We have compiled this list of commonly asked questions about tubal ligation reversal to help you make an informed decision about this procedure. If you have additional questions, please call our offices at 877-588-5594 or use the contact form on the site.
AFTER YOUR TUBAL REVERSAL
How long before I can go back to work?
Our process of tubal reversal is designed from beginning to end to minimize your discomfort both in the process and after you go home. We have done so many reversals that we can do them through a 2 to 3 inch incision. The pain that patients feel after pelvic surgery is usually incisional pain; tubal ligation reversals are no different. The smaller the incision, the less the pain and the sooner you feel like going back to work.
Our patients often will express concerns that they will hurt themselves or undo the reversal if they go back to work too early. This is extremely unlikely; your incision is very strong and designed for you to get up and around right away. If you just feel like you will need to hang around the house we will write you a note, if you need one, for your employer.If you do too much too soon you are unlikely to damage the incision or the reversal you just will be uncomfortable longer than you would have if you had taken it a bit easier.
If you had your tubal ligation through laparoscopy, you should be pleasantly surprised when you have a reversal in our clinic. Patients tell us all the time that it was less uncomfortable to have their reversal than it was to have the tubal ligation in the first place.
When we have put your tubes back together and dye tested them to make sure they are open we close the incision in layers injecting a long acting anesthetic in each layer as we go. This anesthetic reduces your discomfort in the first 24 hours and as a result, you move around more than you would without it. Moving around after surgery helps healing, you feel better sooner and you go back to work earlier.
Pregnancy after tubal reversal: How long before I will be ready to try to conceive?
Unless your reversal is particularly difficult, you may try as soon as you like. I am aware that some people say you should wait several months before trying but our experience is that most can try as soon as they want. We always dye test our patient’s tubes and every once and a while we are not satisfied with the dye test so we take the tube back apart to redo the tubal reversal. We remove the sutures and have to pull the tube apart because the tissues are already healing in a matter of minutes. We have recently been able to secure the tubes of our Essure reversal patients in a way that permits them to begin trying right away.
We always have plenty of time after your tubal reversal to discuss your results and if we need you to wait before trying to conceive we will tell you then. We used to tell patients to wait a month but we noticed that few were paying any attention because some were getting pregnant right away.
What do I do if I think I’m pregnant?
Three things need to be done the minute you miss a menstrual period. First you need to get one of the urine stick tests. If that is positive, you need a quantitative blood pregnancy test (an HCG test). The third thing is to get your doctor to order or do a vaginal ultrasound to make sure the baby is in the womb.
The concern with early pregnancy detection is ectopic or tubular pregnancy. Any time you have surgery on your tubes you increase the risk of ectopic pregnancy. This is true even if you just have your tubes tied. Like so many things in life, there is an easy way to fix this problem and a hard way. If you catch a tubal pregnancy early on you can treat it with a shot or pills. If you let it go on, you will end up having surgery and loose a tube. Wherever you go to have a tubal reversal I hope you remember this. If you come here for your tubal ligation reversal you will have a review session with me about ectopic pregnancy early detection and you will be given a cell phone number to call us any time you want.
We review all of our charts every 6 months to see what our pregnancy and ectopic pregnancy rates are. We are always between 2 and 5 % for ectopics, which is very low. I feel that closing the tube in layers and dye testing the repaired tube is responsible for our success with ectopic pregnancy. The most important factor is the patient being aware of the risk and empowered to act quickly.
What if I have problems after surgery?
If you have problems they are most likely to be minor and in the first 24 hours after your tubal reversal surgery. That’s why we recommend you stay overnight the first day. Serious problems are very rare, but you will be given a pager number to call if you have any concerns at any time day or night. We will check on the day after your surgery to make sure everything is fine before you leave.
We never have had to transfuse, hospitalize or even treat a patient with antibiotics after surgery. That doesn’t mean it could not happen to you it just means that you would be the first. We sometimes hear from patients the night after their tubal reversal when they have concerns. That is why we have you stay locally so that you know we are nearby and we know that you are where we can easily see you if need be. The knowledge that help is easily at hand seems to be all the comforting that most tubal reversal patients need. We are just the same in person as we are on this website and we know that emotional comfort [you being a happy camper] means physical comfort [feeling comfortable]. When you leave after your tubal reversal it is extremely unlikely that anything you would do would disrupt the surgery you have had.
The operation we do is through a 2 to 3 inch incision, we do not go deep inside you, we do not go near any large blood vessels or other structures that are involved in complications with major surgery. We pull your tubes up just under the skin, fix them, dye test them and close your tummy up. The possibility of problems exists but is very unlikely that anything will happen that can’t be fixed over the phone. Tubal reversal is surgery and any surgery has risks but we feel the risks are few and manageable.
What things can change my chances of pregnancy one way or another after tubal reversal?
This is probably the most frequent question that we get. The only way to tell accurately what your chances are of pregnancy is to reverse your tubal. When your tummy is opened to reverse your tubal ligation it’s possible to see your ovaries and tell for sure if they are making eggs regularly, which is important. It’s possible to fix some conditions that will improve your chances of getting pregnant, more about that later.
Anyone who guarantees results is more interested in getting you as a patient than in being honest with you. When you actually look at the tubes during a reversal you can tell what the chances of success are. It has been estimated that the natural fertility of women under age 31 is 76%. Women aged 31 to 35 have a 73% pregnancy rate and ladies over age 35 to 40 have 71% chance of pregnancy when artificially inseminated with sperm from fertile donors. Nothing anyone doing a tubal reversal could improve on these numbers. These figures were calculated from studies of patients who never had a tubal ligation. We see a lot of ridiculous claims being made about success with reversal and with IVF. We just completed a study of all of the patients we reversed in 2011. Our age-corrected pregnancy rates were within a percentage point or two for every class of patients. What this means is that in the year 2011 we were able to give our patients the same chance of being pregnant as they would have if they never had their tubes tied.
There are some things that increase your chance of pregnancy:
If you got pregnant easily before you had your tubes tied, you will probably get pregnant easily if they can be reversed.
Being under age 40 is good. After age 30 your fertility starts to decline and after 40 you can get pregnant but your chances are probably in the 40% range. If you have relatives on your mother’s side that got pregnant after age 40 you may have a better chance because that seems to run in families. If you ever had twins or have a female family member who had twins you probably have good fertility.
Never having had a serious pelvic infection helps your chances. One advantage of our facility is that we only do one or two tubal ligation reversals a day and we can take the time to reverse some of the effects we see from pelvic infections. The best thing is to have never have had an infection, but we will take the time, if need be, to fix what we can.
If the type of tubal ligation you had has left you with enough length of tube and most do, that is good. More is better. There is some controversy as to how much length of tube is needed. Things get real good if you have at least 6 centimeters and 8 or more is excellent. The generally accepted length for fallopian tubes that have never been tied is 13 centimeters. I have seen tubes that have been tied with clips [they don’t use up hardly any tube] and they are only 9 centimeters; some women must have naturally shorter tubes. The tube is not only the “pipe” that brings the fertilized egg from the ovary to the womb: it is an incubator that changes the outside of the early conceptus so that it can settle inside the womb.
The fallopian tube is shaped like a trumpet, it is different widths at different parts of its length. It helps if your tubes were tied in a way that leaves us with two similar pieces to join. We can join narrow tube to wide tube and we will take the time to do it but you have a better chance for a baby if the tubes are closer in width.
If you are in good health, your chances are better. Being pregnant is a strain on you and the body seems to resist pregnancy when you are in poor health. You probably need to think twice about getting pregnant if you are not in good health. It’s dangerous for you and the baby.
Will I have a lot of pain after tubal ligation reversal?
No. Most patients cannot believe how well the do after minilaparotomy tubal reversal. Because of our experience of over ten years with minilaparotomy we have a plan to reduce your discomfort to a minimum. There are many little things that we do that ad up to your getting quickly back to normal after reversal of your tubal ligation.
We do not use mechanical retractors to hold the incision open. We make a small [2 to 3 inch] incision and move it around to each side as needed. We also move your uterus underneath the skin opening. The combination of these two things makes a large incision and a hospital stay unnecessary. I was the first person I know of anywhere in the world to do major gynecologic surgery through a minilaparotomy incision. I first did a hysterectomy this way 12 years ago and just now my method is being reported in the medical journals.
Tubal reversals are microsurgical procedures. I tell patients that it is like operating in a dime-sized area and trying to sew President Roosevelt’s eye shut. Because the tubal reversal involves only a small area on both sides of the pelvis, not a lot is disturbed and there is minimal, if any, deep pain. To keep the incisional pain to a minimum, each layer is injected with a long acting anesthetic. Our technique is gentle and minimally invasive.
By using head mounted loupes, magnifying devices, the incision in your lower abdomen can be smaller and a smaller incision means less pain after your tubal ligation reversal.
If you ask around, you will find those that say a microscope is better for tubal reversal, but I don’t think that’s true. Not everyone can use loupes because you have to hold your head very still for a long time. Those that can, do. The microscope does not move with the surgeon’s head so the incision in your abdomen has to be wider and that means more pain after your tubal reversal and sometimes a hospital stay. The magnification is the same.
As soon as we open your abdomen to reverse your tubal ligation we fill it with a special solution to seal it from air. This reduces the inflammation in your pelvis that occurs when the delicate structures are exposed. This exposure adds to postop discomfort and can cause adhesions to develop. If you ever have played with super glue you know what adhesions look like. Just put a drop on your thumb and touch your index finger to your thumb. The stringy lines look just like adhesions.
If your tubal ligation was done as an outpatient, you will almost certainly have less pain with tubal reversal. Most patients are back pretty much back to normal after 2 days some people rest up for a week. You are not to do strenuous activity for 3 weeks; light exercise is fine as soon as you feel like it. Everyone is different and we know that you may need an extra dose of TLC and we are anxious to give it.
Ectopic Pregnancy [ a “tubal” ]
I have heard that ectopic pregnancy is more likely after tubal reversal, what can you tell me about that?
An ectopic pregnancy is a pregnancy that develops when the fertilized egg settles and starts to grow in the fallopian tube rather than in the uterus. You are more likely to have an ectopic if you have a tubal ligation reversal than if you never had a tubal ligation in the first place. We have just finished an analysis of all our patients from 2010. Our ectopic rate was less than 2%. Some facilities have posted their ectopic rates at 6% or higher. It may be because we close the tube in layers, which sews the tube together from the inside out; sewing them open as well as joining them together, but I really do not know.
The reason we emphasize this is that we don’t want you to ruin any of the lovely work we are going to do on your fallopian tubes when we reverse your tubal ligation. Ectopic pregnancy can be dangerous to you, even fatal, but that is a very rare thing. The idea is that we want you to save your tube so that you can get pregnant again. It should not be a problem if you will remember what we tell you or at least remember to call us if you forget what we tell you to do when you come for reversal of your tubal ligation.
When you think you may be pregnant after tubal ligation reversal you need to use one of the pregnancy tests that you can buy in the drug store or supermarket and test your urine. If the test is positive, you need to get a blood pregnancy test. The blood pregnancy test will not just be a yes or no, it will give a number. The number increases with time and when it reaches a certain level you need to get a vaginal ultrasound exam. Usually, when the blood pregnancy test is at a level of 1 to 2 thousand units [varies with different labs] the baby should be able to be seen with a vaginal ultrasound exam. Your doctor will know what to do to make sure everything is okay. We hope you come to Lakeshore for your tubal reversal, but even if you go somewhere else remember “urine, blood, vaginal ultrasound, right away”.
If it is determined that you have an ectopic pregnancy you can have one or possibly two doses of a medicine that will cause your body to absorb the ectopic so it will not continue to grow and ruin your fallopian tube.
We know from experience with patients that have only one tube reversed that this saves the tube. When a patient has only one tube for reversal, and gets an ectopic treated with medicine, they have only that tube to get pregnant with in the future. These patients prove the medicine works and saves the tube for another pregnancy.
The most important thing is speed. You cannot wait 3 weeks to get a blood pregnancy test. If an ectopic pregnancy is left that long the medicine may not work for you and you will need surgery to fix the problem and that will usually mean that you will lose a fallopian tube. Bottom line, you think you might have an ectopic and you forget this, you just call me.
I think I may have had an ectopic prior to having my tubes tied, is that important?
The good news is that we sew the tubes in layers from inside out which not only sews the tubes together but sews the tubes open. This method of tubal reversal is much more expensive and time consuming but we feel it is less likely to result in ectopic pregnancies. We have just finished an analysis of all our patients from 2006 to 2010, and our ectopic rate was between 2% and 5%. Some facilities have posted their ectopic rates at 10% or higher.
With currently available drug therapy no one should lose a tube to an ectopic pregnancy. All of our tubal reversal patients get instructions on how to detect an ectopic pregnancy early on and seek drug therapy to cause the woman’s body to absorb the pregnancy. If patients pay attention to their menstrual cycles, get testing as soon as they miss a period and non surgical therapy the tube is saved and they can try again.
There are a lot of lawsuits about ectopic pregnancy and in areas where lawsuits are common doctors tend either to do too much or too little. Don’t let someone tell you that they never see pregnant patients until they are 6 weeks or 8 weeks. You are special. Even if your tubes are not untied you have an increase risk of ectopic.
How do I get an appointment to have tubal reversal surgery?
The first step to get an appointment is to fill out the health history form and release so we can get your op note and see if you can be reversed. We prefer to look at your op note but if we cannot get one, or it is unclear, we can work around it.
If you can have a tubal reversal and you want one; you select a date and secure it with a $1,500 dollar deposit. This deposit is not refundable but it reserves a day for you and lets you make travel plans, childcare arrangements or work leave knowing exactly when we will do your reversal. You only need to come once to our facility. You don’t have to come for a consultation, go home and come back for your procedure. Anyone who wishes to can come and tour the facility and meet us at no charge or obligation.
The balance of your tubal reversal fee, $5,400 dollars, has to be paid 2 weeks prior to you surgery date.
Some tubal reversal facilities have extra charges for various things. Are there any hidden costs at Lakeshore surgical center?
We have no surprise “add-on” expenses. We have a flat fee of $6,900 for tubal reversal. You will not be asked to get your lab work done locally before you come. This can save as much as $500 dollars. There are no drug or anesthesia fees or any other extras. We even provide a 2 night stay at a local hotel. It’s a nice hotel , a Hilton.
The other day a lady from California called and expressed concern over the travel. We told her that we have a lot of patients from California and other faraway places. The 3 or 4 facilities, like ours, that do a lot of reversals for $8000 dollars or less are here in the southeastern United States. Whatever you spend on travel will be saved in the cost of your reversal.
We have no surprise “add-on” expenses. We have a flat fee of $6,900 for tubal reversal.
Either we can reverse your tubal ligation or we cannot. We do not add on for difficult cases or discount for easy ones. You cannot get a discount if you bring a friend or if you only have one tube. It will not cost you one penny more if it takes us 3 hours of difficult surgery to fix your tubes instead of the usual 1 hour and a half. Our fees are already discounted; remember this is an operation that can cost $15 to $25,000 dollars.
The way that we do a tubal reversal at Lakeshore Surgical Center is much more expensive. We use a very expensive anesthetic gas, it’s made for use with children but patients wake up more easily with it.
We dye test your tubes to make sure they are open and that is costly and time consuming. There are numerous other little extras that we do not charge for.
You will not be asked to get your lab work done locally before you come. This can save as much as $500 dollars. There are no drug or anesthesia fees or any other extras. We even provide a 2 night stay at a local hotel.
We are less than an hour from the Atlanta airport and this is a big plus for those that fly in because it is usually much cheaper to fly to Atlanta because it is a hub for flights going everywhere. If you are going to fly for your tubal ligation reversal you may want to check ticket costs at www.travelocity.com or other webs that will quote fares to various areas.
What if I change my mind or can’t come on my surgery day?
We charge $1,500 dollars to secure an appointment. This reserves a day in our surgical center for your tubal reversal. There is a $500 rescheduling fee.
The balance of $5,400 dollars is due 2 weeks prior to your tubal ligation reversal appointment.
The simple reason for these rules is that we never do more than 3 tubal ligation reversals a day. Because most of our patients have to make travel plans, work and childcare arrangements several weeks prior to their tubal ligation reversals we have no way to fill empty days on short notice. The day is wasted if you don’t come. We just would have to sit and look at each other.
The advantage to you is that we concentrate on you. We have the time to give your reversal whatever special attention you need or want. If we did 5 or 6 reversals a day it would not matter as much if patients did not come for their appointments.
Dye testing tubes, what we do to make sure they are open before we wake you up] is time consuming and very expensive. We also close your fallopian tubes in two layers which also is time consuming. We cannot take the time to reverse your tubes the way we do it and do more than 3 reversals a day. All this means that this center is designated and reserved for you on that day and if you don’t show up that time is lost.
What if my tubes cannot be repaired?
This is very seldom a problem. Most all tubal ligations can be reversed. We screen our patients carefully and we only see two or three patients in a year that we cannot reverse at least one side. 97 out of 100 patients we see leave here with two good tubes. There are patients who cannot have a tubal reversal and patients who can be reversed but reversal is a bad idea.
The question should be can I be reversed and get pregnant. If you don’t have at least 6 centimeters of tube on one side after your tubal reversal, your chances of successful reversal are 20% or less. We like to see a copy of your doctor’s tubal ligation op note to see how your tubes were tied so we can tell if tubal reversal is a good idea for you.
If we can get a copy of the doctor’s dictated operative note from your tubal ligation we can give you a good idea of your chances of success. If that is not available, we can look first through a very small incision just above your tubes to see if you are “fixable”, only one percent, one patient in 100 cannot be fixed at all.
The last thing I have to say about this is that each tubal reversal patient is different. If you are less than 40 years of age, were real fertile before your tubes were tied and are in good health you may well get pregnant easily with short tubes that would not work for someone else who does not have as good underlying fertility as you do.
Will I have to come for a consultation before my tubal reversal?
The simple answer is no. We do everything here, at no charge, the day before your tubal reversal
You only have to come here once. We can tell everything we need to know about you from your operative note and your completed health history form. Some facilities require you have lab work, at your own expense, we do not. Some require you to come for consultation before your reversal. We have had patients say that these consultations were expensive and basically the only thing that was discussed was the need for IVF.
You can always visit us before your reversal. It is best to plan on a weekday afternoon and to call first. You can tour the facility, meet us, ask all the questions you want and there is no charge to you. We are very proud of our tubal reversal facility and the nice people who work here.
Sometimes we are surprised when we open a women’s tummy. Things are better or sometimes worse than we expected. No amount of consultations or exams can tell everything about every patient in advance. The nice thing about having your tubal reversal at our clinic is that we never do more than 3 reversals a day. If we find something that needs to be fixed we have the time to do it and we will at no extra charge.
There are not a lot of doctors that do tubal microsurgery but there are substantial differences in the fees. Would I be better off going somewhere more expensive?
A tubal ligation reversal in some hospitals can be $25,000 or more. At the Lakeshore Surgical Center, we keep costs down because we have had an in-house surgical suite since 1991, and Dr. Greene has been doing outpatient procedures since 1976. You can pay 2 to 3 times as much, but it does not guarantee you will have better results.
You need to make sure that the doctor does a lot of reversals. We see websites that say they do tubal reversals but when you look closely this is more of a “come-on” to get you in and talk you into IVF. We have had many patients who said they went to a local fertility specialist for reversal and the doctor immediately began to tell them they needed IVF. It may be that you need IVF but you need to consider tubal reversal first. It’s cheaper, safer and takes up a lot less of your time.
Another caution is to avoid doctors that have a menu list: so much for the doctor, so much for the hospital, so much for the anesthesia, so much if you weigh more than 150 pounds, so much if you have had previous c-sections and so on. Usually if someone opens the door to extra charges you are going to find that they apply to you. To a degree, whether you are talking about a paint job for your car or a tubal reversal, people who have deceptive business pricing policies are going to give you less value for your money.
At lakeshore surgical center we either can do your reversal or we cannot, we have no extras.< We used to recommend that patients with travel concerns just see if they could find someone locally for comfort reasons. For a number of reasons I now recommend that you go to somewhere like our clinic that does a lot of reversals. There are 3 or 4 centers that specialize in reversals and do the procedure for less than 7000 dollars. I think that if you don’t come here (my favorite), go to one of the other clinics that do a lot of reversals. Tubal reversal surgery is one time that you can pay a lot more and get a lot less. I can guarantee that if you have decided on tubal reversal of a tubal ligation or an Essure procedure you need to come to one of the facilities in the southeastern United States. The nice man or woman who delivered your baby may tell you that they do reversals but this is one time where experience counts. When the only thing you do is one type of operation you can do it through a smaller incision. Our incisions are usually 2 inches wide, never more than 3 inches. We have done almost 3000 tubal reversals and that’s the only thing we do in our licensed and accredited surgical center.
What can you tell me about the type of tubal ligation I had; will I be likely to get pregnant if I have a tubal reversal?
What can you tell me about the type of tubal ligation I had; will I be likely to get pregnant if I have a tubal reversal?
Patients who are considering tubal ligation reversal need to know that chances of a successful reversal of a tubal ligation depend a lot on how their tubes were tied in the first place. You have a better chance of success when your reversed tubes are longer, rather than shorter.
We can reverse the Essure type of tubal occlusion. This is a different type of procedure and those seeking reversal of the Essure contraceptive device should call for details.
Because the Essure device has only been available for 5 years, we are just now beginning to see women who want them reversed. Despite what anyone tells you (including the Essure manufacturer), they are reversible.
It is important to remember that most tubal ligations can be reversed. If you got pregnant easily before your tubes were tied you will probably get pregnant easily if you have a tubal reversal. If you do not get pregnant after tubal ligation reversal, chances are very good that your tubes will be wide open and not the reason you are not getting pregnant.
Because the tube is shaped like a trumpet or a very long funnel it is different widths throughout its length. Best results happen when the two pieces being sewn back together are close to the same width. When we do your tubal reversal we can narrow one side to match the other. Because we never more than 3 reversals a day, we can take the time necessary to match things up and we feel this is one advantage of our tubal reversals.
We occasionally have patients that do not get pregnant and get an X-ray to see if their tubes are open. Sometimes, patients will call and say one side or the other is blocked. The test is quite common but it is hard to do properly. If you think your tubes are closed and are going to get an X-ray make sure that you are premedicated with Brethine prior to the test. The uterus sometimes spasms when the X-ray dye is infused and Brethine, used with asthma, will stop the spasm. If you have spasms from the dye it will look like your tubes are blocked when they are not.
Sometimes patients need a little help after tubal reversal to get pregnant; a d&c, some pills to cure a low grade infection, some meds to help them ovulate. It usually is nothing drastic.
Will I get pregnant if I have tubal ligation reversal surgery (have my tubes “untied”)?
Studies show that with proper microsurgical tubal reversal technique the tubes are open again upwards of 90% of the time. Even though we fix your tubes you may not get pregnant. What matters to you, and us, are your chances of a baby. The probability of pregnancy is higher with some, and with some it is lower.
This is probably the most common question we get. Your exact chances depend on so many things that the answer for you depends on your particular situation. Probably the most important question is how easy was it for you to get pregnant before you had a tubal ligation. If you have good underlying fertility, that goes a long way. A tubal ligation reversal is unlikely to make you more fertile than you would be if you never had your tubes tied. Your underlying fertility is in the 75% range in your 20’s, approximately 62% from 31 to 35 and 54% over age 35. If we reverse your tubes your tubes won’t usually keep you from being pregnant. Some factors are associated with excellent fertility. If you ever got pregnant on the pill or shortly after stopping it you have good underlying fertility. If you or a female blood relative has had twins or been pregnant after age 40 that is good news for you.
Sometimes we find adhesions or other things that we fix to improve your chances of getting pregnant but that is not too often. One advantage of doing no more than three cases a day is that we can take the time to do these things when necessary. It’s important to have as much length in the repaired tube as possible. Some tubal ligation methods do not leave a lot of tube to fix.
Age is important; your fertility declines gradually after age 35, after age 40 it drops off significantly. The average age of our patients is about 37 years and a lot of them are getting pregnant so don’t let your age be the only thing stopping you. We test your tubes with dye before we finish your operation this makes sure that they are open and we feel that improves your chances of a successful pregnancy.
When we sew your tubes together we sew from the inside out closing the inner muscular layer of the tube separately from the outer serosal layer. Many doctors who do reversals just sew around the outside, they say they don’t need to do it in layers or dye test the fallopian tube to ensure that they are open. Don’t confuse closing the abdomen in layers [everyone does that] with closing the tube in layers.
The Surgical Procedure
Can you do my tubal reversal by laparoscopy?
We do a lot of tubal reversals at Lakeshore Surgical Center; as a matter of fact, that’s all we do and very few of them could be done by laparoscope.
What patients who have looked in to it have told us is that the doctor said: “We’ll try to do your tubal ligation reversal with the laparoscope but you will have to agree that we can do a laparotomy if need be”. In other words, “we may have to open your tummy up anyway”.
We use a minilaparotomy method that lets patients recover as well, if not better than with laparoscopy and the scar is smaller and less visible.
To do a tubal ligation reversal by laparoscopy requires 5 separate small incisions to place the instruments in. One goes in your belly button two on either side half way between the level of your belly button and your pubic hair line and two on either side at the level of the pubic hair line. The total length of these incisions for laparoscopic tubal reversals is about three inches.
With our method for tubal reversal, the incision is 2 to 3 inches and right at the pubic hair line and under most bikinis. One of the things about our method of reversal is that we actually sew inside the tubal opening to outside, I have never done a tubal reversal with a laparoscope, but I know the magnification is not good enough to do tubal reversals the way we do them.
Those doctors that have reported on their experience with laparoscopic tubal ligation reversals say that operating times are longer with laparoscopic tubal reversals. To be fair, this might improve if more surgeons do more cases and there is more experience with this technique.
The published results with laparoscopy are not as good as with minilaparotomy and the cost is much higher. I just feel that the best way by far from a comfort standpoint and from a quality standpoint is to do tubal reversals with the minilaparotomy technique that we use. You will be back at your normal activity with less discomfort and less expense if your tubal reversal is done here. At this writing (Jan 08) some docror has posted a video of a laparoscopic tubal on the You Tube site. It is a pretty awful job. The doctor uses heat to seal off a bleeder near the end of the tube which you should never do because it kills the tissue. He uses an absorbable suture on the tube, another big no-no. Worst of all he wastes about 3 centimeters of tube (length matters). There is just no way to reverse tubes with a laparoscope and do a propper job.
How long does the tubal reversal operation take?
I have often thought I should get a small sign with “one to one and a half” hours printed on it to hide in my pocket. Everyone asks this question when I first meet them. I could just pull out the card. People would think I’m a magician.
Since we close the tubes in layers and dye test the tubes it takes us a little longer to do a tubal reversal. We find that occasionally we are surprised when we look inside the abdomen because there are problems that were not expected based on the information we had prior to surgery, We will fix whatever we can to improve your chances of getting pregnant. We do not charge for these extra things and we don’t look for problems we just do what’s needed.
The extra time we spend closing the tube in layers is so that the tube is both sewn open and together. It takes longer than just sewing the tube around the outside but we feel it gives a better result. When tubal reversals were first done the doctors described the separate layers of the fallopian tube and their technique consisted of closing each layer separately. This layered closure is more natural because each layer of tissue is directly joined to the same type of tissue. No one knows for sure if it is any better than sewing around the outside but we feel it is worth the extra time because the dye we test your tubes with flows through the tube better when we do it this way. If you have an Essure tubal device the operation will take about an hour longer than usual.
I’m scared to have an anesthetic. What can you tell me about that?
A lot of little things add up to a good anesthetic experience. Some things come into play that you might not think would make a difference. We feel that having you come the day before your tubal ligation reversal is important for your comfort. The opportunity to meet us the day before and tour the facility helps you settle down and feel more comfortable with the tubal reversal experience. The first visit is also used to get your paperwork completed. Many patients are anxious about the consent forms and it’s nice to have time to explain the tubal reversal consent and reassure you.
When we do your surgery, we inject each layer with a long-acting anesthetic. This is critical to your comfort because it gives your body a chance to heal without the strain of pain in the anesthetized tissues.
We use a very expensive type of anesthetic gas, [Sevoflurane] that wears off very quickly so that you wake up quickly. This gas is 8 times as expensive as the more common gases but it is particularly suited to outpatient surgeries. We use another drug [Anzimet] that is particularly effective for nausea and we give you a dose of drugs before you wake up to prevent you from having nausea after your tubal reversal. Even though these drugs are very expensive to use, they are part of our commitment to your comfort. Of course, there is no extra charge.
Our patients who come for a tubal reversal will often tell us about previous bad anesthetic experiences only to tell us after their tubal reversal that they can’t believe how well they did in our center. Our anesthesia staff specializes in outpatient surgeries and it shows.
The anesthesia is really only necessary so that you are very still while we are doing the microscopic part of your procedure.
Our surgical center has a full complement of emergency equipment, should it be needed. We are a completed accredited free standing surgical center, just recently reaccredited by The Accreditation Association for Ambulatory Health Care We are just around the corner from 2 fully equipped hospitals should we need to use them. We have never had any anesthesia complications with any of our patients but we are ready if we ever do.
What is outpatient tubal ligation reversal?
When a woman has her tubes tied the tubes are not “tied” they are cut, burned or pinched off with clips, bands, or suture. There is also a newer type of tubal
ligation called an Essure tubal occlusion. We can reverse the Essure type of tubal occlusion. This is a separate type of procedure and those seeking reversal of the Essure contraceptive device should call for details.
The fallopian tubes carry the fertilized egg from the ovary to the uterus. When the fallopian tube is blocked of the sperm cannot get to the egg and the egg cannot get to the uterus. The woman does not get pregnant.
In the past several years several doctors have offered an outpatient tubal ligation reversal to sew the separated tubes back together to restore a woman’s fertility so she can try to get pregnant again. The tubal ligation reversal is a microsurgical operation done with high magnification. There are a few clinics, like ours, that have the know how to do this operation through a 2 to 3 inch opening right above the pubic hair line as an outpatient procedure. The expense of a hospital stay is avoided and the recovery is much easier because of the small incision. As far as know, there is only one clinic in the US the does tubal reversals and only tubal reversals and that is Lakeshore Surgical Center.
When you sew the tubes together, why do you feel that it is important to separately sew each layer of the tube?
We didn’t always do it this way but when we started to sew in layers, we noticed that the dye we test the tube with flowed a lot better. Most people who do tubal reversals just sew around the outside of the tube to bring the two pieces together. They claim the extra time and expense is not necessary. They may be right, no one knows for sure. This is why some clinics do 5-8 procedures a day and we do only 1-2.
The middle layer of the tube is muscular. It makes sense that it is a muscle for a reason. It may play a role in propelling the egg down the tube or it may let the tube move around to capture the egg when it is released from the ovary.
There have been studies that show that the tube moves around when a woman has an orgasm. The muscle layer has to be involved in this movement and it stands to reason that it may play a role in conception.
When you sew all layers together with one stitch you create an unnatural adhesion between the inner and outer layer. The outer layer is loosely attached to the muscular layer in the natural state and we feel that it’s important to not change that. Again, we have no argument with what others may or may not do.
Will I have a big scar on my stomach after my tubal ligation reversal?
No. Because we use a minilaparotomy technique to do your tubal reversal, the incision is about as wide as a playing card. For most patients, the incision is just above the pubic hair line. If you have had a previous cesarean section we will probably use the middle portion of it for your tubal reversal.
One advantage of using head mounted loupes, magnifying devices, the incision in your lower abdomen can be smaller and a smaller incision means less pain after your tubal ligation reversal and a smaller scar.
If you ask around, you will find those that say a microscope is better for tubal reversal, but I don’t think that’s true. The microscope does not move with the surgeon’s head so the incision in your abdomen has to be wider to let the surgeon doing the tubal reversal can see what he or she is doing and that means more pain after your tubal reversal, sometimes a hospital stay and always a wider scar. Not everyone can use loupes because you have to hold your head very still for a long time. Those that can, do.
One little thing that we do, we feel helps a lot with the final appearance of the scar. We bury the suture that holds the skin together under the skin. There are no clips to remove or sutures to cut out after your reversal.
After your tubal ligation reversal, before you go home, we will tell you the things you need to do to take care of your incision and minimize your scar. The fact that we do not use self retaining retractors, we feel, minimizes adhesions under the skin and discomfort in the scar after our tubal reversals. No one really knows, but gentle and minimally invasive surgical technique probably does more to improve comfort and scar appearance than anything else.
You mention dye testing of the fallopian tubes. Why is that important?
As soon as you are asleep we put a tiny tube in your uterus so that we can force dye through your tubes to make sure that they are open at the end of your surgery. This is done before your tummy is closed and you wake up. If the dye does not come out of the end of the tube we know that we need to take them apart and redo them.
Some people say they don’t need to do this step. It’s expensive and time-consuming. I have done a lot of tubal reversals and from time to time I find a tube that I thought was perfect needs to be taken back apart and done over.
Sometimes we find a tube that is a little open but not open enough. The dye comes out but not fast enough. These need to be redone.
The dye is very expensive and it’s tricky to get it to work correctly so you don’t have errors but it’s helpful in other ways. For years, I did tubal ligation reversals in one layer because that was the way I was taught. When we started to do reversals in two layers, from the inside out, we noticed the dye flowed a lot better than before. To me, this meant the tube was more open. No one knows for sure if dye testing helps but it certainly is reassuring to me and to our patients. It is especially gratifying to me when someone who has been told their tubes could never be fixed (like an Essure patient) has dye come pouring out.
Things I have heard or read about tubal reversal that are of concern to me
Do you guarantee pregnancy after tubal ligation reversal?
No. We guarantee to do the very best job we can to do everything to make sure you get pregnant. That’s it. I would be cautious, myself, with anyone who wanted to do a surgical procedure on someone in my family and guaranteed a result.
People are so different that no one can tell for sure if any surgical procedure will work. The guarantee plans that I have seen usually involve raising the price and promising to give some money back if things don’t go as expected as long as you meet certain conditions.
We are not selling appliances or painting your house, we are a surgical center devoted to restoring fertility by reversing tubal ligations. The only guarantee we give is one of devoted, concentrated effort.
We use the best equipment and drugs we can find to do your reversal. We sew you tubes from the inside out, which sews them together as well as open, and we dye test them before we finish to make sure they are properly repaired. We feel that all these things give you a better chance. They are more expensive for us to do, they take more time and skills to perform and that I do guarantee.
I’ve been told my only hope is In Vitro Fertilization (IVF), should I consider tubal reversal?
Many patients have been referred by their own obstetricians for IVF when reversal would make a lot more sense in every way. Not everyone is a candidate for reversal after tubal ligation but it should be the first thing you do rather than the last.
Cost of IVF vs Tubal Reversal
If you have talked to an infertility specialist that does IVF they likely have recommended that you try IVF rather than tubal ligation reversal. IVF is generally at least $10,000 dollars every time you try. Tubal ligation reversals are $6,900 dollars in our clinic and you can try month in, month out. IVF has a success rate of about 22% per attempt and the overall success rate with tubal reversal can be as high as 75%. The math is not too tough; tubal ligation reversal makes economic sense for you, for the infertility specialist IVF makes better economic sense.
Because, like everything else, money seems to come into play we occasionally see patients who can afford tubal reversal but could never consider IVF because of the cost.
After evaluation, it may be that their chances are not the best for reversal of their tubal ligation and IVF would be better if they could afford it, but they can’t. To these patients I say that they may want to consider tubal ligation reversal even though it may not be the best medical choice because it is their only economic choice. If you look at the testimonials on this website, you see women who had IVF, it did not work and then got a tubal reversal here and got pregnant and had a baby. To be fair, we had a women who came here for a tubal reversal, did not get pregnant and the did conceive with IVF. She waited less than a year so she may have turned to IVF prematurely. The bottom line is that if the only thing keeping you from being pregnant is that your tubes are tied try reversal first; come here, go somewhere else but get them reversed.
Why should you consider Lakeshore Surgical Center for your tubal ligation reversal?
Many, many of our emails have lists of questions prompted by other facilities websites. Do you use stents, do you use loupes or a microscope, do you have success rates available for someone in my particular situation, how long does it take you to do the operation, and so forth.
We used to recommend that patients with travel concerns just see if they could find someone locally for comfort reasons. For a number of reasons I now recommend that you go to somewhere like our clinic that does a lot of reversals. There are 3 or 4 centers that specialize in revversals and do the the procedure for less than 7000 dollars. I think that if you don’t come here (my favorite), go to one of the other clinics that do a lot of reversals. Tubal reversal surgery is one time that you can pay a lot more and get a lot less. I can guarantee that if you have decided on tubal reversal of a tubal ligation or an Essure procedure you need to come to one of the facilities in the southeastern United States. The nice man or woman who delivered your baby may tell you that they do reversals but this is one time where experience counts. We are not going to tell you that we are better than anyone else; we are not going to even hint that we are better. Doctors are not supposed to say that they are better than another doctor because it implies a guarantee of results and that is unethical.
We do some things that others may or may not do and I will tell you we are not sure if it makes a difference, we just feel that it improves our results and we have no argument with anyone who chooses to do tubal reversals differently. One advantage of using the dye test is that the dye washes the tubes out. After the tubes have been blocked for a while, they get filled with debris. You can see the debris come out of the tube as the dye pushes it out. The main reason we dye test is to make sure the tube is not only sewn together but it is sewn open.
We only do 1 or 2 reversals a day. We like it this way because we can concentrate on you and your surgery. If we look in your tummy and have something extra to do to improve your chances, we do it. There is no one behind you waiting so we do what is needed in each case. No charge to you whatsoever.
We dye test your tubes after your reversal is done to make sure they are open. It is expensive and time consuming but we feel it is important to make sure your tubes are open before we close your tummy and wake you up. We have no argument with anyone who chooses not to dye test tubes. We just want the special pleasure of telling you as soon as you wake up that your fallopian tubes are open. We sometimes find the tube is blocked and then we know we have to redo that fallopian tube. We did everything just right, the tube looks great, it’s just not open and needs to be redone.
We actually go in the opening inside your tube to sew it together. This is much harder to do than just sewing the outer layers together. The opening is very tiny and it is slow going but we feel the results are better. We also sew the outer layer of the fallopian tube separately from the inner muscular layer. This is another benefit of doing just one or two tubal ligation reversal a day. Some people feel that it’s okay to do it the shorter way and they may be right. We started seeing better results with the dye tests when we adopted this technique so that’s how we do our tubal ligation reversals now.
We have no surprise “add-on” expenses. You will not be asked to get your lab work done locally before you come. This can save as much as 500 dollars. There are no drug or anesthesia fees or any other extras. We do not charge extra if you have had previous surgeries or are more than your ideal body weight.
We are less than an hour from the Atlanta airport and this is a big plus for those that fly in because it is usually much cheaper to fly to Atlanta because it is a hub for flights going everywhere. If you are going to fly for your tubal ligation reversal compare the ticket costs on the web to different centers that you may be considering.
The suture [Gore-Tex], anesthetic gas [Sevoflurane], nausea medicine [Anzimet] are just about the most expensive you can buy, but we feel the results justify the cost. You put your trust in us by coming to us and we feel we owe it to you to use what we feel is best for you. If you go somewhere else for your tubal reversal the doctor may or may not use these things and you should not be concerned. We just feel that we have what we is best for our patients.
We have no add-on charges. You won’t be asked to get 500 dollars worth of lab tests before you come, which is all included. There are no extras, period.
There are only 4 surgery centers that I know of that do reversals for $7,000 dollars or less in the whole world. There are some others that will quote a fee in that range but then they add on for tests, anesthesia, or use of the facility. I assume the other facilities like ours are, as we are, busy all the time. Why on earth anyone who has all they can take care of would make inferences that another doctor was not doing as good a job or that they were doing something that would give a better result is beyond me.
The morning after your tubal reversal you will have a complete explanation of what was done in your particular case. You will be given a dated and signed official operative note that details your surgery. This is an official document that you should keep in a safe place.
I’m coming from out of state and I’m worried about the long trip home after tubal reversal surgery?
This is a very common concern, but not a real problem. We check you the morning of the day after your surgery and make sure you are okay. Occasionally a patient who drove for their tubal reversal will break the trip home into two days instead of driving straight through. Other than that, our patients do not have travel problems.
We expect patients to express concern that something bad can happen after the surgery. The concept of outpatient tubal ligation reversal is relatively new. Most doctors that do tubal reversals don’t do as many as I do and need a much bigger incision to do one. With a bigger incision there is more pain, it is harder to resume normal activities and usually a hospital stay to recover. The small incision [2 to 3 inches] lets you travel home the next day.
At Lakeshore Surgical Center the only thing we do is tubal ligation reversal. The morning after your surgery, we will examine you and you should be fine to travel. The combination of long-acting nerve blocks, a very small skin incision, and careful microsurgical technique make post-op discomfort minimal. You should have less discomfort than you did when your tubes were tied.
I’m coming from out of state; can you help me with travel plans?
We frequently get emails from patients who say “I really like your website but could you recommend someone near my home, I don’t want to travel”. It may be a concern for you. We have patients from all over the U.S. including Alaska and Hawaii. We have an awful lot of patients from California.If you want to restore your fertility you need to consider a facility, like ours, that does a lot of reversals. Come here; go to one of the others that do a lot of these operations because experience counts.
If you are going to get a tubal ligation reversal for less than $7,000 dollars you are going to have to come to the southeastern United States.
We are less than 1 hour from the Atlanta airport and flights to Atlanta are often cheaper because it is a hub for airline travel. You may have to fly farther to get to Lakeshore Surgical Center but it will cost you less. You can compare flight costs at a web address such as Travelocity.com. If you don’t have access to a computer we will mail them to you.
I’m concerned about traveling a long way for tubal reversal; what can you tell me to help me feel more comfortable about that?
We have patients that come from all over the continental United States, Alaska, and Hawaii for tubal reversals. If you are concerned about travel, you are not the first. There seem to be two levels of concern, one is travel after surgery and one is travel of any kind. There are lots of things that we do to make sure you are comfortable to travel the day after your tubal ligation reversal.
By using a minilaparotomy technique, the incision is very small and healing is very rapid. Most patients are ready to go back to work in 3 or 4 days so travel the day after surgery should be comfortable. We try to be very gentle with your tissues and we do not use mechanical retractors to hold the skin apart when we do your tubal reversal.
During your tubal ligation reversal we put long lasting anesthetic in each layer so that pain is reduced in the post operative period. This anesthetic has worn off by the time you leave the next day but because you have little pain in the immediate postop period your body is not expecting to hurt and you feel a lot more comfortable on the way home. We give you strong pain medicine to take home, at no charge, in case you need it.