tubal reversal

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:

Less than 36 years old36 - 39 years old40 - 43 years old
Pregnancy Rates 70-80% 60-70% 30-40%

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.

Table 2

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 when done at University of Utah facility (including facility, surgeon and anesthesiologist fees) is $6,600.00*

*Prices subject to change without notice and may also be subject to additional pharmacy charges.

Douglas T. Carrell, Ph.D., H.C.L.D.

Doug Carrell received his Ph.D. degree in reproductive physiology from the University of Utah in 1995, after receiving a M.S. degree in cellular and developmental biology from Brigham Young University. Dr. Carrell has worked in the area of research and treatment of human infertility for 30 years. Dr. Carrell is ... Read More

Specialties:

Andrology, In Vitro Fertilization, Reproductive Endocrinology & Infertility

Locations:

Andrology & IVF Laboratories (801) 581-3740

Jessie A. Dorais, M.D.

Jessie Dorais, M.D. as a Clinical Assistant Professor, in the Division of Reproductive Endocrinology and Infertility. Dr. Dorais received a Bachelor of Science degree in Biology from Brigham Young University in 2003, and her M.D. from the University of Illinois, College of Medicine in 2007. She completed her O... Read More

Specialties:

Endometriosis, In Vitro Fertilization, Polycystic Ovary Syndrome, Reproductive Endocrinology & Infertility, Tubal Ligation Reversal

Locations:

South Jordan Health Center (801) 581-3834
University Hospital (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834

James M. Hotaling, M.D., FECSM

Dr. Hotaling has significant training in both the clinical aspects of male fertility and genetic epidemiology and he is currently the only fellowship trained male infertility/andrology expert in Utah. He completed a 6 year residency in urology at the University of Washington, elected to pursue a year of sub-sp... Read More

Specialties:

Andrology, General Urology, Men's Health, Reproductive Endocrinology & Infertility, Urology

Locations:

Utah Center for Reproductive Medicine (801) 587-1454

Erica B. Johnstone, M.D.

Erica B. Johnstone, M.D., M.H.S., is a gynecologist and reproductive endocrinologist in the Division of Reproductive Endocrinology and Infertility. Dr. Johnstone clinical interests include reproductive endocrine disorders and all types of infertility, and she also works with hormonal disorders in children and ad... Read More

Specialties:

In Vitro Fertilization, Menopause, Reproductive Endocrinology & Infertility

Locations:

Centerville Health Center
Madsen Health Center
South Jordan Health Center (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834

William R. Keye, M.D.

William R. Keye, M.D., is a board-certified physician specializing in obstetrics and gynecology, as well as reproductive endocrinology and infertility. He received his medical degree from the University of Minnesota, and was an original member of the University of Utah’s I.V.F.(in vitro fertilization) team. He s... Read More

Specialties:

Reproductive Endocrinology & Infertility

Locations:

Redstone Health Center (801) 581-3834
South Jordan Health Center (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834

Specialties:

Reproductive Endocrinology & Infertility

Locations:

A location has not yet been added by this physician.

Andrew K. Moore, M.D.

As a sixth-generation resident of Utah Valley, Dr. Moore is pleased to bring the University of Utah’s world-class reproductive medicine closer to home for Utah Valley and southern Salt Lake county residents. He has office hourse daily in Orem, and also each week in South Jordan. During his first year of practi... Read More

Specialties:

Endometriosis, In Vitro Fertilization, Minimally Invasive Pelvic Surgery, Pelvic Pain, Polycystic Ovary Syndrome, Recurrent Miscarriage, Reproductive Endocrinology & Infertility, Robotic Surgery, Tubal Ligation Reversal

Locations:

Parkway Health Center (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834
Utah Valley Regional Medical Center (801) 581-3834

C. Matthew Peterson, M.D.

Matthew Peterson, M.D., is a Reproductive Endocrinologist in the University of Utah Department of Obstetrics and Gynecology. Dr. Peterson received his undergraduate degree, magna cum laude from Brigham Young University in 1977 and his M.D. from the University of Utah in 1981. His residency training in obstetrics... Read More

Specialties:

Adolescent Gynecology, Endometriosis, Gynecological Surgery, Gynecology, In Vitro Fertilization, Minimally Invasive Pelvic Surgery, Pediatric Gynecology, Polycystic Ovary Syndrome, Reproductive Endocrinology & Infertility, Tubal Ligation Reversal, Women's Genetic Counseling

Locations:

Centerville Health Center (801) 581-3834
Parkway Health Center (801) 581-3834
South Jordan Health Center (801) 581-3834
University Hospital (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834

Reproductive Medicine services are available at the Utah Center for Reproductive Medicine as well as multiple locations through out the state of Utah, including Centerville, Orem, South Jordan and Park City. Our reproductive endocrinologists offer a wide range of services including:

  • Infertility counseling
  • Infertility monitoring and treatment
  • IUD insertion and removal
  • Annual gynecological exams
  • Endocrinology
  • Diagnosis and treatment of polycystic ovary syndrome
  • In vitro fertilization
  • Treatment of endometriosis
  • Pediatric and adolescent gynecology services

Our highly trained reproductive endocrinology specialists are experts in both the treatment and research of infertility and our clinic consistently boasts one of the highest success rates in the nation.

Neighborhood Health Center Locations:

Utah Center for Reproductive Medicine 675 Arapeen Way, Suite 205
Salt Lake City, Utah 84108-1237
Map
University of Utah Health Care
Centerville Health Center
26 South Main
Centerville, Utah 84014
Map
Dixie Regional Medical Center 544 South 300 East
St. George, UT 84770
Map
McKay Dee Hospital 4401 Harrison Blvd.
Ogden, UT 84403
Map
University of Utah Health Care
Redstone Health Center
1743 W. Redstone Center Drive, #115
Park City, Utah 84098
Map
University of Utah Health Care
South Jordan Health Center
1091 W. South Jordan Parkway, Suite 500
South Jordan, 84095
Map
Utah Valley Regional Medical Center
Woman’s and Children’s Clinic
1034 N 500 W
Provo, Utah 84604
  • FAZST
    Keywords: Fertility, reproductive medicine, pregnancy outcomes, folic acid and zinc supplementation trial, semen quality, infertility
    Status: Recruiting
  • MORENDO
    Keywords: Endometriosis
    Status: Active, not recruiting
  • Healthy Conceptions for Couples Intervention Pilot Study
    Keywords: Infertility, Obesity, polycystic ovarian syndrome, emotionally focused therapy, weight loss
    Status: Recruiting