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
There are no advantages to either robotic or laparoscopic tubal reversal, period, exclamation point! There are no advantages in recovery time after surgery, Laparoscopic or robotic surgery require a minimum of 4 incisions at various places in the abdomen, all of which will show in any 2-piece bathing suit. The incision we use is 2 inches right at or below your hair line and you will have to look a long time to find a bathing suit that will show it. I want you to think about the last time you tied your shoes. You could feel when the knot was tight. You probably did not look to see if they were tied properly because your hands told you they were right. With robotic or laparoscopic surgery that feel is lost, they look at a television monitor to tie the sutures and hope for the best. Another important consideration is suture material. We use 8-0 or sometimes 9-0 suture that is used in eye surgery. The finer the suture is important because the tube is very tiny and you don’t want thicker sutures to do the reversal. The smallest suture that is available to use robotically is 6-0 (the higher the number the finer the suture). Your robotic or laparoscopic surgeon has to use suture that is 2 to 3 sizes bigger than we use. Remember, smaller suture is better. The final thing for you to consider is experience. Dr. Turner and I have done almost 3000 tubal reversals.
-Dr. William Greene
We know that doctors read these blogs and this is one question that requires a rather technical answer. First of all, we are talking about closing the tubes in layers not just the abdomen because everyone does that. Most doctors that do reversals just sew around the outside of the tube, the serosal layer, with 3 or 4 stitches. The inner lining of the tube is different near the uterus than it is out at the end of the tube near the ovary. Going from inside the tube to the outside the innermost layer is the mucosal, then the muscularis, next the adventitial layer and on the outside the serosal layer.
The changing of the cell layers is called metaplasia. The cells start out all the same but depending on where they are in the tube they become different. I think, but I don’t know, that the changing in the acid level as they get nearer the ovary causes the metaplastic change. We have done almost 3000 reversals and we have a very low ectopic pregnancy rate (2.5 %) that I believe is due to careful layered closure. Dr. Turner and I sew the tubes in layers from inside to out because we believe it gives the best result. We don’t have any argument with physicians that do differently we just know what we feel is best for those patients that put their trust in us to do the best for them.
-Dr. William Greene