Tubal Ligation Reversal or Tubal Reanastomosis

It is not uncommon for women who have undergone sterilization by tubal ligation to discover that they desire to have their fertility restored. We receive numerous requests for reversal of tubal ligation on a weekly basis. Our center has more than 30 years experience with counseling women about this procedure and performing sterilization reversal for those for whom it is the best choice.

The fallopian tubes are delicate, flexible muscular structures. Different methods for sterilization remove or destroy a portion of the tube, usually roughly midway along its length. Surgery to restore fertility requires a careful reattachment of the portions of tube that remain. Success of the surgery depends on the amount of tube remaining (more is better) and the portion of tube requiring repair. The procedure is delicate, requires special equipment, and is best done by surgeons with a large and frequent experience with the technique. At our center, tubal reanastomosis is done using the mini-laparotomy approach, which is the most studied and probably most effective. All of our patients have the procedure done as a “same day” surgery, and do not require a hospital stay for recovery.

Initial consultation:

Patients desiring tubal reanatomosis are encouraged to make an initial consultation with one of our specialists, who will review their medical history, their fertility history, and the report of the procedure done for sterilization. The operative report from the sterilization is especially important for providing accurate counseling and planning. Additional fertility evaluation is usually required. Based on this information couples are given an individualized assessment as to the likelihood of a successful outcome for surgery. Minimum requirements for proceeding with surgery include a fully counseled and informed choice by the patient, normal male fertility, normal fertile cycles, a uterus capable of supporting successful pregnancy, and evidence of reparable tubes from records of the sterilization surgery. We do not recommend the surgery for women older than 44 years of age.

About Tubal Ligation Surgery:

The procedure is a same day surgery performed under general anesthesia. For patients for whom there is uncertainty about the amount of tube available for repair, we may start with a laparoscopic (small telescope inserted through the belly wall) viewing of the tubes to determine whether the surgery can be done. If laparoscopy findings are favorable, or if it was determined that laparoscopy is not needed, the reversal itself is conducted through a small horizontal incision (one to three inches) very low on the abdomen. Once the tubes are identified, the damaged portions of the tubes and any devices used for the original sterilization (such as clips, rings or sutures) are removed. The separated portions are reattached under a microscope for magnification using refined tools designed to minimize the damage to the tubes and internal organs. The reconnection itself uses two layers of very fine sutures, finer than most human hair. The use of microscopic magnification, fine instruments and sutures, and a team with experience in smoothly conduction the procedure provides a high success rate and reduced the formation of adhesions or scar tissue that can compromise fertility. This procedure is usually performed over 2-3 hours period. The success of surgery is typically tested during the operation by injecting blue dye in the tubes and observing the dye leaking from the end of the tubes.

After the surgery:

Patients usually can go home 3-4 hours after the surgery. A typical recovery requires two to three weeks before resumption of full and normal activities, and some degree of easy tiring may persist for a further week or two. Patients from out of state are asked to remain in the area for 2-3 days before returning home. Postoperative complications are very rare, as this procedure is minimally invasive. Infection, unintended bleeding, and clots are theoretically possible however, and patients are counseled for surveillance for these despite their rarity.

Success rate:

The success rate of the mini laparotomy tubal reversal depended on several factors:

1. Presence of other factors that can reduce fertility such as low sperm count or severe problems with menstrual cycle.
2. The type of tubal ligation: the smaller the damage to the tube during the ligation procedure, the higher the chance of a successful surgery. The smallest damage to the tubes happens when clips or rings are applied to the tubes.
3. Age: women older than 40 may have a reduced success rate.

About two-thirds of patients having sterilization reversal become pregnant, though the probability for pregnancy varies among patients according to their age, other fertility factors, and the specifics of their surgical findings. Miscarriage rates are not increased by reversal of sterilization, but ectopic (“tubal”) pregnancies occur more commonly (up to 10% of pregnancies) and careful surveillance of early pregnancy is warranted for women who have had this surgery. The procedure does not affect the course of pregnancy, labor, or delivery. The table below lists the chances of pregnancy 18 months after the surgery in women of different ages from a typical study of this operation:

Gordts S, Campo R, Puttemans P, Gordts S. Clinical factors determining pregnancy outcome after microsurgical tubal reanastomosis. Fertil Steril. 2009 Oct;92(4):1198-202.

Factors that may affect the decision for reversal of sterilization versus IVF

• Age
• Number of children desired
• Health factors affecting surgical risks
• Type of sterilization performed
• Cost
• Attitudes regarding surgery vs. assisted reproductive procedures (IVF)
• Other fertility factors (Partner’s sperm count, Woman’s cycles)

Pricing:

The total cost of the procedure (including facility, surgeon and anesthesiologist fees) is $6,600.00*

*Tubal Reversals may also be subject to additional pharmacy charges.