Florida Tubal Reversal Surgeon, Dr. Pabon, answers questions about tubal reversals:
Why should I choose Dr. Pabon and Fertility Center & Applied Genetics of Florida?
Dr. Pabon is a Board Certified Reproductive Endocrinologist and Infertility Specialist as well as a Board Certified Obstetrician and Gynecologist. He practices the full spectrum of infertility with both surgical patients and patients requiring IVF giving him a better perspective than most in considering the options for each patient. His technique and efficiencies allow for completion of the procedure in half the time usually required by others; resulting in much less patient discomfort and over 90% patency rates after tubal ligation reversals. Using his microsurgical and mini-incision techniques, Dr. Pabon has performed Tubal Reversals in an outpatient setting since 1993. During his Post-Doctoral and Post-Residency fellowship at the University of Louisville, he perfected his mini-incision techniques; thus making it possible to deviate from Hospital surgeries which required an overnight stay.
During his early training, Dr. Pabon was exposed to the techniques of gynecologic microsurgeons from around the world. He sought exposure to the microsurgical techniques of cardiovascular surgeons in the Texas Medical Center and his General surgical rotation included assisting in cardiovascular procedures at the Texas Heart Institute in Dr. Michael DeBakey’s opera ting rooms. Dr. Pabon gained a broad understanding of the microsurgical techniques used by plastic surgeons, vascular surgeons, urologists and brain surgeons during his medical school training at Baylor College of Medicine as well as during his Residency training at the University of Texas. He continued his training in Microsurgery through his post graduate subspecialty fellowship at the University of Louisville, choosing this program because it provided a balance between basic science, endocrinology, surgery, and assisted reproductive techniques. His broad exposure, training, and practice over more than twenty years has led to a very efficient and successful technique.
Dr. Pabon is not only recognized as a world-class surgeon, but also the Medical and Laboratory Director of Fertility Center and Applied Genetics of Florida, Inc. Dr. Pabon is also a Clinical Associate Professor in the Dept. of Ob/Gyn of Florida State University College of Medicine.
Dr. Pabon performs tubal reversals in a certified outpatient surgical center. He uses strict microsurgical techniques and adhesion preventive techniques in all his procedures. Higher magnification is provided by a full size Zeiss surgical stereomicroscope that can magnify up to 20 times while giving more depth of field than the surgical loupes used by many others. This allows the most accurate dissection and placement of sutures. Dr. Pabon uses sutures in the 8-0 to 9-0 range. These sutures are smaller in diameter than a human hair and two or three sizes smaller in diameter than sutures used in heart bypass surgeries.
If I am overweight, can I still have Tubal Ligation Reversal?
Dr. Pabon does not have a set cut-off for the size (weight) of a patient desiring tubal ligation reversal. However, patients are counseled regarding their size and the increased risk of both surgical complications and pregnancy complications with increased size and weight loss is always advisable before any surgery or pregnancy. There are many patients who may be heavy and carry their weight in parts other than the planned surgical incision site (for example their thighs or rear) and may be turned down by other surgeons because of their “high BMI.” Dr. Pabon looks at each patient individually.
Patients who do have a rather large tummy are advised to lose weight prior to the reversal because the obesity in the area of the planned surgery will make the surgery more difficult and sometimes impossible due to the limited length of the available micro-surgical instruments. In addition, obese patients have a higher risk of post-surgery complications like wound problems, blood clots or lung problems.
What are my options?In Vitro Fertilization versus Tubal Reversal
This is sometimes a complex decision with many variables including cost, success rates, age and so forth. Let us address it in parts.
Cost – This is oftentimes the great motivator toward tubal reversal in our practice. In vitro fertilization and embryo transfer procedures are more costly than tubal reversal.
Success Rates – More than 90% of the time, at least one tube is open after the microsurgical tubal reversal by Dr. Pabon. The chance of pregnancy success after a Tubal Reversal depends on three chief factors: the age of the mother, the type of ligation reversed, and the sperm count of the male partner.
Age – Just because a person had few complications with pregnancy or fertility in their twenties, does not mean that they will be as fortunate in their thirties or forties. The chance of success depends on the quality of the eggs being produced. The eggs of women as young as 33 are known to have more abnormalities that result in decreased pregnancy rates and increased miscarriages as compared to younger women. The trend continues and worsens much more quickly after the age of 36. This is why older women have fewer pregnancies and more miscarriages. This is why almost all egg donation centers limit the age of egg donors to 32 or less. Our center’s cut-off is 30.
An older woman with a prior “unfavorable type” of tubal ligation may choose to go through the IVF program because she desires the highest chance of pregnancy in a short interval of time. A younger woman with the same “unfavorable type” of tubal ligation may choose to try the tubal ligation reversal because she has more time to conceive than the more mature woman. The younger woman has the luxury of being able to wait on IVF without a significant drop in her chance of a pregnancy. The best results after tubal reversal are those of the particular age of the patient. The monthly chance of pregnancy for a normal couple in their mid-twenties is 20-25%. This decreases with age.
In the 1950s a group of immigrants from Switzerland called the Hutterites who live in the Northwest states was studied. They are a religious sect who live in a communal fashion and do not practice contraception. Only 5 of 209 women were infertile (a low infertility rate of only 2.4%). The average age at the time of the last pregnancy was 40.9 years. Eleven percent of women had no more children after the age of 34. 33% of the women were infertile by age 40. 87% were infertile by age 45.
Age of the female partner has been shown in many studies to be the most important factor for pregnancy success. A patient can have the most perfectly repaired tubes but fail to conceive because of age. Older patients don’t have as much time to conceive. Age is sometimes an incentive to proceed with IVF because several months of trying to conceive can be “compressed” into one treatment due to the recruitment of multiple eggs that is routine in IVF.
Type of Ligation – This is simple: the shorter the tube, the lower the pregnancy rates. Tubal ligations that involve extensive damage or burning of large segments of the tube leave less tube to work with. The human fallopian tube is about seven to eight centimeters in length. After a microsurgical tubal ligation reversal, the final tubal length is noted. The chance of pregnancy is lower with shorter final tubal lengths. Pregnancy rates are very low if the final tubal length is less than 2.5 centimeters. The post partum ligations (Pomeroy or Modified Pomeroy), the clips, and rubber bands are among the best to reverse. Patients who have had removal of large portions of their tubes or extensive damage will usually choose to enter the IVF program. There are cases where the patient and her partner have had children and simply want “the possibility of pregnancy” even if the tubal length is very short. In these cases a reversal can be performed after thorough counseling and discussion of the limitations.
The Sperm Count – The World Health Organization has determined that the lowest “normal” count is 20 million per milliliter or cc of ejaculate. 20 million represents the lowest possible number to be considered normal. Most men have counts in the range of 80 to 150 million sperm per milliliter of ejaculate. A more important assessment is the “total normal motile count.” This takes into account the number of sperm that are alive and appear normal. A very good recent study determined that patients with total normal motile counts of less than 10-12 million per cc are best treated with IVF. If a male partner has a suboptimal sperm count, the chance of pregnancy even after the world’s best tubal reversal will be close to zero. Please note that sometimes low sperm counts can signify a medical problem. A qualified urologist must examine the patient. One percent of the time a testicular tumor is discovered.
What is the cost for a Tubal Ligation Reversal?
Dr. Pabon has perfected the technique for Tubal Ligation Reversal to a high level of efficiency therefore allowing our anesthesia team and our Outpatient Surgery Center the ability to give very competitive prices. It is our belief that we have the lowest package price for Outpatient Tubal Reversals in the Continental U.S.A. The prices range from $4500 to $6500.
What are the risks of surgery?
Like any medical or surgical procedure, there are potential risks. The reversals are usually done through a three inch lower abdominal incision. This carries all the routine risks of surgery such as infections, hernias, chronic incision numbness, or injury to other structures. Surgery and anesthesia are not without risk. Severe injuries or even death could occur. That said, Dr. Pabon is very meticulous and detail oriented. The anesthesia team and surgery center are second-to-none. As a patient, you must understand that this is an elective procedure for the purpose of achieving a pregnancy. To that end, you must optimize your health as much as possible before surgery and pregnancy.
One of the most common problems encountered is obesity. If you are obese, it is in your best interest to get in shape for elective surgery. Doing so will decrease the risk of infections and serious complications like pneumonia, blood clots and pulmonary embolus. In addition, you will have a much higher risk pregnancy if you are obese. It is well documented that large women have higher rates of intrauterine fetal death, pre-term labor, diabetes, and high blood pressure.
What happens after surgery? Should I be aware of additional complications?
After a tubal reversal you are asked to check your temperature 3x/day and call if your temperature is higher than 100.5. You should remove the bandage 24 hours after surgery and inspect your incision. Redness, persistent drainage, or swelling should be reported to Dr. Pabon immediately. In addition, you should not have sex or get pregnant for 6 weeks. Sex or strenuous activity could tear the delicate tubes apart and a pregnancy before six weeks of healing will result in a tubal pregnancy.
After a tubal reversal you should always have a blood pregnancy test if you are 5 days late for your menstrual cycle. Your local Ob/Gyn or Dr. Pabon (if you live near us) should be involved very early in order to determine if you have a normal pregnancy or a tubal pregnancy. You should not allow anyone to postpone your initial Doctor visit past the 5th week of the pregnancy as a tubal pregnancy could rupture and cause you to require major surgery. If you are diligent, and a tubal pregnancy is detected very early, it can be treated with medicine instead of surgery and your tubes should not be damaged. This medical treatment carries an 85% success rate.
You must be very responsible. It is a good idea to do a pregnancy test if your menstrual cycle is too early, too late, too light, or too heavy. Tubal pregnancies can present with subtle changes in the usual pattern or character of the menstrual flow. In summary, the most common complication of a Tubal Ligation Reversal is a subsequent ectopic pregnancy. Patients can try to avoid serious consequences by not ignoring a delayed menstrual cycle or a menstrual cycle that appears different in any way. Many ectopic pregnancies are associated with vaginal spotting or bleeding. When in doubt, please contact Dr. Pabon or your qualified Ob/Gyn. so that an early blood test can be ordered. No emergency contacts should come through the web site or e-mail. Please call the office.