North Carolina (NC). She is a 46 year old mother of three older children. Her determination to succeed provides inspiration for readers who are struggling with some of life’s ordeals.

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Reversing Tubal Sterilization

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.

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I am a Registered Nurse and have worked most of my career in Cardiac Surgery Intensive Care Unit. I took a three year break and worked in Labor and Delivery and really loved that, as you can imagine…EVERY day was THE best day of each of my patient’s lives. I loved being a part of it and was emotional during just about all of my deliveries! My husband is a wealth builder…he owns his own financial firm and does investment/financial advising.

We have a happy family with 5 children and would feel blessed with another child biologically or through adoption; unfortunately both of us were sterilized during our previous marriages. No one ever plans for their spouse to leave, their marriage to be torn apart, and be left infertile. As my new husband and I had very similar stories, morals and beliefs and united in marriage and family, we thought long and hard about adding to our family to essentially “tie” our children together with a half sibling– so that when they are older and we are gone, they will still be close and not drift apart. This is what led me to do my research about tubal reversal surgery and what led me to Chapel Hill Tubal Reversal Center.

Before this point, I had NO IDEA that Post Tubal Ligation Syndrome (PTLS) existed and I did not know all of my many symptoms were probably linked together due to the decision I made to have my tubes tied in 2003 after the birth of my daughter. I researched PTLS even further and found a very long list of symptoms and just cried as I showed the list to my husband one night. I was literally astounded.

I remember my mom telling me before I had my tubal ligation she had always heard a “Tubal ligation makes you have much more severe cramps and heavier periods”.

I asked my OB/GYN this question as I was making my decision (I worked with this doctor in L&D at the time) and she said this was not true at all. It is evident that many physicians do not recognize PTLS as a true syndrome and it’s saddening. I am very blessed that my husband empathized with me and all the symptoms I had and supported me in having the tubal reversal for symptom relief, without a second thought. I had my tubal reversal 7/31/08 and if it is God’s plan to add to our family, He can provide that miracle…but if not or until then…I am extremely happy to have had the opportunity to be “reconnected” by Dr. Monteith.

Below is a list of symptoms that I found on a PTLS website and I listed the symptoms I have (there were many, many more).

1. Bouts of rapid heart rate: In 2005, I was having palpations so frequently that I saw a cardiologist that I worked with at the time. He did a stress echo, which was fine, but placed me on a beta blocker medication due to the symptoms interfering with my everyday life. I have since weaned off of the medication myself and it only happens on occasion now.

2. Irritability/mood swings/PMS: I was never this bad before…I’m a very pleasant, laid back person and the past 4 years or so, my PMS symptoms have increased in length more and more until it was about 2 weeks long, and it would go away two or three days after my cycle was over.

3. Trouble sleeping thru the night: Absolutely! I have had severe insomnia since 2003 or 2004. Of course, my doctor gave me another pill to help this symptom…but I hate having such trouble sleeping and try not to take the medicine. I have tried hypnosis, herbs, melatonin, Benadryl, and acupuncture…many things other than using the prescription medicine.

4. Irregular periods: Not so much irregular, meaning I have 25-28 day cycles, but HEAVY and EXTREMELY painful…To the point of being doubled over in pain for the first two days of my cycle and curled up in a ball. It’s worse than any labor I had before I had to have my C-section. A couple of years ago, I would bleed up to 11-14 days every month and I was advised to have a hysterectomy due to the pain and bleeding. Being age 32 at the time, I refused to go that route.

5. Anxiety: I was never a very anxious person before. I have had increased anxiety, to the point I talked to my doctor about it (I was also going through a difficult time)…and was given yet another medication to try. It did help, but it was an antidepressant used for anxiety and was very hard for me to get off of once I decided I did not want to be on medication anymore.

6. Decreased energy: My energy level has dropped so much, but I just figured it was from getting older. I’ve never been a morning person, but this is much worse…it’s like constantly being tired and sluggish.

7. Feelings of doom/apprehension/despair: Some months, not all (especially a couple years back), my PMS symptoms are so severe, that it makes me think very sad thoughts…and it’s always about 2 days at the end of my cycle (which is the same point my migraines come as well…so it could be related).

8. Depression: I’ve had some bouts of what I call depression (non diagnosed) over the last few years…my “depression” is more in the form of anxiety/overwhelming feelings and wanting to sleep and not face anyone.

9. Headaches: Migraines…I used to have them in college when I was on birth control pills. Finally, when they figured out it was probably the hormones and I came off the birth control pills; I did not have any more migraines, until AFTER my tubal ligation. I’ve been on a migraine medication for over a year and use a different one if it gets out of hand. They can be debilitating.

10. Weight gain: I have had a very difficult time trying to lose my ‘baby weight’ from my last pregnancy from 2003 and tubal ligation. Although I had always been proportioned before, the worst of my weight now is around the middle.

11. GI problems: I have had reflux or heartburn since my tubal ligation as well.

I have only had one cycle since my tubal reversal, so I will be watching for much symptom relief!

A complete discussion of Post Tubal Ligation Syndrome and the stories of other PTLS patients who have undergone tubal reversal can be seen in our blog series on PTLS. The first of fourteen articles is Pain After Tubal Ligation: A Symptom of Post Tubal Ligation Syndrome? .

Readers can also view other patient submitted stories about their menstrual symptoms, reasons for reversing tubal ligation, and outcomes after reversal reversal surgery. Each patient’s story is listed below:

Meet Momzilla
Meet Andrea
Meet Rebecca
Meet Katherine

We invite readers to join our Tubal Reversal Message board and discuss and share personal experiences with tubal ligation. We also have a dedicated PTLS forum for readers to share experiences of worsening symptoms after tubal ligation procedures.

How Important Is a Tubal Reversal Doctor’s Experience?

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.

Tubal Repairs That Other Doctors Could Not Perform

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 Consideration

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

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 to repair tubal blockage.

“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.

In a recent email inquiry, someone asked if it would be safer to have tubal reversal surgery in a hospital. My response – “It is much safer to have tubal reversal surgery performed at Chapel Hill Tubal Reversal Center than in a hospital.”

Infection and Medication Error Risks in Hospitals

Roughly 100,000 people wind up with a potentially deadly infection during hospital treatment in the US each year, according to the Centers for Disease Control. Hospital-acquired infections (also called “nosocomial” infections) are particularly dangerous, since hospital germs are especially resistant to antibiotics. One example in the news recently is the bacteria called methicillin-resistant staphylococcus aureus (MRSA). Most of these dangerous bacteria are transmitted by hospital staff from other patients. In addition, hospital patients get the wrong drug one time out of five, according to a study by Auburn University.

Patient-safety incidents continue to rise in American hospitals. The largest increases involve hospital-acquired infections and post operative sepsis (overwhelming infection).

A Chicago Tribune study revealed that serious violations of infection-control standards have been found in the vast majority of hospitals nationally. Since 1995, more than 75 percent of all hospitals have been cited for significant cleanliness and sanitation violations. This report says:

A hidden epidemic of life-threatening infections is contaminating America’s hospitals, needlessly killing tens of thousands of patients each year. Nearly three-quarters of the deadly infections are preventable, the result of unsanitary facilities, germ-laden instruments, unwashed hands and other lapses.

Deaths linked to hospital germs represent the fourth leading cause of mortality among Americans, behind heart disease, cancer and strokes, according to the federal Centers for Disease Control and Prevention. These infections kill more people each year than car accidents, fires and drowning combined.

“The number of people needlessly killed by hospital infections is unbelievable, but the public doesn’t know anything about it,” said Dr. Barry Farr, a leading infection-control expert and president of the Society for Healthcare Epidemiology of America.

Dr. Berger’s Comment

When it comes to cleanliness and strict adherence to infection control procedures, there is no medical or surgical facility better than Chapel Hill Tubal Reversal Center. Our patients often comment about the meticulous nature of our facility. It is clean, orderly, and uncluttered. We are obsessive about this.

The idea that it may be safer to have elective surgery in a hospital is wrong. Hospitals are the right place for treating complicated medical or surgical problems, but they are not the best place for healthy people to have tubal reversal surgery!

Note

Dr. Berger was an Epidemic Intelligence Service Officer at the Centers for Disease Control (CDC).

New patients may want to learn about the relationship between Chapel Hill Tubal Reversal Center and Chapel Hill Surgical Center. They are interrelated health care organizations exclusively for the benefit of patients undergoing tubal reversal surgery.

Chapel Hill Tubal Reversal Center

Chapel Hill Tubal Reversal Center is the name of my private practice. It is located on the second floor of a 2 story building at 109 Conner Drive in Chapel Hill, North Carolina. Prior to 1997, Chapel Hill Tubal Reversal Center was known as Chapel Hill Fertility Center. During earlier years, complete diagnostic and treatment services were provided for all causes of infertility. Because it has always been my primary interest and special skill, I decided to limit my practice to tubal reparative surgery. I am the the only reproductive surgeon who performs tubal reversal surgery exclusively.

Chapel Hill Surgical Center

Chapel Hill Surgical Center is a licensed ambulatory surgical facility that occupies the first floor of 109 Conner Drive in Chapel Hill. This is where the tubal reversal procedures are performed. The facility has 3 operating rooms, a two-stage recovery room, and is staffed by a team of anesthesiologists, a nurse anesthetist, operating room nurses, recovery room nurses, surgical technologists, and an administrative staff. In the past, it was operated as a general ambulatory surgical center that included other doctors from many other surgical specialties. The facility was reorganized to provide tubal reconstructive surgery alone to allow all of the professional staff to concentrate on tubal reversal patients. This has led to the best medical care for women having a tubal reversal procedure.

A Unique Medical Organization

As the Medical Director of both facilities, I am assisted by a dedicated and highly trained staff of over 20 people who devote all of their efforts to caring for 4 couples a day having tubal reversal surgery. The staff to patient ratio (5:1) is higher than found in any other surgical center or hospital. This permits the most attentive and personalized medical care possible. There is no other medical organization like this anywhere else. Most patients learn about us from the Chapel Hill Tubal Reversal Center website, while others are referred by their doctors or previous patients. Couples come here from all 50 states in the US and from every continent around the world.

Our Mission

We take pride in being the premier medical facility for tubal ligation reversal. Our mission for 2008 is to restore hope, fertility, and the opportunity to have children for 800 more couples, as we have done each year in the past.

Tubal Anastomosis at the Uterine Cornua

Tubouterine anastomosis is a tubal reversal procedure that is intermediate between tubotubal anastomosis and tubouterine implantation. It is also called cornual anastomosis because the tube is joined to the cornual area of the uterus with this operation. The cornu is the area where the fallopian tube normally emerges from the the uterus.

When Is Tubouterine Anastomosis Performed?

Tubouterine anastomosis is performed when there is a healthy tubal segment near the ovary, but no segment remains attached to the uterus, following a tubal ligation procedure. It is also performed when a tubal segment attached to the uterus is scarred and has no open lumen.

An incision is made into the uterus at the cornu to find the opening of the fallopian tube tube as it passes through the uterine muscle. If an opening is found, the tubal segment that remains is rejoined to the uterus at this site.

Case Histories

The topic of tubouterine anastomosis is a timely one. During the past week, 2 patients undergoing tubal reversal surgery at Chapel Hill Tubal Reversal Center required this operative procedure. In one case, each fallopian tube had been coagulated or burned next to the uterine cornu, leaving no segment attached to the uterus. The other patient had developed the condition known as salpingitis isthmica nodosa in the portion of the fallopian tube between the uterus and the a Falope ring. In both cases, tubal reversal was able to performed with the technique of tubouterine anastomosis.

Dr. Berger’s Comment

Frequently, patients have been informed by doctors who are not specialists in tubal ligation reversal that their fallopian tubes cannot be repaired after a tubal ligation. This is especially true when the proximal segments of the fallopian tubes are missing or diseased. But there are a variety of surgical techniques that can be used during tubal reversal surgery by a doctor who is an experienced tubal reversal surgeon. This is one of the advantages patients have when they come to Chapel Hill Tubal Reversal Center for their tubal reversal procedures.