Dr. Turner and I close the fallopian tube in two layers instead so they are not just sewn together but are also sewn open. The fallopian tubes have a central channel where the sperm from the male travels to the ovary where it fertilizes the egg and the fertilized egg travels back to the uterus to grow into a baby. When a woman has a tubal ligation of any type, including the implementation of Essure devices, the central channel becomes blocked. Sperm cannot get to the egg to fertilize it so there are no fertilized eggs to grow into a baby.

Imagine, if you will a roll of toilet paper with a central cardboard tube so you can install the roll on the dispenser in your bathroom. If you cut across a fallopian tube and looked at it under a microscope, the various layers are similar to the toilet paper roll. Most tubal reversal surgeons sew the tube together around the outside in a single layer, sometimes using a removable stent to line up the central channel while they sew around the outside. The problem with that technique is once the stent is removed, there is nothing to keep the two central channels together. With our technique, the central channel is sewn open first with 6 very tiny sutures and the outside is then sewn in a second layer sewing this critical part open as well as together. Every expert agrees that you should use a very small suture to do tubal reversals because the tubes are very small. The sutures we use in the inner layer are so thin that if you throw one up in the air they will float. When I was taught how to do reversals I had to wear a surgical mask when I practiced sewing because if I sneezed the practice suture will go across the room. The downside of these very tiny sutures that we use is that they don’t add enough strength, using two layers gives strength to the tubes so they cannot fall apart. The inner layer is called the muscularis because it has muscle fibers to make the tube contract and relax to help the fertilized egg get into the womb to grow into a baby. This action of the inner muscle layer is another reason to make sure it is aligned up perfectly to help the fertilized egg along its way to the womb. The central channel in a woman’s fallopian tube can be as small as the ball in a ballpoint pen. Working at his sort of dimension requires magnification and a steady hand.

The way we do our reversals is more expensive for us but we feel it is better. We have no argument with others that do differently

We received an inquiry from a patient that had gone to a local doctor for tubal reversal and had been told that he could not do a reversal when he tried because there was too much tube missing. The patient had a Pomeroy tubal ligation and this involves removing a section of the tube. The first doctor who had done her tubal ligation sent the piece he removed to the pathologist who measured its length and it was only 2 centimeters (about ¾ of an inch). The other doctor made the mistake of not looking at the pathologist’s report before he tried to do a tubal reversal.

The reason he thought a lot of the tube was missing was that the Pomeroy tubal ligation had separated the tube into two halves and gravity had caused the two halves to spread apart making it look like a lot of the tube had been removed. The lesson here is if you decide on tubal reversal, go to a facility that can prove to you that they have experience with thousands of tubal reversals. Since 2001 Dr. Turner and I have done over 3,400 tubal reversals at Lakeshore Tubal Reversal Center where that is the only thing we do.

As we have talked to the over 3,400 patients who have come to our facility for a tubal reversal, I have noticed that many patients don’t know the first day of their last menstrual period. If you are thinking about tubal reversal I hope you give us a chance to help you, but wherever you go you need to keep track of the first day of your menstrual period each month. Infertility treatment and pregnancy management are based on the first day of your most recent menses. It doesn’t matter how long your period lasted.

The usual range of a woman’s cycle is 24 to 34 days from the first day of one menses to the first day of the next. The only fixed period is that it’s 14 days from ovulation (the release of the egg from the ovary) to the first day of the next menses. Very few women can feel themselves release the egg from the ovary but most women notice changes in their body prior to their release of the egg. The most common symptom is an increase in sticky vaginal discharge. The hard thing to grasp is that you have to have relations before this discharge stops in order to fertilize the egg. The sperm need to be in your body before the egg is released from your ovary. This is a key component to successful conception.

 

I am a great believer in learning from patients and last week was an example. A patient contacted me about having a tubal reversal and wanted to know if tubal reversal increases the chance of miscarriage. The quick answer is definitely not. About 1 in 7 natural pregnancies ends in miscarriage. Most women have one or none, some have 3 or 4 before they have a baby.

The Truth About Miscarriages

A miscarriage is usually a genetic accident. When you and your partner conceive you both contribute genetic information that is coded like teeth in a zipper. With miscarriage, usually as the “zipper” closes, a tooth gets skipped and the genetic information on how to make the baby cannot be read properly and the baby does not develop properly. Tubal reversal does not make miscarriage more likely.

 

Dr. Tuner and I have recently made some small changes in our technique for Essure reversal that have improved dye flow that we check at the ends of the operation before our patients wake up. We always have used a needle we created to sew the tube in its natural opening in the uterus. We had new needles made that are longer because as women have more children the uterus is thicker and we need more reach to tie the tube way down where it belongs in its natural position. The original needle works well but the new design works better. We have also changed the type of suture from a type that is made for cardiac surgery on newborns to a traditional nylon suture that is more “slippery” and easier to retrieve inside the uterine cavity.

Essure Reversals – Custom Made for Our Patients

For us to do an Essure reversal we have to sew the tube in its natural position from outside the uterus. Dr. Turner and I were the first to do an Essure reversal in 2007. There was no book to look in to see how to do it so we decided to develop a procedure to first carefully remove both Essure implants under magnification because they are very small. With the Essures in a jar for you to keep we dilate the opening in the uterus and place the tube in its natural position. Essure reversals don’t work as well as other types but we have gradually improved the technique by carefully evaluating each patient.

What can you do to increase your chances of pregnancy after the tubal reversal? If you decide on tubal reversal I hope you give us the opportunity to serve you. If you go somewhere else we wish you well, but there are some simple things that can help you after reversal whatever you decide. Most women’s cycles are about 28 days. However, the normal range is 24 to 34 days. Cycle length is determined by the number of days from the first day of menstruation in one menstrual period to the first day of the next period.

Why This Is So Important

Everything in infertility and Obstetrics is timed From the first day of menstrual flow about 8 to 10 days later most women will notice an increase in sticky vaginal discharge. It may appear as a bit of dried mucous on underwear or panty liner at the end of the day or stringy mucous threads noticed on bathing or using the bathroom. The start of this mucous is the beginning of your fertile days, it will continue for 4-6 days. If you are going to get pregnant you have to have relations when this mucous is present. Your chance of conceiving when this discharge is not present is very, very low.

We spend so much time talking with patients on Facebook, and in emails, I think we fail sometimes to explain a very important thing about the cost of tubal reversal. Sometimes, not always, you can pay less and get more. The operation we do for $7,900 is anywhere from $20,000 to $30,000 in a hospital. The reason for the savings is that we only do reversals and we have only done tubal reversals for nearly two decades – since 2001. A hospital has to have the ability to do all sorts of surgeries. This takes different equipment and different people with different abilities, as well as separate supplies for many procedures. The higher costs mean that they do fewer cases. I can assure you that there are few people with $20,000 to $30,000 to spend to get their tubal ligations reversed. The few doctors that do reversals in hospitals do not get a lot of experience and experience is extremely important. Dr. Turner and I can go for weeks without a difficult case, but recently there was one that appeared to be very easy until we looked. The surprise difficult case is where experience counts. If you are considering tubal reversal, I hope you give us a chance to serve you. If you go somewhere else make sure that the doctor does a lot of reversals.

There’s something important that I feel needs to be said about Essure Reversals and the techniques we use at Lakeshore Surgical Center. While there are several ways to perform an Essure Reversal, some are better than others. For example, one way is to cut a hole in the uterus, remove the Essure and the surrounding tissue, then sew the tube back into the hole.

We do not use this technique because it significantly weakens the uterus and forces many women to deliver by Caesarean Section to avoid the risk of uterine rupture. The Journal of The American Fertility Society (volume 40, issue 4) reported a review of 16 different doctor’s results using that technique with an average term pregnancy rate of 11%. The first published result was in 1949. Eight of the 16 doctors did not have a single term pregnancy using this technique (with 285 patients).

When Dr. Turner and I performed our first Essure Reversal in 2007, we decided to use a different technique that first removed the Essure by pulling them out, then stretching the natural opening to place the tube back in. To do this, we use a special needle that pulls the tube back into its normal position.

It’s important to note that Ensure Reversals do not work as well as other reversals. But we are getting better results after working on 200+ cases. Our success rate is slightly higher than a single month of IVF. About one year ago, we made a small change that seems to have improved our results even further. We’ve also been able to stop the dye we use to test the tube from leaking. We believe this has also contributed to better results for our patients.

Lowering Your BMI

Because we are a licensed surgical center we have rules that involve patient’s weight. Our patients need to have a BMI (which is calculated from your weight and height) of 34 or less and a lot of patients have to lose weight to come here. I include in this blog a recommendation of a diet plan.

What We Recommend

I have never endorsed a product nor will I ever accept money to endorse a product and what I say here is not to be reproduced without my permission and doing so would violate copyright laws. That having been said I have battled with my weight all my adult life and I believe I have finally found a diet that not only takes it off quickly but without hunger for foods that you cannot eat. I have lost about 50 pounds in 4 months and feel great. The book about the diet is The Fast Metabolism Diet or something similar, the author is Haylie Pomroy. There is a cookbook you can buy from the same author. I did not like the breakfast powder that she sells and the diet involves readily available foods. The cookbook recipes are very filling and my wife tells me they are easy to do. The diet makes metabolic sense by switching you back and forth between foods that have different chemical composition so you don’t get bored. If you do it just as she explains you lose quickly. If you “fall of the wagon” you can catch back up easily.

Our Method is Always Being Perfected

About a year ago, Dr. Turner and I made two changes in our technique for Essure reversal. We never make big changes, but we try something minor to see if it improves results. The Essure device needs to be removed from the uterus, which is hollow, without weakening it. One of the things we did was re-design the special needle that we use to sew a patient’s tube inside the uterus from the outside. Basically it’s been modified to perform in the same way a sewing machine that will sew a seam in a dress. The outside of the dress is facing the operator but the inside (where the dress touches the skin) is out of view, just like the inside of your uterus is out of sight from the outside where the physician doing the reversal can see it.

visualization of a uterus

Why We’re Different Than Our “Competitors”

It sounds like magic but we found a way to create a special needle and then improve on it to where it consistently gives good results. Remember the uterus is hollow so, in theory, you could cut a hole in it to sew the tube inside but this would weaken the uterus. It could even weaken it enough to where it might rupture. Dr. Turner and I carefully remove the Essures and put them in a jar for you to take home. The way we do it does not weaken the uterus because there is no cutting of the uterus wall. There are very few doctors that do Essure reversals but we see ads on the internet from clinics that don’t know Essure reversals from Chinese food who say they do them just so they can get you in their office.

I sent an email on March 18th of this year to family and friends about the virus problem affecting us. Like everything I say to anybody about medical matters, I rely only on sources that I know are reliable and I identify those things that are opinion, not fact.

The email has some important points. I am not an expert in this area, my training is in Gynecology not infectious diseases. There is a lot of very wrong information coming from sources that ought to know better.

A good deal is known about this family of viruses (Coronaviruses) is based on studies of other members of the family that are not a problem at this time. They are easily transmitted between people who are infected (since found to be true for Covid19). People can shed the virus who are not obviously ill and even after they are better (since found to be true for Covid19). They often are “bimodal” which means they can be dangerous in cold weather and come back in warm weather (since found to be true for Covid19).  Social distancing is important and wearing a mask, unless you are home, in your house without anyone who is known to be infected (since found to be true for Covid19).In the March Email, I said it was not known how long the virus can survive on various surfaces it is now known if it can live and be infective for up to two weeks on metal surfaces (makes it important that when you are out of your home, you don’t touch your face unless you have carefully washed your hands or used sanitizer). I mentioned using the National Institute of Health (the NIH) and Dr. Fauci and Dr.Ho and I stand by that.

Several things have been reported by what I consider to be reliable sources and I believe them to be true. Early treatment can save your life and not put you in the intensive care unit on a ventilator (do not wait until it is hard to breathe to go to the hospital). There is no known drug that can cure Covid19. Mask wearing in public will be more protective with certain types of masks (N-95 and N100 that very few are available of). One very important advantage of a mask is that it reminds you not to touch your face.

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