Tubal Reversal Blog ‘tubal sterilization’

In early 2009, Chapel Hill Tubal Reversal Center was contacted by Tanya who was interested in tubal reversal surgery. Tanya had been reading the Tubal Reversal Blog, wanted a tubal ligation reversal, and expressed a desire to document her journey for the benefit of other women.

She adopted her Tubal Reversal Message Board sign-on name and this was the start of the  Tubal Ligation Reversal Journey of Georgia Peach.

In her last submission she described her experience the day of her reversal procedure. Her husband, Kevin (or now Mr. Peach), also gave his experience the day of surgery for the benefits of other husbands/partners. Now Dr. Monteith tells the story from his viewpoint.

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Tubal ligation is a surgical procedure that blocks the fallopian tubes to prevent pregnancy. Many people commonly refer to tubal sterilization as having their ‘tubes tied’. The more correct medical term is tubal occlusion (occluding or closing the tube), because not every fallopian tube is ligated or tied when it is closed. There are many different ways to perform a tubal ligation, but all the procedures cause some destruction of the fallopian tubes. There are many ways to perform a tubal ligation: tying and cutting, cauterizing (burning) and clipping or banding the fallopian tubes are the most common techniques.

Read the rest of this article and comment on it. »

The ligation reversal specialists at Chapel Hill Tubal Reversal Center are experts in tubal ligation reversal. We evaluate and treat a large number of women who request sterilization reversal. While most women seek ligation reversal to have more children,  some seek relief from worsening physical and psychological symptoms experienced after they had their sterilization procedures. Many of these women report symptoms of Post Tubal Ligation Syndrome (PTLS). Previously, we described medical conditions that can mimic PTLS. This article describes common psychological conditions that can have symptoms similar to PTLS. These conditions can exist independently of a sterilization procedure or could be associated with the profound guilt and regret some women experience after sterilization.

Depression

Depression is a common condition affecting many people. Depression can be categorized into several types; however, for simplicity we will focus on major depression.

Major Depression

Symptoms of major depression last for a minimum of six months and may include:

• Loss of interest in normal daily activities
• Feeling sad or down
• Feeling hopeless
• Crying spells for no apparent reason
• Problems sleeping
• Trouble focusing or concentrating
• Difficulty making decisions
• Unintentional weight gain or loss
• Irritability
• Restlessness
• Being easily annoyed
• Feeling fatigued or weak
• Feeling worthless
• Loss of interest in sex
• Thoughts of suicide or suicidal behavior
• Unexplained physical problems, such as headaches

There are many overlapping symptoms between major depression and Post Tubal Ligation Syndrome. Identifying the symptoms of depression can be easy, but identifying the cause of depression can be difficult.

Anxiety

Generalized anxiety disorder can be a common condition. Anxiety is characterized by excessive or exaggerated worry about life events. People with symptoms of generalized anxiety disorder tend to expect disaster and can’t stop worrying about health, money, family, work or school. The degree of worry is often unrealistic or out of proportion for the situation. Daily life becomes a constant state of worry, fear and dread. Eventually, the anxiety so dominates thinking that it begins to interfere with daily functioning, including work, school, social activities and relationships.

Generalized Anxiety Disorder

The symptoms of generalized anxiety disorder may include:

• Excessive, constant worry and tension
• An unrealistic view of problems
• Restlessness or a feeling of being “edgy”
• Irritability
• Muscle tension
• Headaches
• Sweating
• Difficulty concentrating
• Nausea
• The need to go to the bathroom frequently
• Tiredness
• Trouble falling or staying asleep
• Trembling
• Being easily startled

People with anxiety disorders have an extreme sense of nervousness, panic, and inability to concentrate or focus. They may have depression as well. Anxiety can be generalized (happens during most of the day without any apparent cause) or can be situational (triggered by a specific event).

Post Traumatic Stress Disorder

Post traumatic stress disorder (PTSD) can develop after a person has experienced a traumatic or terrifying event in which serious physical harm occurred or was threatened. PTSD is a lasting consequence of traumatic ordeals that cause intense fear, helplessness, or horror, such as a sexual or physical assault, the unexpected death of a loved one, an accident, or a natural disaster. Most people who experience a traumatic event will have reactions that may include shock, anger, nervousness, fear or guilt. For a person with PTSD, however, these feelings continue and even increase, becoming so strong that they prevent the person from living a normal life. Symptoms of PTSD often are grouped into three main categories:

• Reliving – This involves reliving the event through thoughts, memories, and dreams of the trauma. These may include flash backs, hallucinations, and nightmares. People with this form of PTSD may also feel great distress when events occur that remind them of the trauma they suffered.
• Avoiding – This involves avoiding people, places, thoughts or situations that are reminders of the trauma. This may lead to detachment from family, friends, and loss in interest in things that were once enjoyed.
• Increased arousal – This includes excessive emotions and problems relating to others, including difficulty feeling or showing emotion, difficulty sleeping, irritability, outbursts of anger, and difficulty concentrating. Physical symptoms may also occur.

Self Evaluation

Women seeking tubal ligation reversal may be at higher risk for the above conditions for various reasons, such as sterilization performed while in an abusive relationship, sterilizations done under pressure, or death of a child or spouse after a tubal ligation. It is helpful to discuss with yourself and your partner whether you may be experiencing symptoms of depression, anxiety, or Post Traumatic Stress Syndrome. The insights of a trusted friend or loved one help in this self evaluation. In some cases the advice and intervention of an experienced mental health provider may be helpful.

If you have had a tubal ligation and are experiencing any of the problems associated with Post Tubal Ligation Syndrome (PTLS), consider having an evaluation by your doctor for undiagnosed medical conditions. If  depression, anxiety or other symptoms interfere with your daily life, work, or relationships, then you may benefit by consultation with an experienced mental health provider.

PTLS Article Series

This is the fifth article in our fourteen part series on PTLS and associated medical conditions. Our next article, Post Tubal Ligation Syndrome|A Long Journey, will address our experience with Post Tubal Ligation Syndrome.

Readers can also view 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 Praybelieving
Meet Katherine

We invite readers to join the Tubal Reversal Message Board and participate in the PTLS Forum to share personal experiences with physical or psychological symptoms following a tubal ligation.

History of Tubal Sterilization

The first tubal sterilization method was tubal ligation and resection, reported in 1881! Ligation and resection- or ‘tying tubes’ was the most common surgery for sterilization until the advent of laparoscopic surgery in the mid 1900’s. As laparoscopic surgery became more popular, electrocoagulation (electrical burning) of the fallopian tubes became a popular method of female sterilization.

Tubal Electrocoagulation Results in Burned Tubes

The first description of laparoscopic electrocoagulation, in 1962, used a type of electrical current termed monopolar current – hence the term monopolar tubal coagulation. This sterilization procedure uses electric current to destroy part of the fallopian tube. The burned part of the tube turns into scar tissue and the remaining tubal segments are separated and blocked. This was a very popular form of laparoscopic sterilization from 1970 until the early 1980’s.

Although monopolar electrocautery is a very effective form of tubal sterilization, studies showed that it had a higher complication rate than for electrocoagulation using bipolar current, where the damage to the fallopian tube (or other structures) is more easily restricted. Sterilization procedures done by monopolar current are gradually decreasing and being replaced with bipolar current. Monopolar cautery, however, is still used for tubal sterilization by some doctors.

Can Burned Tubes Be Repaired?

Patients often ask whether burned tubes can be repaired. In most cases, monopolar electrocoagulation sterilization procedures can be reversed. The success of reversal is dependent on the amount of fallopian tube that has been damaged by the electrocautery. This information is usually available in the tubal ligation operative report. When in doubt, a screening laparoscopy can be performed. Approximately 50% of patients at Chapel Hill Tubal Reversal Center will become pregnant after a reversal of a monopolar coagulation sterilization procedure.

Many people, including doctors, have been told that tubal sterilization is permanent and irreversible. Although monopolar tubal coagulation is intended to be permanent, this procedure is usually revesible. The best place for women to have their tubes ‘untied’ when they have been burned is Chapel Hill Tubal Reversal Center – the only medical facility that specializes in reversal of tubal ligation.

Submitted by Dr. Charles Monteith

History of Tubal Sterilization

The first tubal sterilization procedure, reported in 1881, was tubal ligation and resection. Ligation and resection – or ‘tying tubes’ was the most common surgery for sterilization until the advent of laparoscopic surgery in the mid 1900’s. As laparoscopic surgery became more popular, electrocoagulation (electrical burning) of the fallopian tubes became an additional method of surgical sterilization. Tubal sterilization by electrocoagulation uses electric current to cut and destroy the portion of the tube that is exposed to the electric current. These portions of the tube eventually heal and close.

Monopolar Tubal Coagulation

The initial method of laparoscopic tubal coagulation, in 1962, used a type of electrical current termed monopolar current. Monopolar tubal electrocoagulation was a popular type of laparoscopic sterilization through the 1970’s and 1980’s. The medical community began to realize that the complication rate from this form of electric surgery was higher than for other electric surgical methods of tubal sterilization. Sterilization procedures done by monopolar current have gradually been replaced with bipolar current.

Bipolar Electrocoagulation of the Fallopian Tubes

The first reported sterilization using bipolar electrocoagulation was in 1972. This was done via a laparoscope inserted just under the belly button. During bipolar coagulation, the electrical current can be more precisely controlled, resulting in less tubal damage than monopolar coagulation. This sterilization procedure results in higher reversal success rates than monopolar electrocoagulation.

Reversing Tubal Sterilization

Many people, including doctors, mistakenly believe that tubal sterilization is permanent and irreversible. Although bipolar coagulation sterilization is intended to be permanent, this procedure can be reversed successfully in almost all cases. The success rates depend on how many different areas of the tube were damaged with electrocautery. Approximately 60- 70% of patients at Chapel Hill Tubal Reversal Center become pregnant after a reversal of a bipolar coagulation sterilization procedure. Chapel Hill Tubal Reversal Center is the only medical facility that specializes exclusively in reversal of tubal ligation. We perform tubal ligation reversals every day, and our tubal reversal doctors are experts in reversing all types of tubal ligations- or ‘untying’ tubes that have been ‘tied’!

Submitted by Dr. Charles Monteith

Falope Ring Sterilization

The Yoon Falope rings were developed in the 1960’s as a safer alternative to laparoscopic monopolar cautery tubal sterilization. This procedure is performed by inserting a laparoscope just under the belly button. The fallopian tube is then identified and a device holds the tube while the silastic ring is slid over a 2-3 cm ’knuckle’ of tube that is kinked off by the ring. This is done once for each side.

The common misperception is that the Falope ring is what prevents pregnancy and that reversal of the procedure simply requires removal of the ring. The Falope ring causes the squeezed ’knuckle’ of tube to undergo avascular necrosis (to die and become absorbed by the body). After this happens the ends of the tubal segments outside the ring close up, thereby preventing sperm from reaching the egg.

Falope Ring Sterilization Reversal

Reversing Falope ring sterilization is not as easy as just removing the ring. The closed ends of the tubes must be opened and the tubal segments must be rejoined.

Falope rings cause destruction of a minimal length of fallopian tube and reversal of this type of tubal ligation gives excellent results. Approximately 75% of patients at Chapel Hill Tubal Reversal Center become pregnant after a reversal of a Falope ring sterilization procedure.

Many people believe tubal sterilization is permanent and irreversible. Although tubal sterilization with Falope rings is intended to be permanent, this procedure can be reversed. Chapel Hill Tubal Reversal Center is the only medical facility that specializes exclusively in reversal of tubal ligation.

Hulka Clip Sterilization

One common form of female sterilization is the use of Hulka clips to block the fallopian tubes. The Hulka clip was approved for use in the United States in the 1970’s and was invented in Chapel Hill, North Carolina by Dr. Jaroslav Hulka at the University of North Carolina at Chapel Hill.

The Hulka clip is a small, gold plated stainless steel spring loaded clip. The clip in introduced into the abdominal cavity via a laparoscopic clip applicator. This image shows the open clip in the applicator and the tip of the laparoscope with its fiber optic lighted end. When the clip is placed across the fallopian tube, it is closed and a small spring holds the clip firmly across the tube. The Hulka clip has the advantage of damaging only a very small portion of the fallopian tube- approximately 7mm (the thickness of three quarters stacked on each other).

The Hulka clip causes bilateral tubal occlusion by squeezing a very small portion of the tube. The squeezed portion is deprived of its blood supply and eventually undergoes avascular necrosis (dies and is absorbed by the body). This causes the fallopian tube to be divided in half and the two ends to close up. The Hulka clip is held in place between the two divided tubal segments by a small amount of scar tissue which forms within the clip.

Hulka Clip Reversal

A common misconception is that the Hulka clips can simply be opened to reverse the sterilization process – that the tubes can be unclipped. Unfortunately, tubal ligation reversal for Hulka clips is not as simple as opening the clips. Hulka clip tubal occlusion is reversed by removing the section of the tube with the clip across it and then, using microsurgical techniques, joining the remaining tube segments back together in perfect alignment.

Tubal reversal of Hulka clip tubal occlusion is better than for most other methods of sterilization because such a minimal amount of tube is destroyed in the occlusion process. Approximately 76% of patients at Chapel Hill Tubal Reversal Center become pregnant after a reversal of a Hulka clip sterilization procedure.

Common Misconception About Tied Tubes

Many patients seem to imagine the fallopian tube is like a shoe lace which is tied up like a bow to prevent pregnancy. As tubal ligation reversal specialists, we wish it were that easy- then untying tied tubes would be easier!

‘Tying ones fallopian tubes’ is a common language phrase used to describe several different surgical procedures which result in sterilization (a procedure intended to permanently prevent pregnancy). The more correct medical term is bilateral (both sides) tubal occlusion (closure of the fallopian tube).

There are many different ways to occlude (close) the fallopian tubes: ligation and resection (tying and cutting), clips and rings, and coagulation (burning). No matter how the procedure is done the end result causes the tube to close, heal shut, and prevent sperm from fertilizing an egg.

Tubal Sterilization is Reversible

Many people believe tubal sterilization is permanent and irreversible. Although Hulka clip sterilization is intended to be permanent, this procedure is ideal for tubal reversal. The Chapel Hill Tubal Reversal Center is the one medical facility which specializes in tubal ligation reversal.

We have become experts in reversing all types of tubal ligations- or ‘untying’ tubes that have been ‘tied’!

Submitted by Dr. Charles Monteith

Tying Tubes

Many people seem to imagine the fallopian tube is like a shoe lace that is tied in a bow to prevent pregnancy. As a tubal ligation reversal specialist, I wish it were that simple- then reversing tied tubes would be a whole lot easier!

Perhaps a well meaning doctor may have told a patient one day, “I am going to tie your tubes so you don’t get pregnant.” Maybe the doctor wrote a letter to a medical journal explaining the procedure and then the terminology stuck. More likely, a reporter may have simplified the terminology for the surgical procedure of tubal ligation to make a catchy title for an article. Others may then have started using the term “tying tubes” to quickly explain a complex procedure. These explanations often have a long life span and make their way into common language.

The more accurate terminology is bilateral tubal occlusion (closure of both fallopian tubes) which results in sterilization (not being able to conceive). There are many ways to perform bilateral tubal occlusion. The most common tubal sterilization procedure is performed at the time of cesearean delivery (c-section) or immediately after having a baby. It does involve tying the tubes with a suture – but then also cutting out a segment of healthy tube, resulting in closure of the tube as it heals. The suture then dissolves. The intial suture tying is most likely where the phrase ‘tying tubes’ came from.

Another common method is to burn the tubes with electrical energy (electrocoagulation). This is usually done by laparoscopic surgery and is usually done remote from pregnancy. Lastly, there are many devices- clips and bands – which can close off the tubes and cause a portion of the tube to be destroyed.

No matter how the procedure is done, the end result is obstruction of the fallopian tube that prevents pregnancy.

Many people believe that tubal sterilization is irreversible. Although bilateral tubal occlusion is intended to be permanent, the procedure can be reversed. Chapel Hill Tubal Reversal Center is the one medical facility that specializes exclusively in reversal of tubal ligation. We have become tubal ligation reversal experts………experts at untying tied tubes!

Submitted by Dr. Charles Monteith

Is There a Simple Procedure to Untie Tubes?

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.

How Tubes are “Tied”

Pomeroy Tubal Ligation

Tied and Cut

Final Result

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.

Dr. Berger’s Comment

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.

Past topics in the Tubal Reversal Blog include posts and comments about patient care at Chapel Hill Tubal Reversal Center. This topic summarizes important articles about tubal ligation and tubal reversal reported in the news during 2007.

Sterilization is Most Popular Family Planning Method
Approximately 10 million American women use the pill for contraception, while sterilization has been chosen by 15 million men and women.

One In Five Women Regret Decision For Tubal Ligation
One in five women under age 30 who undergo tubal sterilization later regret the procedure, despite the number of children they have.

Is Sterilization the Best Contraception Choice?
Women requesting a tubal ligation should be counseled regarding other long-term, reversible methods of contraception and informed that vasectomy is safer and more effective than tubal ligation.

Relationship Conflict Before Sterilization
Women whose relationship was marked by substantial conflict before they underwent tubal ligation were most likely to regret the decision.

Young Age, Prodding Partner and Sterilization Regret
Young age and a prodding partner are risk factors indicating that a woman undergoing sterilization may later regret her decision.

Tubal Reversal Among Overweight Women
Overweight women’s chances of becoming pregnant after tubal reversal improve when they lose weight.

Dr. Berger’s Comment

These news reports touch on some of the issues patients talk about when they come to Chapel Hill Tubal Reversal Center for tubal sterilization reversal. The popularity of tubal ligation, and the fact that many women regret their decision to have a tubal ligation, are well documented. Young age and marital conflict are risk indicators for subsequent regret. Before performing a tubal ligation, doctors should ensure that the implications of ending childbearing potential are clearly understood and discuss vasectomy as an alternative permanent method of birth control. Women undergoing tubal reversal who are overweight should be aware that losing weight will improve their chances of becoming pregnant again.