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.
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.
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.
The success rate of the mini laparotomy tubal reversal depended on several factors:
- Presence of other factors that can reduce fertility such as low sperm count or severe problems with menstrual cycle.
- 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.
- 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 old||36 - 39 years old||40 - 43 years old|
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
- Number of children desired
- Health factors affecting surgical risks
- Type of sterilization performed
- Attitudes regarding surgery vs. assisted reproductive procedures (IVF)
- Other fertility factors (Partner’s sperm count, Woman’s cycles)
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.
Dr. Marc Bernhisel is happy to be back at the University of Utah again! Dr. Bernhisel graduated from the University of Utah in 1975 with a Bachelor's degree in Biology (cum laude) and attended the University of Utah medical school graduating in 1979 (AOA). He also did residency in Obstetrics and Gynecology was at the University of Utah. He then com... Read More
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 35 years. Dr. Carrell is the clinical laboratory director of t... Read More
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 adolescents. Her research interests in... Read More
Megan H. Link, M.D., is a gynecologist and reproductive endocrinologist in the Division of Reproductive Endocrinology and Infertility. Dr. Link’s clinical interests include endometriosis, fertility preservation, reproductive endocrine disorders and all types of infertility. Dr. Link received her bachelor’s degree from The College of Idaho and ear... Read More
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 and gynecology was accomplished at M... Read More
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
|Centerville Health Center||801-581-3834|
|Dixie Regional Medical Center||801-581-3834|
|South Jordan Health Center||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
- 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 Drive, Suite 205
Salt Lake City, Utah 84108-1237
|University of Utah Health
Centerville Health Center
|26 South Main
Centerville, Utah 84014
|Dixie Regional Medical Center||544 South 300 East
St. George, UT 84770
|University of Utah Health
South Jordan Health Center
|5126 W. Daybreak Parkway
South Jordan, 84009
- Healthy Conceptions for Couples Intervention Pilot Study
Keywords: Infertility, Obesity, polycystic ovarian syndrome, emotionally focused therapy, weight loss
Keywords: Overweight, Infertility, BMI, Weight loss, Free, Reproductive medicine
Keywords: Fertility, reproductive medicine, pregnancy outcomes, folic acid and zinc supplementation trial, semen quality, infertility