Microsurgical Tubal Reversal (Tubal Reanastomosis)
Tubal Reversal Treatment at San Diego Fertility Center
Approximately 1% of women who undergo tubal ligation have a change in circumstances and subsequently opt to have a microsurgical tubal reanastomosis procedure (tubal reversal). With the use of the surgical microscope, very fine suturing materials and special surgical training, success rates after tubal reversal have improved dramatically. Tubal ligation that results in the least amount of tissue destruction or removal (such as the Pomeroy procedure and clip and ring application through laparoscope) is most amenable to tubal reversal. The type of sterilization procedure done and the length of the remaining viable tube will affect the outcome. Isthmic anastomosis (mid-portion of the tube) yields the highest success rate, whereas, ampullary-cornual anastomosis (most distant portion of the tube from the uterus) is associated with the poorest outcome. Patients with tubal lengths of more than 4 centimeters after tubal reversal generally have a favorable prognosis.
Success Rates of Tubal Reversal
Reversal of tubal sterilization is a microsurgical procedure performed to restore the function of fallopian tubes blocked by previous sterilization surgery. Often life leads to unexpected changes and women who previously were convinced they no longer needed or wanted fertility may, in fact, change their minds. Fortunately, the success of microsurgical tubal reversal is very high!! This is especially true if the procedure is done by highly trained and experienced surgical sub specialists, like those found at the San Diego Fertility Center. In our hands, the success rates for this procedure is up to 90% or more. Success rates will vary depending on some of the issues discussed below (see "What makes tubal reversal successful?")…so keep reading!
Who should consider tubal reversal?
Women who have previously undergone tubal ligation, tubal cauterization, tubal clip application or any other type of tubal sterilization procedure may be excellent candidates for microsurgical tubal reversal. The type of tubal sterilization procedure can influence the success rates of the reversal and this information is important to provide to Dr. Kettel or Dr. Hummel when you meet with them at your initial consultation. The best way to provide this information is to bring a copy of the dictated operative summary from your sterilization procedure.
Tubal sterilization procedures work to prevent pregnancy by damaging some portion of the fallopian tube. This blocks the pathway between the egg and sperm and effective contraception results. However, each different technique used to perform tubal sterilization damages the tubes differently. The amount of intact, normal tube left after the sterilization procedure can effect the overall success of the reversal.
Who should perform tubal reversals?
Microsurgical tubal reversal is an operation that absolutely has to work the first time!! Repeated attempts to reverse sterilization are almost always unsuccessful. For this reason, chose your surgeon carefully. Both Dr. Kettel and Dr. Hummel are board-certified, subspecialty trained physicians in the field of Reproductive Endocrinology and Infertility and are elected members of the Society of Reproductive Surgeons. They are experienced in all aspects of fertility surgery, including tubal reversal, and enjoy an esteemed national reputation for their expertise.
What makes tubal reversal successful?
There are three specific factors that determine the success of tubal reversal.
1) Tubal length - After completing the tubal reversal, the overall length of the intact remaining open tube should be greater than 4 centimeters (about 2 inches). Sometimes, extensive tubal damage occurs during the initial tubal sterilization or some other disease damages the tubes and the resulting tubal length could be compromised. The success of tubal reversal is diminished if the tube cannot reach to the ovary to pick up eggs. If there is a significant possibility of having short tubal segments, Dr. Kettel or Dr. Hummel may recommend that a laparoscopy be done at the beginning of your procedure before making an incision to start the surgery. If there is a problem, this could limit the amount of surgery and save valuable time and money.
2) Sperm quality - If your husband or male partner does not have proven fertility, it is important to make sure there is no unsuspected problem with sperm quality. Under these circumstances, we often require that a semen analysis (sperm count) be done before the tubal reversal surgery. Obviously, if there is a problem with sperm then there may be a problem becoming pregnant after the reversal. It is better to know about this before surgery than go through an entire operation only to find out that your chances for pregnancy are slim.
3) Age of the female - Despite our never ending hopes to discover the fountain of youth, the truth is that it is simply harder for women to get pregnant as they get older. The age related decline in fertility begins around age 37 and decreases steadily thereafter. All women will eventually lose their fertility, but it is very difficult to know when this occurs. A blood test done on the third day of menstrual bleeding (cycle day 3) to measure serum FSH and estradiol can be very helpful in determining the degree of these age-related changes.
Last updated:
October 27, 2005
Authors: Dr. William Hummel and Dr. Michael Kettel