Microsurgical tubal reanastomosis (tubal reversal)

Tubal ligation has been a popular form of permanent contraception preferred by many couples. Prior to the advent of in vitro fertilization (IVF), women who had previously undergone a tubal ligation and who subsequently wished to conceive were offered a microsurgical tubal reanastomosis (tubal reversal) procedure as their only means of conceiving. Over the years, surgical techniques were perfected as they became less invasive, more efficient, and more successful. However, as IVF became available, patients were now offered an even less invasive and highly successful alternative. Subsequently, the tubal reanastomosis procedure was largely abandoned over time as IVF popularity increased. In fact, many Reproductive Endocrinology/Infertility programs around the country no longer offered tubal reanastomosis training to their fellows, leaving a handful of experts with the expertise to perform the procedure. Despite this, tubal reanastomosis remains a safe, effective, successful and simple way to restore fertility to women with a prior tubal ligation, with the following basic advantages:

• SAFE: as in any surgical procedure, risks of bleeding, infection, and anesthesia exist, but such risks are minimal in tubal reanastomosis
  • Microsurgical techniques are employed to control even the smallest of bleeding in order to optimize the success of the procedure
  • Antibiotic prophylaxis is given at the onset of every case to prevent infection
  • Risk from general anesthesia is minimized as the average operating time does not tend to exceed 75 minutes
  • A small (2.5 inch) incision is introduced in the lower abdomen (if a scar already exists from prior surgery the same incision will be used), which means patients go home the same day and have a fast recovery

  
  

• EFFECTIVE: despite the fact that fallopian tubes may be cut, clipped cauterized/fulgurated (burned), or tied during tubal ligation, tubes can be repaired to restore complete functionality at a very high rate
  • Fallopian tubes are successfully opened in the vast majority of cases (over 90%)
  • If the final tubal length (following repair) is determined to be 4 cm (1.5 inches) or more (decision made during surgery), a tubal reanastomosis can be performed
  • A tubal reanastomosis can be performed in patients who only have one fallopian tube, or in those where only one tube can be repaired (success rates are similar to patients where both tubes are repaired)

  
  

• SUCCESSFUL: tubal reanastomosis yields high pregnancy rates as couples do not typically have any underlying infertility problems
  • Pregnancy rates depend on the type of tubal ligation which was performed, the final tubal length, and the patient's age
  • Pregnancy rates reached are in the range of 70%

  
  

• SIMPLE: only a few basic requirement must be fulfilled prior to scheduling the procedure
  • If your current partner had not initiated any pregnancies a semen analysis is recommended
  • A review of the operative report of the tubal ligation is useful but not absolutely necessary
  • Call with your menses to schedule your tubal reanastomosis