Tubal Ligation Reversal or Tubal Reanastomosis
Many women choose tubal ligation (“tied” fallopian tubes) as a form of contraception. However, with changes in circumstances, many regret the decision and wish to regain their fertility. A tubal reanastomosis or surgical reversal of a tubal ligation is the traditional–and the most successful–treatment for a woman who wants to conceive again. The surgeons at Kutteh Ke Fertility Associates of Memphis are board-certified reproductive endocrinologists who are experienced in theis technique. Its’ success depends on several factors and it is important to explore all the issues involved when considering tubal reanastomosis. This article will provide information to help you make your decision about this surgical procedure.
Factors That Affect Success of Tubal Reversal Surgery
In order to determine your chance of success with tubal reanastomosis, some basic information and testing is required. These include:
- Prenatal Screen includes a panel of blood tests to determine your general health before conception.
- Progesterone blood test to determine your ovulation status.
- Semen analysis to determine if there is an adequate amount of moving sperm in your husband in order to achieve pregnancy.
- Operative Note and Pathology Report (if available) from the original tubal ligation surgery which will describe the method used to “tie” the tubes. Some tubal ligations, such as those performed with electrocautery (“burned”) are not reversible so we would like to see the operative report from when your tubes were tied. The report will also give us an idea of how much normal fallopian tube remains. Preferably, once the fallopian tubes have been rejoined (reanastomosed), they are at least 6 centimeters in length each with a healthy tubal end (fimbria).
The woman’s age is another important factor although obviously, there is nothing that can be done about it. Woman are less fertile after age 35 despite being able to easily conceive before. The following table summarizes some of the most common factors that can influence the success of tubal reanastomosis.
The Surgery for Tubal Reversal
Tubal reanastomosis surgery takes about 2 hours and involves a lower abdominal incision – a ‘bikini incision’. The actual reanastomosis is delicate work and is performed under microscopic visualization using extremely fine suture material. Patency (open passage) of the reanastomosed (reversed) tubes is confirmed before the procedure is completed. Although surgery can be performed as a day procedure, you may want to stay in hospital overnight. Expect to take 3 – 4 weeks off work for recovery.
The complication rate is low but it is not zero. There are the usual risks associated with anesthesia such as nausea but serious risks are uncommon (less than 1 in 200). Surgery may lead to bleeding, infection or injury to adjacent organs but again these are uncommon for this procedure. Obesity and the prescence of other pathology such as pelvic scarring, fibroids or cysts may increase the complication rate. Your doctor will discuss this with you before surgery.
What is the Success Rate?
If all of the factors listed in the table above are optimal, then a couple should expect a 70% – 80% chance of pregnancy within a year after the surgery. If you have not conceived 6 months after the procedure, we would recommend testing to see if the tubes have remained patent. Clearly, the presence of any poor factor will reduce the success rate. Your doctor will be able to give you an individualized success rate after your evaluation.
Miscarriage is possible after tubal reanastomosis although it does not occur any more frequently than the general population. Of higher concern is the risk of a tubal (or ectopic) pregnancy following this surgery. The risk is approximately 1 in 12 pregnancies achieved and is higher than the general population. After the reanastomosis, it is very important that you confirm pregnancy with a physician as soon as you think you are pregnant. The physician should evaluate you for an ectopic pregnancy as soon as possible.
An issue that many couples forget to consider is future contraception. Once reversed, you are fertile again and once you have successfully delivered you may need to consider contraception again.
What Does Tubal Reanastomosis Cost?
The cost of the surgery with hospital charges is $5600 to $6400 in our center. The cost of the initial evaluation with tests is approximately $600-$800. Many times, your insurance will cover the cost of the evaluation but rarely will it cover the actual surgery. Please contact us with any questions regarding charges or insurance coverage.
Are There Any Alternatives?
If your tubal ligation is not reversible or you are not a good surgical risk or if you simply want one pregnancy only, then in vitro fertilization can be considered (IVF). While generally no more successful than a properly performed tubal reanastomosis, IVF can be a better choice for some couples. Click here for more information about IVF.
Who Do I Contact for Information Regarding Tubal Reanastomosis?
Click here if you would like to schedule an appointment or if you have questions. You may receive information from one of our Nurse Practitioners or Physicians.
About Our Staff
Fertility Associates of Memphis is composed of fertility specialists who have completed fellowship training, specializing in infertility. We have the only board-certified reproductive endocrinologists in Memphis who offer all types of ART. Learn more about our staff by clicking here.
Kutteh Ke Fertility Associates of Memphis, PLLC