Michael C. Doody MD/PhD/FACOG/REI

The Center for Reproductive Medicine

The Tubal Reversal Professionals

Fallopian tube at the time of sterilization using silastic rings

   The process of obtaining a tubal reversal begins with an interview and physical examination. The interview involves a give and take conversation between the physician and prospective patient. The risks, benefits, side effects, potential complications, outcomes and alternatives are discussed in full. The physician must make sure that all of these issues are understood before the procedure is performed. Patients who come from out of town may have some of these issues covered by phone or with written literature, but the face to face conversation insures that the message has been received. This talk is arranged the day before surgery for out of town patients.

    A full medical history is taken so that any conditions which might influence the outcome of the surgery or the subsequent pregnancy are considered and discussed. Mothers who had no problems with a previous pregnancy will occasionally develop a medical condition such as diabetes or hypertension which could impact on the health of mother or baby. Smoking is a problem which may decrease chances of good tubal healing after a tubal reversal, so we insist that every honest effort be made to stop smoking before the procedure is done. Smoking will affect our financial guarantee. A semen analysis should be done prior to the surgery. It is not at all unusual to find an unexpected male fertility problem, and this may greatly affect the decision to have a tubal reversal as opposed to In Vitro Fertilization.

    The surgery is scheduled at an outpatient facility adjacent to the Center fo Reproductive Medicine. Patients may be discharged on the day of the surgery or on the next day, depending on the preferences of the physician. The patient is completely asleep during the entire procedure. A small incision is made horizontally near the upper pubic hair line. This incision is usually the width of three fingers held side by side, but sometimes it will be more or less. The tubes are then examined carefully under a surgical microscope. Depending upon the amount of tubal damage, a decision is made as to whether one or both tubes are repairable. If at least one tube is not repairable, the operation is ended (see Our Guarantee) and In Vitro Fertilization is recommended as the next step. It is important to keep in mind that at least one tube is repairable over 90% of the time.

    From this point forward, microsurgical principles are employed. These include the use of  frequent irrigation with fluids to keep the tissues moist, meticulous efforts to minimize any bleeding, the use of very fine reabsorbable sutures, very high quality non-traumatic surgical instruments and other details to numerous to outline here. Strict adherence to microsurgical principles and the surgeon's skill are the keys to the success of this procedure. Average actual operating room time is 1 1/2 hour.

After the functioning portions of the tubes are spliced together, the results are checked by putting a dyed fluid into the uterus and observing the motion of this fluid through and out of the tubes. Postoperatve scar tissue is minimized by the use of an adhesion prevention material called Seprafilm. The incisions are closed, local anesthetics are used to minimize pain and the patient then wakes up.

    If the patient is from out of town, she will be allowed to travel one or two days later (if everything is progressing well). The average patient takes between 10-15 pain pills for discomfort during the recovery process. Most people will want to stay away from work for 1-2 weeks, but individuals with tiring jobs or those with strenuous jobs requiring heavy lifting will need to be out longer. Intercourse can resume 3 weeks after surgery, but some form of contraception is needed for a total of three months before attempts at conception can begin. We recommend that a higher dose multiple vitamin (such as Stresstabs) be taken, along with additional Vitamin E and Vitamin C. Nutrition is very important during the healing process, and we do not recommend any form of weight loss diet for three months after the surgery. When pregnancy occurs, it is important to have a physician actively determine its location as soon as possible, because tubal pregnancies do occur at a higher than normal frequency in women who have had a tubal reversal.

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http://www.knoxvillefertility.com

copyright 2001, 2002, 2003, 2004 michael c. doody md pc