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Change of heart; After four sons and a tubal ligation, a mother decides to reverse the process and welcomes daughter No. 1

Laurie Ortiz, 32, had four kids -- all growing, lively boys -- when she decided to undergo a tubal ligation procedure.

At the time, having her "tubes tied" felt like the right choice for the South Dayton mom.

But then, with time, Ortiz realized she wanted more children. After a bit of searching, she found a doctor in Western New York who performs operations to reverse ligations -- a process called tubal reanastomosis -- and had the reversal done in summer 2009 at Sisters Hospital.

Ortiz's daughter, Delaney Sebastiana, was born June 23, 2010, and is today the delight of her family, her mother said.

"The boys adore her," said Ortiz, who works for the state as a staff member in a group home for the developmentally disabled in Perrysburg. "They take care of her, play with her -- they even change a diaper or two. My 12-year-old son said, 'Mom, when I move out, Delaney's moving with me.' "

Ortiz is a success story in the tubal reanastomosis picture in Western New York, which seems, through some anecdotal evidence, to be growing, some local doctors said.

While it's been possible to attempt to reverse a ligation operation ever since the sterilization procedure for women was devised, nowadays there are better and safer ways to do the reversal procedure. There also are many more success stories like that of Ortiz, said Dr. Ralph C.

Sperrazza, an Amherst doctor who is one of the chief medical practitioners handling the surgeries in Western New York. Sperrazza handled Ortiz's procedure.

"In the last 20 years [doctors] have been using techniques [for ligation] that do far less damage, and which make the tube repairable," said Sperrazza, who has been affiliated with Sisters Hospital for 33 years and who also operates his own practice, Western New York Infertility and IVF Medical Associates, on Main Street in Snyder.

"It's not new, but there are refinements to it," Sperrazza said of the reversal operation. "What we're seeing now is, there's just much more of a demand for it. Lots of people are changing their minds -- which may be a newer phenomenon."

At Women & Children's Hospital of Buffalo, Dr. Kevin Fitzpatrick, clinical chief of OB/GYN services for the Kaleida Health system, said that he does about one reversal a year. He attributed some of that level of interest to the fact that more women who have had their tubes tied seem to choose in vitro fertilization over the reversal of a tubal ligation because it is not as invasive.

"In my practice, we'll have probably four or five requests for information on the reversal for every one person who goes forward with the procedure," said Fitzpatrick, whose private practice, Omni OB/GYN, is located in West Seneca.

Doctors cautioned that both tubal ligation and its reversal are serious procedures that should not be undertaken lightly.

"I would always caution a woman: this is permanent," Sperrazza said, of ligations and reversals. "I talked several patients out of having their tubes tied, because it is so permanent. It's a lot to do it -- and then to reverse it."

Added Fitzpatrick: "Any surgery is dangerous and it can take a couple of hours, because it's microsurgery. The tubes are pretty small. So it's major surgery.

"When you counsel a person about sterilization," Fitzpatrick said, "you really want to make sure the person understands it's a permanent decision. You want to make sure they know this is a permanent procedure."

Both the ligation and the reversal require surgery and general anesthesia, and Ortiz recalled being in the hospital for a one-night stay with her reversal operation.

"To me, it was sort of like having a C-section," the mother of five said.

She said she took about three to four weeks to recover from her operation and feel like herself again.

The operation can also be expensive. While Ortiz's reversal was covered by her state-provided health plan, Sperrazza said the operation can cost around $10,000 for many people paying out of pocket.

"There are patients who I discourage from going this route," he said. An example would be women who are older than 40, he said.

Fitzpatrick said he believes the cost of the procedure -- without insurance coverage -- is another reason some local women don't opt for the reversal when they otherwise might be interested in it.

"There's not that many that are done [overall] in Western New York. A lot of it is the reimbursement for it -- a lot of payers won't pay for it," he said. "It's kind of an expensive procedure, and that limits the number of people who are eligible for it."

Sperrazza said that he has performed 18 tubal ligation reversals and, excepting one patient with another condition that affected conception, he is running a "90 percent success rate" with getting those patients to live birth of babies.

"The national success rate is more like 60 to 70 percent," he said.

The procedure itself takes about two hours, he said.

Sperrazza said it requires an incision similar to a C-section; after examining the fallopian tubes and pelvis, the doctor cuts away some scarred portions of the tube from the ligation procedure, exposing fresh openings, which he then sutures together using very fine suture material.

"It's like you have a length of hose with a bad, withered portion of the hose," the doctor said. "You are going to cut back that hose 'til you come to a normal portion and then stitch it together with the other normal portion."
Sperrazza said he generally advises patients to wait a few months before attempting conception.

But for Ortiz, who was previously married for eight years but now is in a new relationship with a former high school friend, that part of the process was no problem.

"I got pregnant right away," she said. "I was so excited. I didn't expect it to happen so fast."

And she added that despite her growing brood -- besides Delaney, there are sons Joshua, Gilberto, Dante and Christian -- she may even be interested in adding another child to the family.

"I'd like to have one more."


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