Tubal ligation reversal is very successful at allowing women who have had their tubes tied to become pregnant again. In general, 70% of women who have their tubes untied at Chapel Hill Tubal Reversal Center become pregnant after reversal of tubal ligation. This overall statistic is based on all patients, but there is variation depending upon an individual’s age and method of tubal ligation.
Susan is an international patient who traveled to Chapel Hill Tubal Reversal Center from Dubai, United Arab Emirates (UAE) for both tubal ligation reversal and ovarian conserving surgery. The day before her reversal surgery Susan and her partner, Stephen, sat with Dr. Monteith for a pre-operative interview. They have a unique story and we asked if they would allow us to share their story with our Tubal Reversal Blog and Tubal Reversal Message Board readers.
This is the third article in a three part series about Patricia and her quest for tubal ligation reversal surgery at the age of 46. For readers who are now joining this blog series, the first part of Patricia’s story can be read here – Patricia: Tubal Ligation Reversal at 46.
Read the rest of this article and comment on it. »
In the Fall of 2008, I was preparing to meet with a patient who was traveling to Chapel Hill Tubal Reversal Center from Fort Campbell, Kentucky (KY) for a tubal ligation reversal. The patient’s name was Catrina. She is 33 years old and newly married to, Chris, an Army Staff Sergeant.
Catrina sent us an operative report from a diagnostic laparoscopy (camera surgery), that discovered she had a tubal ligation. During our interview, I asked her why her general gynecologist had done this surgery. I was surprised by the story she had to tell.
The tubal ligation reversal experts of Chapel Hill Tubal Reversal Center are experienced at sterilization reversal. Many women who have had their ‘tubes tied’ will come to our center to have their ‘tubes untied’. Unfortunately, a ligation reversal is not as easy as ‘untying’ the tubes- we wish the process was that simple.
We employ a microsurgical approach to repair and reattach the ends of the tubes. This process is called tubotubal anastamosis, and provides a patient with an excellent chance of becoming pregnant naturally. We specialize in ligation reversal and in reversal of difficult tubal ligation procedures.
We would like to present the story of one of our patients who had an atypical sterilization procedure.
The patient’s name is Ofralinda. She and her husband, Juan, came to us from Texas. Ofralinda is 35 and she works as an OSHA compliance officer. Her husband is in construction. Ofralinda desired a tubal ligation reversal in order to have more children. She had a rare and atypical sterilization procedure termed the Uchida procedure.
A Japanese physician, Dr. Uchida, first described this method of sterilization in 1961. This method involves removing a large segment of the fallopian tube and suturing (sewing) the cut end of the fallopian tube into the wall of the uterus. Dr. Uchida first published information about his method of sterilization after having performed over 50,000 procedures without any pregnancy failures. This is an effective but also complicated method of surgical sterilization. Most modern physicians have never performed or seen a Uchida sterilization. We have seen several patients who have presented with a Uchida sterilization procedure and we have had success with reversal of this method.
Ofralinda had a 60-minute outpatient tubal ligation reversal. Her surgery went well. We found her tubes to be short (due to the large amount of tube removed with her initial Uchida sterilization) but otherwise healthy. We were able to successfully repair both of her fallopian tubes. She has since been discharged back to her home and we wish her well. We would like to hear a report of a successful pregnancy from her within the year.
We specialize in tubal ligation reversal. Our tubal ligation reversal specialists perform over 800 reversal procedures every year on women from across the world. We regularly have patients from as far away as Hawaii, Alaska, and the Caribbean. Occasionally, we will have patients from Australia, Asia, and Europe. 
Most tubal ligation procedures are reversible. The pregnancy rates after reversal are generally higher than after in vitro fertilization (IVF) and we specialize in difficult tubal reversal procedures.
We periodically write case reports on patients who undergo tubal ligation reversal at Chapel Hill Tubal Reversal Center. The patient we will profile today had a ligation reversal procedure at our center last month.
She and her husband traveled to Chapel Hill from West Virginia. She is 34 years old and previously was an in-vitro fertilization (IVF) nurse. She is the mother of two children (ages 5 and 2). Her husband works as an engineer and is the father of both of their children. She had a tubal ligation after her second child because of two difficult, high-risk pregnancies.
Her first pregnancy was a vaginal birth complicated by heavy post-partum bleeding. Her heavy bleeding required a dilation and curettage (D and C) and emergency abdominal surgery to control the blood loss. She was diagnosed as having a placenta accreta. This is a condition where the placenta has invaded into the uterus too deeply and does not separate normally from the uterus at the time of delivery. She recovered from this surgery and eventually had a second pregnancy. This child was delivered by C-section and she had a Pomeroy tubal ligation done during the C-section. The operative report described tying and cutting the tubes as well as burning the ends. The pathology report described 1.5 cm tubal segments as being removed.
She explained to us, “My decision to have a tubal ligation was not done prayerfully but was more of a medically made decision.” She and her husband now desire more children in their life, and they traveled to Chapel Hill Tubal Reversal Center to have her tubal ligation reversed.
We were concerned that her doctor described in the operative report the tubal cauterization (burning) after tying and cutting the tubes. Since the mention of the cauterization was vague (we had no idea if a small segment was burned or the entire tube was burned) we discussed starting with a screening laparoscopy. Our patient was able to talk to her doctor who performed the tubal ligation. The doctor assured her only the ends of the tubes were burned. Since this can be a common practice and seemed minimal, the decision was made to proceed with ligation reversal without starting with a screening laparoscopy.
During her operation we found the right fallopian tube was abnormal. The right tube was long and healthy appearing, but there was no fimbriated end of the tube. This area is one of the most critical areas of the tube. The fimbriated ends act like millions of small fingers, which pick up the egg and direct the egg down the tube. The repair of this tube would require a more difficult microsurgical salpingostomy and creation of a ‘neo-fimbriated’ end of tube.
A microsurgical salpingosotomy was performed on her right tube. The left side was more normal- we had two tubal segments that we repaired with the usual anastomosis procedure. The entire operation was about one hour and fifteen minutes.
The story of this patient illustrates several important concepts:
1. She was a knowledgeable medical professional. She understood what it meant to have a tubal ligation. Many patients of all walks of life will have changes of heart as their lives change. Even medical professionals will make health care decisions for themselves, which later turn out to not be right for them. None of us can predict the future.
2. She was an IVF nurse and was aware of the pros and cons of tubal ligation reversal vs IVF. She and her husband decided ligation reversal was a more appropriate path for them.
3. Operative and pathology reports provide helpful information in planning for tubal repair, but they can sometimes be misleading.
4. The right tube was very difficult to repair. Often we will question ourselves as to whether a difficult tube should be repaired or should we just focus on the ‘better’ tube. We can never predict with 100% certain what will or will not work to help get a patient pregnant, so we like to give all patients the benefit of the doubt and try at all costs to open all the tubes we operate on.
We wish her and her husband a successful outcome of her tubal reversal operation and hope their prayerful decision will be soon rewarded.
Submitted by Dr. Charles Monteith
Undergoing a tubal ligation reversal at Chapel Hill Tubal Reversal Center is an important endeavor and we want to maximize every patient’s chance of ligation reversal success. Operative reports are important because they allow us to determine the likely success of tubal ligation reversal surgery.
When a surgeon performs an operation on a patient they are required to keep a written record describing the entire procedure. This is an important part of patient care and many hospitals provide transcription services to assist with creating operative reports. After surgery is completed, the physician will dictate an operative report. Operative reports contain the pre-operative diagnosis, post operative diagnosis, operative procedure, surgeon’s name, findings of the surgery, and what was done during the surgery.
There are two types of operative reports: vague and detailed.
A vague operative report gives generalized information regarding your surgery. Such a report might read, for example, “The tubes were tied in a standard fashion”, or “The tubes were burned in 3 separate areas,” or “A segment of each tube was removed.” These vague reports leave much to the imagination because there is no recognized ’standard fashion’ and we do not really know how far apart ’separate’ burns are.
A detailed operative report will give very specific and easy to understand information regarding your tubal sterilization. Such a detailed report might read, for example, “The tubes were tied in the isthmic (middle) section and a 2 cm interval segment was removed.” or ” The tubes were cauterized (burned) in 3 adjacent areas in the isthmic portion.” These reports give very specific information about what was done and where it happened.
There is no substitute for a detailed operative report. A good operative report can give us enough information to formulate what the likely success of any reversal procedure will be. In general, we can give ligation reversal success based upon the type of ligation a patient has had. If an operative report is ominous, then this allows us to advise patients to consider either a screening laparoscopy or in vitro fertilization (IVF) before attempting ligation reversal. This can prevent having an operation that would have a limited chance of success.
If an operative report can not be obtained then consideration should be given to having a screening laparoscopy. Patients should also be aware that most tubal ligation procedures can be reversed and only a small minority of ligation procedures can not be reversed.
Patients with any questions regarding operative reports, tubal ligation reversal, or tubal reversal success rates should contact a nurse at Chapel Hill Tubal Ligation Reversal Center.
An operative report is a typed report describing exactly what the doctor saw and did during your tubal ligation procedure.
Tubal ligation operative reports can be obtained from the hospital or health care facility where you had your tubal ligation surgery. Your doctor may have a copy of your operative report in their office. The hospital will have a copy of the report in your hospital record and will keep them on file for a limited time.
The time a health care facility will keep records will vary by state. Most states have laws specifying how long records must be kept. If a state does not have laws regarding keeping medical records, then the state medical board will have guidelines which the board encourages physicians to follow. North Carolina, for instance, has no state laws mandating how long medical records will be kept. The North Carolina State Medical Boards recommends physicians keep records for a minimum of 10 years. Medicare and Medicaid records are recommended to be kept for a minimum of five years.
The physician’s office or hospital will typically keep records in their file room for a limited time and then transfer the files to another storage area for several years. Some facilities will create digital records of your health care information and store this information indefinitely.
Contact the medical records department of the hospital where your tubal ligation was performed. You will have to fill out a medical records release form. The operative report can be mailed or faxed to you and to our facility. Please be aware some medical facilities are very busy and have limited medical record personnel. This means they may take some time to send records and you might have to keep a close watch to make sure the records are actually sent in a timely fashion. Chapel Hill Tubal Reversal Center has instructions and a form you can use to obtain a copy of your operative report.
If you can not get your operative report you can try to get your doctor to give you more information about the type of ligation surgery you had. Although this is not as accurate as an operative report, this can provide some information. Many doctors will do their tubal ligation surgeries the same way over many years and they should be able to tell you how your procedure was done.
Your best option is to consider a screening laparoscopy. This involves placing a small telescope under your umbilicus (belly button) and looking at the fallopian tubes. This provide quick and accurate information about the condition of your fallopian tubes. When the screening laparoscopy is performed here, we proceed immediately with the tubal repair. If the laparoscopy shows that the tubes cannot be repaired, the procedure is ended without the laparotomy incision and a partial refund is given to the patient.
Yes. We frequently encounter many patients who are unable to obtain their operative report. The choice of whether to start with screening laparoscopy is up to the individual patient. Since most tubal ligation procedures are reversible, it is an option, and not a requirement.
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 fallopian tubes’ is a common language phrase used to describe several different surgical procedures that result in tubal 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.
One common form of laparoscopic (camera) sterilization is the use of Filshie clips to occlude both fallopian tubes. The Filshie clip was approved for use in the United States in the mid 1990’s. The Filshie clip is a small titanium clip which is lined with a thin silicone cushion. The clip was an improvement over the Yoon Falope Ring and the Hulka Clip because it was as easy to apply with less risk of operative complications. The clip also has the advantage of destroying only a very small portion of the fallopian tube- approximately 4mm (approximately the thickness of two quarters stacked on each other). The adjacent tube is not affected. The majority of Filshie clips placed in the United States are done by laparoscopic surgery; however, there is a growing trend to use them for tubal occlusion at the time of cesarean delivery (c-section).
The Filshie 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 Filshie clip is held in place (in between the two divided ends) by a small amount of scar tissue which forms over the clip.
A common misconception is that the Filshie clips can simply be removed to reverse the sterilization process- that the tubes can be unclipped. Unfortunately, tubal ligation reversal for Filshie clips is not as simple as just opening the clips. Filshie clip tubal occlusion is reversed by removing the clips and using microsurgical techniques to open the closed ends and join the tubal segments back together in perfect alignment.
The reversal of Filshie clip tubal occlusion is usually technically easier than some 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 Filshie clip sterilization procedure.
Many people believe tubal sterilization is permanent and irreversible. Although Filshie clip sterilization is intended to be permanent, this procedure can be reversed. Chapel Hill Tubal Reversal Center is the one medical facility that 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
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Gary S. Berger, M.D. |
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Charles Monteith, M.D. |
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