Women who have undergone tubal ligation may desire tubal reversal surgery to return their fertility.
Am I a candidate for tubal reversal?
There are several types of tubal ligations. Physicians may excise a portion of the tubes, coagulate (using heat electricity), or place a surgical band around the tube.
- We evaluate the male partner fertility potential,
- We screen for ovarian reserve with hormonal testing.
- A sonohysterogram (transvaginal ultrasound with injection of saline into the uterus) is performed to evaluate the uterine cavity and ovaries.
The tubal reversal surgery
The tubal reversal surgery is performed under general anesthesia. A hysteroscopy (placing a small camera through the cervix into the uterus) is often performed at the same time to evaluate the uterine cavity. The patient can usually go home that day or the next day.
During the hysteroscopy, we clear any pathology in the uterus, such as polyps or fibroid that impair the pregnancy success.
After the hysteroscopy we perform a mini laparotomy (an incision in the abdominal wall) to carefully examine and evaluate the fallopian tubes for successful reversal. The damaged portion of the tubes is removed and tubes are carefully reattached using microsurgical techniques helped by a magnified image with a microscope. Very small sutures are used to bring the ends of the tubes together, utilizing microsurgical techniques to prevent scar tissue that may impede the future function of the tubes. A dye is placed through the tubes to ensure that the tubes are unobstructed.
What are the risks and success of tubal reversal?
- Age is one of the major factors of a successful pregnancy, and if you are debating when to have the procedure, the younger an individual is, the better. We prefer to do tubal reversal in women aged less than 43 years.
- The longer (10 or more years) time has elapsed from the date of tubal ligation, the lower the success of reversal.
- Pregnancy rates tend to be highest in women who had a fallopian ring used in their tubal ligation compared to tubal cautery, which can sometimes damage a large segment of the tube.
- The length of the tube in the end of the procedure should be about 4 centimeters or longer for good function.
- The success rate for reversal is about 50-80%.
- The risk of ectopic pregnancy is about 5% (in ectopic pregnancy an embryo implants somewhere other than the uterus, such as in a fallopian tube).