Is Tubal Reversal right for you?

Have you had your tubes tied (tubal ligation) after a previous pregnancy and now seek to be pregnant again? If the answer is yes, then having a tubal reversal may be the best way to achieve that.

For a pregnancy to occur naturally, sperm must enter the fallopian tube through the uterus by way of the vagina and cervix (opening to the uterus or womb). The oocyte (egg) is released from the ovary and is picked up from the other end of the tube (ovarian or fimbrial end). When the fallopian tubes are blocked, sperm and eggs are kept apart and fertilization is prevented.

The fallopian tube is a narrow muscular tube arising from the upper corners of the uterus and ending just next to the ovary. The inner tubal lining is rich in cilia, microscopic hair-like projections that beat in waves that move a fertilized egg (embryo) towards the uterus. The fallopian tube is normally about 10-12 cm (4-5 inches) long.

Tubal ligation is the general term for any surgical procedure that blocks the fallopian tubes to prevent pregnancy and is usually intended as a form of permanent sterilization or contraception. Ligation means to apply a ligature or tie. Tubal ligation is often called “tying” the tubes. Frequently, there is a misconception that the fallopian tube has been tied (like a knot) or with a suture or string and that simply removing or “untying” of the knot or suture will open back up the tubes. However, there are many surgical methods used to ligate the tubes which can affect the ability and success of doing a tubal reversal.

After your tubal reversal surgery, you ideally want to end up with as much length of tube as possible. The fallopian tube is not only a channel for egg and sperm to meet, it is also where the fertilized egg has to mature and develop for preparation of implantation into the lining or wall of the uterus. If the fallopian tube is too short, the embryo does not have enough time to mature and pregnancy is less likely to happen. In general, at least 5 cm or greater in tubal length is needed for the best chance for tubal reversal success.

It is very important that we be able to obtain your Tubal Ligation Operative Note dictated by the doctor who performed your procedure. It allows us to see what type of tubal ligation method was performed and the amount of fallopian tube that was removed or damaged. In addition, there may have be other important findings noted such as adhesions (scar tissue), prior tubal damage or other problems that could affect the success rate or even the possibility of doing a tubal reversal.

If the operative note is not available, a diagnostic laparoscopy (placing a small telescope into your abdomen through your belly-button) can be performed to evaluate the amount of fallopian tube that is available. If you are not a good candidate for tubal reversal or if there are other infertility factors involved, In Vitro Fertilization (IVF) may be the preferred method for achieving pregnancy.

About Tubal Reversal

Post-partum or C-Section Tubal Ligation

Most commonly done after vaginal delivery or at the time of C-Section. A portion of the fallopian tube is ligated and cut (removed). The Operative Note should note where and how much tube was removed. This method is usually reversible due to the small amount of tube taken.

Clips (Filshie, Hulka); Bands or Rings (Fallope, Yoon) Tubal Ligation

This is the most successful type of tubal reversal since it usually damages the least amount of fallopian tubes thereby providing adequate amount of tube left to repair.

Cauterization or “Burning” of the Tubes

There are two types of “burn” methods; bipolar and unipolar. Both use an electric current that is passed through the tube to cauterize or “burn” the tube. Unipolar methods are not used now days because it’s considered more dangerous and damages much more tube. Bipolar burns can be reversed as long as there was not multiple or extensive burn areas performed on the tubes. Again, the Operative Note can be very helpful in determining the amount of tubal damage done.

Fimbriectomy

This is an older technique where the end of the tube (fimbriae) is removed. The fimbria is the most important part of the tube since its function is to sweep over the ovary and pick up the egg. This tubal ligation technique is rarely used now days but is generally considered not reversible.

Essure

A new tubal sterilization technique that uses a micro-coil device to block the opening of the tube with no incisions or anesthesia needed. Tubal reversal cannot be performed in this case since the opening of the tube is blocked and the micro-coil is permanently placed into the tube.

Our gynecologic surgeons at Piedmont Reproductive Endocrinology Group (PREG) perform tubal reversals A tubal reversal (also called microsurgical tubal anastomosis or tubal reanastomosis) involves microsurgical techniques to open and reconnect the fallopian tube segments that have been previously ligated. After opening the blocked ends of the remaining tubal segments, the newly created tubal openings are then placed together with a retention suture in the connective tissue (mesosalpinx) that lies beneath the fallopian tubes. The retention suture prevents the tubal segments from pulling apart. Microsurgical sutures (very fine sutures that are thinner than a human hair) are then used to precisely align the muscular portion (muscularis) and outer layer (serosa), while avoiding the inner layer (mucosa), of the fallopian tube. During this part magnifying glasses (operating eye-loops) are used to magnify the operative site and allow accurate alignment of the tubal segments.

In order to minimize post-op discomfort, reduce formation of scar tissue, and shorten your recovery time, we perform your tubal reversal through a small incision right above the pubic hair line that is 3-5 inches long (bikini-incision). Gentle tissue handling and not using mechanical retractors also help to minimize your post-op recovery pain and increase your chances for pregnancy success.

The tubal reversal procedure generally takes 2-3 hours and is performed in our fully accredited Piedmont Reproductive Endocrinology Group Surgery Centers located in Greenville, SC and Columbia, SC. This out-patient procedure does NOT require a hospital stay or hospital expense. Most women return to their normal activities within 5 to 10 days, compared with the standard 2 to 5 day hospital stay and 4 to 6 weeks recovery period after in-patient tubal reversal surgery.

Tubal Reversal success definitely depends on the type of prior tubal ligation done. The more tube that is left or undamaged to work with the better the reversal success rate.

Success rates are also depended on other infertility factors such as advancing female age (>38 years of age), presence of a male factor infertility (abnormal semen analysis) or hormonal imbalances, all that can affect chances of pregnancy despite having open tubes.

In general, up to 75% of couples (with no other infertility factors present) usually become pregnant within one year of having a successful tubal reversal.

Our reproductive surgeons take every precaution to minimize your risk for complications by performing our out-patient tubal reversals at the Piedmont Reproductive Endocrinology Group Surgery Centers which have been certified by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). Although with any surgery complications may occur. The most common complications include: infections (skin, pelvic, incision), bleeding (possibly requiring blood transfusions), damage to other pelvic organs (bowel, bladder, female organs, blood vessels), as well as reaction to medications and anesthesia. In general, these complications occur in less than 1% (1 out of 100) of patients undergoing any type of abdominal/laparoscopic surgery.

There is a 5-10% risk that your fallopian tubes can re-close or block after a successful tubal reversal surgery. Since this will be the second surgery on the tubes, scar tissue, adhesions or poor healing may re-close the tubes despite a successful reversal. It is generally recommended to have a hysterosalpingogram (HSG; an x-ray dye test to evaluate if tubes are open) to be performed 6 months after your tubal reversal if pregnancy has not occurred to rule out a possible tubal blockage.

There is a 10% risk of as ectopic or tubal pregnancy after having a tubal reversal. Again, since this is the second surgery on your delicate tubal structures this ectopic pregnancy risk is increased over the normal risk of about 2% in the general female population without prior tubal surgery. Early detection and treatment of ectopic (tubal) pregnancy with medications can prevent having to have surgery and greater tubal damage.

  Tubal Reversal
  IVF
Surgery
    Yes    No
Costs
    $8,000 (out-patient)    $12,000/cycle plus meds ($3,500-$4,000)
Success
    50% (within 1 year, no other fertility factors)    50-65% per cycle
Multiple Births
    0-10% (with Clomid)    1.5%
Ectopic Risk
    10-15%    <5%

 

If there is multiple fertility factors involved (abnormal sperm analysis, hormonal imbalances or advancing female age) In Vitro Fertilization (IVF) may be the better treatment for achieving pregnancy. If you have questions regarding the better option for you, please contact a member of the Piedmont Reproductive Endocrinology Group (PREG) staff at 864-232-7734.