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Tubal ligation ( severing the fallopian tubes ) is the
most common form of permanent female sterilization and can usually be
reversed surgically. Tubal reanastamosis ( reconnection of the tubes )
is a procedure performed through a mini laparotomy by a reproductive surgeon.
The surgeon removes the blocked portion of the fallopian tubes and then
microscopically sutures the tubes back together.
We offer tubal reanastamosis ( reconnecting the fallopian
tubes ), which in otherwise fertile patients is the most successful type
of tubal surgery. Success rates are usually between 50 and 80%, but vary
according to where the tubes were cut, if scar tissue has formed, and
other confounding factors. We offer both IVF and
tubal reanastamosis. The best method depends on the patient's age, semen
parameters, and method of sterilization.
Per cycle pregnancy rates are higher with IVF, thereby
making IVF the treatment of first choice in older women. After tubal reversal,
there is no limit to the number of times pregnancy may be attempted through
intercourse. The number of repeat IVF cycles is often limited by cost.
However, egg quality declines as females age, and numerous
" natural " cycles after tubal reanastamosis may not be an option.
Before tubal reversal, a fertility evaluation is performed
to ensure that ovulation occurs regularly and that there are no secondary
causes of infertility. If other disorders are identified, they usually
can be treated effectively.
Tubal reversal microsurgery should be performed by a
reproductive surgeon with advanced training in microsurgery. The surgeons
at the Jones Institute have undergone extensive advanced training and
have vast clinical experience in laparoscopy and microsurgery.
Tubal and peritoneal pathology is among
the most common causes of infertility and the primary diagnosis in approximately
30% - 35% of infertile couples. A history of pelvic inflammatory disease
( PID ), septic abortion, ruptured appendix, tubal surgery, or ectopic
pregnancy suggests the possibility of tubal damage.
Other causes of tubal factor infertility
include inflammation related to endometriosis,
inflammatory bowel disease, or surgical trauma. HSG
and laparoscopy are the two classic methods for evaluation of tubal patency
in infertile women and are complementary rather than mutually exclusive;
each provides useful information that the other does not and each has
advantages and disadvantages. HSG images the uterine cavity and reveals
the internal architecture of the tubal lumen, neither of which can be
evaluated by laparoscopy. Laparoscopy provides detailed information about
the pelvic anatomy that HSG cannot, including adhesions, endometriosis,
and ovarian pathology.
Distal tubal occlusive disease exhibits
a wide spectrum of severity. HSG will generally reveal complete distal
tubal obstructions but cannot reliably detect or define lesser degrees
of disease when the tubes are patent. Laparoscopy is the definitive method
for diagnosis of distal tubal occlusive disease and also provides the
means for treatment. As might be expected, surgical outcomes are inversely
related to the severity of disease. For the milder forms of distal tubal
disease, postoperative term pregnancy rates can exceed 50%. Results achieved
with surgery for more severe disease have varied widely but success rates
are lower ( 10% - 35% ) and risk for ectopic pregnancy is higher ( 5%
- 20% ). Postoperative tubal patency rates far exceed pregnancy rates;
patency is more easily restored than function. The majority of pregnancies
occur within the first two postoperative years.
Tubal Surgery in the era of ART:
For women with tubal factor infertility,
treatment options include reconstructive surgery and IVF.
Over the last two decades, IVF success rates have steadily increased and
now frequently exceed those that can be achieved with surgery. Consequently,
IVF has become the treatment of choice for most tubal factor infertility,
particularly for couples with other infertility factors or severe tubal
disease. However, surgery remains an appropriate option in certain circumstances
and for couples with ethical or religious objections or financial restrictions
that preclude IVF.
Approximately one million American women
have an elective tubal sterilization procedure each year; many will regret
the decision, and about 1% will later request its reversal. The prognosis
for successful pregnancy after sterilization reversal relates to age,
type and location of procedure, and final length of the repaired fallopian
tubes. Younger women, those whose sterilization was performed using rings
and clips, and women having no other infertility factors have the best
prognosis; success rates are lower for older women, those who were sterilized
by cautery ( particularly multiple burn techniques ), and women with other
infertility factors.
Cumulative pregnancy rates are similar
when one or both tubes are repaired, although the time to conception is
longer after unilateral reanastomosis. In properly selected candidates,
overall conception rates are generally quite good ( 45% - 82% ) after
microsurgical sterilization reversal.
Laparoscopic tubal reanastomosis
is an option for highly skilled surgeons, although success rates may be
somewhat lower ( 25 - 53% ). Risk for ectopic pregnancy ranges between
1% and 7%. Among all surgical treatments for tubal factor infertility,
sterilization reversal has the highest postoperative fecundity.
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Phone
800-515-6637 or 757-446-7100