This article profiles a patient who came to A Personal Choice for reversing tubal ligation at which time she was found to have ovarian endometriosis.
Travel from California
The patient and her husband traveled from Monterrey, California for tubal ligation reversal. She is 44 years old and is a banker. She has two children from previous marriage, ages 12 and 15. Her husband is a meteorologist. He has two children from a previous marriage, ages 16 and 18. They moved from Texas to California and have been married together for 1 year and 3 months. Together, they desire a child of their own.
IVF Evaluation
Prior to traveling to visit us, they had a consultation with a reproductive endocrinologist near where they live. They expressed dissatisfaction with their consultation because they felt the doctor only wanted to offer them in-vitro fertilization (IVF). They did consider IVF but decided the procedure was not for them. During the preoperative consultation they specifically stated:
“We wanted to have a baby as God intended it.”
They did their own search for tubal reversal doctors and chose to come to A Personal Choice because we specialize exclusively in reversing tubal ligation. They felt their chance for a successful reversal procedure would be best at our center.
Preoperative Evaluation and Surgery
She was a healthy person and denied any known preexisting problems or menstrual abnormalities. We reviewed her tubal ligation operative and pathology reports that described at least 3 cm removed from each fallopian tube. We discussed their expectations and the risks and benefits of tubal reparative surgery.
During her surgical procedure and upon entering the abdominal cavity, we discovered brown fluid suggesting the presence of endometriosis. Close inspection of the right ovary revealed endometriosis inside of it and partially involving the right tube.
We removed the endometriosis and repaired the right tube. The left tube and ovary were normal. The left tube was repaired without difficulty.
She did well during the surgery. In the recovery room, we informed her and her husband of the unexpected endometriosis and the successful repair of both fallopian tubes.
Endometriosis
Endometriosis can be suspected in most patients based on a careful evaluation of a menstrual history. Many women with endometriosis will have extremely painful menstrual periods. Menstruation can be so painful patients may require large amounts of pain medications, miss time from work, or will have pelvic pain which drastically affects their personal lives. Many women give a history of severe pelvic pain, especially with intercourse and will plan their sexual activity based on their menstrual cycles. Many patients, like this one, can have minimal or no symptoms of endometriosis.
We could not have predicted this patient’s endometriosis in advance because of her absence of preexisting symptoms. Fortunately, we were able to successfully reverse her tubal ligation and remove the endometriosis at the same time.
We wish her well on her trip back to Monterrey California and hope a healthy pregnancy will be in her near future.
