Tubal Reversal/Questions

Does Your Tubal Reversal Center Perform Infertility Treatment other than Tubal Reversal Surgery?

Infertility occurs in many couples around the world. It is believed that about 14% of couples face infertility problems. According to worldwide statistics, 2 million married couples face infertility problems and, unfortunately, this number is growing every year. It’s important to note that infertility is not a disease and can occur in perfectly healthy men and women.Read More

Does Your Tubal Reversal Center Perform 3D / 4D Ultrasound?

Atchafalaya Tubal Reversal offers high-precision ultrasound technology in the office. Ultrasounds are a safe and reliable way to help Dr. Morice confirm pregnancy after tubal ligation reversal and monitor a baby’s development.Read More

If I had a Tubal Reversal with another surgeon and it did not work can I come to Dr. Morice and have another Tubal Reversal?

You generally only get one chance with a Tubal Ligation Reversal surgery. In rare cases, your first Tubal Reversal surgeon may tell you that your tubes have an excellent length (very little tube had to be removed and a large amount was left after your ligation). In those special cases, Dr. Morice can review your operative report and your subsequent dye test (you will need to have a dye test (“HysteroSalpingoGram”) after your first Tubal Reversal before Dr. Morice can make this determination) to know if you would be a good candidate for another Tubal Reversal surgery. Because you generally only have one shot at a Tubal Ligation Reversal it is incredibly important that you choose the best and most experienced Tubal Reversal surgeon from the start. Choose only a very experienced and successful surgeon, highly trained in the use of microsurgical instruments and experienced with the many complications and variety of problems that can occur during the actual surgery of repairing your Fallopian tubes. In many cases ‘putting the tubes back together’ involves many special techniques that are not easy and which will determine the difference between having a successful outcome versus being told by an inexperienced surgeon that “the surgery did not go well.” Less experienced surgeons may not be skilled in performing the more complicated procedures such as neofimbrioplasty, tubal reimplantation, excision of hydrosalpinx, manipulation of the ovary or mesosalpinx (without disrupting blood flow), etc, etc to bring the two separated tubal segments close together for a re anastomosis, and with multiple site same-tube re anastomosis so that the Fallopian tube(s) can be repaired. Carefully choose the right Tubal Reversal surgeon the first time so that you can have the best chance of a successful Tubal Ligation Reversal. As you research Tubal Reversal surgeons you will see that there are only a handful of us in the entire US with the experience and results that you should expect from undergoing this procedure.

Where does Dr. Morice Perform Microsurgical Tubal Ligation Reversal?

Dr. Morice is on staff at Thibodaux Regional Medical Center in Thibodaux, Louisiana, Physician’s Medical Center in Houma, Louisiana, and the Gulf Coast Surgical Center in Houma, Louisiana. He performs Tubal Reversals at all three facilities, however, he is currently performing all of his Tubal Reversal Surgeries at the Physician’s Medical Center in Houma, Louisiana (http://physicianshouma.com/).

Do I Get to Go Home on the Same Day of My Tubal Reversal?

Generally: yes. If you are traveling for more than 4 hours to get back home, we will recommend that you stay overnight just to be safe. We have arranged discounted rates at local hotels since most of our patients travel in from around the country and from around the world. Our average Tubal Reversal surgery time is about 90 minutes. Depending on where you are on the surgery schedule (ie 7am, 9am, 11am, 1pm, or 3pm) you can plan on getting out of the surgery center 3 to 4 hours after you surgery is completed. We work with the surgery center to try to schedule our patients with less than 4 hours of travel (those who can return home the same day) earlier in the day so that they can get home the same day. Our patients who will be staying overnight are generally scheduled later as they will be in town for another night and it is not as important for their Tubal Reversal surgery to be performed earlier in the day. This scheduling protocol is strictly out of consideration for those of our patients who are able to travel back home on the same day of their surgery.

Can I have my tubes put back together even if I had them tied 15 or 20 years ago?

Yes :-)… However, in rare cases, older surgeons used older techniques to remove the more Fallopian tube and disrupt more of the Fallopian tube’s blood supply (this may result in a diminished Tubal Reversal success rate). Also, over the years scar tissue may have formed which may decrease your overall success rate of a Tubal Reversal). A copy of the pathology report and the operative report always helps us decide if you are still a good candidate after all of these years. Fortunately, most people are!

Actually, exactly what are my chances of getting pregnant if I get a Tubal Ligation Reversal?

Success rates of Tubal Ligation Reversal vary significantly among Tubal Reversal surgeons. We only consider the Tubal Reversal surgery “successful” if you get pregnant and deliver a baby. Dr. Morice’s success rates will vary among the ages and fertility factors of our patients, but most fall between 70% to 80% of all of our patients. Your ovarian function (which we can test with bloodwork), your age, and your partner’s age, and your type of tubal ligation all influence the success rate of your Tubal Reversal surgery. In some cases Dr. Morice requests these laboratory procedures (ovarian function, semen analysis) to help better understand the likelihood of your success before deciding if it is appropriate for you to undergo a Tubal Ligation Reversal. The exact surgical method of how your Fallopian tubes were ligated makes a big difference, as does the length of Fallopian tube that was removed or damaged during your ligation. The longer your Fallopian tube(s) and the more open they are will contribute to your success.

Is having a Tubal Ligation Reversal surgery dangerous?

It is surgery, and there are always standard risks of surgery: bleeding, infection, anesthesia, and injury to other structures in the pelvis and abdomen such as the bladder and rectum. These complications are extremely rare with a Tubal Ligation Reversal. This is considered a very safe operation.

How about the risk of an ectopic pregnancy?

There is an increased risk of tubal (ectopic) pregnancy following any tubal surgery. As a precaution, as soon as a pregnancy is achieved, Dr. Morice recommends a very early evaluation to rule out a tubal pregnancy.

What does Dr. Morice need to know to determine if my Tubal Ligation Reversal will have a good chance of working… In other words, if I am a “good candidate?”

A copy of your Operative Report from your tubal sterilization reversal, as well as any pathology report, should be faxed (1-866-702-0120) or emailed (tubalreversalcenterla@gmail.com) to Dr. Morice’s office before you make an appointment. Fax this to Dr. Morice’s attention. On the fax, please include the following: your age, weight, height, number of prior pregnancies (including any miscarriages), menstrual cycle pattern (regular or irregular cycles), prior infertility and/or medical problems, cigarette/alcohol/drug use by either yourself or partner, and date of most recent pregnancy for both yourself and your partner. He will review the reports and you will be informed of the likelihood of a successful reversal. Additionally, if you have any laboratory reports, x-rays, or hormone studies, please send these. Referrals from your gynecologist are helpful as they often include more pertinent data regarding your history.

My doctor burned my tubes, but her operative report does not say how much of the tubes she burned. Can you still fix my tubes?

If you had your tubes burned, it is important to know just how and how much of the tubes were burned. Even if you had your tubes burned in two or three places, if the operative report does not specify the distance between the outer areas that were burned, it is impossible to know for sure how much healthy tube is left to be put back together. Your best chance for a successful pregnancy is if you have at least 5 centimeters of the healthy tube on each side… However, pregnancies can occur with less tubal length. If your doctor burned 3 spots each 1 centimeter apart (a relatively usual practice) then you would have ‘lost’ 5 centimeters directly, plus a centimeter on each side… so about 7 centimeters of a destroyed tube would have to be removed to put back the rest of the healthy tube. This would leave you with 3 cm on each side (on average assuming that the original tubal lengths were 10 centimeters each). With 3 centimeter tubes (after re-anastomosis) you would have a less than average chance of a successful pregnancy… However, if you are young and fertile, you will have a 50% to 60% chance of a successful pregnancy. If your doctor simply burned each tube in two spots 1 centimeter apart, you would have ‘lost’ 3 centimeters, plus 1 on each side… so about 5 centimeters of a destroyed tube would have to be removed to put back the rest of the healthy tube. This would leave you with about 5 centimeters of a healthy tube on each side (again assuming that the original tubal lengths were 10 centimeters each). If you are young and fertile, you should have a greater than 80% chance of a successful pregnancy – Please understand that these estimates are based on several presumptions (you and your partner’s fertility, the average tubal length, the amount of burned tube, and any scar tissue present).

I live out of town. Can I go back to my regular doctor after the surgery?

Most patients who get their tubes reversed by Dr. Morice have traveled from outside of the Morgan City / Houma / Thibodaux area. After your surgery, Dr. Morice will be happy to see you and to take care of you for as long as you desire… But if you live more than a few hours away it may be more convenient and safe for you to have a local obstetrician managing your pregnancy. Therefore, once you get pregnant most patients will continue care with their regular obstetrician. Dr. Morice is happy to discuss your MTR and subsequent care with your obstetrician at any time.

How ‘YOUNG’ do I have to be? I’m 44… Am I too old?

As the ability of the ovary to produce an egg declines with age, patients who are 40 years old or above are generally required to have blood work done to evaluate the quality of their ovaries. In fact, any patient may have this testing done. Dr. Morice is focused on the success of your tubal sterilization reversal. If your ovaries are not producing good eggs, your likelihood of a successful tubal reversal will be diminished. If your ovarian function is diminished, IVF, instead of a reversing tubal, may be the best option for you. The most common blood work ordered to evaluate the ability of your ovaries to produce good eggs may include testing for FSH, LH, estradiol, inhibin B, and progesterone on specific days during your normal menstrual cycle. A high estradiol level may also indicate that an ovarian corpus luteum cyst left over from the previous menstrual cycle is still hormonally active. The corpus luteum is what remains of a follicle after an egg is released. For a short time after ovulation, this cyst will continue to produce the hormones needed in the event of a pregnancy. Inappropriately timed hormone production can interfere with normal growth of the uterine lining and inhibit follicle selection and growth during your cycle (ovarian function). So, when the estradiol test is too high on the third day of the cycle and a cyst is still present in the ovary, these labs can either be repeated at the beginning of the next cycle, or the ovarian cyst can be suppressed with birth control pills. If a cyst is not seen, additional checking for age-related fertility problems will be performed.

In some cases, a special test called a clomiphene citrate challenge test (CCCT) is performed. FSH and estradiol levels are measured on the third day of your cycle. On your cycle days, 5 through day 9, 100 milligrams of clomiphene citrate (Clomid) is taken. Two days later, your FSH level is measured again. A high FSH value (above 10) is a poor predictor of fertility.

If it does not appear that you are making good eggs, Dr. Morice will recommend that you proceed with IVF rather than a tube tied reversal. You may need to consider an IVF procedure using an egg donor. Dr. Morice works with several excellent physicians around the U.S. who perform IVF procedures and who have lists of egg donors available. For the purposes of achieving pregnancy, Dr. Morice will not perform a tubal reversal on any patient with a poor chance of fertility due to poor ovarian function.

I’m a newlywed, and my partner is older and has never had children. Does he need to be tested before I have a tubal reversal?

Any male over 30 with a history of never fathering a child is a candidate for a semen analysis. Any man over 40 is strongly advised to get a semen analysis. Also, men who work in chemical plants, work with radiation, who have a history of Mumps, who have a history of testicular trauma, or who have a history of a varicocele need to consider having a semen analysis. Just like blood work done on you, the semen analysis can be ordered by fax at your local laboratory facility and your partner can have the test performed locally. Dr. Morice will receive a faxed copy of the semen analysis report and he will review it with you to evaluate of your chances for a successful tubal reversal.

I live out of town. How is this going to work with me coming into town to have my tubal reversal procedure?

If you are coming from out of town you will have an office visit the afternoon prior to surgery. You will meet Dr. Morice and go over the surgery with him. Your history and physical will be performed, and you will have a pelvic ultrasound in the office. You will then be able to go to your hotel and rest for the night. The following morning you will arrive at the hospital where the tubal reversal is scheduled and you will meet the anesthesiologist to review with you the General Anesthesia that is used for the tubal reversal procedure. A tubal ligation reversal takes an average of 90 minutes. After your tubal reversal, and after you have eaten regular food and have voided and ambulated, you will be discharged home. You can then return to your hotel. Most patients are able to travel home the evening of their tubal ligation reversal surgery, or the morning following their tubal reversal surgery, depending on how far away they live.

Will Dr. Morice be able to check my blood work before I come in from out of town to have my tubal reversal surgery? What if my blood work is abnormal?

Your blood work will be done at a local laboratory or hospital the week before your tubal reversal. Dr. Morice will fax orders to your local facility and the results will be faxed back to Dr. Morice so that he can review them before you come to Louisiana. In rare cases, your blood work may show that you are not a good candidate for a surgery at the time, and you may then be advised to do things that would help correct any abnormal labs. Once your blood work returns to normal, you can be rescheduled for your tubal ligation reversal.

I would like to know if you have to be under a certain weight

More so than weight, we look at Body Mass Index (BMI). BMI, determined by your height and weight, gives us information on the amount of body fat expected to potentially complicate a surgery. For an MTR, it is best to have a BMI of less than 30 (ie. a 5’6″ patient who weighs less than 185 lbs). A BMI of less than 25 is ‘normal.’ The bigger the patient, the bigger the incision and the more difficult the surgery. Also, heavier patients tend to have more fertility issues. We can do a tubal reversal to anyone with a BMI of less than 35, but for safety issues, patients with BMIs above this are not the best surgical candidates. If your BMI is above 35, please make every attempt to achieve weight loss through a strict dieting and exercise program. Please realize that optimal weight will increase your fertility as well and that we want to make sure that you are fertile so that you will be able to get pregnant after we reverse your tubes. A BMI calculator is available at www.nhlbisupport.com/bmi

There may be an additional surgical fee for patients with a BMI of 35 or greater as the procedure may take more time and require additional surgery and anesthesia.

When can we have SEX after the surgery?

Regarding the TTC after tubal reversal, generally we ask that you refrain from any sexual activity for at least two weeks after tubal reversal surgery, and then just take it slow and easy. Remember, you should use birth control for the first two months after your tubal reversal so that any sexual activity needs to be performed with caution. While your tubes will take a few weeks to a couple of months to heal, the abdominal incision may take even longer to heal. If you resume sexual activity too soon, pain at the incision site may be a problem.

If I had my tubes ‘tied,’ should I consider In Vitro Fertilization (IVF) or a Microsurgical Tubal Reanastomosis (MTR or also called “Tubal Ligation Reversal”) procedure?

This will depend on your age, prior fertility issues, and type of tubal ligation surgery. If you are 37 years old or younger, with no prior fertility issues, you will most likely benefit more from an MTR than from IVF. If you are over 38, or if you have had prior fertility issues, IVF may be the best choice for you. This question will be best answered only by a careful review of your history, labs, and the surgery that you had to ligate your tubes.

What are the advantages and disadvantages of both tubal reversal and IVF?

Tubal reversal surgery – MTR: The biggest advantage of MTR over IVF is that once you have completed the reversal, you may no longer need any intervention through a physician (such as expensive medications or procedures) in order to get pregnant. Regular intercourse, in time, should lead to a pregnancy. There is also a very low risk for multiple pregnancies (twins occur naturally in only 1 out of every 90 pregnancies). The biggest disadvantage is that this is a minor surgical procedure. Also, there is the possibility that the tubes may have been too damaged to be reversed, or that other infertility issues will prevent pregnancy. Also, after your additional child (or children), you will need to use contraception (or have your tubes tied again).

In vitro fertilization – IVF: In vitro fertilization involves stimulating your ovaries with medications and taking a number of eggs from your ovaries during a minor surgical procedure. These removed eggs are then individually fertilized with sperm and then transferred back into the uterus with the hope that one will implant. The biggest advantage of IVF is that you can avoid the minor surgery involved with MTR, but you will still need a minor surgical procedure for egg retrieval. Also, the outcome of IVF is known 10 days after the procedure (with the first pregnancy test) vs. waiting 6 months to a year or more to find out whether MTR was successful. Success rates with IVF will vary greatly according to the IVF program, with the average pregnancy rates less than 50% per attempt in women under 40 years old. Some IVF programs report pregnancy rates of only 20 to 30% (or sometimes less). The biggest disadvantages of IVF are that you have to take medications to stimulate the development of multiple eggs. Risks of over-stimulating the ovaries can be life-threatening (Ovarian Hyperstimulation Syndrome – OHSS). Also, the risk for multiple pregnancies is greatly increased.

Another disadvantage is that if the first attempt does not work, you must do IVF again. Often there would be embryos left over that were frozen from the first cycle so that it is much less expensive and easier for a second attempt using the frozen embryos. However, if no frozen embryos are left from the first cycle, the cost for the second attempt is usually the same as for the first one.

I was just wondering how long have you been doing this procedure? Is it also a procedure you do often?

I started doing reversals in 2001… so for 14 years now. I usually do between 4 to 6 cases every week making this the most common procedure that I do. I would do more, but not everyone is a good candidate for a Tubal Reversal and we must suggest IVF to many patients. I am very focused on having a high success rate, so if I were to operate on patients who are not good candidates, my success rate would be less and I would be giving false hope to patients who would otherwise be better candidates for In Vitro Fertilization (IVF) procedures.

I live in Galliano, LA and was wondering if you do this surgery at Thibodaux hospital or if you only do it in Houma or Morgan City?

Currently, I am doing all of my Tubal Ligation Reversal surgeries in Houma at the Physician’s Medical Center. Over the past decade, I have performed these cases at different hospitals and surgery centers and I have had the pleasure of working with a variety of operating room personnel and hospital administrations. As my goal is to keep costs down and maintain the greatest skill set in the operating room, Physician’s Medical Center has been able to offer these requirements as well as provide exceptional patient care. Alternatively, I do most of my major surgeries (all robotic cases, pelvic floor procedures, etc) at Thibodaux Regional. However, the prices that Thibodaux Regional charges for self-pay patients to use their Robot, Operating Room, and Anesthesia are significantly higher, so the cost would be greater if you prefer Thibodaux.

Discussion

Many women desire to have another baby after a prior tubal ligation for many reasons, such as a second marriage, a change in financial status, or the loss of a child. Unfortunately, most people are not aware that tubal ligation is so highly successful. Most gynecologists consider a patient who has had a tubal reversal to be an ‘infertility’ patient and they simply send them to a physician who specializes in IVF, rather than a physician skilled in tubal reversal. Yet a tubal reversal can be reversed through a low cost, short outpatient surgery! Information is widely available about IVF results in the United States from the Centers for Disease Control (CDC). This can be compared to the higher rates of successful pregnancy outcome following a tubal reversal.

Tubal Reversal surgery allows couples the option of natural conception, or if desired, ovulation induction and Intra-Uterine Insemination. Unlike IVF, reversal can give a couple opportunities to have more than just one child without having to undergo any further procedures. For most women, the tubal pregnancy rate is higher than the birth rate with IVF and is therefore considered the best treatment.

The type of tubal ligation will determine whether your chance of pregnancy is closer to 85% or less than 60%. Of the major tubal sterilization methods, the most common are tying and cutting out a segment of the tube (ligation/resection). The second and third most common procedures are mechanical occlusion by tubal clips/rings or coagulation (burning) of the tubes. The least likely is removing the end of the tube (a fibroidectomy). The likelihood of a successful pregnancy following these procedures varies. The greatest success rate occurs in patients who had a mechanical occlusion using Filshie clips. The least successful is in patients who had a fibroidectomy. The reason for this relates to the amount of tube that will be left after the reversal is performed. Greater length relates to a higher success rate, therefore, if more tube was removed or damaged during the tubal ligation, then less tube will be left after the tubal reversal. A normal fallopian tube before ligation is approximately 10 cm (4 inches). Women with longer tubal lengths have significantly higher pregnancy rates than women with shorter tubal lengths.

It is especially important to understand that your expected fertility is based on your age, your medical history, your ovulatory function, and your partner’s semen analysis. These factors will play a large role in the rate of successful first signs of pregnancy after Tubal Reversal. Younger women have higher pregnancy rates than older women, as do patients who are in good health without any history or risk factors for infertility.

After your reversal, you may not need a follow-up office visit. Most patients have absolutely no problems and are feeling complete ‘back to normal’ just a few weeks after their procedure. If there are any concerns or unanswered questions, patients can either call the office at any time or schedule a visit after their surgery is performed.

While it takes a month or two for the tubes to heal, we ask that patients wait two months before trying to get pregnant. Any couple may choose infertility assistance such as induction of ovulation and/or monitoring of new follicles. Dr. Morice also performs super-ovulation (stimulation of the ovaries with medication to force them to make better eggs), Intra-Uterine Insemination (IUI: injection of prepared sperm into the uterine cavity at the time of ovulation), trigger shot administration (an injection of medicine that will force ovulation), and sperm preparation (separation and selection of the most motile and active sperm from the semen sample) when indicated. This more aggressive approach for the infertile couple has been beneficial in accelerating pregnancy rates among older or poorly ovulating patients.

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