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Lisa Hourmouzis, RN
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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.

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Nearly 500,00 women undergo tubal ligation surgery in the United States every year. Of those women, as many as one-fourth will change their mind and desire more children after tubal ligation leading to questions about the possibility of tubal reversal surgery.

The most common question women have as they research the option of tubal reversal surgery is whether the surgery will be successful. The success of the surgery depends on several factors, including a woman’s age, the type of sterilization, and the length of tube remaining after the reversal procedure. One way to determine the outcome of the reversal surgery is through a review of the operative report from the tubal ligation. Based on this information, the tubal reversal surgeon is able to make an interpretation regarding the type of sterilization a woman has had and estimate the amount of tube that may have been damaged during the procedure. Tubal reversal specialist, Dr. Gary Berger, is a reproductive surgeon who limits his practice to tubal reversal surgery. Two-thirds of Dr. Berger’s patients become pregnant in an average of 10 months after their reversal procedure.

Another priority issue is tubal reversal cost. One reason for the increased costs quoted by some facilities is the lengthy operating time due to lack of experience with the procedure. This often means that the woman is hospitalized for several days, with significant added costs as a result. Dr. Berger has developed a low-cost, outpatient reversal procedure that has resulted in the most tubal reversal babies born worldwide. With short operating times (approximately one hour) and no overnight hospital stay required, tubal reversal cost is kept to a minimum. Dr. Berger also offers an all-inclusive fee for the reversal procedure, there are no unexpected or “hidden” costs.

Potential reversal patients often ask whether the length of time since the tubal ligation will affect the outcome of the surgery and, fortunately, the answer is no. The damage that is done to the tubes at the time of the sterilization does not worsen over time, so the length of time since the tubal ligation does not specifically affect pregnancy rates. However, age does play a factor so pregnancy rates should be viewed by age if a number of years have passed before tubal reversal surgery is performed. Fortunately, women age 40 – 42 have pregnancy rates of approximately 50% following surgery with Dr. Berger at Chapel Hill Tubal Reversal Center.

Recovery times can vary greatly between doctors and facilities, and this issue is usually mentioned as an important factor in choosing a doctor for surgery. Although everyone recovers at a different rate, most of Dr. Berger’s patients return to work in 5 – 7 days following surgery and are back to the majority of their usual activities within 7 – 10 days. Tubal reversal performed by Dr. Berger usually takes less than an hour. Minimizing operating time is important, since longer anesthesia and surgery times are associated with increased complication rates and recovery from surgery. Compare this to the standard approach for tubal reversal surgery where operating times of 3 – 4 hours can result in hospitalization for several days, a recovery period of 4 - 6 weeks, and unnecessary hospitalization costs.

Dr. Berger’s successful and safe reversal procedure has been featured on television on The Discovery and Learning Channels. Chapel Hill Tubal Reversal Center is a medical facility exclusively for tubal ligation reversal. Dr. Gary Berger is recognized as the tubal reversal doctor with the most experience with this procedure. Although tubal reversal is not right for everyone, Dr. Berger can repair the fallopian tubes in 98% of women who have had a tubal ligation and want to have another baby. These are two of the many reasons why women come from all over the US and abroad to have Dr. Berger perform their tubal ligation reversals.

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