This is the second article focusing on the risk of pregnancy in older women. This article focuses on the risks of later pregnancy.
Many patients of Chapel Hill Tubal Reversal Center are over 40 years of age and they often ask about the risk of pregnancy in older women.
This series is intended to provide comprehensive information to women who desire pregnancy after tubal reversal surgery.
This is fourth in a series of articles for women wanting to become pregnant after tubal ligation reversal and who are age 40 and older. This article describes the multiple benefits of tubal reversal compared with IVF (in vitro fertilization).
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.
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.
To the patients of the Chapel Hill Tubal Reversal Center message board, sorry. It has been a long time since I last posted a blog. I have worked six to seven days a week for the last eight years and sometimes 36-hour shifts in the hospital. Needless to say, many sleepless nights and long hours. Recently, I completed a six-month training period with Dr. Gary Berger while at the same time, working in the hospital and delivering babies. Before starting my new career at Chapel Hill Tubal Reversal Center, I took some time off to be with my family and now I am back!
It has been a long process to become a tubal ligation reversal specialist, but well worth it.
My path to become a specialist in tubal ligation reversal actually started 18 months ago when I first made contact with Dr. Berger. Six months of meetings, followed by six months of tubal ligation reversal training has gone by quite fast. This week has gone by even faster. Monday, July 21 was my first ‘official’ day with Chapel Hill Tubal Reversal Center. As I write this blog, this is my fourth day of surgery and we have completed 16 tubal ligation reversals thus far. So far, we have had nothing but success. All patients this week have had at least one tube opened or successfully reversed. I hope they will all become pregnant.
My first day untying tubes was wonderful, and all of the surgeries went well. Each day has been both a challenge and a joy. Dr. Berger and I are doing four reversal surgeries a day. I help him with his two patients and he helps me with my two patients. We have been working very well together and the staff at the center have been great and very accommodating.
The best thing about my new career has been the patients. The patients have been wonderful people to work with. I have the opportunity to meet patients from all over the United States and from all walks of life. They each have a unique story to tell. They have been wonderful individuals and couples who desire either more children or improvement in their menstrual symptoms. In the first three days of my new job I received more ‘Thank you Doctor….’ than I did in eight years as a general Ob/Gyn.
I think this will be the beginning of a long and lovely career…..
‘Tying tubes’ is a phrase that is commonly used to refer to surgical procedures that result in tubal sterilization.
There are many different ways to block the fallopian tubes for tubal sterilization: ligation and resection (tying and cutting), tubal clips or rings, and electrocoagulation (burning). No matter how the procedure is done, the end result is closure or occlusion of the fallopian tube. This prevents sperm from reaching an egg.
The most common female sterilization procedure is the ligation and resection method. This was the earliest reported method of sterilization, and it is still a very common and effective procedure. According to the method described by Dr. Ralph Pomeroy, an absorbable suture is tied around a “knuckle” of the fallopian tube that has been elevated and a segment is resected (cut out). The cut ends close as the tube heals. As the suture dissolves, the two tubal segments pull apart. Ligation and resection is currently the most popular form of sterilization for women. It is often performed during a cesarean delivery (C-section) or following a normal delivery.
A common misconception is that fertility can be restored by simply ‘untying’ the tubes. Tubal ligation reversal is not that simple. Tubal ligation and resection is reversed by opening the closed ends of the tubes and joining the tubal segments back together in perfect alignment using microsurgical techniques. Approximately 70% of patients at Chapel Hill Tubal Reversal Center become pregnant after a reversal of a ligation and resection procedure.
Many people believe tubal sterilization is permanent and irreversible. Although tubal ligation and resection sterilization is intended to be permanent, this procedure can be reversed. Chapel Hill Tubal Reversal Center is the medical facility that specializes in tubal ligation reversal. We are experts in reversing tubal ligations- or ‘untying’ tubes that have been ‘tied’!
Submitted by Dr. Charles Monteith
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.
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.
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.
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
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.
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.
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.
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
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
Today we had another successful day of untying tubes. We began the day at 7AM. Four patients were scheduled for tubal ligation reversal surgery.
I was able to first assist Dr. Berger in the first three surgeries of the day, but had to leave prior to the fourth surgery. I am becoming proficient at identifying tubal anatomy and repairing tubes that have been tied.
The first patient had her tubes tied several years ago and she was now in a new relationship. Both she and her partner desired more children. They made the decision that they would undergo tubal ligation reversal and try to pursue their dream of having children together. Her surgery went well and we were able to successfully reverse her tubal ligation.
The second patient was similar to the first and desired more children. Her surgery also went well.
The third patient had her tubes tied, but after her surgery she lost a child to Sudden Infant Death Syndrome (SIDS). We often hear stories like this from many patients who come to Chapel Hill Tubal Reversal Center. It is extremely sad to hear the stories these patients tell. My heart aches for them as they try to replace their children and add to their family. Every time I hear these stories I think of my own children and what it would be like to experience such a loss. I can not fully imagine the pain from such loss but I can understand the strong desire to replace a cherished soul. I am happy to report that her surgery went extremely well and she had an excellent operative result. I take enjoyment out of every reversal surgery I have participated in, and feel an extra sense of accomplishment when assisting in untying tubes for patients who have lost children unexpectedly.
I had to leave before the fourth patient had surgery. Fortunately, I will be back in the morning for four more reversal surgeries and to meet four more interesting people and learn about their stories.
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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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