What is tubal ligation. How effective is this permanent birth control method. What are the pros and cons of getting your tubes tied. How does tubal ligation compare to vasectomy. Why is female sterilization a sensitive issue. How to find the right physician for birth control guidance.

What is Tubal Ligation and How Does It Work?

Tubal ligation, commonly known as “getting your tubes tied,” is a permanent form of birth control for women. This surgical procedure involves blocking or closing the fallopian tubes, preventing eggs from traveling to the uterus and being fertilized by sperm. As a result, pregnancy is prevented.

Dr. Kristyn Brandi, an ob-gyn and abortion provider at New Jersey Medical School, emphasizes the importance of patient understanding: “I make sure that each patient understands that tubal ligation is a permanent procedure. It’s a misnomer that a patient’s ‘tubes get tied,’ which leads people to think we can untie them. In reality, the procedure involves cutting, cauterizing, or removing the tubes altogether.”

How effective is tubal ligation?

Tubal ligation is considered more than 99% effective in preventing pregnancy. This high efficacy rate makes it one of the most reliable forms of birth control available. However, it’s crucial to note that while it prevents pregnancy, it does not protect against sexually transmitted diseases (STDs).

The Rising Popularity of Permanent Birth Control Options

Since the June 2022 Supreme Court decision allowing states to restrict or deny abortion access, healthcare providers across the United States have reported an increase in the popularity of permanent birth control options. This trend reflects a growing interest in long-term contraceptive solutions among women who are certain they do not want to bear children in the future.

Who is tubal ligation for?

Tubal ligation is designed for women who have made a definitive decision not to have children or to have any more children. It’s a serious choice that requires careful consideration and consultation with a healthcare provider. The procedure is most suitable for those who:

• Are certain they do not want to become pregnant in the future
• Have completed their family planning
• Are looking for a permanent contraceptive solution
• Have discussed the decision thoroughly with their partner (if applicable)
• Have considered and ruled out other long-term birth control options

Tubal Ligation vs. Vasectomy: Comparing Permanent Sterilization Methods

While tubal ligation is a permanent sterilization option for women, vasectomy serves as the male counterpart. Understanding the differences between these procedures can help couples make informed decisions about their contraceptive choices.

What is a vasectomy?

A vasectomy is a surgical procedure for men that blocks or cuts the vas deferens, the tubes in the scrotum that carry sperm. This prevents sperm from mixing with semen during ejaculation, effectively preventing pregnancy without affecting sexual function or hormone levels.

How do tubal ligation and vasectomy compare?

Both procedures are highly effective forms of permanent birth control, but there are some key differences:

1. Invasiveness: Tubal ligation is generally more invasive than a vasectomy, as it requires abdominal surgery.
2. Recovery time: Vasectomy typically has a shorter recovery period compared to tubal ligation.
3. Reversibility: While both procedures are considered permanent, vasectomies are generally easier to reverse if a couple changes their mind about having children.
4. Effectiveness: Both methods are highly effective, with success rates over 99%.
5. Cost: Vasectomies are often less expensive than tubal ligations.

Pros and Cons of Tubal Ligation

As with any medical procedure, tubal ligation comes with its own set of advantages and disadvantages. Understanding these can help women make an informed decision about whether this permanent birth control method is right for them.

What are the benefits of tubal ligation?

• Permanent and highly effective birth control
• No need for ongoing contraceptive management
• May reduce the risk of ovarian cancer, particularly in women with BRCA gene mutations
• Doesn’t affect hormones or menstrual cycles
• Provides peace of mind for those certain they don’t want children

What are the potential drawbacks of tubal ligation?

• Irreversibility: Very difficult or impossible to reverse if a woman changes her mind
• Surgical risks: As with any surgery, there are risks of infection, bleeding, and reactions to anesthesia
• No protection against STDs
• Potential for regret, especially if done at a young age
• Cost: Can be expensive, ranging from $0 to $6,000 depending on insurance coverage

Alternative Long-Term Contraception Options

While tubal ligation is a popular choice for permanent birth control, it’s not the only long-term option available. Dr. Brandi points out, “There are other forms of birth control that are more effective than tubal ligation, like the [hormone] implant or the IUD. Many people are surprised to learn that these are more effective than tubal ligation but are not permanent.”

What are some alternatives to tubal ligation?

• Hormonal IUD: A small T-shaped device inserted into the uterus that releases progestin
• Copper IUD: A non-hormonal option that uses copper to prevent pregnancy
• Hormonal implant: A small rod inserted under the skin of the upper arm that releases progestin
• Hormonal injections: Shots given every three months to prevent pregnancy

These methods offer long-term contraception without the permanence of tubal ligation, allowing for greater flexibility in future family planning decisions.

The Sensitive History of Female Sterilization

Female sterilization carries a complex and often troubling history that continues to influence perceptions and practices today. Understanding this context is crucial for both healthcare providers and patients considering tubal ligation.

What historical issues surround female sterilization?

In the past, female sterilization was sometimes used as a tool for discrimination and control, particularly targeting vulnerable populations. Some concerning historical practices include:

• Forced or coerced sterilization of women of color
• Sterilization of low-income women without proper consent
• Sterilization of incarcerated women
• Targeting women with certain health conditions for sterilization

Dr. Brandi emphasizes the importance of ethical practice in this area: “There is an important balance medical professionals should have between helping patients access care and making sure we do not coerce a patient into choices that may not be in their best interest despite our best intentions.”

How does this history impact current practices?

The troubling history of female sterilization has led to increased awareness and safeguards in modern medical practice. Today, there is a strong emphasis on:

• Informed consent: Ensuring patients fully understand the procedure and its implications
• Patient autonomy: Respecting women’s right to make their own reproductive choices
• Ethical guidelines: Implementing strict protocols to prevent coercion or discrimination
• Cultural sensitivity: Recognizing and addressing historical traumas in different communities

Navigating Societal Attitudes Towards Female Sterilization

Despite being a personal medical decision, female sterilization often intersects with societal expectations and cultural norms. This can create challenges for women seeking tubal ligation, particularly those who are younger or have not had children.

What societal barriers might women face when seeking tubal ligation?

Research has identified several common obstacles:

• Paternalistic attitudes: Doctors may discourage or deny the procedure, especially to younger women
• Assumption of future regret: Concerns that women might change their minds about wanting children
• Cultural expectations: Societal pressure to have children or larger families
• Gender bias: Different standards for male and female sterilization procedures

A study published in the Rhetoric of Health & Medicine in March 2019 found that many women seeking tubal ligation reported being dissuaded or denied by their doctors, even when they were certain about their decision not to have children.

How do attitudes differ between male and female sterilization?

The same study revealed interesting disparities in how male and female sterilization are presented and perceived:

• Marketing materials for vasectomies often featured happy couples and families
• Tubal ligation brochures tended to show unhappy or confused solo women
• Men seeking vasectomies generally faced fewer obstacles or questioning of their decision

These differences reflect broader societal attitudes about gender roles and expectations surrounding parenthood and family planning.

Finding the Right Physician for Birth Control Guidance

Given the complexity and permanence of tubal ligation, it’s crucial to find a healthcare provider who can offer comprehensive, unbiased guidance. The right physician will help you navigate your options and make an informed decision that aligns with your personal goals and values.

How can you find a supportive and informative healthcare provider?

Consider the following steps when seeking guidance on tubal ligation or other birth control options:

1. Research: Look for ob-gyns or reproductive health specialists in your area
2. Read reviews: Check patient testimonials and ratings for potential providers
3. Ask for recommendations: Consult friends, family, or online communities for referrals
4. Schedule consultations: Meet with multiple providers to find one who listens to your needs
5. Prepare questions: Come to appointments with a list of concerns and queries

Dr. Holly Bullock, an ob-gyn, describes her approach: “When I have a patient who wants permanent contraception, I make sure they know about all options of contraception in general, and when it comes to permanent contraception, we talk about methods for people with uteruses and people with penises.”

What questions should you ask your healthcare provider?

When discussing tubal ligation with your doctor, consider asking:

• Am I a good candidate for tubal ligation?
• What are the potential risks and side effects?
• How will this affect my menstrual cycle and hormones?
• What are my other long-term contraceptive options?
• What is the procedure like, and what can I expect during recovery?
• Is this decision reversible, and if so, what are the success rates?
• How might this decision impact my future health and well-being?

Remember, a good healthcare provider should be willing to have an open, judgment-free discussion about your reproductive health choices. They should provide you with comprehensive information about all available options, helping you make the best decision for your individual circumstances.

Tubal Ligation or Permanent Female Sterilization: A Misunderstood Birth Control Method

Since the June 2022 Supreme Court decision that allowed states to restrict or deny abortion access, permanent birth control options are becoming more popular, according to healthcare providers across the country.

For women, that option is tubal ligation, which is also known as having your tubes tied. It’s a form of permanent sterilization for women: A woman’s fallopian tubes, through which an egg would normally travel to the uterus each month, are blocked or closed through surgery. This prevents the egg from ever being fertilized by sperm, and therefore prevents pregnancy. The procedure is for women who know and choose, with certainty, that they do not ever want to get pregnant or bear children. Per Planned Parenthood, costs can range from $0 to $6,000 depending on insurance and other factors.

Myths and Misunderstandings About Tubal Ligation (Female Sterilization)

“I make sure that each patient understands that tubal ligation is a permanent procedure,” says Kristyn Brandi MD, MPH, an ob-gyn and abortion provider at New Jersey Medical School in New Brunswick and the board chair of Physicians for Reproductive Health.  “It’s a misnomer that a patient’s ‘tubes get tied,’ which leads people to think we can untie them. In reality, the procedure involves cutting, cauterizing, or removing the tubes altogether.”

Tubal Ligation vs. Vasectomy: What Is the Difference?

In men, a vasectomy is when the vas deferens, or the tubes in the scrotum that carry sperm, are blocked or cut. This prevents sperm from joining semen as it leaves the body during ejaculation. Without sperm in semen, an egg cannot be fertilized during coitus to cause pregnancy.

Sterilization for women and men is the most common method of birth control in the United States, according to a study published in March 2019 in Obstetrics & Gynecology, used by nearly half (47.3 percent) of all married couples, with 30.2 percent having tubal ligation and 17.1 percent having a vasectomy.

Pros and Cons of Tubal Ligation or Getting Your ‘Tubes Tied’

The pros of having tubal ligation include never having to think about birth control again, though it does not protect against sexually transmitted diseases. It is considered more than 99 percent effective. The cons of having your tubes tied are that it is very difficult, if not impossible, to reverse the procedure if you change your mind about wanting to have children in the future, and it is also a more extensive surgery than vasectomy. For long-term committed couples who know they do not want to have any children or more children together, vasectomy may be an option. Vasectomies are also easier to reverse if the couple decides later on that they do want to have children together.

A tubal ligation is just one form of long-term contraception, says Dr. Brandi. “There are other forms of birth control that are more effective than tubal ligation, like the [hormone] implant or the IUD. Many people are surprised to learn that these are more effective than tubal ligation but are not permanent.”

Why Female Sterilization Is a Sensitive Issue

Female sterilization has a troubling history. In the past, women of color, women with low incomes, women who were incarcerated, and women with certain health histories were either encouraged to undergo sterilization or were sterilized without their knowledge or consent. “There is an important balance medical professionals should have between helping patients access care and making sure we do not coerce a patient into choices that may not be in their best interest despite our best intentions,” says Brandi.

Different Messages Behind Female and Male Fertility, Sterilization

In addition, a paternalistic culture has often encouraged women to put off sterilization either until they were older or had had children, even if a woman herself sought out sterilization because she knew she didn’t ever want children.

In a study published in March 2019 in Rhetoric of Health & Medicine, Sara Davis and Abby Dubisar found that women on online forums and social media sites such as Reddit and Twitter wanted tubal ligation but were dissuaded from it or denied it by their doctors. At the same time, patient brochures on sterilization featured happy couples and families in the vasectomy pamphlets but unhappy or confused solo women in the tubal ligation ones, they found.

Finding the Right Physician for Birth Control Guidance

If you are interested in learning more about tubal ligation, speak with your obstetrician-gynecologist to find out if you are a good candidate.

“When I have a patient who wants permanent contraception, I make sure they know about all options of contraception in general, and when it comes to permanent contraception, we talk about methods for people with uteruses and people with penises,” says Holly Bullock, MD, MPH, an assistant professor of obstetrics and gynecology at the University of Arizona College of Medicine in Tucson. The American College of Obstetricians and Gynecologists recommends that providers incorporate vasectomy counseling as an option for people asking about tubal ligation, because the failure rate is slightly lower at 0.15 percent for a vasectomy versus tubal ligation at 0.5 percent; Dr. Bullock notes that rate may not apply to every patient.

The Risks of Permanent Contraception for Women

“I know that seems likes splitting hairs, but for people to have a failed tubal ligation, it is more likely to be an ectopic pregnancy, which is a medical emergency where the pregnancy grows outside of the uterus,” Bullock says. “With a failure of a vasectomy, it is more likely to be an intrauterine pregnancy, which then allows for options. A person may choose to continue the pregnancy, choosing parenting or adoption, or to end the pregnancy with abortion care. It is worth acknowledging that access to abortion has become extremely limited in our country in the past month. A vasectomy is also less risky, because it is done under local anesthesia in an office setting, while a tubal is done under general anesthesia, and there is a bigger risk of more problems.”

As a comparison, failure rates for the IUD and implant are 0.1 to 0.8 percent for various forms of the IUD and 0.01 percent for the implant, according to the Centers for Disease Control and Prevention.

People who have had tubal ligation have a lower risk of developing ovarian cancer, too. Bullock says that with patients who express an interest she discusses every aspect of the procedure, such as whether it will be done following a vaginal or cesarean delivery or not related to pregnancy.

The Reality of Female Sterilization

Also, “if someone were to change their mind, I talk about whether adoption or in vitro fertilization (IVF) could be an option, or a tubal reversal procedure, where tubes can be reattached, and the rates of success with that.” Success rates for a tubal reversal vary and may not result in a pregnancy — and insurance often doesn’t cover the reversal procedure or IVF, Bullock notes.

Since tubal ligation is permanent and regret can surface during or after the procedure, Bullock says she speaks with her patients frequently about whether they are sure they want to move forward. “I always make sure that someone, before the procedure of taking the tubes, has a chance to say they’ve had a change of mind. I let them know we can revisit their decision up until the day of the procedure, and sometimes people change their minds. I want to help them achieve their unique family size goals.”

There’s a History of Forced Female Sterilization

Even if a person is sure in their decision, they will likely still be asked by multiple healthcare providers about the choice. “It may seem judgmental, but we live in a society with a past medical history of making this decision, especially Black and brown people or those of different abilities, without their consent. We want to make sure that a person is not being coerced,” says Bullock. “There are rules that have come from an ugly history in our country of forced sterilization, to protect patients, especially those with state or federal health insurance like Medicaid, that require a 30-day waiting period before having the permanent birth control method of their choice.” Once the paperwork for it is signed, it is not binding, but it starts the waiting process, she says.

Permanent Sterilization Regrets: A Look at Statistics

In research published in Clinical Obstetrics and Gynecology that compared female and male sterilization, the lead author, Grace Shih, MD, found that more women in their twenties were likely to express regret about having their tubes tied (20 percent), than were women in their thirties (6 percent). About 6 percent of men who had vasectomies expressed regret and sought reversals.

Ultimately, if you think a tubal ligation is right for you, find a physician who will work with you and listen to you and won’t tell you that permanent contraception requires you to be a certain age or have had a certain number of children, Bullock says. “It is painful to shop for a doctor who will listen to you, and I definitely feel for those patients,” she says.

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Tubal Ligation Surgery | Kaiser Permanente

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Surgery Overview

Tubal ligation is surgery to close your fallopian tubes. It’s also called having your tubes tied.

To close your tubes, the doctor may band, burn (cauterize), tie and cut, or clip them. The doctor may also completely remove the fallopian tubes. After this, an egg can’t move down your tubes and can’t be fertilized. This means you can’t get pregnant.

This surgery can be done in two ways. In laparoscopic surgery, a doctor puts a lighted tube (scope) and other tools through a few small cuts. These cuts are called incisions. One is just below your belly button. The other is lower on your abdomen. After this surgery, you will probably stay in the hospital for 2 to 4 hours. You can likely go back to work in 2 to 7 days.

The other type of surgery is called open surgery(mini-laparotomy). In this surgery, the doctor makes a larger incision above your pubic hairline or below your belly button. You will probably stay in the hospital for 1 to 3 days if you have this surgery. You can probably go back to work in about 1 to 2 weeks.

Surgery can be done right after you give birth (postpartum tubal ligation). Open surgery is usually used.

After the surgery, you should not be able to get pregnant. While there is a very small chance you could get pregnant, tubal ligation is a very reliable form of birth control.

Tubal ligation won’t affect your menstrual cycle or when you start menopause. It also won’t affect your desire for sex. But you could feel more relaxed about having sex. This is because you don’t have to worry about getting pregnant.

What To Expect

After a tubal ligation, you will most likely go home the same day. Your surgeon will give you instructions about what to expect and when to call after the surgery.

• You may have some slight vaginal bleeding caused by the movement of your uterus during the surgery.
• If you had a laparoscopy, your stomach may be swollen (distended) from the air that was used to lift your skin and muscles away from your abdominal organs so the surgeon could see them better. This should go away within a day or so, but it may last longer. You may also have some back or shoulder pain from the air in your belly. This will go away as your body absorbs the air.
• You can shower 24 hours after the surgery. But avoid rubbing or pulling on your incision for at least a week.
• You can have sexual intercourse as soon as you feel like it and it doesn’t cause pain. This is usually 1 week after surgery.
• Be sure to rest for a few days (or at least 24 hours) before you start to resume your normal activities. You should be able to resume all activities within a week.
• No backup method of birth control is needed after the surgery.

A follow-up exam in 2 weeks is usually scheduled.

Watch

• Tubal Ligation: Returning Home

How Well It Works

Tubal ligation is not 100% effective at preventing pregnancy.

• There is a slight risk of becoming pregnant after tubal ligation. This happens to about 5 out of 1,000 women after 1 year. After a total of 5 years following tubal ligation, about 13 out of 1,000 women will have become pregnant.^{footnote 1}
• Pregnancy may occur if:
  • The tubes grow back together or a new passage forms (recanalization) that allows an egg to be fertilized by sperm. Your doctor can discuss which method of ligation is more effective for preventing tubes from growing back together.
  • The surgery was not done correctly.
  • You were pregnant at the time of surgery.

Risks

Major problems from tubal ligation aren’t common.

• Minor problems include infection and wound separation.
• Major problems include heavy blood loss, general anesthesia problems, organ injury during surgery, and need for a larger laparotomy incision during surgery.

Although fewer problems occur with laparoscopy than with other kinds of tubal ligation surgery, these complications can be more serious. For example, in rare cases, the bowel or bladder is injured when the laparoscope is inserted.

The general risks of surgery are greater if you have diabetes, are overweight, smoke, or have a heart condition.

If a tubal ligation fails and you become pregnant, you have an increased risk of having an ectopic pregnancy.

References

Citations

1. Roncari D, Jou MY (2011). Female and male sterilization. In RA Hatcher, et al., eds., Contraceptive Technology, 20th rev. ed., pp. 435–482. New York: Ardent Media.

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Voluntary surgical sterilization (VCS) or female surgical contraception is an irreversible and one of the most effective methods of contraception. Female DHS is a widely used method of contraception, the demand for which is actively growing in the developed countries of the world. Sterilization at the request of the patient is allowed in Russia from 1993 years old

In Russia, operations are carried out in accordance with Art. “Medical sterilization” Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens; On December 28, 1993, the Ministry of Health of the Russian Federation issued Order No. 303 “On the use of medical sterilization of citizens.”

Indication for DHS :

– desire to completely prevent fertilization.

• medical indications include the presence in a woman of severe malformations and disorders of the cardiovascular, respiratory, urinary and nervous systems, malignant neoplasms, blood diseases (contraindications to pregnancy and childbirth for health reasons).

Currently the most common ways to create occlusion of the fallopian tubes:

• Pomeroy method: the fallopian tube is folded to form a loop, tightened with absorbable suture material and excised near the ligation site.
• Parkland’s method: the fallopian tube is tied in two places with the removal of a small internal section.

Postnatal sterilization can be performed during a caesarean section.

DHS does not adversely affect the postpartum period, lactation, menstrual function, sexual behavior and somatic health.

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Dear patients!
Multidisciplinary Clinic and Maternity Hospital “Paracelsus” informs you, according to the Letter of the Ministry of Finance of the Russian Federation to the Federal Tax Service dated March 25, 2022. N BS-4-11 / 3605, that subparagraph 3 of paragraph 1 of Article 219 of the Tax Code of the Russian Federation provides for the taxpayer’s right to receive a social tax deduction in the amount paid by him in the tax period for medical services provided by medical organizations engaged in medical activities , him, his spouse, parents, children (including adopted children) under the age of 18, wards under the age of 18 (in accordance with the list of medical services approved by the Government of the Russian Federation).

Joint order of the Ministry of Taxation of Russia and the Ministry of Health of Russia of July 25, 2001 N 289 / BG-3-04 / 256 (hereinafter – the order of July 25, 2001) approved the form of the Certificate of payment for medical services for submission to the tax authorities of the Russian Federation (hereinafter – the Certificate payment for medical services).

This certificate certifies the fact of receiving a medical service and its payment through the cash desk of a healthcare institution at the expense of the taxpayer.

Thus, if the taxpayer submits to the tax authority a Certificate of payment for medical services, the taxpayer’s failure to submit the relevant contract for the provision of medical services and (or) documents confirming payment cannot be grounds for refusing to provide such a deduction.

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“Is IVF possible after tubal ligation during caesarean section.

…” – MCRM

Today, December 31, I want to congratulate everyone with whom I talked in 2014. And I really want to thank everyone. For kindness, attention, for caring attitude, for recommendations, advice, appointments, for the fact that your hearts are filled with compassion, patience, wisdom, caring. Thank you for your invaluable work, for your 100% dedication to the profession! I congratulate you all on the upcoming holidays. Be happy and loved! Healthy and prosperous! Successful and lucky! May everything you dream about on New Year’s Eve come true in your life! First of all, I want to say a big, huge thank you to Olga Evgenievna Vasilyeva and Elvira Valentinovna Isakova. Thank you for your laconicism, rigor, confidence, attentiveness. Thank you for giving hope even in very difficult situations, finding solutions to complex treatment problems and an individual approach to each patient. Thank you for the generosity of your professional knowledge, for your smiles and kind words! Thanks to Nina Vasilyevna Vilina, Lyudmila Aleksandrovna Kudryavtseva, Svetlana Anatolyevna Melnikova. Unforgettable your kind attitude towards patients! May it come back to you with a vengeance! Thanks for the advice to Elena Leonidovna Soboleva and Elena Viktorovna Turlak. It is pleasant to communicate with professionals, and there is always confidence in further successful treatment. Thanks to Andrei Adolfovich Kirsanov, Ekaterina Leonidovna Katsanda, Olga Shcherbakova, Tatyana Semerkina. We do not know each other personally, but you advised me in letters and on-line. Your responses have always been prompt, comprehensive, informative and full of hope! I also want to say thank you to the receptionist girls! Elena Karamysh, Yulia Nikitina, Tatyana Katunina, Maria Leonidovna, Maria Vladimirovna are always friendly, smiling and always find a minute of time to find out how things are going. Stay always as beautiful and cute! Thanks to cashiers Tamara Petrovna and Galina Nikolaevna! Sometimes you will not immediately understand the prescriptions and the number of drugs, but in one second you will calculate everything and tell you! Smile and wish “all the best”! Let in the new year, in connection with the move, your workplace increase in size and be spacious and comfortable! I really hope that 2015 will be a good year for everyone!!! Happy New Year! With new hopes and faith in miracles! And of course, with new Happiness!

Today, December 31, I want to congratulate everyone with whom I spoke in 2014. And I really want to thank everyone. For kindness, attention, for caring attitude, for recommendations, advice, appointments, for the fact that your hearts are filled with compassion, patience, wisdom, caring. Thank you for your invaluable work, for your 100% dedication to the profession! I congratulate you all on the upcoming holidays. Be happy and loved! Healthy and prosperous! Successful and lucky! May everything you dream about on New Year’s Eve come true in your life! First of all, I want to say a big, huge thank you to Olga Evgenievna Vasilyeva and Elvira Valentinovna Isakova. Thank you for your laconicism, rigor, confidence, attentiveness. Thank you for giving hope even in very difficult situations, finding solutions to complex treatment problems and an individual approach to each patient. Thank you for the generosity of your professional knowledge, for your smiles and kind words! Thanks to Nina Vasilyevna Vilina, Lyudmila Aleksandrovna Kudryavtseva, Svetlana Anatolyevna Melnikova.