OUTPATIENT TUBAL LIGATION REVERSAL SURGERY


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Tubal reversal surgery, also known as microsurgical tubal reanastomosis, has been a common surgical therapy for decades. Until in vitro fertilization (IVF) became routine and successful, tubal reversal surgery was very common. Tubal Reversal

Over the last 5 years, or so, the success rates for IVF at highly successful programs have nearly reached that of tubal reversal surgery in the best candidates. Because of this tubal reversal surgery has become much less common nationally. Therefore, it is important that any woman considering tubal reversal surgery also be counseled about the benefits and drawbacks of IVF as compared to tubal reversal surgery. In the most ideal circumstances, every woman considering tubal reversal surgery would be counseled at a program that offered both options with high success rates.

Reproductive Medicine and Surgery Center of Virginia is Such a Place

Despite some benefits of IVF, there are a number of excellent reasons a woman with a previous tubal ligation may desire a tubal reversal surgery rather than undergoing IVF. In the case of a patient desiring more than one child, tubal reanastomosis is more cost-effective. Many patients prefer to conceive "naturally" rather than requiring the technological complexity of IVF. Although considered quite safe, unresolved issues remain regarding the possibility of increased risks of some birth defects related to babies conceived from IVF. Increased incidence of multiple gestations is also more easily avoided with tubal reanastomosis.

A key issue for high-quality patient care is to counsel the patients appropriately about who is a good candidate for tubal reversal surgery, as compared to IVF, and be able to give informed recommendations. Keep in mind the saying, "If all you have is a hammer every problem looks like a nail." If your practitioner only offers tubal reversal then you may not get the most informed and objective perspective. In some cases, IVF would be more likely to result in pregnancy.

Success for tubal reversal surgery is quite variable and depends on such things as how the fallopian tubes were "tied", the time since the surgery, the sperm count of the male partner, and the length of the remaining fallopian tubes. Tubal reversal also has a higher risk of ectopic pregnancy (pregnancy outside of the uterus). So, pregnancy rate is lower than delivery rate. Keep in mind also that "tubal patency" after surgery (the tubes being open after surgery) does not mean you can become pregnant. Delivery rate of a baby following surgery (not tubal patency rates or even pregnancy rates) is all that is important to couples.

An advantage for patients who come to the Reproductive Medicine and Surgery Fertility Center of Virginia are the state of the art facilities. In addition to extensive experience performing these procedures, Drs. Bateman, Williams and Smith Co direct the In Vitro Fertilization Program.

Drs. Bateman and Williams are subspecialty certified in infertility (Reproductive Endocrinology and Infertility) by the American Board of Obstetrics and Gynecology and Dr. Smith is board subspecialty trained in Reproductive Endocrinology and Infertility.

Dr. Bateman founded the IVF program in Charlottesville, VA, in 1986 and has been performing tubal reversal surgery since 1980. Dr. Williams joined Dr. Bateman in 2001 and also regularly performs tubal reversal surgery. Dr. Smith joined Drs. Bateman and Williams in 2010 and also regularly performs tubal reversal surgery.

Our tubal reversal fee is very competitively priced and we offer a tubal reversal money back guarantee. Our tubal reversal fee is very competitively priced and we offer a tubal reversal money back guarantee. The full amount is paid approximately two weeks prior to the date of your surgery. Our office is responsible for paying the facility and anesthesiologist fees. The total cost for this procedure if performed in an outpatient setting is only $5,926.00.

Unfortunately, we do not offer payment plans for this procedure. Most insurance carriers will not cover the initial office visit to see the physician to discuss tubal reversal. The new patient consult is under $349. You will be expected to pay this fee at the time of your visit.

However, if you schedule surgery, the money that you paid for your consultation will be applied to the surgery balance. To schedule a new patient appointment to discuss your options, please call 434-654-8520. If you have any questions regarding financial matters, please ask for Jody. Many options are available to help patients afford fertility treatments.

Frequently Asked Questions: Outpatient Tubal Ligation Reversal Surgery

If I just want clamps removed is it still tubal reversal?

Yes, however the tubal ligation was performed (there are 5-6 common techniques and many less common ones) it has caused scarring in the tube that is blocking the sperm from swimming up the tube to find the egg. The removal of this blockage is called a tubal reversal. In the case of “clamps”, they are a method to crush the tube and cause damage that leads to permanent scarring. When the clamp is taken off the scar tissue still blocks the tube.

Will the physician tell me that day if it can be done or not?

If we are provided with the operative report and pathology report (if pieces of the tubes were taken out) then we should be able to make plans that day. There are situations where a woman’s tubes have been cauterized in multiple places (burned extensively) or the end of the tube, called the fimbria, are cut out. These are not able to be corrected surgically.

In these cases In Vitro Fertilization (IVF) is the only reasonable option. Of note, we always recommend a husband/partner get a semen analysis prior to the tubal reversal surgery. A few times a year we make plans to do tubal reversal surgery but cancel them due to a very low sperm count for the male partner. This usually leads to the couple pursuing IVF instead, which is much more successful in this case.

What is the cut off age for having this done?

There is no specified cut-off. However, when we meet we will have a realistic discussion of how likely it is to work. This takes into consideration many things, age is one of them.

What are the chances of me having a baby?

In general, for all comers, it is 75%. However, there are many things that must be taken into account, such as how tubal ligation was performed, age of the woman, sperm count of the man, other medical problems, etc. It’s also important to understand that over 90% of the time one or both tubes are open after surgery, but that doesn’t mean you will necessarily get pregnant. Some tubes do not work well because of the surgery to block them followed by surgery to reopen them. In other circumstances a woman’s age or her husband’s sperm count are preventing success following tubal reversal surgery.

How do they do the procedure, will I be cut like a c-section?

No. If a woman is not significantly overweight it can usually be done through a small incision called a “mini-laparotomy”. This incision is much smaller than a c-section incision. It is small enough to be safe and comfortable to go home the same day. It is hard to give an absolute cut-off for weight but about 180-200 lbs. tends to be the upper limit of what can be accomplished with a “mini laparotomy.” It certainly depends on how tall a woman is and how she distributes her fat. Some overweight women have very thin waists but large hips and legs and a mini laparotomy could still be accomplished.

A physical exam is important. A “laparoscopic” approach may be recommended in overweight patients where the abdominal wall is too thick to do the procedure the more common way by “mini laparotomy”. Laparoscopy is a minimally-invasive technique using a camera and long-handled instruments placed through 2-10mm ports in the abdominal wall. See our laparoscopic tubal reversal video for more details.

Weight loss is always the best option prior to surgery. In general, women over 200 pounds often have an abdominal wall thickness that is too large for the usual small incision (mini-laparotomy) to be made. But it depends on how tall you are and how your body fat is distributed. If you are over 200 pounds it does not mean the surgery cannot be done, rather it may make it prudent have the procedure performed laparoscopically.

There is an upper limit to safely perform laparoscopy, and it depends on how fat is distributed on a woman, but upper limit on weight for the laparoscopic technique generally falls somewhere approaching 250 lbs. If over 250 lbs. it would be best to work on weight loss. Of course, we hope you will become pregnant soon after your surgery with us and having you weight in as good control as possible prior to pregnancy is important for the health of both mother and baby.

Why do they do an ultrasound during the consult?

We frequently do an ultrasound to make sure the uterus is small enough to be accessed through a mini-laparotomy incision. Measurements of the uterus and ovaries are also made that can be helpful in planning the best surgical approach and to assure there are no other problems that might lower success following tubal reversal, such as fibroids (myomas) or cysts.

Is it outpatient surgery or do I have to spend the night?

Usually it is outpatient surgery. This incision is much smaller than a incision. It is small enough to be safe and comfortable to go home the same day. The incision may have to be made larger if a woman is significantly overweight or there is scar tissue inside her belly. The size of the incision usually determines whether you need to spend the night in the hospital. Most women can go home the same day the surgery is performed.