Reversal of Tubal Sterilization

Tubal ligation reversal is a successful treatment for many couples.  The success of the operation depends upon several factors including:

1. The female’s age
2. The amount of fallopian tube that was damaged at the time of sterilization
3. Whether electrocautery was used as the electrical burn often spreads to, and damages, adjacent tissues.
4. The length and health of the remaining fallopian tube

Tubal reversal microsurgery is a straightforward surgical procedure where the segment of the damaged fallopian tube is removed and healthy tissue is rejoined to produce a functional fallopian tube. 

Prior to surgery, it is important to ascertain the patient’s candidacy for the procedure.  It is also necessary to determine if there is a good chance that the surgery will result in a pregnancy by ruling out other potential causes of infertility. The following tests should be performed prior to considering tubal reversal surgery:

1. Semen analysis to insure that the male partner is fertile
2. A thorough evaluation of the previous operative report detailing the sterilization procedure and the amount of damage to the tubes. Review of pathology reports is also helpful
3. In patients over 35, a day 3 FSH and estradiol blood test should be performed to exclude premature menopause and decreased fertility
4. Documentation of ovulation by day 21 progesterone blood tests
5. A hysterosalpingogram (HSG) is helpful in documenting how much tube is still attached to the uterus. This is important as anastomosis made “tube-to-tube” has a significantly higher success rate than when the tube is connected to the uterus.

Once a patient is deemed suitable for tubal reversal, the procedure is performed using the latest microsurgical techniques.  The hospital stay and time off work are minimal.  Our success rates with tubal reanastamosis are excellent. 

Dr. Kustin will evaluate each case separately and he will advise whether it is feasible to proceed with reversal of tubal sterilization.  Some cases are not suitable for this procedure and the chance of success may be much better using IVF and embryo transfer. This is because the integrity of the fallopian tubes is not important to the success of an IVF cycle. In IVF, the eggs are aspirated directly from the ovary, mixed with the partner’s sperm in the laboratory, incubated, and the resultant embryos are placed directly into the uterus.

Many couples, as well as those who have experienced failed tubular reversal surgery, may opt for in vitro fertilization. In general, the per cycle success rates with IVF exceed those of tubal reanastamosis. The advantage to tubal reversal, especially in younger women, is that there is no limit (other than age or other conditions causing infertility) to the number of times conception can be attempted in a natural cycle. The number of IVF attempts may be limited by cost.