Most Common Questions and Answers about Tubal Reversal

What is a tubal reversal?

A tubal reversal or tubal ligation reversal consists of very carefully re-attaching two ends of a Fallopian tube that were previously separated in the middle of the tube. Separation during tubal ligation, frequently called “tying tubes” may have been done by cutting and tying, burning, cauterization, or placing rings or clamps.

What should I look for in a microscopic tubal reversal surgeon?

Microscopic tubal reversal surgery has been called the ultimate in microsurgical procedures and is, indeed, one of the most challenging surgeries in medicine. You’ll want a surgeon who has many years of performing microscopic tubal reversals with thousands of successes. Be sure an experienced surgeon is performing your tubal reversal. If a surgeon’s office partner has had thousands of successes, but he himself has been doing reversals for just a few years, you may want to keep looking.

One of the most important things to look for are hundreds of successful tubal reversal patient testimonials. Satisfied tubal reversal patients are usually eager to share their stories about their tubal reversal and babies. If a surgeon is successful, he will have many tubal reversal patient testimonials like Dr. Rosenfeld does. Many of our tubal reversal patients offer their emails or Facebook pages so you can talk with them personally about their experiences.

My tubes were tied a long time ago, is it too late?

The length of time your tubes have been tied is not important to having a successful tubal reversal procedure. We help women everyday who had tubal ligation 10 or more years ago. Here are some testimonials from tubal reversal patients who had their tubes tied for a long time.

How long should I wait after tubal reversal to try to get pregnant?

Generally, Dr. Rosenfeld recommends waiting 3 weeks before inserting anything into the vagina. And 2 menstrual cycles are recommended before trying to conceive after tubal reversal surgery.

How big is a Fallopian tube in diameter?

The diameter of a tube is about 1 cm, slightly larger than 1/3 of an inch. This is the same size as a baby’s arteries around its heart. This is why Dr. Rosenfeld has been assisted for the past 25 years by a pediatric surgeon who trained at the Texas Heart Institute and worked in Guatemala before him coming to the United States. Together Dr. Rosenfeld and his assistant have improved the tubal reversal procedure to increase the probabilities of pregnancy.

How long is a tube prior to a tubal ligation procedure?

The normal length of a Fallopian tube is 12 cm long, which is approximately 4 ½ inches.

How much length of tube do I need to have a tubal ligation reversal performed?

When 6 cm (approximately 2 inches) is present, Dr. Rosenfeld has excellent tubal reversal results.

How does Dr. Rosenfeld know if I have enough tube to repair?

Dr. Rosenfeld will review your operative notes from your tubal ligation surgery, if they are available. This will help him determine how much tube was cut, burned, tied, or if rings or clamps were placed. If he feels he can repair 6 cm or more, you will have a much better chance of becoming pregnant with tubal reversal compared to IVF. If your tubes appear to be less than 5 cm, or if your husband’s sperm count is low, Dr. Rosenfeld will refer you to the best IVF practitioner he knows.

Is it best to do a tubal reversal in a hospital?

Dr. Rosenfeld performs all his tubal reversal surgeries at the state-of-the-art hospital complex called First Street Surgical Center. It is very rare that a patient needs to spend a night in the hospital. But if a patient comes from far away and needs to stay overnight in Houston before travelling, excellent accommodation near our tubal reversal surgery center is readily available.

How many United States surgeons devote their practice to tubal ligation reversal?

There are fewer than a handful of doctors who perform tubal reversal on a daily basis.

Should I go to a surgeon whose practice is dedicated to performing tubal reversals?

Absolutely. This procedure is considered one of the most difficult and technically challenging surgeries in all of medicine. It is as difficult as repairing a baby’s heart.

Why do so few doctors in the United States have tubal reversal expertise?

Doctors who finished their medical training after 1985 were trained to do IVF instead of microsurgical tubal ligation reversal surgery. Tubal reversal surgery is more demanding of a doctor’s time. IVF demands much less of the doctor’s time and is much more expensive which makes it more lucrative. In fact, this was written in recent articles in medical journals including the fact that tubal reversals have higher success rates of pregnancy. Another article shows that not only are tubal reversals more successful, but also, they yield fewer multiple births of twins and triplets.

Should I go to Mexico for tubal reversal surgery because it is cheaper?

Absolutely not! You get what you pay for. I have not seen one successful patient in 30 years who have had their reversal in Mexico.

What are the costs for a tubal reversal?

Our fee includes all costs from the first office visit through post-operative care. Office visits, labs, ultrasound, surgeon’s fees for all procedures performed including removing cysts or other abnormalities, assistants’ fees, hospital fees, take-home medications, Exparel pain medication, post-op office visit within 2 weeks of surgery, and follow-up phone or email consultations to help you conceive. Note that few tubal reversal doctors offer Exparel for pain management because it is more expensive than other medications. However, Dr. Rosenfeld wants his patients to be comfortable as patients who are able to get rest and relax heal more quickly. Here are some testimonials from patients who have used Exparel after tubal reversal.

What is the dye test?

Chromotubation is the dye test that Dr. Rosenfeld performs after reconstruction of your Fallopian tubes. Dye is placed into the tubes to make sure they are watertight and perfectly aligned. It is time-consuming, but necessary, to ensure the tubes are not blocked, not leaking, and have no abnormalities that might interfere with conception.

What are the risks of adhesions forming?

A single adhesion can prevent conception or cause discomfort. Be sure your surgeon uses adhesion-prevention techniques like the adhesion barrier, Interceed. It is a knitted plant-based fabric placed over the internal surgical area that dissolves in about 30 days. The material keeps organs separated so they cannot stick (adhere) together during that month of healing.

This technique is an added expense for the surgeon, so many do not use it. Be sure your surgeon does use adhesion prevention which is included in Dr. Rosenfeld’s all-inclusive tubal reversal fee.

How many tubal reversals are performed each day?

Select a surgeon who does no more than 2 surgeries per day. The delicate tubal reversal procedure requires patience and attention to detail.  Tubal reversal surgery is an outpatient surgery procedure.

What if I have other gynecological problems?

For us, the goal of your tubal reversal is to become pregnant, not just to put your tubes back together. Meeting this goal requires careful examination of your reproductive organs. Select a surgeon who does everything possible to find any additional gynecological problems such as fibroids, polyps, or other abnormal conditions which can be corrected during surgery.

Dr. Rosenfeld uses a thorough ultrasound before surgery and a hysteroscopy during surgery to identify any potential gynecological problems and corrects them. Treatment of observed problems during the tubal reversal surgery greatly reduces the chance of needing additional surgeries before being able to conceive.

What about the size of the sutures?

Ultrafine sutures size 10-0 used for tubal reversal surgery. Two layers of smaller sutures provides the best results when rejoining delicate organs like Fallopian tubes. Choose a tubal reversal surgeon who uses ultra-fine 10-0 nylon sutures like those used in cosmetic surgery procedures. The picture at the left is the product label for the ultrafine sutures Dr. Rosenfeld uses in his surgery.

The smaller the suture, the better the Fallopian tube ends align reducing the chance of adhesions which can delay or prevent conception. It is very important that you insist on use of ultrafine sutures. Many doctors do not use them as specialized training is required.

Are there any hidden fees?

Medical providers frequently have confusing billing systems that result in charges from the doctor, the anesthesiologist, the hospital, the labs, and other necessary services. It is important when discussing the cost of any medical procedure that you ask many questions to ensure that all fees are considered.

Frequently, tubal reversal surgeons will have extra fees associated with treating patients who are overweight or have other medical conditions. Be sure to ask about this type of hidden fee when working with other surgeons. Our tubal reversal patients will not receive extra charges from any other medical service provider for anesthesia, operating room expenses, lab work, removal of gynecological abnormalities during the tubal reversal, or any other fee.

The all-inclusive fee for tubal reversal with Dr. Rosenfeld includes 100% of all costs associated with the tubal reversal from the first office visit through to your post-op visit to ensure you are healing as expected. We also answer patients’ phone calls and emails to support their efforts to get pregnant.

Note that any well-woman appointments, fertility-related office visits, or testing or other follow-up medical testing required because of failing to become pregnant right away are not part of the tubal reversal procedure or follow-up. This assistance is available at Dr. Rosenfeld’s office or you may feel free to choose your own healthcare provider.

What happens during the first phone or in-office consultation?

Dr. Rosenfeld offers you a free in-office or phone consultation. After you provide information for our staff via our tubal reversal registration form, we request your tubal ligation operative report from the hospital where you had your tubes tied. It takes about 2 weeks to get the report and review it to determine if you are a candidate for tubal reversal. So about 2 weeks after you register, we call you to schedule your free consultation.

During this talk with Dr. Rosenfeld, he gives you more specific information about your expectations for the surgery based on his review or your tubal ligation operative report. He answers any questions you have and, of course, you can call back later if you think of more questions. To get started, completing the online patient registration form or call us to speak with a nurse to register over the phone.

What if my tubal ligation surgery report is not available?

While having the detailed account of the tubal ligation surgery is helpful, Dr. Rosenfeld can consult with you over the phone to try to determine what type of surgery you had and what the chances of pregnancy.

Will I be approved for tubal reversal surgery if I am overweight?

Obesity is a risk factor for causing complications for tubal reversal surgery and for your health during pregnancy. A BMI of 32 or below is required in order to have the best possible outcome. Learn more about why being overweight affects your safety and the tubal reversal results along with deas for reducing weight.

Am I too old for a tubal reversal?

Dr. Rosenfeld’s age limit for performing tubal reversals is 42. He is always concerned about patient safety and maximizing the possibility of getting pregnant after tubal reversal so he recommends IVF for patients over 42. He has many successful tubal reversal stories from women in their late 30s and early 40s…one of them had 5 babies in 6 years!

Why is tubal reversal better than IVF?

In most cases, tubal reversals offer more success for most women over IVF and are less costly, especially when multiple pregnancies are desired.

If Dr. Rosenfeld’s review of your tubal ligation operative report indicates you are a good candidate for tubal reversal, you will be able to conceive naturally after the surgery. You will be able to produce as many pregnancies as you wish. In most families, this is a preferred option to in vitro fertilization (IVF) because tubal reversal is 1/2 the cost of one IVF cycle.

Often, multiple IVF cycles are required to conceive. IVF is very profitable for many clinics, so you may be told that tubal reversal is not possible or rarely successful. This is incorrect.

Please visit with Dr. Rosenfeld…your consultation is free…before choosing to use IVF after a tubal ligation. He will provide you with honest, factual information to help you choose between IVF and tubal reversal.