Tubal Reversal

As detailed in the book Physicians Healed, I began my OB-GYN training doing contraception. As time went on I saw that most contraceptives were actually abortifacient. But there were other bad humors in my contraceptive practice as well.  Putting all fourteen-year-olds on birth control pills, it seemed like we were unleashing an epidemic of sexually transmitted diseases, including cervical dysplasia and cervical cancer. It seemed like there was a generalized loss of respect for patients. Not only did we trivialize the patients, but also our profession. We thought of ourselves as plumbers of the reproductive tract. Tubal ligation was a short, common and seemingly trivial operation.

Later I began to rethink things. In my genetic fellowship it began to dawn on me that Mary was the Ark of the Covenant. Her womb was thus a sanctuary, or Holy of Holies which contained the baby Jesus. I gained greater respect for the vocation of motherhood. I began to have much greater respect for the womb. It’s not just a hollow muscular organ. It is where women cooperate with God in development of new human life.

Later I learned to become a natural family planning doctor. I began to see that rather than being a plumber of the reproductive tract, I could be the doctor to a marriage. I learned the contraceptive doctor unleashed more than ten plagues on society. These may include teen pregnancy, abortion, divorce, fatherless children, gang violence, men’s loss of respect for women and many more. And I heard about a confessor in Yugoslavia who told penitents that their fallopian tubes were “a river of love and life.” Their anatomic integrity was essential to love, marriage, family, and society. In the distal fallopian tube is where the sperm, egg and God met for the individual act of creation.

Couples preparing for a new marriage often want tubal reversal. They sense that anatomic integrity of the fallopian tube is essential to love and marriage. They sense that being open to new life is integral to their marital relationship. Many are called to reverse tubal ligation but fewer actually do it. It requires faith, determination and some money. While I always encourage women to do it, I have great admiration for those who see it through to completion.

Some factors can be helpful in preparation. An X-ray of the uterus and tubes (hysterosalpingogram) is helpful. One would hope to eventually have a fallopian tube which is at least four cm long. The operative report of the tubal ligation can be helpful, although it is not always reliable or complete. The surgeon doing the tubal ligation sometimes does more damage than necessary. Doing more damage at the time of the tubal ligation makes the tubal ligation less likely to fail, but could create more difficulties for reconstruction. There can be other factors as well, such as endometriosis, scarring, fibroids, ovarian cysts, etc. In the final analysis, one cannot be guaranteed full knowledge ahead of time.

It is a technically challenging operation. The structures are very small. The operation is usually done with high magnification with an operating microscope. It usually takes several hours of careful work.

Those who desire tubal reversal are usually older than those who got their tubes tied. Successful reconnection of the tubes does not guarantee pregnancy. Age has an influence on fertility, after this operation and in general. The chronological age cannot be changed. A program to decrease toxins, increase nutrients and exercise, and balance hormones may reduce biological age. It could be helpful in anyone preparing for a successful pregnancy.

Thus, I usually recommend tubal reversal for anyone who has been sterilized. It is not trivial, either for patient or doctor. I admire those women who have courage and determination to complete it. And they seem to be glad they did it, whether they get pregnant or not. It is an honor to be able to care for such heroic women.