Tubal Ligation Reversal (microsurgical tubal reanastomosis) – Tubal sterilization is one of the more common means of birth control used in the United States.
Unfortunately, this permanent form of contraception will not allow you to change your mind and attempt pregnancy unless you undergo another surgical procedure. This operation is known as tubal ligation reversal or microsurgical tubal reanastomosis.
The success of this type of surgery is dependent upon several factors. Foremost of these is the amount of fallopian tube remaining after the sterilization. If at least 4 centimeters of healthy tube is present, then pregnancy rates of 60 – 85% are not uncommon. The amount of tube remaining can usually be determined by having Dr. Russell review the operative report from your sterilization operation. If your surgery involved the use of cautery or burning the fallopian tube your chances of getting pregnant after this operation may be less, and in these cases, patients would more likely achieve pregnancy by undergoing In Vitro Fertilization (IVF).
In most instances the technique is an outpatient or short-stay procedure using a small abdominal incision and micro-surgical techniques to restore the connection between the interrupted tubal segments. As with any surgery, there are risks involved including infection, poor tissue healing, further damage to the fallopian tubes, uterus or ovaries as well as other surrounding tissues, and anesthetic complications. Furthermore, one must consider the post-operative recovery period and time off from work, usually relatively minimal but possibly prolonged. Each patient must determine these risks with her surgeon based on her individual circumstance. Keep in mind that the tubes will always be somewhat damaged following any type of surgery and the risk of ectopic (tubal) pregnancy is ever present. If a reversal is successful there is also the need to again consider post-partum contraception options.
Not all types of tubal sterilizations are reversible. If the remaining fallopian tube segments are not healthy due to previous damage or the segments are extremely short, successful reversal is not feasible. Some types of tubal sterilizations are not technically reversible such as distal fimbriectomy and trans-cervically placed proximal coils (Essure). Others, such as the Irving and Uchida techniques or those in which very large tubal segments were damaged or removed, may be technically reversible but the observed post-operative pregnancy rates are so dismally low that most surgeons do not recommend attempting it. Therefore, it is extremely important to know what sort of sterilization procedure was performed when considering surgery. Patients should obtain a copy of their sterilization operative note and pathology report (if tubal segments were removed) for review with their surgeon. A semen analysis for the male partner should always be done prior to surgery; if the findings are significantly abnormal, tubal reversal is extremely unlikely to result in a successful conception. Ruling out a significant male factor avoids unnecessary and costly surgery with its attendant risks.
The cost of tubal reversal is widely variable depending on the surgeon, hospital and region. Insurance policies very rarely cover the procedure. In some areas, the cost of tubal reversal exceeds IVF which then directly affects the procedure’s availability. In other areas, surgeons performing tubal reversals have set up high-volume outpatient surgery clinics which allow costs to be kept to a relative minimum. Keep in mind that the experience of the surgeon is critical to the likelihood of success. Microsurgery requires extensive further training beyond a general OB-GYN or surgery residency; look for a surgeon with such training and experience.
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