Tubal Ligation Reversal Surgery
Most women who undergo tubal ligation, or surgical sterilization, do so with the intention of not having any more children. However, sometimes a shift in circumstances can influence a woman to change her mind and decide she wants to become pregnant again. Fortunately, medical technology provides certain options that can make this possible, one of which is tubal ligation reversal. Our Sacramento-area practice, Northern California Fertility Medical Center, offers this procedure, medically known as tubal anastomosis, to restore a woman's fertility and allow her to become a mother once again.
Prior to a tubal ligation reversal, couples must undergo a series of tests to ensure that additional issues will not interfere with achieving conception after the surgical procedure. Blood tests will be used to ensure that ovulation is still taking place and a hysterosalpingogram (a test that involves the introduction of an X-ray-sensitive dye into the uterus and an examination of its progress outward into the fallopian tubes) is performed. This ensures that no scarring or additional blockages exist in the fallopian tubes that may prevent the surgery from being successful. The male partner will be asked to undergo semen analysis as well.
Once it has been determined that there are no additional obstacles to fertility, the tubal ligation reversal procedure may proceed. At Northern California Fertility Medical Center, near Sacramento, our infertility specialists use advanced microsurgical techniques, aided by an operative microscope, to perform this delicate surgery. Because direct access to the fallopian tubes is required, this procedure cannot be done with endoscopic equipment, but necessitates a laparotomy, or open abdominal surgery.
Once the tubes are accessed, the closed ends are re-opened, and a thin, flexible stent is passed through both sections of the fallopian tube to provide stability and ensure that the opening remains unobstructed through the surgical process. The separated ends of the tube are drawn together and very fine sutures are used to reconnect the muscular layer of the tube first, followed by the outer layer. The delicate, innermost layer of the tube is left undisturbed. Once the stitches are complete, the stent is gently removed and the outer incisions are closed.
After the procedure, the patient will remain overnight in the surgery center's recovery area. Once the patient has been discharged, there will be a period of limited activity for approximately three weeks, while the body is given time to heal. Detailed pre- and post-operative instructions will be provided to the patient prior to surgery. Any questions you may have about specific activities should be directed to your surgeon.
Unlike vasectomy reversal, the success of tubal ligation reversal is unaffected by the length of time since the sterilization procedure was performed. However, the particular method used in the original procedure is paramount. Women who have had their tubes closed off with the use of clips or rings have a very high chance of success with tubal anastomosis (about 70 percent). If the tubes have been burned or cut, the success rate drops to about 50 to 60 percent. Unfortunately, if the fimbriated ends of the tubes have been removed, the chances of a successful reversal are very low and In Vitro fertilization (IVF) is recommended instead. If you are able to provide our infertility specialists with a copy of the operative report from your sterilization procedure, it will significantly improve our ability to determine your candidacy for tubal ligation reversal.
How tubal reversal is performed
Tubal ligation reversal involves microsurgical techniques to open and reconnect the fallopian tube segments that remain after a tubal ligation procedure.
Usually there are two remaining fallopian tube segments - the proximal tubal segment that emerges from the uterus and the distal tubal segment that ends with the fimbria next to the ovary.
The procedure that connects these separated parts of the fallopian tube is called microsurgical tubotubal anastomosis, or tubal anastomosis for short.
Other terms used to describe this procedure are:
Icrosurgical tubal reanastomosis
Icrosurgical tubal reversal
Icrosurgical tubal repair
Microsurgical tubal anastomosis
After opening the blocked ends of the remaining tubal segments, a narrow flexible stent is gently threaded through their inner cavities or lumens into the uterine cavity. This ensures that the fallopian tube is open from the uterine cavity to its fimbrial end. The newly created tubal openings are then drawn next to each other by placing a retention suture in the connective tissue that lies beneath the fallopian tubes. The retention suture avoids the likelihood of the tubal segments subsequently pulling apart.
Microsurgical sutures are used to precisely align the muscular portion (muscularis) and outer layer (serosa), while avoiding the inner layer of the fallopian tube. The tubal stent is then gently withdrawn from the fimbrial end of the tube.
Microsurgical tubal implantation
In a small percentage of cases, a tubal ligation procedure leaves only the distal portion of the fallopian tube and no proximal tubal opening into the uterus. This may occur when monopolar tubal coagulation has been applied to the isthmic segment of the fallopian tube as it emerges from the uterus. In this situation, a new opening can be created through the uterine muscle and the remaining tubal segment inserted into the uterine cavity. This microsurgical procedure is called tubal implantation, tubouterine implantation, or uterotubal implantation.
What Are The Success Rates of Tubal Ligation Reversal?
Several factors play a key role in the success rate of tubal ligation reversal. These include:
The type of tubal ligation procedure originally performed
The age of the woman at the time she seeks tubal ligation reversal, women over 40 should discuss their personal chances of achieving success with their health care provider before choosing tubal ligation reversal
The amount of damage caused by the original tubal ligation procedure directly correlates to the possible success of the tubal reversal procedure.
Women who make the best candidates for tubal ligation reversal are those whose tubal ligations included either the removal of a small section of the fallopian tubes, or those whose tubal ligation was achieved by clips or rings placed around the tubes to prevent eggs released during ovulation from traveling through the fallopian tubes.
Overall, success rates for tubal ligation reversal can vary from 20 percent to 70 percent.