What is 'Tubal Ligation Reversal' or 'Tubal Reversal Surgery' (Also called 'Microsurgical Tubal Reanastomosis' or 'MTR')?
Tubal Ligation Reversal,Tubal Reversal Surgery, and Microsurgical Tubal Reanastomosis ('MTR') are all the same surgery that repairs disrupted Fallopian tubes. MTR is the more technical 'medical' term. Tubal Reversal surgery is a very safe and very effective operation that has been performed successfully for several decades. Depending on the surgeon's training and experience, this procedure may be performed in many different ways to achieve the same result: a restructuring of the Fallopian tubes back to their original function so that you can get pregnant again. During the Tubal Reversal the damaged section(s) of your fallopian tube(s) is (are) carefully excised using a microscope, leaving only the remaining healthy and open Fallopian tube segments. These segments are then reconnected with extremely fine, hair-like sutures in multiple layers using a microsurgical technique that Dr. Morice perfected while performing Tubal Reversal surgeries over the past 14 years. Throughout the Tubal Reversal, and after the completion of the Tubal Reversal, Dr. Morice injects dye into the uterus and through the fallopian tubes to be certain that the Tubal Reversal is working and at the end, has worked. These dye tests allow Dr. Morice to see how well the Fallopian tubes function after being reconnected. The rate of flow of the dye through the Fallopian tubes helps Dr. Morice provide you with a prediction of how successful you will be in conceiving a child after your Tubal Reversal is completed.
Does Your Tubal Reversal Center Perform Infertility Treatment other than Tubal Reversal Surgery?
Yes, we do. Infertility is a significant problem which occurs in many couples around the world. It is believed that about 14% of couples face infertility problems. According to worldwide statistics, more than 2 million married couples face infertility problems each year and, unfortunately, this number is growing every year. It is very important to understand that infertility is not a disease and that infertility often occurs in perfectly healthy men and women. For those couples who are affected by infertility, Dr. Morice and the other physicians and healthcare providers at the Tubal Reversal Center do provide infertility treatment. Infertility treatment at the Tubal Reversal Center varies from simple oral medications and behavior modification, to injectable medications, trigger shots, and IUIs. These treatments are not performed on patients with tubal factor infertility (ie a patient who has had her tubes tied) as these infertility treatments are only successful in patients with at least one open tube.
Does Your Tubal Reversal Center Perform 3D / 4D Ultrasound?
The Tubal Reversal Center offers high precision, state-of-the-art ultrasound technology in our offices. Our ultrasound systems are constantly upgraded as newer technology emerges in this field. 2D, 3D, and 4D ultrasounds are a safe and reliable way to help Dr. Morice and the Tubal Reversal Center staff confirm and monitor your pregnancy after your tubal ligation reversal.
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 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 reanasotmosis, and with multiple site same-tube reanastomosis 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.
Does Dr. Morice do Tubal Ligation Reversal Surgery only in Louisiana?
Yes, although Dr. Morice provides instruction to other physicians in other states, he only performs surgery in Thibodaux, Louisiana, Houma, Louisiana, and Morgan City, Louisiana. All Tubal Reversal Surgeries are currently being performed 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.
Is a Tubal Reversal possible after having my tubes tied for 20 years?
Absolutely, but we must be aware that older surgeons had older techniques for tying tubes which may have damaged your tubes more than the newer techniques of tubal ligation. It is very important to review your operative report and pathology report if they are available. Also, over the years scar tissue may have formed which may decrease your overall success rate of a Tubal Reversal). Close review of your pathology and operative reports allows us to better understand your chances of success after a Tubal Reversal surgery. Fortunately, most people are still good candidates even after all of those years of having their tubes tied!
How likely are we to get pregnant if I have a Tubal Ligation Reversal surgery?
Very likely. While pregnancy success rates fluctuate tremendously based on the experience and training of each Tubal Reversal surgeon around the world, Dr. Morice and his staff have more experience and more skill in performing Tubal Reversal surgery than most surgeons. Over more than a decade of performing this very specialized procedure, Dr. Morice is able to restore most tubes to near perfect anatomical structure so that most tubes look like they had never even been tied in the first place!
A Tubal Reversal surgery is only 'successful' if a pregnancy is achieved that results in a live birth. Success rates differ between patients based on their ages, partner's age, type of tubal ligation, medical issues, and fertility factors, but our success rate is generally within 70% to 80%. We can also perform bloodwork to help identify how well your ovaries are working and semen analysis to help confirm your partner's sperm quality and quantity. Also, the amount of Fallopian tube removed or damaged with your tubal ligation affects your success as more tube remaining after your tubal ligation is linked to a better chance of pregnancy.
How dangerous is Tubal Ligation Reversal surgery?
Surgery always has risks such as blood loss, potential infection, complications with anesthesia, and damage to other structures and anatomical areas within the abdomen and pelvis. Tubal Ligation Reversal is a very safe procedure as these structures are separate from the areas where the Fallopian tubes are so that while repairing the Fallopian tubes it is very unlikely that any damage would occur to any of these nearby structures. The most likely complication of any surgery, including a Tubal Reversal, is infection. During your surgery you will be given prophylactic antibiotics and a strict sterile technique is utilized to reduce the chance of an infection.
Ectopic pregnancy can occur with a normal pregnancy, but is it more common with a Tubal Reversal?
Yes, ectopic pregnancies are more common with both Tubal Reversal and with IVF. Any surgery on the Fallopian tube can lead to scarring in the tube that can increase the likelihood of the embryo having a hard time moving through the tube. If the embryo gets stuck in the tube, it may stay there and start to develop inside of the tube. This is an ectopic pregnancy, and it must be handled with great care. If you do have an ectopic pregnancy, it is extremely important to have a skilled surgeon such as Dr. Morice remove the ectopic pregnancy so that he can save the tube. Many gynecologists will simply cut out the entire tube when you have an ectopic pregnancy rather than performing a specialized tube-saving procedure that will save the tube.
Because of the slight increase in the risk of an ectopic pregnancy after a Tubal Reversal, Dr. Morice urges every patient to get an ultrasound as soon as possible once a pregnancy in confirmed after your surgery. You can come to either of Dr. Morice's offices to have an ultrasound performed at no charge, and we will continue to perform ultrasounds and monitor you at no charge until we are certain that your pregnancy is inside of your uterus and doing well.
Because of the slight increase in the risk of an ectopic pregnancy after a Tubal Reversal, Dr. Morice urges every patient to get an ultrasound as soon as possible once a pregnancy in confirmed after your surgery. You can come to either of Dr. Morice's offices to have an ultrasound performed at no charge, and we will continue to perform ultrasounds and monitor you at no charge until we are certain that your pregnancy is inside of your uterus and doing well.
How does the Tubal Reversal Center determine if I am a good candidate for a Microsurgical Tubal Reanastomosis?
Careful review of your history and current situation provides us with this information. Although rare, the best candidates for Tubal Reversal surgery are young, fertile, healthy women who have regular periods, with partners who are also young and healthy with good sperm quality. Also, the best candidates have had tubal ligations that have removed or damaged as little tube as possible. Most patients do not meet all of these criteria, and so a review of all of these factors is performed to make sure that we are not performing a Tubal Reversal surgery on a patient who has a poor chance of getting pregnant. Many of our patients are in their 40's and have declining fertility (declining ovarian function due to age) such that having a Tubal Reversal sooner rather than later can make a huge difference in their success.
In some cases we recommend that you get additional bloodwork to help us better understand your ovarian function and / or your partner's sperm quality. Your operative report and pathology report will be carefully reviewed (fax them to 1-866-702-0120 or email to nurse@TubalReversalCenter.com). We also need to know your exact age, height, weight, pregnancy history, menstrual pattern, and medical conditions such as diabetes, hypertension, and fertility problems. The use of cigarettes, alcohol, or drugs by you or your partner is also important. In some cases old laboratory reports and x-rays (especially any HysteroSalpingoGram) will be helpful.
In some cases we recommend that you get additional bloodwork to help us better understand your ovarian function and / or your partner's sperm quality. Your operative report and pathology report will be carefully reviewed (fax them to 1-866-702-0120 or email to nurse@TubalReversalCenter.com). We also need to know your exact age, height, weight, pregnancy history, menstrual pattern, and medical conditions such as diabetes, hypertension, and fertility problems. The use of cigarettes, alcohol, or drugs by you or your partner is also important. In some cases old laboratory reports and x-rays (especially any HysteroSalpingoGram) will be helpful.
I know that my surgeon burned my tubes, she 'destroyed them' - but I'm not sure how much I have left. Can I still have them reversed?
All gynecological surgeons are taught the same surgical 'burning' technique to damage the Fallopian tubes in order to perform a tubal ligation; however, surgeons are human and not all surgeons perform the same exact procedure. Additionally, some tubes bleed and surgeons often burn more of the Fallopian tube to stop the bleeding... which damages even more of the tube. In order to get the most accurate information on exactly how much Fallopian tube was destroyed on each side during your tubal ligation, we need to review your operative report.
In most cases, the operative report accurately describes the amount of tube that was burned and outlines the specific technique that your surgeon used when burning your tubes. Unfortunately, sometimes the operative report is not accurate.
In most cases with 'burned' tubes it is only the middle section of the tube (between the Isthmus and Ampullary segments) which has been destroyed. As such, your tubes have plenty of length remaining for a reanastomosis (tubal repair / reversal) by anastomosing (connecting) the remaining tubal isthmus and ampullary segments together to complete the tubal reversal. In some cases the Isthmus has to be anastomosed to the tubal infundibulum or even to the tubal fimbria. In rare cases the end of the tube that contains the fimbria is missing entirely. In these cases, new fimbria (in part or in whole) must be created and a neofimbrioplasty (making a new open end that resembles the fimbria) must be performed to surgically reconstruct the fimbria. In other rare cases the tube has been destroyed right up to the uterus itself and a tubal reimplantation (sewing the tube back into the uterus) has to be performed. In an even more rare case the entire tube has been burned to the point where it is not repairable (this is exceedingly rare).
In most cases, the operative report accurately describes the amount of tube that was burned and outlines the specific technique that your surgeon used when burning your tubes. Unfortunately, sometimes the operative report is not accurate.
In most cases with 'burned' tubes it is only the middle section of the tube (between the Isthmus and Ampullary segments) which has been destroyed. As such, your tubes have plenty of length remaining for a reanastomosis (tubal repair / reversal) by anastomosing (connecting) the remaining tubal isthmus and ampullary segments together to complete the tubal reversal. In some cases the Isthmus has to be anastomosed to the tubal infundibulum or even to the tubal fimbria. In rare cases the end of the tube that contains the fimbria is missing entirely. In these cases, new fimbria (in part or in whole) must be created and a neofimbrioplasty (making a new open end that resembles the fimbria) must be performed to surgically reconstruct the fimbria. In other rare cases the tube has been destroyed right up to the uterus itself and a tubal reimplantation (sewing the tube back into the uterus) has to be performed. In an even more rare case the entire tube has been burned to the point where it is not repairable (this is exceedingly rare).
I have a wonderful OB/GYN who I absolutely love!. Although she is not trained in infertility and tubal ligation reversals, she thinks very highly of Dr. Morice and she has recommended that I see Dr. Morice to get my tubal ligation reversed. I am very concerned about seeing Dr. Morice because I want to go back to my OBGYN after my surgery and I want her to deliver my baby. We are travelling a long way to go to Dr. Morice (we live 2,200 miles away from Morgan City). How does that work? How long do I need to keep seeing Dr. Morice? Do I have to travel all of that way back to Morgan City after my surgery?
Dr. Morice performs tubal reversals on patients from all over the world and he wants you to go back to your regular OBGYN once he has made you fertile again. Your relationship with your OBGYN is a very special relationship which should never be jeopardized. Dr. Morice has the very focused goal of restoring your fertility and then returning you to the care to your OBGYN.
While our clinics offer free ultrasounds to confirm your pregnancy, and we will follow you and help you with infertility issues, you are encouraged to see your regular OBGYN after your pregnancy is confirmed. Since most of our tubal reversal patients live far away, it is impractical to make long trips back to see Dr. Morice once your surgery is completed. All of the sutures used during your surgery will dissolve so it is not necessary to come back for suture removal.
Please remember, no matter where you live, our office and staff are always available to answer any questions and to address any concerns that you might have after your surgery. The most common, although rare, complication from surgery is an infection of the skin where the cut was made to perform your tubal reversal. If you are in any way at all concerned about a possible infection, please take a high resolution pictureof the affected skin and email it to us so that we can examine the skin. We will also ask you detailed questions about your physical health, wound care, and symptoms. If appropriate, we will call in antibiotics for you or advise you to see a local physician if we suspect an infection has occurred... but again, this is a very rare situation.
Also, we are available for any questions that your local OBGYN might have. Any and all questions or concerns can be discussed personally between your OBGYN and Dr. Morice. Your local physician will appreciate the details and specifics that we can provide regarding your surgical procedure which will help him / her make important decisions about your care. You are certainly not obligated to make any return trips back to see Dr. Morice, especially if your trip would be an inconvenience due to your length of travel back to Louisiana, but you are ALWAYS welcome to visit us again for a free evaluation of any suspected problem or concern.
While our clinics offer free ultrasounds to confirm your pregnancy, and we will follow you and help you with infertility issues, you are encouraged to see your regular OBGYN after your pregnancy is confirmed. Since most of our tubal reversal patients live far away, it is impractical to make long trips back to see Dr. Morice once your surgery is completed. All of the sutures used during your surgery will dissolve so it is not necessary to come back for suture removal.
Please remember, no matter where you live, our office and staff are always available to answer any questions and to address any concerns that you might have after your surgery. The most common, although rare, complication from surgery is an infection of the skin where the cut was made to perform your tubal reversal. If you are in any way at all concerned about a possible infection, please take a high resolution pictureof the affected skin and email it to us so that we can examine the skin. We will also ask you detailed questions about your physical health, wound care, and symptoms. If appropriate, we will call in antibiotics for you or advise you to see a local physician if we suspect an infection has occurred... but again, this is a very rare situation.
Also, we are available for any questions that your local OBGYN might have. Any and all questions or concerns can be discussed personally between your OBGYN and Dr. Morice. Your local physician will appreciate the details and specifics that we can provide regarding your surgical procedure which will help him / her make important decisions about your care. You are certainly not obligated to make any return trips back to see Dr. Morice, especially if your trip would be an inconvenience due to your length of travel back to Louisiana, but you are ALWAYS welcome to visit us again for a free evaluation of any suspected problem or concern.
Thoughts on all of this…
There are so many reasons why women decide to undergo either a tubal reversal or IVF and become pregnant again. We have helped families for so many different reasons, from those who have lost a child (or children) in a housefire to those who have lost a spouse or decided to get married again after thinking that their family was complete. For others, having their tubes tied was based on finances and now, later in life, they can afford to have more children. It is estimated that of the more than 1 million women each year who have a tubal ligation, up to 20% of them will regret the decision later in life. That means that an estimated 200,000 women every year wish that they would not have had their tubes tied. Unfortunately for most of these women and their families, most will go straight to IVF thinking that it is their only option… and since they cannot afford to go through IVF they will never be pregnant again. Equally as unfortunate is that most physicians are unaware of the success (or even the existence) of tubal reversal surgery so they will refer patients to IVF. However, information about how successful tubal ligation reversal surgery is has been available for decades. Tubal reversal has been shown over and over to be a more successful route to a pregnancy after a tubal ligation than IVF in those patients who are good candidates for a reversal. A ‘good candidate’ for a reversal is someone who has adequate ovarian function (usually related to age), a history of a tubal ligation that left enough tube for a reversal, a history of never being infertile in the past before their tubal ligation, a partner with adequate sperm production, and a willingness to undergo an outpatient surgical procedure and then give themselves time to get pregnant the old-fashioned way (by having sex).
Getting down to the specifics, it is important to have Dr. Morice and his staff review as much information about your history and tubal ligation surgery as possible. If you are over 40, or if your partner is over 40 and has not recently had children, you or your partner will be asked to do more blood tests to find out how well your ovaries are working or a semen analysis to see how well your partner’s sperm is functioning. This information helps us determine if a tubal reversal is right for you, or if you would have a better chance of pregnancy with IVF. All of the information is combined to make this decision; for example a 42 year-old woman with a tubal ligation history of Filshie clips applied to the very middle of her tubes, who has regular menstrual cycles and normal ovarian function, has a 47 year-old partner with a normal semen analysis, is a non-smoker and only consumes alcohol socially, who had no problems getting pregnant in the past will have the same chances of getting pregnant as a 22 year-old who had her tubes ligated by extensive cautery (“fulgaration” “burning”), who smokes, and is slightly irregular with her menstrual cycles (all other factors being the same). The “good candidate” is one who, based on all of these factors, has a great chance of becoming pregnant again after a tubal reversal. Patients who are not good candidates for a tubal reversal are told that they are better off going straight to IVF.