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North Carolina Center of Reproductive Medicine
400 Ashville Ave. Suite 200, Cary, NC 27518
Tel : 919-233-1680 Fax : 919-336-5089
TO: Heather
FROM:
COMPANY: NCCRM
DATE:
RE: Tubal Reversal Inquiry
PAGES:
CURRENT NAME: _____________________________________________________________________________
NAME ON MEDICAL RECORD: ________________________________________________________________
BIRTH DATE: _________________________________________________________________________________
HEIGHT: _____________________________________________________________________________________
WEIGHT: _____________________________________________________________________________________
(Please refer to the BMI criteria on the next page)
MEDICAL HISTORY:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
CURRENT MEDICATIONS: ____________________________________________________________________
PRJECT NAME
HOME/CELL/WORKPHONE: __________________________________________________________________
EMAIL ADDRESS: ____________________________________________________________________________
Thank you for contacting NCCRM about tubal ligation reversal or Essure/Adiana reversal
surgery. We are proud of the service we provide and our goal is to help you achieve a
successful pregnancy.
The first step is to provide us with an operative report and pathology report from your
tubal ligation. These can usually be obtained from the physician who performed your surgery
or from the hospital/facility where it was performed. The information you provide will
allow us to determine if you are a candidate for the tubal reversal procedure. These may
be mailed or faxed to 919-336-5089. Please be sure to put your contact information on the
paperwork and include your phone number, height and weight.
The second step is a review of the information you have provided. The physician will
determine if you qualify for the procedure. We will contact you with the final decision.
The third step for patients who are approved is a consultation with the physician. NCCRM
has two offices one in Cary, NC the other in Greensboro, NC; you may make your
appointment at the location most convenient for you.
*It is very important to stay at your current weight.*
If you do not stay at the normal weight BMI as listed below, liposuction may be needed and
an additional fee of $1000 is due at the time of surgery. You will be weighed on the day
of surgery. If on the day of surgery your BMI is over 38, the procedure will be cancelled
with no refund. We do encourage losing weight before surgery for health and medical reasons.
Typically, the upper limit BMI to qualify for surgery at any out patient surgery center is 38.
BMI Categories:
•
Underweight = <18.5
•
Normal weight = 18.5–24.9
•
Overweight = 25–29.9
•
Obesity = BMI of 30 or greater
For BMI calculator to see where you are please visithttp://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Why is liposuction sometimes performed at NCCRM before tubal reversal surgery?
Tubal Reversal Surgery is a very precise surgery that requires a microscope to place your
tubes back together. The microscope needs to get as close to the tubes as possible to be
able to get the best focus to ensure success. Removing excess fat using liposuction
immediately before the tubal reversal procedure allows our surgeon to get the best possible
view of the tubes. After the fat is removed from the area of the incision, he is able to go in
and perform the tubal reversal.
The cost of the Tubal Reversal is $4550*
• The cost for the initial consult and ultrasound is $280.00. Your insurance may cover this
cost.
• Semen analysis is suggested for your partner, the cost is $100.
• 50% of money is due before scheduling the surgery and the remainder is due two weeks
before surgery.
• $1000.00 additional fee for liposuction if needed in order to perform the reversal.
• Please note that there is a $750 non-refundable penalty fee for refund request after money
has been paid on account.
• A 50% fee is charged for cancellation of surgery within 2 weeks of surgery pre-op visit
• No refund is given if cancelled within 1 week of the surgery pre-op visit
• There is a $500 fee for rescheduling the surgery after it has been booked.
The final step is the tubal anastomosis, which is performed in our Cary office. The procedure
takes approximately 2 hours to perform with a recovery room time of 1 - 2 hours. You will then
be discharged to go home. Patients who live more than an hour and a half away should spend
the night in Cary. The Comfort Suites (919) 852-4318 and Hampton Inn (919) 859-5559 are
less than a mile away from our office and they have special discounted rates for our patients.
You will need a post operative visit one to 2 weeks after surgery included in the price, or you
may follow up with your local M.D. if you live more than two hours away.
• If you have medical questions please contact Heather at 919-233-1680 ext. 180 or via
email [email protected]
• If you have financial questions please contact Schann at 919-233-1680 ext. 138 or via
email [email protected]
*The above discounted pricing is for cash paying customers.
(Certified check, credit card and debit card)
*Please refer to our website for standard pricing*