Consultation day before surgery
Every year we have a free tubal reversal contest at A Personal Choice Tubal Reversal Center. This year we are helping a very deserving patient who has experienced pelvic pain after tubal clips.
Usually we select up to three winners each year to receive free tubal ligation reversal, free Essure reversal, free Essure removal, or free vasectomy reversal.
We were the first, and to my knowledge, are the only practice that offers such a contest. This is one of many reasons why I consider us the best place for tubal reversal surgery!
It may seem unprofessional for a doctor to offer a free surgery contest. If you think it is unprofessional or ‘tacky’ then I have two responses for you:
- You may not realize this but reversal surgery is not covered by health insurance. No mater what the reason. The cost of reversal surgery can prevent many from having surgery. All patients will have to pay out of pocket to have surgery. Some people may not be able to have another baby without the help of a free contest. More information: Cost of tubal reversal
- Not everyone has reversal to have a baby. Some people have terrible side-effects from their tubal ligation procedures. Some women develop pelvic scar tissue or fallopian tube endometriosis. Some have vague diffuse symptoms with no clear cause. These woman have been diagnosed as having Post Tubal Ligation Syndrome. It is hard to get health insurance to cover these surgeries because tubal reversal is considered elective (ie optional) fertility surgery for non-life threatening conditions. Health insurance companies know that if they covered reversal for pain then 100% of patients would say they had pain as a reason for their reversal… so they just don’t cover the surgery.
When you understand that many are not able to afford reversal surgery then you can understand how a free tubal reversal contest can help benefit some people.
This year we selected two winners. One winner is having pelvic pain after tubal clips.
The other woman is a true angel of God and she wants to have another baby. The second winner will have her surgery in the near future and we will publish an article about her after she has her surgery.
In years past, we selected winners and performed their surgery on the same day. We typically did the surgeries on the last day before our office closed for Christmas break. The free reversal was kind of like a Christmas present!
This year we decided to do the surgeries sooner in the year and have each winner come on a different day. We will publish their personal stories over time. So far that plan has worked out great!
First Contest Winner: Experiencing pelvic pain after tubal clips
Our first winner is from Ohio. Her story is illustrative of how tubal ligation can cause serious problems. She had tubal clips and immediately started experiencing pelvic pain after tubal clips were applied.
Most women do not have serious problems from tubal ligation. Most women have no symptoms at all but I always tell patients…MOST does not mean ALL.
Some women have terrible unexplainable side-effects. Most doctors have difficulty diagnosing and treating the problem.
Often these patients have a hard time finding someone who will listen to them. Most doctors do not believe that tubal ligation can cause problems.
Our first winner is having a tubal reversal to treat sharp shooting pelvic pain after tubal clips were applied. The pain started immediately after her tubal ligation procedure. She also wants to get pregnant but her main reason is to treat her symptoms.
Pelvic pain after tubal clips: Multiple doctors visits and regret
The following is her contest statement.
My decision to have tubal ligation was made after my youngest child was born. While I was pregnant, me and my fiancé at the time, found out he had a short period of time to live due to liver failure and eventually kidney failure as well.
It was the hardest decision of my life as I always wanted more children but not with anyone else but the man I would choose to marry after the baby had come.
I have regretted tubal ligation surgery the moment I was home from having my baby and surgery. Something was wrong. My hormones were off, I experienced abdominal pain when ovulating for the last 8 years which sends me to the emergency room at least 7 times per year since having my tubal.
In 2019, I found a doctor who would investigate my pain and actually believed me. After an MRI was done it was found that my left clamp had come off and was lying in my lower abdomen.
This doctor decided he would do the surgery to remove clamps but refused to actually reverse the procedure, the right tubal clamp and my appendix were removed because the clamp had started growing scar tissue around my appendix. The left clamp wasn’t visible during surgery and is still inside of my abdomen causing severe pain during ovulation.
I’ve never actually been diagnosed with PTLS but after years of pain and no other reasons for my abdominal and pelvic pains I’m sure this is my condition. I believe no woman should live in such pain and the surgery caused so many disruptions in my otherwise healthy body that I’m saving to have my tubal reversed the correct way. I just want to be normal again.
My fiancé passed in early 2020 from his medical conditions leaving me to care for our three children. One day I would like to become a mother again and finally have my reproductive system back to normal.
Thank you for this opportunity, I’ve followed your practice for the last few years and admire you and your team. God Bless you.
Statement after being notified she was a winner
I’m extremely excited to have been chosen as one of the contest winners.
This is a life changing opportunity that Dr. Monteith and the amazing staff at A Personal Choice has chosen me to receive. After many prayers to God, they have been answered through this experience. I’m forever grateful to have found you Dr. Monteith!!
Thank you to everyone on this journey❤
Day#1 Surgery consultation visit and surprise reversal surgery!
Consultation visit
I met Charnette on a Wednesday afternoon for her surgery consultation. She had traveled from Ohio. Her sister came with her to act as her accompanying adult and to help care for Charnette after surgery. We require all patients to have a single accompanying adult to help them in the hotel after surgery and on the return trip home.
Charnette works in manufacturing. She has three children ages 14, 12, and 8. Her partner does not have children. In fact, her partner does not even know she is getting a reversal surgery! Charnette told him she and her sister were going to Raleigh for a girls trip!
Although this is not the first time I have heard of a ‘surprise reversal surgery’, I was a surprised because she had just won the free reversal contest. How did she keep the fact that she won from her partner? I asked her how was she going to pull this off? What is she going to do when she returns home? Isn’t he going to see her incision?
She told me when she gets back is when she is going to tell him.
I told Charnette that was a cool idea. I was really wondering how she was going to play off having a surgery and having an incision over her pubic area! I am glad she made it clear to me how she was going to pull off her plan. It all made perfect sense.
Tubal ligation symptoms: Multiple ER visits and surgery
I met with Charnette and her sister on the first day they arrived in Raleigh. We had an afternoon consultation and the following is what she explained to me.
Charnette said her symptoms started immediately after her tubal ligation procedure in 2014.
She started to feel pain and pressure in her pelvis. She said the pain would often happen during ovulation. Often it would be a shooting, electrical, lightning type of pain that would radiate towards her back.
She also noticed that she smelled different. I have heard a lot of things from a lot of patients over the year but this symptom was a new one for me.
I have heard some patients say they have a change in their vaginal discharge and that might be the cause for the change in odor but Charnette denied any changes in that area. She says she felt like she just smelled different. I asked her was it her sense of smell but she said it was her body…she said, “I just thought I smelled like rotted meat.”
Charnette said she would go to the emergency room frequently because of episodes of pain. She had multiple x-rays and CT scans and even an MRI, which saw the migrated tubal clips but could not identify any other causes. None of the doctors associated her symptoms with tubal ligation.
She said she lost up to four jobs because the debilitating pain she was having. Sometimes her pain would be so much..she could not go to work or she would have to go frequently to the emergency room for pain. Her sister, who was with her, personally testified she saw Charnette go through all of these problems and she felt bad for her.
Charnette sought the services of an Ohio doctor who was involved in a class action lawsuit against the clip manufacturer. The doctor had experience in dealing with complications from migrated Filshie tubal clips. She said that doctor saw a clear association between the clips and her symptoms.
A laparoscopic procedure was performed for removal of the migrated tubal clips. Health insurance will cover laparoscopy for evaluation of pain…especially after multiple ER and doctor’s visits. At the time of surgery they found her right clip but not the left clip. The right clip was adherent to her appendix and it required that both the clip and the appendix be removed. The doctor was unable to locate the left clip.
Putting a pin in the map before surgery
Her symptoms persisted after the removal of the right clip. The doctor wanted to do a second surgery in the hospital to find the left clip. I am unaware of the details but usually doctors like to request fluoroscopy or x-ray guidance when they are searching for hard to find foreign objects.
Charnette was open to having a second surgery but she also wanted the doctor to rejoin..or reverse her tubal ligation. She believed the tubal ligation was contributing to the symptoms and she also wanted to have another baby.
The doctor told her if he reversed her tubes in the hospital at the same time he removed the left clip then the cost for the reversal would be an additional $20,000.
That was when Charnette started looking into other options. She came across the A Personal Choice Tubal Reversal website and she entered the contest for free tubal reversal surgery. She never thought she would win but she had hope.
She said she did not plan on winning the contest. She had started saving money for reversal surgery. She knew she wanted to come to our center because of the quality of care we provide.
After the consultation, Charnette and her sister returned to the local hotel. She picked up her after surgery prescriptions for pain and nausea medications. They went out to eat, had a girl’s night out, and then went to bed early to return the next morning for her surgery!
Day#2 surgery visit: Tubal clip may not be the cause of pain
Clowning around after surgery!
Charnette checked into our facility at 845 am. She was the second patient to have surgery. We ask all our patients to put a pin in the map and mark their home town.
As I usually do, I met Charnette before her surgery and took the time to talk to her and her sister. Usually I try and keep the mood light and joke around with patients before surgery…so needless to say we had a little fun and shared some laughs.
Charnette came into the operating room and we performed our customary safety time out. We verified her name, date of birth, signed consents, medical/surgery history, and allergies.
Although most patients are apprehensive about going under general anesthesia, Charnette seemed relaxed. Her surgery went very well.
Her entire surgery lasted 43 minutes.
We were able to repair both tubes. Both her fallopian tubes were 7 cm in length, which is a very good length.
Most fallopian tubes are 8 to 10 cm long. Most of our patients have tubes which are, on average, 5 cm in length after reversal. We consider 5 cm to be a great length. Her tubes were 7 cm and her chance of pregnancy could be as high as 80%.
More information: Tubal lengths and chance of pregnancy
Confirmation of clip removal
The estimated blood loss was 4 milliliters… which is about a teaspoon!
At first I could not find her last remaining tubal clip!
I looked extensively in front and behind the uterus without any luck. I examined her pelvis and as much of her upper abdomen as I could but the clip was not found. I was about to give up but I thought to give it one last chance and examined her intestinal fat layers and finally found the clip embedded in her omentum!
The last remaining clip was found and removed. Her tubal clip was safely embedded in her intestinal fat.
My experience has shown that most patients don’t have symptoms from migrated clips when the clips are picked up by the fatty omentum. After the surgery, it was my opinion Charnette’s clips may not have been the cause of her symptoms. Her tubal ligation may have been the cause of her symptoms all along.
After the surgery, Charnette was taken to the recovery room and I went out to the waiting room to give her sister the good news.
Recovery room
Charnette did well in the recovery room. She woke up quickly. She did not have much pain. She had no nausea or vomiting.
I brought her sister back to see her. I talked with both of them together and informed them of the results of her surgery, the lengths of her tubes, and that we found the clip!
The nurses reviewed her post operative instructions and I took an opportunity to take a photo with her and her sister and that last darn Filshie clip!
Day# 3 Postoperative consultation
Charnette returned for her post-operative visit the day after her surgery. She was doing great!
She did not have any nausea or vomiting. She was able to eat dinner and breakfast. She was able to walk without difficulty.
The nurse reviewed her postoperative instructions, removed her bandage, cleaned her incision, and replaced a new bandage.
As I do with all my patients, I met with Charnette and we sat down together in the consultation room. I reviewed our MD recommendations and gave her a letter to take to her Ob/gyn. I also reviewed and gave her a copy of her tubal reversal operative note to also take to her doctor. I informed her of the tubal lengths and explained what we found and did during the reversal surgery.
I told her the tubal clip was embedded in her omental fat and explained how commonly we find clips hiding there.
Group photo after post-operative evaluation
I advised her the clip was MOST LIKELY not the cause of her symptoms because when I find clips in the omentum most patients report no symptoms. Most patients are not even aware the clips had migrated from the fallopian tubes to the omentum.
Typically, when I see patients with pelvic pain pain after tubal clips the clips are usually embedded in the back wall of the abdomen or are deep within the tissues around the uterus, round ligament, or in the intestinal wall itself.
I am not 100% sure the clip was not causing her problem. It is equally likely that the tubal ligation could have been contributing to her symptoms. We will see how things go over the next 12 months because only time will tell.
The staff and I took a photo with Charnette in the front lobby after her post-operative appointment.
We wished her well on her return journey home. We hope she experiences relief from her symptoms and, God willing, she can become a mom again!
Important insights from Dr Monteith
Most patients we see have reversal to become pregnant again; however, 10% to 20% of patients come for reversal to treat symptoms or side-effects experienced immediately after having a tubal ligation. We see a fair number of women who have pelvic pain after tubal clips.
Tubal clips are a very common method of tubal ligation. Believe it or not, tubal clips, especially Filshie clips, commonly can fall off after they close the tube.
I see this more when the clips are placed at the time of c-section or within 24 hours of having a vaginal birth. Clips do a great job of closing the tubes and not causing a lot of scar tissue. It is the lack of this scar tissue that allows the clips to migrate. The point being scar tissue sometimes acts like glue and locks the clip in place.
Most migrated clips do not cause symptoms. Most is not all. Clips that are attached to the intestines, back wall of the abdomen or embedded in the bladder or deep within the tissues around the uterus can cause terrible symptoms.
Many patients will go to their local Ob/Gyns to have the clips removed. Most doctors will not listen. Some will and we do a laparoscopy to remove the clips. I just want to emphasis three main points.
Point 1. Simply removing clips will not allow you to become pregnant
Some patients are thrilled to have their local doctor remove the clips because they know health insurance will pay for the surgery.
Patients should be aware…IF THEY WANT TO BECOME PREGNANT then simply removing the clips will not allow them to become pregnant because the tubes have been permanently sealed closed by the clips within the first week of the clips being placed.
After the tubes heal closed the clips are not serving any function.
So your local doctor may remove the clips and your insurance may pay for the surgery but you will not become naturally pregnant.
Point 2: Pelvic pain after tubal clips: Clips will be in unique locations!
Clips are easy to miss. The two most common areas for migrated clips are deep in the pelvis immediately in front of or behind the uterus or in the omental fat.
Day after surgery
In Charnette’s case the hidden clip was on the backside of the omentum. A clip in this location is very easy to miss during a laparoscopic surgery. The doctor will insert a camera into the belly button.
You can easily see the pelvis and the uterus but you can only see a part of the omentum. Usually they will put you in the steep trendelenburg position during the laparoscopy (ie stand you on your head) and the omentum will move down underneath your rib cage and towards your stomach. Remember when you are in the step trendelenburg position, the patient under general anesthesia is leaning far backwards and their head is closer to the ground and their feet are way up in the air.
Your doctor may not even see most of your omentum or intestines during a laparoscopic surgery. Most surgeons know it is very hard to thoroughly examine the intestines during a laparoscopic surgery.
This above factors are why clips are sometimes be missed during a laparoscopic surgery.
Point 3: Sometimes it is not the clips but the tubal closure that causes problems
Sometimes the clips are not the cause of the symptoms.
On rare occasions, we see the tubal closure itself as the cause of the symptoms. We commonly see endometriosis of the fallopian tubes at the site of the tubal ligation as a cause of symptoms in some patients. Sometimes we see scar tissue around the tube or ovary.
Sometimes the tubal ligation causes scarring of the muscular layers of the tubes or uterus (Salpingitis Isthmica Nodosa or adenomyosis) and this can cause painful cramps and abnormal bleeding.
Learn more about the other free contest winners
If you would like to see more information about prior winners visit:
- 2020 winners: Free Tubal Reversal Winners 2020
- 2021 winners: Free Tubal Reversal Winners 2021
- 2022 winner: Free Tubal Reversal Winner 2022
