This started in the blogosphere based on an article published in (Lancet 2014; 384:29-36) that mentioned. patients who miscarry and either take low dose aspirin or don’t. Women who took low dose aspirin after a miscarriage got pregnant quicker than those who didn’t. There was no attempt to see the effect on women who didn’t miscarry to see if it helped them get pregnant more quickly.
The only proven pre-conception need for women is to take a vitamin with folic acid in it. If you miscarry, you might want to take low dose aspirin as long as you don’t have a medical condition that makes it a bad idea. Aspirin allergy is very rare and when associated with nasal polyps (also rare) can be rapidly fatal. Best to ask your doctor if you are not sure.
The take-home message here may be that if you see something on the internet it may not be accurate. In the area if infertility, there is so much ridiculous nonsense floating around that you need to be very careful. The reality is that women who are having problems with reproduction can be searching for something to help them. There are people who take advantage. The Lancet study was to see if there is any advantage to waiting to try to conceive after a miscarriage and there is not. There are other reasons why a woman may not take low-dose aspirin such as being on anticoagulants and a history of bleeding problems, to name a few so stick with the vitamin with folic acid unless you talk to your doctor.
The process that our facility uses we do not cut a hole in the uterus to reverse our Essure patients. We put the tube in the uterus in the hole that’s normally there. The first thing we do is to remove the Essure devices microsurgically, without cutting the uterus in any way. If a patient comes to us to just have the Essures removed we do the same thing, no cutting a hole in the uterus!
For an Essure reversal, when a patient wishes to have more children, the next step is to dilate the tiny natural hole in the uterus. This is done using tiny silver wire dilators that are each slightly larger than the previous one. Once we have used all the silver wire dilators we us stainless steel dilators to get the natural hole large enough to accept the tube. The final step is to sew the healthy tube in the natural hole in the uterus.
We have seen a report about a doctor who cuts a hole in the uterus to reverse Essures having a patient rupture her uterus at 39 weeks. The patient was not in labor. Uterine rupture is frequently fatal to the baby and can be fatal to the mother too. I have no issue with how anyone does reversals. Every doctor has to choose what’s best for his or her patients based on their ability to do the best and safest job. The way we do Essure reversals takes a little longer and requires two surgeons to do but we feel it is the best way for our patients.
Very, very few tubal ligations are not reversible. Of the patients who come to us for tubal reversal, one person in 100 cannot be reversed, dye tested and sent home ready to conceive. Unless a doctor has a lot of experience doing reversals, he or she is not qualified to tell if a patient can be reversed. We are aware of a doctor who offers laparoscopy for $1500 prior to reversal surgery. If he feels a patient cannot be reversed, he refunds the $6400 fee he charges for reversal. I am not aware if they refund the hotel expenses, $125 scheduling fee or the $500 dollars in lab work he requires you to get before you come.
If we did what that doctor does, we would charge 99 patients almost a total of $150,000 to find the one person in 100 that we cannot reverse. A very good deal for the doctor and a very poor deal for the patients. The bottom line is we can almost certainly reverse your tubes and to charge you extra to look first is an unnecessary expense for you.
Many patients will tell us that the doctor who tied their tubes told them “there is no way this can be undone”. The microsurgical tubal reversal technique to reverse tubes is relatively new and not many doctors are aware of its potential to help women get pregnant again. The medical journal of the American Fertility Society: Fertility and Sterility just reported last year on the cost and effectiveness of microsurgical tubal reversal (Vol 104, No. 1, July 2015). This journal is devoted to advanced technologies like IVF and they have recognized that microsurgical tubal reversal is a good idea for most woman under 41 years of age and even some over 41.
We probably have an inquiry about hysterectomy to remove an Essure once a week. This is a bad choice to remove an Essure. Just last week a patient, who has had a hysterectomy to remove her Essure sent us an X-ray that shows both are still there. I am going to ask her permission to use that picture on our website with her name covered up to protect her privacy. We also were recently contacted by a patient whose doctor told her that he could remove her tubes to get rid of the Essure. That approach would leave the part of the Essure in the uterus still inside of her. The most important thing to consider should be the risk associated with hysterectomy. One patient in a thousand who has a hysterectomy dies from the operation. People will say “my insurance will pay for a hysterectomy” but not the $4500 you charge to remove them microsurgically. When you consider the deductible you will pay and lost wages for 2 or 3 weeks recovery there is not much to be saved by undergoing an unnecessary and dangerous operation.
-Dr. William Greene
There have been estimates that 40% of all surgeries are either unnecessary or could be handled in a simpler less dangerous way. If you are proposing a surgery that is a good idea you should welcome a patient’s decision to get a second opinion. Chances are they will come back to you reassured that they have made a good choice in selecting you as a doctor. Many of the patients that come her for reversal surgery were sent by their local physicians for IVF (test-tube baby) and were horrified at the cost in time and money. They realized that it was safer, cheaper, and more likely for them to conceive if they had their tubal ligations reversed. One of many reasons that Dr. Turner and I love doing tubal reversals is that there is no doubt the surgery is clearly a good idea. A woman with a tubal ligation clearly needs help to conceive and tubal reversal has obvious advantages.
-Dr. William Greene