Outpatient Tubal Ligation Reversal Surgery

Tubal reversal surgery, also known as microsurgical tubal reanastomosis, has been a common surgical therapy for decades. Until in vitro fertilization (IVF) became routine and successful, tubal reversal surgery was very common.

Over the last 5 years, or so, the success rates for IVF at highly-successful programs have nearly reached that of tubal reversal surgery in the best candidates. Because of this, tubal reversal surgery has become much less common nationally.

Therefore, it is important that any woman considering tubal reversal surgery also be counseled about the benefits and drawbacks of IVF as compared to tubal reversal surgery. In the most ideal circumstances, every woman considering tubal reversal surgery would be counseled at a program that offered both options with high success rates.

Reproductive Medicine and Surgery Center of Virginia is Such a Place

Despite some benefits of IVF, there are a number of excellent reasons a woman with a previous tubal ligation may desire a tubal reversal surgery rather than undergoing IVF. In the case of a patient desiring more than one child, tubal reanastomosis is more cost-effective. Many patients prefer to conceive “naturally” rather than requiring the technological complexity of IVF. Although considered quite safe, unresolved issues remain regarding the possibility of increased risks of some birth defects related to babies conceived from IVF. Increased incidence of multiple gestations is also more easily avoided with tubal reanastomosis.

A key issue for high-quality patient care is to counsel the patients appropriately about who is a good candidate for tubal reversal surgery, as compared to IVF, and be able to give informed recommendations. Keep in mind the saying, “If all you have is a hammer every problem looks like a nail.” If your practitioner only offers tubal reversal, then you may not get the most informed and objective perspective. In some cases, IVF would be more likely to result in pregnancy.

Success for tubal reversal surgery is quite variable and depends on such things as how the fallopian tubes were “tied”, the time since the surgery, the sperm count of the male partner, and the length of the remaining fallopian tubes. Tubal reversal also has a higher risk of ectopic pregnancy (pregnancy outside of the uterus). So pregnancy rate is lower than delivery rate. Keep in mind also that “tubal patency” after surgery (the tubes being open after surgery) does not mean you can become pregnant. Delivery rate of a baby following surgery (not tubal patency rates or even pregnancy rates) is all that is important to couples.

An advantage for patients who come to the Reproductive Medicine and Surgery Center is the faculty. In addition to extensive experience performing these procedures, Doctors Bateman, Williams and Smith Co-Direct the In Vitro Fertilization Program. These doctors are subspecialty certified in infertility (Reproductive Endocrinology and Infertility) by the American Board of Obstetrics and Gynecology. Dr. Bateman founded the IVF program in Charlottesville, VA, in 1986 and has been performing tubal reversal surgery since 1980. Dr. Williams has been doing tubal reversal surgery regularly since 1998.  Dr. Smith joined Drs. Bateman and Williams in 2010 and also regularly performs tubal reversal surgery.

Tubal Reversal Surgery Guarantee

We are so confident that we offer the highest quality of surgical care that we are pleased to offer a partial refund if one of your tubes does not remain open after the surgery.  If you have not conceived within 12 months after your surgery we will order you an x-ray of the Fallopian tubes, called a hysterosalpingogram, to determine if one or both tubes are open.  If your insurance does not cover it, we will pay $250 toward an HSG at a radiology center close to you or it can be done at no cost at our facility.

If at least one of your tubes did not stay open after the surgery, then we will either refund you $2,000 or we will give you a credit of $3,000 toward completing a cycle of in vitro fertilization at our center.

Some centers “untie” your tubes then don’t bother to find out if you have had success. We are truly invested in your success and want to do everything we can to assure you get to your goal of having another child after tubal ligation.

Most, but not all women are candidates for the refund program.  Some medical issues/problems will exclude participation.  Some methods of tubal ligation will also exclude refund guarantee where the tubes are extensively damaged.  If you are eligible for the refund guarantee, you will sign a contract prior to the surgery guaranteeing your refund.  If you are not eligible, you will sign a contract stating such.

The all-inclusive cost with partial-refund guarantee is $6,076.

This means that if we have not been successful in opening one or both of your tubes after tubal ligation reversal with East Coast Tubal Reversal Center we will refund you $2,000 or give you a $3,000 credit toward an IVF cycle at our center. This means you will have paid $4,076. We are one of only a few centers that are performing high-quality tubal ligation reversal for that low of a price- so our center should be the most cost-effective in the country.  This guarantee is not applicable to patients with insurance coverage for this procedure.

Financing

Our tubal reversal fee is very competitively priced and we were the first program in the world to offer a money back guarantee. The full amount is paid two weeks prior to the date of your surgery and will include the physician, anesthesia, and facility fee. Our office is responsible for paying the facility and anesthesiologist. The total cost for this procedure if performed in an outpatient setting is only $6076.00.

We do not offer payment plans for this procedure. Most insurance carriers will not cover the initial office visit to see the physician to discuss tubal reversal. The new patient consult is under $417. You will be expected to pay this fee at the time of your visit. If you live more than 3 hours from Charlottesville, we are happy to extend a phone consultation appointment for you to talk with the doctor about tubal ligation reversal.

However, if you schedule surgery, the money that you paid for your consultation will be applied to the surgery balance.

Out of Town Patients

Many of our couples come from out of town or out of state and some require an overnight stay.

Included

  • 1 or 2 night stay at Hilton Gardens Inn– located next door to the outpatient surgery center.  1-night stay if you live greater than 3 hours driving distance and 2-night stay if you are flying to our center.
  • Cost of initial consultation office visit and pre-operative pelvic ultrasound (to assure normal uterus and ovaries) $417.00 (paid at initial visit and subtracted from the cost of the surgery charge when you schedule).  This amount is not refunded if you decide not to have your surgery.

Contact Us to Schedule Today

To schedule a new patient appointment to discuss your options, feel free to use the contact form below or if you would rather please call 434-654-8520. If you have any questions regarding financial matters, any of our front desk coordinators can assist you.

Frequently Asked Questions: Outpatient Tubal Ligation Reversal Surgery

If I just want clamps removed is it still tubal reversal?

Yes, however the tubal ligation was performed (there are 5-6 common techniques and many less common ones) it has caused scarring in the tube that is blocking the sperm from swimming up the tube to find the egg. The removal of this blockage is called a tubal reversal. In the case of “clamps”, they are a method to crush the tube and cause damage that leads to permanent scarring. When the clamp is taken off the scar tissue still blocks the tube.

Is Essure reversal possible?

Essure removal with tubal reversal is possible but success rates of Essure patients compared to standard tubal ligation reversals are much poorer, estimated to be in the 25-35% range for pregnancy success rates following the procedure. Good candidates for standard tubal ligation reversal are much better, approaching 75% pregnancy success rates. For this reason it is recommended that Essure patients do In Vitro Fertilization (IVF) instead of attempt surgery to remove the Essure coils due to the much higher success rates from IVF and the fact that most women undergoing Essure surgery with attempted tubal reversal will fail and ultimately need IVF to conceive, costing significantly more than if IVF was elected to begin with.

Will the physician tell me that day if it can be done or not?

If we are provided with the operative report and pathology report (if pieces of the tubes were taken out) then we should be able to make plans that day. There are situations where a woman’s tubes have been cauterized in multiple places (burned extensively) or the end of the tube, called the fimbria, are cut out. These are not able to be corrected surgically. In these cases, In Vitro Fertilization (IVF) is the only reasonable option. Of note, we always recommend a husband/partner get a semen analysis prior to the tubal reversal surgery. A few times a year we make plans to do tubal reversal surgery but cancel them due to a very low sperm count for the male partner. This usually leads to the couple pursuing IVF instead- which is much more successful in this case.

What is the cut off age for having this done?

Our age cut-off is 44 years old. However, when we meet we will have a realistic discussion of how likely it is to work. This takes into consideration many things; age is one of them.

What are the chances of me having a baby?

In general, for all comers, it is 75%. However, there are many things that must be taken into account, such as how the tubal ligation was performed, age of the woman, sperm count of the man, other medical problems, etc. It’s also important to understand that over 90% of the time one or both tubes are open after surgery but that doesn’t mean you will necessarily get pregnant. Some tubes do not work well because of the surgery to block them followed by surgery to reopen them. In other circumstances a woman’s age or her husband’s sperm count are preventing success following tubal reversal surgery.

How do they do the procedure, will I be cut like a c-section?

No. If a woman is not significantly overweight it can usually be done outpatient through a small incision called a “mini-laparotomy”. This incision is much smaller than a c-section incision. It is small enough to be safe and comfortable to go home the same day. It is hard to give an absolute cut-off for weight but about 180-200 pounds tends to be the upper limit of what can be accomplished with a “minilaparotomy.” It certainly depends on how tall a woman is and how she her fat is distributed. Some overweight women have very thin waists but large hips and legs and a minilaparotomy could still be accomplished.

If a woman is too heavy for the procedure, weight loss is always the best option prior to surgery. In general, unless a woman is quite tall, women over 200 pounds often have an abdominal wall thickness that is too large for the usual small incision (mini-laparotomy) to be made. But it depends on how tall you are and how your body fat is distributed. If you are over 200 pounds, it means the surgery will need to be postponed. We will recommend an amount of weight that will need to be lost prior to undergoing the procedure.

Why do they do an ultrasound during the consult?

We do an ultrasound to make sure the uterus is small enough to be accessed through a mini-laparotomy incision. Measurements of the uterus and ovaries are also made that can be helpful in planning the best surgical approach and to assure there are no other problems that might lower success following tubal reversal, such as fibroids (myomas) or cysts.

Is it outpatient surgery or do I have to spend the night?

It is outpatient surgery. This incision is much smaller than a c-section incision. It is small enough to be safe and comfortable to go home the same day. The incision may have to be made larger if there is scar tissue encountered inside her belly. The size of the incision usually determines whether you need to spend the night in the hospital. Most women can go home the same day the surgery is performed.

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