Tubal reversal (untying tubes) refers to a surgical procedure that restores patency of the fallopian tubes after their ligation. The procedure is highly successful, with average pregnancy rates in the 60-70% range, being higher in younger patients and lower in an older population. The success of the procedure is based on the couple’s fertility potential (age or male factor), the type of ligation performed (clip, ring, cutting, tying, burning, removal of the tube), and the amount of tube left and the health of the fimbria.
Expected pregnancy rates by age and method of tubal occlusion:
|Age (years)||Pregnancy rate (%)||Clip/Ring (%)||Ligarion/burning (%)|
We perform tubal reversals through a minimally invasive technique using microsurgical instruments. Patients have usually a single 1.5-2” incision at the top of the pubic hairline (bikini incision) and are able to go home the SAME DAY of the surgery. Our procedures are done in a private hospital which offers the bestin safety, equipment and personal attention.
During the pre surgical consultation we will review your medical history and your medical record, specifically your operative and pathology reports from the day of your tubal ligation, if available. It is important to assess your ovarian reserve and your partner’s sperm count as these will help us determine your fertility potential after the reversal.
We will meet after surgery (usually in 2 weeks) to review the surgical findings and outcome. You may attempt pregnancy the cycle AFTER the procedure. Most people conceive in 6 months. Once pregnant, close evaluation is advised as the incidence of ectopic pregnancy (pregnancy in the tube) is higher (5-10%) than baseline (2%). This is accomplished by following your blood HCG levels (pregnancy hormone) and performing an early ultrasound.
If there is inadequate information in your medical record, or if you are at high risk of scar tissue due to prior surgeries, infection, PID or pelvic pain, then we may need to further evaluate the proximal tubes by HSG, or your pelvis by laparoscopy. A laparoscopy requires a 0.5 cm navel incision to fit a small camera which allows us to assess tubal length and overall anatomy before proceeding with the mini-laparotomy incision for the tubal reversal. Most of the tubal ligations can be reversed, but in a small percentage of patients only one tube can be fixed; rarely both sides are inoperable. If only one tube is patent after surgery, the pregnancy rates stay about the same, but the time to accomplish pregnancy may be twice as long.
If 6-12 months after trying to conceive no pregnancy is attained, we usually perform a hysterosalpingogram (HSG) to evaluate tubal patency.
To reduce the complications from the increased risk of ectopic pregnancy, we ask our patients to strictly follow our guidelines of performing a urine pregnancy test after missed menses, and if pregnant, to follow the blood HCG levels carefully with your physician. An early ultrasound is recommended to confirm location of the pregnancy. Even if a tubal pregnancy is identified, patients who adhere to this strict monitoring are usually successfully treated medically, thus minimizing further testing, risks and need for surgery.
Risks of Tubal Reversal Surgery:
- Unique to this procedure: Inability to perform or complete the surgery or to attain pregnancy without further assistance. Ectopic pregnancy.
- Similar to other abdominal surgeries: Bleeding, infection and damage to adjacent structures/organs as well as complications associated with anesthesia.
Tubal reversal vs. IVF
- If more than one pregnancy is desired and you are less than 35 years old, tubal reanastomosis may be a better option for some women
- Time to conception may be faster with IVF, but cumulative pregnancy rates after reversal can be higher than IVF
- Although highly successful, the pregnancy rates of IVF are lower in older women, and thus a reversal may be an appropriate an option
- Tubal reversal carries a much smaller risk of multiple gestation
- If other surgical procedures are necessary, these can be performed at the same time of the reversal
- If the semen analysis is subnormal, IVF may be a more appropriate option
- If pelvic scarring or damage is anticipated, IVF may be a better option.
- If you have irregular cycles, IVF may be a better option
Minimally Invasive Outpatient Surgery:
- Smaller incision
- Faster recovery
- Lowers costs
- Lowers post operative risks such as infection