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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:
________________________________________________________________________________________________
________________________________________________________________________________________________
SURGICAL HISTORY:
CURRENT MEDICATIONS: ____________________________________________________________________
PRJECT NAME
HOME/CELL/WORKPHONE: __________________________________________________________________
EMAIL ADDRESS: ____________________________________________________________________________
Thank you for contacting NCCRM in reference to a 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 the surgical
procedure or from the hospital 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 and the other in Greensboro, NC; you can make your
appointment wherever it is more convenient for you.
Important Weight Information
If you do not stay at the normal weight Body Mass Index (BMI) as listed below, liposuction
may be needed and the additional payment 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 38 or over, the procedure
will be cancelled with no refund. Note: If your BMI is 30 or greater, there is a strong chance that
you will need liposuction in order for the surgeon to access your fallopian tubes. 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
To find out what your Body Mass Index (BMI) is, please visit:
http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
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 the doctor 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. Liposuction improves the chance of success in those cases where the uterus is difficult
to elevate due to fatty tissue.
Cost of the Tubal Reversal is $4550.00
Cost of Essure/Adiana Reversal is $6250.00
• 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 accomplish 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 or tubal reversal procedure, which is performed in our
Cary, NC office. The procedure takes approximately 2 hours to perform with a recovery room time
of 1 - 2 hours. You will then be discharged. Patients who live more than an hour and a half away
should spend the night in Cary. The Best Western Plus offers a special NCCRM rate of $75.00
a night. Please mention NCCRM when you call 919-481-1200. 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, too. You will need a post operative visit one to 2 weeks after
surgery included in price, or you may follow up with your local doctor 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*