posted
Donna, I hate to mention this and have it sound dishonest in any way, but your doc can send you for a LAP for any other problems you may have and have it covered by your insurance. I say my GYN in Feb and told him my plans for TR, and he was going to send me for a LAP because of my PTLS symptoms and it would be covered by your insurance plan as long as it was requested by your GYN for medical reasons, so you wouldn't have to pay the extra $ for the LAP at CH. Then send or fax him the request for medical records from CH and they really have no reason to deny the request for your records to be sent. Hope this helps....
posted
Hello Donna whilst I see your questions have already been answered by our tubal reversal nurses Julia and Laura, please allow me to add some more information by quoting Dr. Berger and tubal-reversal.net:
"There are 3 main techniques that can be used for reversing tubal ligation.
Tubal ligation by fimbriectomy involves removing a portion (usually up to one-third) of the fallopian tube closest to the ovary. With microsurgical techniques, the end of the remaining fallopian tube can be opened and the inner tubal lining gently folded outward over the cuff to improve the chances of egg capture. This tubal reversal procedure is called microsurgical salpingostomy.
It is generally thought that tubal reversal cannot be successful following a fimbriectomy because of the loss of the important egg-capturing fimbria. Fortunately, the inner lining of the remaining tube also has the cilia that help transport the egg into and down the tube once it has been reopened. Cilia are particularly abundant in the ampullary portion of the fallopian tube. The length of the remaining tube and presence or absence of its ampullary segment can be determined by x-ray (hysterosalpingogram). This is recommended prior to undergoing a salpingostomy procedure. The pregnancy rate after fimbriectomy tubal reversal is 30-40%.
Fimbriectomy differs from other methods of tubal ligation. Fimbriectomy is performed by removing the fimbrial and infundibular portion of the fallopian tube next to the ovary, leaving behind one tubal segment attached to the uterus. The other, and more common, methods of tubal ligation leave behind 2 tubal segments with the fimbrial end still present. This is true whether the fallopian tube has been separated by ligation and resection, electrocoagulation, or mechanical obstruction. After fimbriectomy, the remaining tubal segment can be opened by the technique of microsurgical salpingostomy."
Donna, here are a few other message board posts that address your question:
There is cilia located throughout the inside of the fallopian tube. This is what makes it possible to recreate the fimbrae. Please have your films sent to us, so that Dr. Berger and Dr. Monteith can review them.
posted
Yes I believe someone from your office confirmed from my OR report and my pathology that fimbria were removed from both sides.
I also saw that I had no fimbria when the HSG was done but I still had decent lengths as it looks from my pathology that 3.5 cm of the end and fimbria were removed from each tube.
So guessing if you start with 10 cm on average that still leaves me with 6.5 I guess.
I tried to ask what cm's it takes to fold over the end of the tube for the cilia to be exposed but got no answer from either Doctor.
I'd still like to know that if you could ask please. Does it require at least (speaking of averages here now) 3 cm to fold over the end of the tube or on average has it been less than that that is required. To me that would be an important element -to take another 3 cm would leave me with 3.5 and altho I know women have gotten pregnant with smaller tubes, my age and no fimbria would make it almost a no brainer that it would never happen.
Either way I'm still going to get it done for the PTLS, I guess it's just whether or not I not set myself up for even TTC based on these facts.
Could you please ask Dr. Berger or Dr. Monteith how much they usually require if all else is normal with tube to 'fold' over to expose cilia? Also is cilia in the entire tube, or just near the end approaching the fimbria? I know a few ladies have asked same question on here and it not been answered. Thanks, Donna
Thanks for the information. Contrary to an earlier post, tubal reversal surgery is possible - and frequently performed - after a fimbriectomy, especially when good tubal lengths remain. (Even on one side) Please send a copy of the films for Dr. Berger and Dr. Monteith to review. Having open tubes after a reversal restores fertility, provides a chance for pregnancy to occur naturally any month (unlike IVF) and has higher pregnancy rates in most cases, even with repair of a fimbriectomy. Do we know for certain that your fimbrae were removed?
posted
The lap is an extra $1000 I don't have unfortunately and my insurance is paying for all this pre-testing so figured might as well get done what I can get done with copays.
IVF many doctors don't do them on women over the age of 45. I'll be 46 in February and be lucky if I can convince my hubby to go that route, never mind the RE. He's this kind of guy, 'if it's meant to be, it will be" sort of deal. Short of getting rid of him...lol...a TR is my only alternative at any attempt (for now) at a baby with him. I figured once I got pregnant, or the thought anyway, the DF might come back around to the way he used to be, excited and telling his coworkers before we even told family.
Plus the IVF doesn't alleviate my PTLS symptoms which can be BRUTAL some months, like right now for example. I've never been the same after my TL and I was in my 30's when I got it done, so this crap these doctors tell you, it's pre-menapause symptoms is bull-crap. Gosh, I'd love to challenge the Medical Field with recognizing this PTLS (just too many other things going on).
Ahhhh...life is always a struggle but the rewards wouldn't be so appreciated if we didn't have to go over barbed fenced wire to get there.
posted
Donna, I don't think the doctor can withhold your medical records. In any case, once you get your blood work done, you may just want to schedule a lap w/ CH. They don't need the HSG results to be ablt to do anything. If you had the lap, you would know where you stand.
If you don't have fimbria, I think you should probably listen to your RE and go IVF. I know it doesn't sound like you want to go that route, but seriously it makes more sense, and no one wants to waste that much money without a fair chance at success.
posted
I had my HSG with the RE last Tuesday and was elated with what I thought I saw, even more excited with what I was told (maybe).
RE told me at initial consult that both my tubes were completely gone. RE's ARE so wrong or they assume the worst so you'll consider IVF.
At the HSG, which RE did himself, we saw my right tube fill up and leak over, not a lot but there wasn't a complete closure there (thus explains my pregnancy 2 years ago).
Then we saw my left tube fill up (slowly) and what I saw was at least 3-4 inches of EACH TUBE still present when RE was even shocked that dye was going in that tube.
He clearly dismissed that both tubes are blocked 90% that I couldn't get pregnant and no fimbria to catch the egg and sweep it into the tube....GRRRRR
NOW its been like pulling teeth trying to get them to send my records of this HSG to Chapel Hill for Dr. Berger and Monteith to look over. I've called several times asking for a copy of my HSG so I can forward it to your office and the nurse says, well I'll see what i can do and then no one calls me back.
I really believe this RE doesn't want to tell me that I'd be a good candidate for the reversal given what we both saw AND the fact that two years ago, with NO fimbria and no repair, I still managed to get pregnant and at age 43.
I am just waiting on all my testing to ensure my egg quality is good (afraid to have this RE's office do it now for fear they'd give me false reports) because they just keep talking to me about donor eggs, donor eggs. However, I don't want to peeve this RE off, he's the best there is in Charlotte and if I need him for IVF, I'd want to keep that in my back pocket so trying to tread lightly here.
I am needless to say very excited and cranky that I let an RE cause the emotional roller coaster my DF and I have been on. We're together again but not talking about having a baby that is for sure which is very tough...I'm no spring chicken
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