Wed | Nov 14, 2018

Dear Doc | My wife wants to get her 'tubes' untied

Published:Sunday | July 22, 2018 | 12:00 AM

Q Dear Doc, I have a young wife who is 30 years old and I am not much older. We have been married a while now, but we have no kids together. However, she desires to give me a child, but we have one thing in our way that we're asking for your advice.

You see, my wife had the surgery done where she had her tubes tied. It wasn't for anything life threatening to her or for the child she had; she was in some trouble otherwise and decided that that was the best thing for her under the circumstances.

I know that the tubes can be untied surgically but may not be 100 per cent successful for her getting pregnant again, but please let us know what options we have, including artificial insemination. Please advise our options, along with costs, and where we can have either procedures done. Thanking you in advance for your response.

A Thank you for your question. I have often been asked this question, and the answer is not usually straightforward.

Tubal ligation, commonly called tying of the tubes, is considered a permanent method of contraception. For this reason, I usually simply say it cannot be reversed. However, that is really just a simple, easy answer, and like with everything, there are exceptions.

In order to determine whether your wife's tubal ligation can be reversed, there are a few things that need to be taken into consideration.

I will go through them now, and, in case she is not a candidate, list other options.

Contrary to what the term 'tying the tubes' suggests, the actual procedure does not

simply tie or knot the fallopian tubes. This is commonly why patients often think it is simply an 'untying' or 'unknotting' of the tubes that is required to reverse the procedure. However, there are various methods of performing a tubal ligation, and the possibility of reversal, as well as its success, is dependent on what method was used. If rings or clips were used to ligate the fallopian tubes, there is a better reversal success rate than if the tubes were burnt (cauterised), or if a portion of the fallopian tube was removed.

This brings me to my next point. Sometimes during the procedure, a portion of the fallopian tube is removed, and indeed, tubal length is another important factor in successful reversal. The reversal procedure is more successful in patients with 4cm or more of residual fallopian tube present. Usually if less is present, the reversal procedure isn't offered due to the very poor success rates.

Other aspects taken into consideration are the age of patients, and the time from the initial tubal ligation procedure to the reversal procedure.

If she is not a candidate for reversal, the other option is in-vitro fertilization (IVF). This involves removing the eggs from your wife's ovaries, then combining them with your sperm in order to form an embryo, then implanting the embryo into her uterus (womb).

Artificial insemination is not an option in this case.

The initial counselling and determination of her suitability for a tubal ligation reversal can be done by her gynaecologist. If she requires IVF, it is done in Jamaica at the Hugh Wynter Fertility Management Unit.

 

Erectile dysfunction after leg amputation

 

Q Dear Doc, I am 50 years old and have been suffering with diabetes and high blood pressure for more than 20 years, which has now resulted in a leg amputation. As a result, I have not been able to maintain any form of erection and I am therefore wondering if any of the medications on the market will be able to help me at all, or is it just over for me as it pertains to sex?

A Erectile dysfunction is a common problem in men with diabetes, and results from nerve and blood vessel damage, caused from long-term poor control of blood sugar. The addition of high blood pressure, which is also known to be associated with erectile dysfunction, further compounds your situation.

Having had both high blood pressure and diabetes for an extended period of time, which appears to be not very well controlled based on your requirement for a leg amputation, seem to be your greatest issue.

Simply taking a pill to fix your erectile dysfunction is really just putting a Band-aid over the problem, which will result in long-term, devastating effects, and not only to your sex life.

Improving your blood sugar levels can help prevent further nerve and blood vessel damage that causes the erectile dysfunction. In some cases, re-establishing good glucose control may decrease the problem, though permanent damage already done to nerves and small blood vessels may not be reversible.

Also, ask your doctor if any of the medications that you are taking might be affecting your erectile problems. Making a change to your medications might help.

Then, if that fails to show improvement, erectile dysfunction medications may include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). These pills can help ease blood flow to your penis, making it easier to get and keep an erection. Check with your doctor to see whether one of these medications is a safe choice for you.

deardoc@gleanerjm.com