Tubal Reversal Surgeons Reverse Adiana Sterilization

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.

FOR IMMEDIATE RELEASE May 26 2008 (Chapel Hill, NC)

Almost every publication about tubal ligation stresses that it is a permanent method of birth control. The public, and even most doctors, believe this to be true. Although tubal sterilization is intended to be permanent, the procedure can be reversed by an experienced tubal microsurgeon in over 95% cases.

Doctors say that tubal ligation is a permanent method birth control because it cannot be discontinued easily such as stopping the use of birth control pills or patch, removing an IUD, or barrier contraceptives. In the past, reversing a tubal ligation procedure involved complicated in-hospital surgery with its attendant high cost ($15,000 to $35,000). Dr. Gary Berger, Medical Director of Chapel Hill Tubal Reversal Center, has developed an outpatient tubal reversal procedure that results in surgery that is easy to undergo and avoids the expense of hospital charges. This has reduced the cost of tubal ligation reversal to less than $6000. This is approximately half the cost of a single treatment cycle with in vitro fertilization (averaging $12,000 in the US).

There are some methods of female sterilization that are not reversible. These include complete removal of the fallopian tubes (total salpingectomy) and extremely destructive methods of partial salpingectomy that do not leave two segments to repair. An example of the latter is when only a short portion of the tube is attached to the uterus and the remaining segment contains only fimbrial tissue with no tubal muscle or opening. In this case, the fimbrial tissue alone cannot be rejoined successfully to the uterine segment of tube. Fortunately, these are unusual occurrence. In cases where there is a sufficient length of tube attached to the uterus, it can be opened and be able function normally even without the fimbrial end. This is called ampullary salpingostomy. This technique is useful in reversing a fimbriectomy (removal of the fimbrial or ovarian end of the fallopian tube).

Reviewing the operative report from a tubal ligation procedure usually will indicate how destructive the procedure was. Pathology reports, when available, also can provide additional information beyond what is contained in the operative report. When there are questions about whether or not tubal repair is possible in a specific case, diagnostic laparoscopy can be performed to examine what remains of the fallopian tubes. If there are sufficient segments to repair, tubal reversal can be done during the same operation while the patient is under anesthesia.

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 easiest method of tubal ligation to reverse is the “clip” procedure. The Hulka Clip was developed in the 1970s by Dr. Jaroslav Hulka, a professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill. The tubal ring also is an excellent method for reversing. The clip and ring procedures tend to damage the least amount of the fallopian tube and leave behind long segments to repair. The overall pregnancy rate is 65% at one year following reversal of tubal clip procedures and increases for younger women to 87% for women less than 30 years of age. The pregnancy rate after tubal reversal surgery continues to rise with the passage of time because once the tubes are open pregnancy can occur any month. Many women who have undergone tubal ligation reversal have added several babies to their families.

Tubal ligation and resection (removal) of a portion of the fallopian tube is the most frequent method of blocking the tubes. This involves tying a segment of tube and removing it. There are many variations of this technique. The tubal ligation procedure described by Dr. Ralph Pomeroy a century ago is still the most commonly used today. Experience shows that 98% of these procedures are now reversible and approximately two-thirds of women with a Pomeroy tubal ligation become pregnant following tubal ligation reversal.

With a specialized procedure such as tubal ligation reversal, the surgeon’s experience is the most important factor in predicting success from the operation. Depending on the patient’s type of tubal ligation and condition of the remaining tube after ligation, the techniques of tubal reparative surgery vary among patients. Having an experienced tubal reversal specialist perform the operation is essential, particularly if a woman has a difficult situation due to short or missing tubal segments, fimbriectomy, or has inherent disease of the tubes.

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References

http://www.tubal-reversal.net/blog/2007/tubal-ligation/tubal-ligation-not-permanent.html
http://news.tubal-reversal.net/pregnancy-study-2007-method.htm