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Getting The Ball Rolling:
1. Very FIRST thing: Get an appointment with your Primary Care Provider. Discuss with your PCP your desire to have a reversal. It is also a good idea to schedule a yearly physical along with this appointment to get a Pap smear &
an over-all check up. Tell your PCP that you want a referral to get a reversal. They will usually give you one gladly. If not, contact the list owner or other members for suggestions.
2. More than likely, you will get referred to your bases OB/GYN department for an intake appointment. It is a good idea to have at hand your post-operative report & any medical records pertaining to your original tubal ligation. (See below for info on getting these items.) As there are limited installations that provide tubal reversals, chances are you will be referred to another
installation for your actual surgery. (See Tricare Travel below.) Whether you are at an installation that provides TRs or you are referred to another base, you will have several tests ordered by the staff at your home duty station. If these tests are ordered by staff at the referred to installation, you can get them at your home duty station in order to save time & miles. You may have to
get proof of these tests being ordered & take them to your PCP in order to have them at your home base. Most doctors are more than happy to coordinate this with one another.
3. Once referred to an installation that does TRs or if you are at one that already provides this service, you will have these tests. Depending on the wait & amount of staff on hand, these tests may take anywhere from a few weeks
to several weeks in order to fully complete. Expect a slow process (up to 1-2 years) as there are many women seeking this service through the military. The speed of your own personal case depends on where you are stationed & physician
availability. It will help for you to have a flexible schedule & as much information on your past ligation as possible. Also, if you have any of the tests ordered in the last year for reasons unrelated to a TR, please let your
physician know. In most instances, if you have had a particular test recently, they will acknowledge it & you will not have to repeat it. The tests you may be required to have are: HSG (where dye is inserted into your uterus to see how much tube may be left & the health of your reproductive organs), a Clomid Challenge (where you will orally take Clomid, an ovulation inducer, & have blood levels drawn on certain cycle days this tells them if you are ovulating properly), a routine blood profile which may include an HIV test, & your husband will have to provide a semen analysis (see Low Sperm Count below). These tests are mandatory by all installations for the purposes of getting a TR. The military wants to make sure you can GET pregnant if they are going to spend the money & the resources to fix your tubes.
4. Once you have passed all tests & your spouse has had a good semen analysis on record, you will be put on a waiting list for the installation that will do your surgery. As stated before, you may be waiting a short time or a very long time depending on several factors. Usually, active duty service members who request this surgery are priority over dependents. When your time comes, you will be scheduled for your surgery. Keep in regular touch with this facility.
Things That May Help Speed Your Wait Along:
1. Have a complete a copy as possible of all of your medical records. The Medical Records Dept. usually frowns on this, but sometime when you have your medical records checked out for an appointment, take them & photocopy them. If for instance, you are assigned at Fort Hood, but are going to Wilford Hall at Lackland AFB for a reversal, Lackland will not have a copy of what is in your chart at Hood & vice-versa. It will help you & your doctors to have a copy of records on hand during visits to assist them with what might not be available in your chart at that particular location.
2. BE PERSISTENT! Especially if you are a reversal patient at Wilford Hall Medical Center @ Lackland AFB. You must be firm & continually call to get things scheduled. The reversal surgeries, even though so many women seek them,
are not a priority to the military. You will have to be persistent in contacting them. The squeaky wheel gets the grease. Use discretion & not over-do it & become pushy, but let them know you are not going away until you get your TR.
Your Pre-Op Appointment:
Once you have your appointment for your TR surgery, you will also be scheduled a pre-op appointment a day or two before your actual surgery. This is usually done at the installation where your surgery will be performed. The following is a list of what to expect, but not an entirely full account of what may happen. Each installation is different so there will be differences in your itinerary for the pre-op visit.
1. You will have a final visit with the physician who will be part of your surgical team. You will have one last going over of the procedure & the risks involved will be explained to you in full. You will probably sign a consent
form at this time as well. Be sure to ask any last minute questions at this visit. It is a good idea to write down anything you think of that you want to ask & bring it with you to the visit. Your spouse should be present at this
visit also. Make sure he does not have any questions about the procedure or risks involved. The doctor is there to help both of you. If time allows, you may ask to meet the rest of the surgical team. This will help you to feel more
confident in the whole situation & ease any fears you many have. Have your medical records with you if they are not already at the doctor's office. Some places send them for you, while you have to hand carry them to other places.
Your height, weight, & vital signs will be recorded.
2. At this point, you will probably pre-register in the hospital. Be SURE to have your ID cards & Tricare cards with you. This way, when you are taken from Recovery, you will already have a room assigned to you.
3. Anesthesiology. This is a very important part of your pre-op. You will speak to an anesthesiologist &/or a nurse. They will ask you your full medical history. It may be a good idea to make a list of any childhood illnesses or family conditions ahead of time & bring this with you. One thing that is important: BE TRUTHFUL! Anesthesia can have different effects on you if you take certain drugs or have certain diseases. You need to be as honest as possible about any drugs you have taken (legal or illegal) & how much you drink or smoke. If you have to have your spouse step out of the room during this visit so you can have total privacy, please do so. It is extremely important that you be totally honest about your lifestyle & habits at this visit. Any medications you are on, bring them with you. Show them to the person interviewing you so they can take down the correct amounts & dosages. In a
case where you have asthma, bring all inhalers. They will take these into the operating room with you during surgery in case you have a health crisis.
4. You may have to pre-register at outpatient surgery. At this time, usually, you will be told where you are on the surgery roster & at what exact time you need to report to the outpatient desk. Some installations give you a number to
call back after a certain time & you will know then when to come in. When you do come in for your actually surgery, it is a good idea to be about 15 minutes early to have plenty of time & not feel rushed. Bringing along a book or
magazine to read during wait time is a good idea, also.
Tricare & Traveling:
Tricare regs state that a person does not have to go over a one-hour drive for specialized medical care without being authorized funds, TDY pay, or being reimbursed. If you or your spouse is active duty, you may want to request a TDY assignment to the installation where you are seeking your surgery. This will usually net the most money to pay for your essentials & expenses. You can also get travel reimbursement from Tricare. You will need to keep all receipts for any expenses & food you eat or buy during your trip to & from your surgery & medical appointments. Some installations will give you the option of using MEDEVAC as transportation to & from your surgical appointment. Check with your hospitals MEDEVAC Coordinator for this option. Also, the doctor at the receiving installation where you are getting your surgery can write orders for you to be MEDEVACed.
Different Criteria:
For the majority, most criteria that a couple will have to meet to get a TR from the military is the same, but some installations have certain restrictions in addition to the usual. Be prepared for & ask questions about such things as
weight restrictions. Also, if you & your spouse have a child together, you may not be eligible in some places. If your spouse has ANY children that are biological, that may take eligibility away from you also. These are things you may be faced with depending on the rule of your base hospital. It is important that you ask what the restrictions are in the very beginning. You dont want
to waste your time on something you cannot get & be let down over it.
Calling Tricare:
Do NOT call Tricare directly & ask about getting a reversal. They will tell you they dont cover it as an expense. No one seems top know why they say this when they DO cover it, but they will tell you that they dont. Dont waste your phone call.
Prime vs. Extra or Standard:
If you have Tricare Standard or Extra, you will need to get Prime before your TR can proceed. It is not a covered expense under anything but Tricare Prime.
What Tricare WILL NOT Pay For:
Tricare will NOT pay for any infertility services, especially a tubal reversal, at any other place other than a military installation. They will not pay any part whatsoever on going to a private physician or doctor that is not within their referral network for a tubal reversal. A military installation is the ONLY place any infertility treatment or tubal reversal is covered under Tricare.
If You Can Not Get A TR or If You Do Not Conceive:
If the military is unable to do your TR for any reason or to do a successful one, you are probably eligible for in vitro fertilization. This is true if you have a reversal & are unable to conceive for a period of time. Unlike the
reversal, IVF services DO cost in the military. The price ranges from 3,000.00 to 3,600.00 depending on the facility. This charge is for the embryologist & is a payment up front. At this time, the military has no physicians in the embryology field, so a civilian doctor is employed for the IVF procedures. If you are unable to get pregnant after your reversal or are unable to have a successful reversal for whatever reason, ask your physician about IVF services.
As with the TR, each installation has its own separate set of criteria to meet. Check on this if you have no other alternative. Normally, if a TR cannot be successfully done, you will automatically be put on the waiting list
& services offered to you. Your physician will have complete information.
Low Sperm Count?
Normal minimal limits on a semen analysis are anything over 21 million per milliliter. Some hospitals are lenient with this figure while others are adamant about it. If your spouse has a low sperm count, there are several things you can do to try and correct it:
1. Avoid excessive alcohol, bath soaks in the tub, snug jeans & tight underwear. These things make the scrotum hot. Heat decreases sperm quantity & quality. Cool or temperate showers are best & wearing boxers instead of briefs can dramatically improve semen counts.
2. If your spouse is consuming certain herbs or taking any kind of fat burner or thermogenic formula for energy or to lose weight, STOP THEM IMMEDIATELY. These are all SPERM KILLERS. While they may make him feel good & help shed a
few pounds here & there, they are killing off his sperm.
3. Try the Sperm Recipe regime of vitamins for several weeks. This is PROVEN to work: 1 Multi (no Iron), 1 Vitamin C 1000 MG, 1 Zinc 25 MG, 1 L-Arginine 500 mg once a day.
4. If all else fails, a man needs to be screened for things like a low-grade infection (white cell increase in semen) or a variocele vein. This vein is a large vein that runs through the scrotum & can be enlarged. It can produce
just enough heat in the testes to cause a significant decrease in sperm, even making a man sterile. It is easily corrected with office outpatient surgery.
This particular condition is a leading cause of infertility in men. A referral to a urologist can easily remedy the situation.
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