There was an article recently in USA Today that points out that 60% of all surgeries are done in same-day surgery centers. This is probably true and a great source of frustration for the hospital industry that has incredible political clout and knows patients prefer outpatient care. The article seems to be a bit unfair, further noting that 30% of anesthesia providers are not board certified in outpatient centers are not board certified. That is also true in traditional hospitals because you have to be a doctor anesthesiologist to be board certified and nurse anesthetists, not doctor anesthesiologists do most cases either in a hospital or in an outpatient surgical center. They also estimate that 1 out of three outpatient centers employ doctors that are not board-certified. Our surgical center is accredited by The Accreditation Association for Ambulatory Health Care (AAAHC), licensed, and fully equipped. Both Dr. Turner and I are board-certified. I cannot speak for every ambulatory surgery center but our experience supports the well-established fact that patients are far safer in outpatient surgical centers than they are in traditional hospitals. We have done over 3300 tubal reversals since 2001 without any serious complication.
We recently opened a new way of communicating with patients by their phones and it has been revealing. Until now, most communications have been through our website and those that found us on our website had looked at several other options and decided on us. With the blue bubble on the home page letting patients open up a phone dialog we seem to get a chance to talk to people that have not looked at other sites and they seem to want to why they should come here for their reversal.
The things that make us stand out are simple. Our fees do not have any extras, all lab work, all other charges, even your hotel stay are included. You only come here once, the day before surgery, the next day we reverse your tubes, and we see you briefly the morning of the 3rd day before you go home. We do not charge for your consultation with Dr. Turner or myself. We will talk to you over the phone once we have your application complete. We dye test your tubes to make sure they are both sewn together and sewn open. The best assets we have is the friendly people in this office who are always glad to answer questions and the goodwill of the patients we have helped.
-Dr. William Greene
I feel a need to clarify two words that often come up in tubal reversal surgery. We hear patients use these words incorrectly so often that I worry if some websites are using them incorrectly and that’s where patients are becoming confused.
The first term is “scar tissue”. It refers to an abnormal growth of tissue next to an area where the tissue has been damaged. The best way to provide one example is a cut on your skin that leaves a raised, reddened growth along the cut or incision. This happens often with a surgical incision. It usually, but not always, happens on the outside of the body. The tissue type that is usually involved is epithelial, or covering tissue. The fallopian tubes are not usually scarred but can have thermal damage from being burned with that type of tubal ligation.
The second term I want to clarify is “adhesions”. We see adhesion often when patients have had multiple C-sections. We have seen patients with five C-sections that looked like they never had been operated on, and we have seen patients with just one C-section that had a lot of adhesions. The internal organs normally live in a wet, airless environment. Opening the abdomen to operate exposes them to air in the room causing the potential for adhesions. Adhesions can also be caused by infections. If you put a dab of Super Glue on your thumb and touch your forefinger to it, the stringy things that form are a lot like filmy adhesions. Some adhesions are very thick and cannot be broken apart easily. In doing tubal reversals Dr. Turner and I can usually work around adhesions. We both use a very small incision and keep everything wet with a special solution so the air exposure is minimal
Dr. Turner and I have noticed that most of our patients have looked at several facilities before deciding to come to Lakeshore Surgical Center. On one hand, we feel flattered that people pick us over other choices but it has to be hard for patients to understand everything that’s involved.
If you are considering tubal reversal, I hope you give us a look. Read the testimonials from our patients, look at our Facebook page, and notice how our fees include everything (even your hotel room). We fix your tubes in layers so they are not just sewn together but are also sewn open. During the procedure, we dye test your tubes (most people don’t because it’s expensive). If you have questions, just give us a call!
If you decide on tubal reversal I hope you come to Lakeshore Tubal reversal. But wherever you decide to go, you need to be aware of a risk associated with the reversal. The reversal surgery has similar risks to a “D and C” or ovarian cyst but when a woman has had a reversal of a tubal ligation, she has an increased risk of an ectopic pregnancy. The important thing to remember is that having your tubes tied, in the first place, increases your risk of an ectopic or tubal pregnancy. A tubal pregnancy is one that develops in the Fallopian tube instead of in the uterus. They never grow into a baby because the fallopian tube is not big enough to hold them but they can cause heavy bleeding. The good news is that if you catch an ectopic early, it can be treated with a pill or a shot.
What to Do If You Are Pregnant
We teach patients a simple way to remember what to do if the get pregnant. Make a fist with your palm facing you. Raise your index finger, that’s a urine pregnancy test. Next, raise your middle finger, that’s a blood pregnancy test to be done if the urine pregnancy test is positive. The two fingers make a “V” that stands for the vaginal ultrasound that you will need if the blood pregnancy test value is high enough. The final step is to look again at your 2 fingers, they look like a rabbit’s ears to remind you to get this testing done “quick as a bunny”. Having your tubes tied, in the first place, has a risk of ectopic pregnancy of about one in two hundred, our patients have had a risk of one in forty (about 2 ½ percent ). Most people who do reversals report ten to thirty percent. I think the way we do reversals, with dye testing, sews the tube in a way that it is not only sewn together but sewn open.
When we decided to only do tubal reversals in 2001, we frequently would hear patients say “I really like your website but I would prefer to have my reversal done locally because I have known my doctor for years and he, or she, says they can do it for me.” Patients do better when they are comfortable so I would tell them to go where they feel most comfortable.
I don’t tell patients this anymore. Experience with over 3,300 tubal reversals has made it clear to me that experience is very important in tubal reversal surgery. We do 2 reversals a day because some require a lot of time to do the best job. Some reversals can best be done by someone who is very experienced. I hope that if you decide on a tubal reversal that you come to Lakeshore Tubal Reversal Center. If you decide to go somewhere else, go to one of the 2 or 3 centers that do a lot of reversals.
Keeping The Cost Down
You should ask the doctor you select how many reversals they have done this month or this year. The operation we do for $6,900 will cost you at least $25,000 in your local hospital. This price differential alone keeps doctors from doing many reversals. There are just not that many people with $25,000 (or more) that want a tubal reversal. When you own your own accredited, licensed surgery center like we do and only do one procedure you can keep the cost down.
Why Essure Removal & Essure Reversal Is Cheaper at Lakeshore Surgical Center
People have asked why we don’t charge more for Essure removals and Essure reversals. The simple answer is that the way we do both procedures is safer and simpler than the way others do these procedures. You are not required to pay for a hotel stay (that’s included in our fee), you do not have to get $500 worth of lab tests (we pay for that), and there is no separate fee to schedule an appointment.
I worry that some people may think that because we cost less we don’t do as good a job and that is just not true. We don’t cut a hole in the uterus to get the Essures out because it is not necessary and the blood supply to the uterus is from the outside in and there are huge blood vessels right next to where the tube goes into the uterus. The way that we do these operations does not mean that you have to have a cesarean section if you get pregnant because your uterus has been weakened by cutting a hole in it. There is a Facebook page where people are told the only way to remove the Essures for either reversal or just removal is to cut a hole in the uterus because of the risk of leaving part of the Essures in. This is absolute nonsense!
Can Fibroids Increase the Risk of Miscarriage?
We often have women who have been told they have fibroids and approximately 20%, or 1 out of five, women of reproductive age do have fibroids. They are almost always benign growths of uterine muscle that will shrink after menopause. They can cause symptoms and not cause any symptoms at all. They usually don’t require hysterectomy but some doctors will do a hysterectomy to relieve symptoms.
Sometimes they can be removed without doing a hysterectomy. Doctors have told women that they are supposed to increase the risk of miscarriage and I am one of them. A recent study (Leiomyomas in pregnancy and Spontaneous abortion Obstetrics Gynecology 2017; 130(5): 1065-1072) proves that what we have been telling patients is not true. There is no increased risk of miscarriage with fibroids.
Finding a Doctor That Specializes in Tubal Reversals
The internet is a difficult place to look for health care services. I am saddened to say that we often see absurd claims made about the doctor’s experience. I have enough trouble answering for my own shortcomings but one claim stands out to me.
There is a facility that claims to have done “over 12000 reversals”. The problem is that same doctor claims to have started doing reversals 10 years ago. The result of that claim is that would mean 1200 a year. If you worked every day never taking a day off that would mean doing about 5 tubal reversals a day.
We do 2 a day and I cannot think of a way to do 5 and do a good job. What this doctor should say is that he took over a clinic that had been in business for many years before he came and the total number that were done before he came plus what he has done is 12000. We have done over 3200 since we started just doing reversals in 2000.
-William Greene Jr. MD
Are There Tests for Age & Decreased Fertility?
There is a recent article which was published in the Journal of the American Medical Association which will change very dramatically how we use these tests. The authors measured pregnancy rates in women from 30 to 44 years of age and could see no differences based on AMH (anti-mullerian hormone), FSH (follicle stimulating hormone) in women with low, intermediate or high levels of these tests.
This confirms our observation in women who come to us having these tests done. We have recommended the AMH test to women over 40 but will not do this in the future. We will continue to recommend it to women over age 43 because very low levels have been proven to be correlated with poor results with IVF.
Factors Associated with Tubal Reversal Success
Factors that seem to be associated with a better chance of tubal reversal resulting in pregnancy are a family history of pregnancy after 40 years of age, pregnancy while taking oral contraceptives or hormone injections (Depo Provera), number of times pregnant, molima (symptoms each month that happen prior to menses) and normal vaginal lubrication when having sex.
Can I Have Reversal if I Have Thyroid Problems?
We frequently have patients who have or who have had thyroid problems. We always encourage them to get their thyroid status evaluated. The two most common tests are the TSH test (thyroid stimulating hormone) and the Free T-4 test (amount of active thyroid hormone). The standard of care is for patients who are known to have had thyroid problems to have any medications to have those medicines adjusted so that these two values are normal.
What is new is an article (Fertility Sterility Oct 2017) that states that a new test, for anti- TPO antibodies, may help identify infertile women at risk for miscarriage. It is important to note that by far and away the most common cause of miscarriage is genetic. This does not mean that if you miscarry there is something wrong with your genes.
Am I Too Old to Have a Tubal Reversal?
The average age of our patients is 37. We only do tubal reversals on women and we just did our 3000th patient last summer. As a result of confining our practice to just reversals and Essure removals, we have a lot of data and the ability to tell our patients what their chances of success are.
On our website, our experience is broken down into age groups and tubal ligation types. There is no great drop off from 25 years of age to 40 and then the percentages do go down to about 40%. We do not include ectopic pregnancies because we only have 2.5% and an ectopic is not a success. We had one reversal patient who delivered when she was 47.
Accredited Surgery Center
Our surgical center is accredited like a hospital is. One of the requirements is that we compare our results to those of similar facilities. The accrediting organization, The Accreditation Association for Ambulatory Health Care, comes to our center and checks everything from how we protect your privacy to how we make sure the drugs that we use are not out of date.
Comparing results is difficult because few people that do reversals report results, and a lot of what is reported is deceptive. One example is the frequent claim of “98% Success”. When you read the fine print they mean 98% of their patients are operated and reversed, not necessarily pregnant. We have seen results reported where ectopic pregnancies were included as part of their total. An ectopic pregnancy is not a success in any way! If you read the fine print, their ectopic pregnancies are 10-30%. Including their ectopics makes their results look better but it’s deceptive. Because we only do reversals, dye test our patients to make sure they are fixed right, and close the tube in layers, our ectopic rate is only 2 ½ % (this is very low). You can see our success rates on our website broken down by age and the type of tubal ligation that the patient had before coming to us.
Will Removing Essure Eliminate Symptoms?
I have symptoms that I believe are due to my Essures. How do I tell if removal will make them go away?
Bayer, the current manufacturer of Essures has announced that they will no longer be selling them. There is a report that they have spent 413 million dollars defending lawsuits from consumers with these devices. They claim that Essure problems are not the reason for their withdrawal. This announcement will probably cause concern for many women.
The important thing is to make sure that you have not heard about symptoms and have decided that you have those symptoms. Most women do very well with Essures but a minority do not. If you don’t need to have them removed or reversed don’t do it. If you decide that you need them removed do not let anyone talk you into a hysterectomy to remove them.
Common Essure Symptoms
The things that cause women to seek removal: low back pain, bleeding, skin rashes, hair loss, depression, and metallic taste in the mouth can all be due to things other than your Essure. If you never had your symptoms until the devices were put in you that should raise your suspicion that the Essures are at fault.
We have seen some women that did well with their Essures for several years and then developed symptoms. Two things that seem related to the nickel in the Essures are a history of allergy problems with cheap gold jewelry and a metallic taste in the mouth. Most all of the patients who have come to us for Essure removal have noticed immediate and dramatic changes. That having been said, no one should tell you that removal of your Essure devices will make you symptoms go away.
There is an ad on the internet that says the doctor has a 98% success rate. What’s that all about?
What this doctor should have explained is that 98% of the time he or she can complete the reversal. This does not mean that 98% of their patients get pregnant; just that they can do a reversal and send a patient home with their tubes reversed, ready to try and get pregnant.
To me, this is deceptive because it might lead you to expect if you go there you have a 98% chance of getting pregnant. We have a chart on our web site that shows the pregnancy rates for different tubal ligation types at different ages. Your chances are 70-80% up to age 40 and then your chances are about 40%.
We just completed our 3000th reversal and we can reverse and dye test 99% of our patients.
When we had done 2500 patients we reviewed our success and created a chart for you to see what our experience has been. We do only microsurgical procedures on women and that’s all we have done for the past 15 years.
Are There Benefits to Robotic Tubal Reversal?
My doctor referred me to a local group for robotic surgery to reverse my tubal ligation but it is very expensive, what do you think?
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 requires 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 hairline 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, a smaller suture is better.
Over 3,000 Tubal Reversals Performed
The final thing for you to consider is our level of experience. Dr. Turner and I have performed over 3000 tubal reversals, and I can assure you that no one else has or ever will have that kind of experience because there are not enough people that have the money to pay the extra $2,000 to $5,000 dollars to reverse their tubes.
It seems since you started doing Essure Reversals that a lot of people have started following your lead, do you wish you had not gone public when you did the first one?
Dr. Turner and I did the first Essure reversal on November 5th 2007 and we had the first Essure reversal baby born in 2010. Both of these events were widely covered in the press because the Essure devices were supposed to be impossible to reverse. There are two basic ways you can do an Essure reversal. The way we do it is to, remove the portion of the tube that contains the Essure and sew the undamaged remainder of the tube in its original hole in the uterus. The other way to do it is to make a new hole in the back or side of the uterus and fix the tube in the hole. The medical term for these procedures is tubouterineneoimplantation, but the way that we do it does not weaken the uterus and require any babies to be delivered by cesarean section. The way that we do it does not require cutting the tube off from its blood supply. I think this is important because the fallopian tube has a rich blood supply so it must need good blood flow to do its job properly. Dr. Turner and I wrote an article, with drawings, about how we do Essure reversals but we could not get it published because, I suspect, that medical journals don’t want to offend the Essure people that advertise extensively.
We used to tell patients with Essure that the results with Essure reversal were about 30% because that was our experience with the first ones we did. Recently, the results have gotten closer to 75% but we have only done 112 of them so we don’t have enough cases to predict accurately. We have done almost 3000 regular reversals so we can be specific with a patient’s age and type of tubal ligation. Those results are posted on our web site and we count only intrauterine pregnancies (not including ectopics as we have seen done).
Questions About Tubal Reversal
I have a bunch of questions about tubal reversal. Can I call and get answers?
Absolutely, we are open and available by phone during normal business hours. If you call in advance, you can come to our licensed, accredited surgical center and see us in person.
I can tell you there are 4 basic questions that just about everybody wants to know.
1. HOW LONG DOES THE SURGERY TAKE?
The first is how long do the operations take and the answer is usually an hour to an hour and a half for a regular reversal. To remove an Essure it takes, on average 45 minutes. To reverse an Essure it takes about 2 hours.
2. AFTER SURGERY, HOW LONG BEFORE WE CAN START TRYING TO CONCEIVE?
The next most common question is how long after the procedure before I can resume sexual relations. The answer to that one is as soon as you want to. We do our procedures through a 2-inch incision right at your pubic hairline and the operations inside your pelvis are confined to an area about the size of a dime on each side so there is not usually a lot of tissue being disrupted. We used to tell people to wait a month but some obviously were not listening because they got pregnant right away. We stopped telling people to wait because our experience showed that was unnecessary.
3. HOW LONG BEFORE I CAN GO BACK TO WORK?
Question number three is how long before I can go back to work. The answer depends on what type of work you do. We will write an excuse for whatever you think you need but most patients are ready to go back in 2-3 days as long as there is not a lot of heavy lifting required of them.