Getting Started . . .

Thank you for contacting us, and for your interest in RAD’s Tubal Reversal Program. You probably have many questions about our Program, and we hope this brochure will help you understand the process. Our physicians and staff are committed to your success, and to helping you be as informed as possible.

Our Tubal Reversal Program is unique because of the surgical abilities of our Director, Dr. Barbara McGuirk. In 1996, Dr. McGuirk began learning and perfecting the tubal reversal procedure through a laparoscopic (keyhole) approach. This is a method that requires great technical skill, and is only carried out by a select group of reproductive surgeons in the U.S. and around the world. Most other surgeons that perform tubal reversal surgeries utilize older approaches requiring larger incisions, and usually operate in a hospital setting. This can require a great deal more healing and recovery time, as well as cost, and has not been demonstrated to be more successful.

Dr. McGuirk is committed to evaluating each prospective patient on an individualized basis. Our clinical and administrative teams will help you gather the information you need in order to make your consultations with Dr. McGuirk as productive and informative as possible.

Why Laparoscopic Tubal Reversal?

Here are some reasons that the laparoscopic approach may be beneficial to you:

Less pain. Having small abdominal ‘keyhole’ openings, rather than one larger incision, leads to much less pain post-operatively.
Shorter recovery. Laparoscopic procedures are notably shorter in duration than ‘open’ procedures, and require less anesthesia and recuperation. Most people are back on their feet, and back to work, in 3 to 5 days.
Less trauma and scarring. Your reproductive organs are never exposed to the outside air, reducing risk of infection, injury and scarring.
Outpatient setting. Like other laparoscopic fertility procedures, there is rarely a need for an overnight hospital stay.
State-of-the-art optics. Our equipment is unparalleled, allowing much better visualization of your tubes compared to ‘open’ procedures.
Lower cost. With laparoscopy in an outpatient setting, we can provide predictable, lower costs associated with the entire procedure.
Experienced Co-Surgeons. Dr. Ronald Feinberg has been ‘scrubbing’ with Dr. McGuirk on thousands of laparoscopic procedures since 1996, and has assisted her with laparoscopic tubal reversals. Dr. George Kovalevsky joined our practice in 2005, and also works closely with Dr. McGuirk. All three physicians are fellowship trained reproductive endocrinologists and are Board certified.

As we get to know you better, whether by telephone, e-mail, or in person, here are some common questions we might have for you:

What Is Your Age? Your age could have a direct impact on your ability to achieve a successful pregnancy, independent of success with the tubal reversal procedure. We have performed reversals for women in their early 40s, but have informed them ahead of time about age and decreased fertility.
How Was Your Sterilization Procedure Carried Out? Certain types of tubal ligation procedures are more amenable to reversal than others. For example, if your tubes were ‘clipped’, ‘looped’, or a small part removed after childbirth, that carries a better prognosis. If your tubes were cauterized (i.e. burned), that could be a lower prognosis because it is impossible to know ahead of time how much healthy tube remains.
What Is Your Weight and Body Mass Index (BMI)? This is an important consideration prior to any elective laparoscopic procedure, and can have an impact on pregnancy outcome.
Are You Healthy, and Were Your Pregnancies Healthy? Good health prior to conception is a philosophy RAD takes very seriously. Taking a thorough medical history prior to tubal reversal is an important aspect of our Program.
Do You Have Any Gynecologic Problems Now or In The Past? Women with a previous history of gynecologic surgery, tubal disease, pelvic infection, endometriosis, fibroids, or ectopic pregnancy may have a more guarded prognosis with tubal reversal procedures, and should be counseled and evaluated thoroughly. Our Program pays attention to these details.
Have You Considered In Vitro Fertilization (IVF)? Many of our patients start out inquiring about tubal reversals at RAD, but realize that IVF may be a better medical and/or cost-effective option for them. Our practice provides full-service, subspecialty reproductive endocrinology and fertility care, and our physicians consult with and counsel many patients who are trying to make informed choices.

What Medical Testing Does RAD Recommend?

Many patients want to know the details of medical testing we recommend prior to moving ahead. This is a brief description of tests we recommend, along with some reasons for why we believe these tests are important:

Is Your Partner Fertile? Male infertility has reached epidemic proportions, and a male’s previous fertility history is no guarantee of normal sperm currently. It would be a shame for you to go through a tubal reversal procedure, only to learn afterwards that you can’t get pregnant because of your partner’s poor sperm. We strongly recommend that a semen analysis on your partner be carried out ahead of time.
Are Your Pelvic Organs Normal? We recommend you undergo a thorough examination and pelvic ultrasound by one of RAD’s clinician staff. In addition, we recommend a specialized ultrasound — saline sonohysterography — to make sure the inside of your uterus is normal.
Are Your Ovaries Functioning Normally? We recommend certain hormone tests early in your menstrual cycle (i.e. cycle day 3), to help assure you that ovarian reserve is normal. If you have irregular cycles, that problem should be discussed with our clinical staff.
How Can We Test Your Tubes? In order for your tubal reversal to be successful, the portion of tubes connected to your uterus needs to be normal, and have a reasonable length. This can be tested by an X-ray dye test known as a hysterosalpingogram, or HSG. Knowing that X-ray dye flows easily into the beginning portion of your tubes is very important information. Dr. McGuirk’s consultation with you focuses closely on the results of your HSG.

How Can I Make Things Convenient and Efficient for Myself?

Over the years, we have learned that complexity and high costs create unnecesary barriers for people. In our Program we recognize the value of your time, and we don’t want you to have to jump through too many hoops. Another goal of our Program is to maintain our costs at a reasonable level, and to advise you of what other costs are involved. Towards that philosophy, we can help you plan ahead, by answering the following common questions:

How Much Time Does the Testing Take? All testing noted above can be performed within a one week ‘window’ after your menstrual cycle has stopped. If you live locally near one of our offices, our coordinators will accommodate your schedule and inform you in advance of the time required for each test.
Is All Testing Done In Your Office? All tests except the HSG are performed in our office. The HSG is carried out in the radiology department of Christiana Care Hospital, very close to our office. RAD clinicians perform the HSG procedure in conjunction with hospital radiology staff.
Do These Tests Have to Be Performed By Your Office? The short answer is no. If you live a distance from our office, our coordinators will help you carry out tests closer to your vicinity if that is more convenient for you, and instruct you on forwarding results to RAD. For example, if your gynecologist and/or radiologist is willing to perform the HSG test, that is generally just fine.
Does Your Office Perform Semen Testing? Yes, and we have a certified lab within our office to carry out detailed semen analyses. If you live within an hour of our Christiana Care or Dover offices, your partner can collect a sample at home, and either you or he can bring the sample to our lab. Alternatively, many men prefer to collect a sample at our main office, where it is analyzed immediately.
Does Your Office Perform Blood Testing? Yes, and this is easily coordinated and scheduled.
Will the Doctors Do a Telephone Consultation? As much as we might like to accommodate this, most states do not permit a physician to provide medical advice to patients who are located in a state where the physician doesn’t have a license. However, once your testing is completed, the physicians can review all of your information for a nominal charge, and have our coordinators let you know whether it seems logical for you to come to Delaware for a consultation.

What Are The Costs?

We are serious and diligent about our work, and we work best with potential patients who have a serious interest in our Program. Towards that end, we have broken down the cost structure for you, so you understand each aspect of the process:

Initial Information. If you’ve read this far, you already know that you’ve gotten a lot of information about our Program at no cost. Likewise, if you have follow-up questions, our staff will do our best to answer them by e-mail or telephone, and at no charge.
Initial Consultation. Your initial meeting with our clinical staff (nurse practitioner or physician assistant) will involve a detailed history and review of your relevant records. One important item for us to review is the operative note from your tubal sterilization procedure. If you have other relevant records or test results, please bring those with you. Charge for this consultation: $125.
Testing and Workup at RAD. If our practice performs all of the testing outlined above, our charge is $675, payable in advance by cash, check, or credit card. After the HSG procedure, the hospital will bill you directly for approximately $375. Unfortunately, we can not schedule or perform any testing for you prior to you making payment to RAD. Fees for the testing are nonrefundable, even if the tubal reversal procedure is not performed. However, if you remain a patient at RAD by chosing a different treatment, such as IVF, certain testing fees can be applied to that.
Testing and Workup Outside of RAD. If our practice doesn’t perform the testing, but assists you in getting your testing done near your home, our administrative charge is $150, payable in advance by cash, check, or credit card. This charge includes the time spent by our physicians reviewing your results after they are received by our office.
Consultation with Dr. McGuirk. This is an important aspect of your care within our Program, as it provides a chance for you and your partner to understand all medical issues surrounding the tubal reversal procedure. During this visit Dr. McGuirk will discuss pros and cons of the procedure, (individualized to your history and testing), the risks and benefits, technical details, and necessary follow-up care. She will typically spend 45 minutes or more with you. The cost for this consultation is $250, but is credited to your procedure fee if you decide to proceed.
Laparoscopic Tubal Reversal (Professional Component). The physicians’ fee for the procedure is $4,200, which includes two laparoscopic surgeons — Dr. McGuirk and either Drs. Feinberg or Kovalevksy assisting. Assuming $250 was already paid for the consultation with Dr. McGuirk, a balance of $3,950 is due when surgery is scheduled. Included in this fee is the post-operative visit one week later to have sutures removed and to discuss the details of the procedure. If additional procedures are required, charges for this will be discussed with you in advance. For example, some patients present to us with other gynecologic problems that can impact fertility or cause symptoms, such as fibroids, polyps, or endometriosis. Dr. McGuirk will discuss these issues with you ahead of time at the consultation.
Facility and Anesthesia Fees. Our negotiated fees with the Delaware Outpatient Center for Surgery (DOCS) — a highly regarded ambulatory surgery center — are $2,000, payable to the Center. This global fee includes all equipment and supplies for your procedure, nursing and technician assistance during your procedure, and outstanding recovery room one-on-one nursing care. If additional surgical procedures are required, the DOCS facility fee will be higher by approximately $500 to $750. Anesthesia services cost $500 to $750, and are billed to you separately.
Followup HSG. This is recommended 3 to 4 months after the tubal reversal procedure to assess whether the tubes are open. This test can be done by RAD clinical staff for $150 (hospital fees also will apply), or by your gynecologist.
Followup Pregnancy. If/when you believe you are pregnant, it is recommended that you start pregnancy hormone testing immediately. The risk of tubal (ectopic) pregnancy is higher in women who have undergone tubal reversal surgery. RAD offers this testing to all of our patients. Most insurances will cover pregnancy testing via blood studies and ultrasound, especially if ectopic pregnancy is a concern. If you do not have insurance coverage for early pregnancy testing, our coordinators will discuss fees with you.

What Financing and Payment Options are Available?

Our practice is pleased to offer you several affordability options, including payments by credit card, financing through Commerce Bank, financing through ARC (www.arcfertility.com), or rapid credit approval through CareCredit (www.carecredit.com), a GE Money company. You should feel free to discuss your specific situation with our practice coordinators.