TUBAL REVERSAL SURGERY: GETTING YOUR FERTILITY BACK

Tubal ligation is a method of birth control for women. The Fallopian tubes are blocked by clamping or sealing to prevent pregnancy. A woman’s egg needs to pass through the Fallopian tubes to meet the sperm, and thereafter enter the uterus following fertilization. Once the Fallopian tubes are “tied”off, the passage of egg is blocked, leading to sterilization.

Women, who have previously undergone tubal ligation, may later decide to conceive. Tubal reversal surgery is an option through which this is possible. A tubal ligation reversal rejoins the blocked segments of the Fallopian tubes, thereby opening up a passage for the eggs.

Every year in the US, more than 650,000 women opt for tubal ligation. 30% of women inquire about a tubal reversal procedure after having their tubes tied but only six percent of these women decide within the next 5 years to undergo a reversal procedure in order to be able to conceive again.

Many reasons may prompt a woman to get a tubal reversal. Young age during tubal ligation, change in marital status, incomplete understanding of tubal ligation, are possible reasons for wanting a reversal procedure.

Eligibility

Not everyone may qualify for a reversal procedure. Important factors that are considered before a reversal surgery is offered to women include age, BMI, type of ligation, amount of tubal damage and other fertility concerns. Women above 44 years of age may not be eligible for reversal surgery, due to egg quality.

Tubal ligation procedures that offer the least amount of damage to the Fallopian tubes have the best chances of being successfully reversed. Tubal rings and clips, for example, are easily reversed through surgery. However, Essure and Adiana seal systems are more permanent methods of sterilization, and therefore tend to have very low chances of success with a reversal procedure. Women with low chances of success with a reversal ( ie Essure, tubes removed, Adiana) may instead explore in vitro fertilization through egg retrieval from her ovaries, followed by fertilization in the laboratory, and finally implantation of the embryo into her uterus.

Procedure

A tubal ligation reversal involves abdominal surgery, and can be performed as an inpatient or outpatient procedure, generally taking from 1 to 3 hours. General anesthesia is required for the procedure.

Tubal ligation reversal is performed by making a small incision—minilaparotomy or a laparoscopy—in the abdomen to access the reproductive structures. A microscope-guided or laparoscopic- guided surgery will then be conducted to remove the blockage of the Fallopian tubes and rejoin the remaining tubal structures with absorbable stitches. A dye is injected into the tubes to test successful tubal rejoining. The diameter of the Fallopian tubes varies along its length. The best chances of success involve rejoining two parts of the tube of similar diameters.

Moreover, the Fallopian tubes are typically 8 inches long, and women who have a minimum of 4 inches of tube after the re-joining procedure have the highest pregnancy success rates after a tubal reversal procedure. This surgical procedure requires special instrumentation and is best performed by highly experienced surgeons.

Recovery usually takes 2 – 3 weeks following surgery. In the meantime, the incision sites have to remain clean and dry. Strenuous activities, intercourse and the intake of aspirin has to be avoided during recovery. Risk factors of this type of surgery include infections, blood loss, injury to neighboring organs and the side effects of anesthetics.

Prognosis

A woman below 35 years of age has a 50 – 80 % chance of becoming pregnant within two years after reversal surgery. However, it is important to note that success rates vary greatly depending on a woman’s age and associated fertility factors (semen quality, uterine receptivity, etc.) and type of tubal procedure performed. In addition, conception after tubal reversal is associated with a 2 – 7 % chance of developing ectopic pregnancy. It is advisable to closely monitor your pregnancy following successful conception after reversal procedures.