Doctors at Chapel Hill Tubal Reversal Center become the first to reverse tubal sterilization by the Adiana technique
October 9th, 2009 (Chapel Hill, NC) – Julia Smith, RN, Nurse Administrator at Chapel Hill Tubal Reversal Center in Chapel Hill, North Carolina, today announced the first successful tubal reversal procedure to repair the fallopian tubes in women who have undergone the Adiana method of tubal sterilization. This is the first pregnancy after Adiana reversal for the newly approved sterilization system.
Adiana sterilization was approved for use in the US by the FDA in July 2009. The procedure can be performed in a physician’s office and involves using radio frequency energy to remove cells in the lining of a small area of the fallopian tubes nearest the uterus. The device itself is then implanted in this prepared area. The Adiana system is similar to the Essure sterilization method in being a non-surgical female sterilization method which promotes scarring to create a tubal blockage.
Dr. Gary S. Berger and Dr. Charles Monteith performed the reversal during a one hour and ten minute tubal surgery procedure. The healthy fallopian tubes were separated from the blockage and tubal implantation was performed through a newly created opening in the back of the uterus. Since the Adiana and Essure sterilization methods involve a small segment of the narrowest part of the fallopian tube, long tubal segments remain after the reversal procedure which is a major factor in tubal reversal success rates. The pregnancy success rates can be found in the latest tubal reversal study available at http://press.tubal-reversal.net/2009/pregnancy-rates-by-age-and-tubal-ligation-method.html
Dr. Berger and Dr. Monteith performed the tubal reversal procedure on a 35-year old woman who underwent sterilization by the Adiana technique as part of an experimental trial to test the new sterilization procedure six years ago. Although she underwent tubal sterilization intending for the procedure to be permanent, the patient’s decision to reverse the procedure was promoted by the unexpected and sudden loss of a child.
Chapel Hill Tubal Reversal Center is the only facility in the United States that specializes in the practice of tubal reversal surgery and repair of blocked fallopian tubes. Patients travel from across the US and from abroad for surgery at the specialty facility with its highly trained and experienced surgeons and staff. Additional information regarding tubal reversal surgery, Adiana reversal and Essure reversal is available at Chapel Hill Tubal Reversal Center, including profiles for Dr. Berger and Dr. Monteith, can be found on the website at www.tubal-reversal.net.
Claims about the chances of getting pregnant after tubal reversal are often made without supporting documentation such as the number and characteristics of the patient population, study method, and length of follow-up after surgery. These are essential for understanding the basis of pregnancy rates. Statistics must be based on specified numbers of patients for any characteristic, such as age or tubal sterilization method. Most internet sites about tubal reversal do not provide any data at all. Although a doctor can say that his patients have a high success rate, supporting documentation is needed to know whether the claim is valid. The accuracy of any claim of success rates should be questioned in the absence of detailed information.
Evidence Based Medicine
The only way a doctor can truly know what the pregnancy and outcome statistics are for his or her patients is to maintain ongoing patient contact about the outcomes of treatment and record the information systematically in an analytical database. At Chapel Hill Tubal Reversal Center, nurses enter information into an electronic patient database at the patient’s registration, the surgical procedure, and all post-operative communications between patients and staff. Patients are contacted routinely by our nurses during the first year after their tubal reversal procedures.
Chapel Hill Tubal Reversal Center Database
The comprehensive follow-up database at Chapel Hill Tubal Reversal Center is unique. We know of no other doctor or medical facility with a follow-up system and database that can provide such accurate statistics about the chances of getting pregnant after tubal reversal and the outcomes of the pregnancies that occur.
Limitations And Possible Under Reporting
Although we encourage patients to inform us when they have a positive pregnancy test, not all pregnancies are ascertained. Some patients become lost to follow-up after surgery. This occurs when someone moves or changes email address and telephone numbers but does not provide their new contact information to us. In these cases, we may not find out about the long term outcomes of their tubal reversal procedures unless they complete the Pregnancy Report Form each time they conceive. We know that not all patients adhere to this protocol. From the women who do remain in contact with us over the long term, however, it is clear that new pregnancies continue to occur as time passes after surgery. The pregnancy rates reported in this study, therefore, are minimal estimates of the cumulative pregnancy rates for patients at Chapel Hill Tubal Reversal Center.
Tubal Reversal Pregnancy Report 2009 Table Of Contents:
The study population consisted of 5,046 women who underwent tubal reversal surgery from July 2000 through June 2008 at Chapel Hill Tubal Reversal Center.
Women’s Ages
The women in the study ranged in age from 20 to 51 (Figure 1). The mean average was 34 years of age. Approximately three-fourths of the women were in their 30s.
Figure 1. Age Distribution of Study Population
Years of Age
Tubal Ligation Methods
The type of tubal ligation that was performed is an important factor affecting the outcome of tubal reversal surgery. The most common method involved tying and cutting out a segment of the tube (ligation/resection). The second most common method was tubal coagulation (burning the tubes) followed in frequency by mechanical occlusion with tubal clips or rings. Other procedures, including fimbriectomy (removing the end of the fallopian tube) were the least common. In cases where the patient’s operative report of the tubal ligation was not available, the method was classified as unknown.
Table 1. Tubal Ligation Method
Method
Number
Percent
Ring
853
17%
Clip
409
8%
Ligation/resection
1923
38%
Coagulation
1605
32%
Other/unknown
256
5%
Total
5046
100%
Tubal Reversal Pregnancy Report 2009 Table Of Contents:
Pregnancy Rates At Chapel Hill Tubal Reversal Center
From July 2000 to June 2008, 5046 women underwent tubal ligation reversal at Chapel Hill Tubal Reversal Center. The operative techniques of microsurgical tubal anastomosis, tubouterine implantation, and salpingostomy were used as appropriate to each patient’s situation, and often these techniques were combined in a single case. Including all women’s ages, methods of tubal ligation, and operative techniques used for tubal reversal, the overall pregnancy rate was 66% based on 3317 pregnancies reported during this 8 year interval.The following tables show pregnancy rates specific for age, method of tubal ligation, and remaining tubal lengths available for repair and the interaction between these factors.
Pregnancy Rates By Age
As expected, younger women had higher pregnancy rates than older women. The pregnancy rate after surgery ranged from 80% for women under 30 to 31% for women 40 years of age and older (Table 3).
Table 3. Pregnancy Rates by Age
Age
Total Cases
Pregnant (No.)
Pregnant (%)
<30
761
610
80%
30-34
1873
1367
73%
35-39
1795
1152
64%
40+
617
188
31%
Pregnancy Rates By Tubal Ligation Method
Reversal of tubal clip procedures had the highest pregnancy rate (75%), followed by tubal rings (72%), coagulation (66%) and ligation/resection (63%). Patients with other or unknown methods of tubal ligation had the lowest pregnancy rate (54%).
Table 4. Pregnancy Rates by Tubal Ligation Method
Method
Total Cases
Pregnant (No.)
Pregnant (%)
Clip
409
306
75%
Ring
853
614
72%
Coagulation
1605
1053
66%
Ligation/Resection
1923
1207
63%
Other/unknown
256
137
54%
Pregnancy Rates By Age And Method
Pregnancy rates taking into account both age and tubal ligation method are shown in Table 5. The highest pregnancy rate (90%) was reported by women under 30 years of age who had reversal of a previous clip method of sterilization. Of the two variables, age is more predictive than tubal ligation method regarding the likelihood of becoming pregnant after reversal surgery.
Table 5. Pregnancy Rates by Age and Tubal Ligation Method
Age
Clip
Ring
Coagulation
Ligation/Resection
<30
69/77 (90%)
137/163 (84%)
190/244 (78%)
192/248 (77%)
30-34
114/139 (82%)
227/299 (76%)
461/620 (74%)
517/744 (70%)
35-39
110/151 (73%)
210/303 (69%)
353/554 (64%)
421/681 (62%)
40+
13/42 (31%)
40/88 (46%)
49/187 (26%)
77/250 (31%)
Tubal Reversal Pregnancy Study 2009 Table Of Contents:
Tubal reversal is the most successful treatment for women wanting to get pregnant after having a tubal ligation. This report presents detailed pregnancy statistics from over 5000 patients at Chapel Hill Tubal Reversal Center. It is the largest study ever reported about tubal ligation reversal, pregnancies, and pregnancy outcomes.
Introduction
The desire to have a baby after a tubal ligation is common for women in second marriages, following the loss of a child, wanting to restore their bodies to be whole again, and for a variety of other reasons.
Most people are not aware that tubal ligation – usually considered a permanent method of birth control – can be reversed through low cost, one hour outpatient surgery. Even many doctors think mistakenly that treatment by in vitro fertilization (IVF) is needed for women who want another baby after having a tubal sterilization. The results from this study show that tubal reversal at Chapel Hill Tubal Reversal Center is successful for most women wanting to get pregnant after having their tubes tied.
Tubal Reversal – The Alternative to Treatment by IVF
Information is widely available about in vitro fertilization (IVF) results in the United States from the Centers for Disease Control (CDC). Tubal reversal pregnancy and birth statistics, however, are difficult to find and generally have been based on small numbers of patients under special study conditions. This report analyzes pregnancy rates and pregnancy outcomes for a very large population of women (5,046) who had tubal reversal procedures at Chapel Hill Tubal Reversal Center. This is the most detailed study of tubal reversal surgery available on the internet or in medical publications.
FOR IMMEDIATE RELEASE CONTACT: Julia Smith RN August 11, 2009 (919) 656-8204
TUBAL REVERSAL SURGEONS REVERSE ESSURE PROCEDURE Implantation technique allows for successful reversal of sterilization procedure
(CHAPEL HILL, NC) – Chapel Hill Tubal Reversal Center in Chapel Hill, North Carolina, announces the successful completion of sterilization reversal of the Essure procedure, previously considered a permanent form of female birth control.
More than 115,000 women worldwide have undergone sterilization with the Essure device since 2002. The Essure procedure involves placing a small, flexible plug into each fallopian tube at the junction of the uterus and the tube. Once in place, over a 3-month period, scar tissue grows into the micro inserts blocking the tubes to prevent the sperm from fertilizing the egg. The permanent nature of the procedure is related to this scarring and the previous belief that tubal ligation reversal surgery would be impossible.
The procedure Dr. Gary Berger and Dr. Charles Monteith use to reverse the Essure method involves cutting the device out of the uterine muscle and then implanting the remaining fallopian tube segment into the uterine cavity through a new opening in the uterus. This procedure is called tubouterine implantation. The reason the Essure device is removed is that part of the metal spring projects into the uterine cavity. If a pregnancy were to occur with the device in place, this could be harmful to the pregnancy.
Since the Essure has only been available since 2002 – and most women who have had this sterilization procedure do not desire or seek reversal – there is currently not enough data on the outcomes of Essure reversal to provide pregnancy statistics. However, the tubal reversal surgeons at Chapel Hill Tubal Reversal Center have performed the tubouterine implantation procedure hundreds of times for other situations and the success rate in those cases has been 25% -50% depending on the amount of healthy tube remaining and the age of the patient.
Chapel Hill Tubal Reversal Center is the only facility in the United States that is limited specifically to the practice of tubal reversal surgery. Additional information regarding tubal reversal surgery at Chapel Hill Tubal Reversal Center, including profiles for Dr. Berger and Dr. Monteith, can be found on the website at www.tubal-reversal.net.
Interview with Dr. Charles Monteith Tubal Reversal Surgeon at Chapel Hill Tubal Reversal Center
Charles Monteith, M.D. speaks about his education, training, and certifications. Dr. Monteith says he currently performs tubal reversals eight to twelve a week and the reasons women mention for wanting to have their tubes reversed. He says these include a new partner, or people have just changed their minds and decide they want to have more children. He adds a lot of women have experienced changes in their bodily functions after tubal ligation, and that patients refer to this as Post Tubal Ligation Syndrome.
Transcript of Video Interview With Dr. Monteith
Interviewer: Can you tell us about your medical school and residency training?
Dr. Monteith: I went to medical school in San Francisco, University of California in San Francisco and finished my MD degree there and then subsequently returned to the University of North Carolina, Chapel Hill to do my obstetrics and gynecology residency.
Interviewer: How long have you been performing reproductive surgery?
Dr. Monteith:I have been performing Gyn. surgery since 1997 but as of a year and a half ago dedicated myself exclusively to working with Dr. Berger and doing tubal reversal surgery.
Interviewer: And before you started working with Dr. Berger did women frequently ask for tubal reversal procedures was that something that something that came in your practice prior?
Dr. Monteith: As a generalist I did not see a lot of women that requested tubal surgery. However, our practice was a majority of young pregnant women. So I didn’t get a fair assessment of how many women were out there that wanted to have tubal ligations reversed. However I did have a partner that did perform exclusive GYN services she fairly often had requests or inquiries about tubal reversal surgery.
Interviewer: What made you pursue a certification in tubal reversal?
Dr. Monteith: I think I had had practiced high risk obstetrics and gynecology for a good seven years after I finished my residency and just one day I realized I needed to change what I was doing or I wasn’t going to last very long doing it. The way medicine has become is very high volume very stressful and little time with patients. I felt like I really wasn’t helping people to the best of my ability. Patients would come they would go. They would their insurance and have to go find another provider. People would come with job movement in the middle of pregnancy or leave in the middle of pregnancy and I just found that I didn’t get a lot of personal fulfillment out of it. I especially like my role as a tubal reversal provider because I like I’m being with a physician is supposed to be. I’m using my skills to help people to the best of my ability. And I especially feel because it’s not a widely offered service that I’m doing even better for a lot of women.
Interviewer: How many reversals do you perform each week?
Dr. Monteith: On average about eight to twelve a week currently.
Interviewer: What are some of the reasons women mention for wanting to have their tubes reversed?
Dr. Monteith: It seems like the most common reason is basically none of us can predict the future and most commonly it seems women find themselves in new relationships. Usually it is bad marriages, separations and divorce. And they find themselves with a new partner and just very strongly they would like to have children together. A close second to that would be to people that have just changed their minds and decide they want to have more children. And then a lot of women have experienced changes in their bodily functions after tubal ligation.
Interviewer: Are you referring to Post Tubal Ligation Syndrome?
Dr. Monteith- Ah yes, what most patients refer to as Post Tubal Ligation Syndrome.
Interviewer: And how frequently do you hear that as a condition that women feel they have developed?
Dr. Monteith- We hear it very commonly. There are probably a lot of women who come through here that never voice it or share it. But, at least in my experience here, I see a patient at least once a day if not every other day that has experienced worsened menstrual symptoms or bodily functions after a tubal ligation procedure.
Interviewer: And how much follow-up or are you able to follow-up after the surgery to see if that has improved?
Dr. Monteith: I am in the process of doing that now. Last year, we did a small case study on five women that had tubal ligations and experienced Post Tubal Ligation Syndrome. This summer it will be a full year and thus far in talking with them it seems at least about 70% of them have gotten better. Very frequently I am amazed that women post on the message board how much improvement they feel after they have reversal surgery.
Interviewer: How much contact do you have with patients after their reversal surgery?
Dr. Monteith: Most patients come from long distances so there is not a lot of direct contact but the most amazing thing is our tubal reversal patients seem to keep close contact by email and through electronic means. So, we hear from a large number of our patients.
Interviewer: What’s the best part of tubal reversal surgery and what you’re doing currently?
Dr. Monteith: The best part is really just using my skills to help a woman, a couple or a family to achieve what they would otherwise not be able to achieve and that is to add more children to their family or their relationship. Or to improve their perceptions about their body.
Interviewer: What do you like about Chapel Hill Tubal Reversal Center?
Dr. Monteith: The thing I like the most about this center and I come from my experience of working a large university and also from working at a large good quality hospital in Raleigh is that this center works with amazing efficiency. We take great care of patients. The staff seems to be real happy and motivated. And we are all dedicated to doing just one thing and that’s tubal surgery. And it feels good to work in a place with such high efficiency for the betterment of patients.
Interviewer: How does Chapel Hill compare to the in patient care of a hospital?
Dr. Monteith: There about the same as some of the best hospitals I have worked at and probably even better. Mainly because we are all focused on one thing and the staff really knows their jobs. And we are all dedicated to making that one goal happen, and that’s safe outpatient tubal repair surgery.
FOR IMMEDIATE RELEASE CONTACT: Julia Smith RN December 14, 2008 (919) 656-8204
TUBAL REVERSAL CENTER DOES ITS PART TO ADDRESS TOUGH ECONOMIC TIMES Chapel Hill Tubal Reversal Center lowers tubal surgery fees during the holiday season
(CHAPEL HILL, NC) – Julia Smith, RN, Nurse Administrator at Chapel Hill Tubal Reversal Center, today announced company plans to address the impact of the economic downturn on health care costs. Plans include a significant reduction in tubal surgery fees over the next two months to allow couples to move forward with less financial and emotional stress to have surgical procedures that correct tubal blockage.
Chapel Hill Tubal Reversal Center is dedicated to the practice of tubal ligation reversal surgery. Patients travel from across the United States and around the world for reconstructive tubal surgery with Dr. Gary Berger and Dr. Charles Monteith and the specialized procedure can carry a considerable price tag. However, with the reduced price structure, patients will be offered three fee options, Ms. Smith explained.
1) The standard fee is $6900. With this fee, patients can schedule an appointment and hold a date with a $250 down payment and the balance paid three weeks prior to the surgery date.
2) Between December 15, 2008 and February 1, 2009, surgery can be scheduled with Dr. Berger for a fee of $5400 or with Dr. Monteith for $4900. The discounted fees are due at the time a patient schedules the appointment and surgery must be performed no later than February 15, 2009.
The fees offered by Chapel Hill Tubal Reversal Center are all-inclusive and cover the doctors’ professional fees, the anesthesiologist’s fee, supplies, operating room charges and facility fees, initial consultation with the surgeon and follow-up by phone and e-mail. The company also offers a pre-payment plan for patients interested in long-term payment arrangements. With the pre-payment option, patients can pre-pay the surgical fee without interest prior to the surgery date. To utilize the option, a non-refundable $250 fee is paid to open an account and patients may then make payments of any amount as they are able – for as long as they wish. For discounted fees to apply, the balance must be paid in full prior to scheduling surgery.
“A woman’s natural fertility rate decreases as she ages, so it is best to move forward sooner rather than later when it comes to reproductive procedures,” Ms. Smith explains. “We hope our reduced fee options will allow women to proceed with surgery to restore their fertility without the added stress of waiting until the economy recovers.”
Determining who is the best doctor for untying your tubes comes down to different factors. Using a patient satisfaction website such as RateMDs.com will give you an opportunity to learn how other women have rated the doctor they used on some of these factors.
Taking a further look at the referenced site above, we can find that physicians are rated on staff, being punctual, helpfulness and knowledge. These determine the patient satisfaction score each doctor is given. You should consider looking at the most rated doctor.
Not only is that site available to see patient satisfaction with a doctor, there are several others as well. However, RateMDs.com does rank number one in a Google search for “rate doctors” so you may find it the best resource.
There are other ways as well to determine those factors for choosing the best doctor for untying your tubes. You can begin with a simple search around his own website. He does have a website, does he not?
There you should be able to learn:
1) his training and background, 2) how many surgeries of this type he has performed, 3) how often he does the surgery which leads back to number 2, 4) his personal statistics for success and pregnancy after tubal reversal, 5) about his surgical facility, and 6) the cost for this operation.
Additionally, there should be many testimonials from women who have had him or her perform their operation.
Does he have a message board or some other way available for you to discuss questions and concerns with other women? That is another good way to learn about how previous patients feel about the surgeon. Do they stick around afterwards and participate on the message board?
As you look around the Internet for information about tubal reversal, see whose name keeps coming up. When you read other women’s stories about their tubal ligation reversals, what kind of reports are given about different doctors?
These are just a few of the ways you can find out the patient satisfaction with the doctor you may be considering. When you do your research, you will find that your local doctor does not provide you with the best choice for untying your tubes, unless that doctor is Dr. Gary Berger of Chapel Hill Tubal Reversal Center.
Contact Information: Lisa Hourmouzis, RN 919.968.4656 office 252.339.2322 mobile LisaH@tubal-reversal.net
New tubal reversal specialist joins Chapel Hill center FOR IMMEDIATE RELEASE: July 21, 2008
CHAPEL HILL, N.C. – Dr. Gary S. Berger, medical director and world-renowned tubal reversal surgeon, welcomes Dr. Charles W. Monteith to the Chapel Hill Tubal Reversal Center surgical team.
Dr. Monteith is the first tubal reversal surgeon to join the practice since the initial tubal reversal microsurgery performed by Dr. Berger in 1982.
Monteith began his fellowship training with the center in January 2008, and has assisted in more than 100 reversal procedures under the guidance of Dr. Berger.
According to Dr. Monteith, his plan is to keep tubal reversal surgery a viable option for women wanting to have children after tubal ligation surgery.
“My interest in becoming a tubal reversal surgeon began when I realized that tubal reversal surgery was gradually becoming less available to patients because of limited training opportunities for younger physicians,” said Monteith.
Dr. Monteith graduated summa cum laude from Xavier University in Louisiana. He attended medical school at the University of California at San Francisco where he received a Howard Hughes Medical Research Fellowship used to conduct research in molecular genetics.
After completing his residency in obstetrics and gynecology at the University of North Carolina at Chapel Hill, he accepted a clinical assistant professor position with the department of obstetrics and gynecology in 2001. He also served as assistant professor in obstetrics and gynecology at Wake Medical Hospital in Raleigh for seven years where he practiced high-risk obstetrics and advanced surgical gynecology.
Chapel Hill Tubal Reversal Center is the only facility in the United States dedicated exclusively to tubal reversal surgery. Dr. Gary Berger has successfully performed over 7,000 tubal reversals using the one-hour outpatient microsurgical technique he developed and refined. His technique has been featured on The Learning Channel and Discovery Health.
109 Conner Drive Suite 2200, Chapel Hill, NC27514(919) 968-4656
Outpatient Tubal Reversal
http://www.tubal-reversal.net/patient-satisfaction-messages/Messages from tubal reversal patients of Dr. Berger and Dr. Monteith about the care they received at Chapel Hill Tubal Reversal Center
http://www.tubal-reversal.net/includes/footer.php was last modified on November 15th, 2009 19:32:20
109 Conner Drive Suite 2200, Chapel Hill, NC 27514 Tel: (919) 968-4656 Fax: (919) 869-1976
