Tubal Sterilization Reversal
Microsurgical Tubal Reanastomosis
Tubal sterilization is one of the more common means of birth control used in the United States. Unfortunately, this permanent form contraception will not allow you to change your mind and attempt pregnancy unless you undergo another surgical procedure. This operation is known as a reversal of tubal sterilization or microsurgical tubal reanastomosis.
The surgery is considerably more involved than the operation performed for the sterilization. Whereas the sterilization involved simply tying, clipping, banding, or burning of the fallopian tubes, this procedure employs the use of very thin microsuture to carefully put the tubes back together. In many respects, the operation is very similar to the delicate repair of small blood vessels and/or nerves that plastic surgeons perform in cases of hand injury. It is necessary to use an operating microscope or another magnifying source to adequately visualize the tubal anatomy, and this makes for a tedious surgery that may take from one to two hours to perform. Tubal sterilization is frequently performed through the laparoscope or small incision(minilaparotomy), and because the surgery takes so little time (15 - 30 minutes), is a day surgery. Reversal of tubal sterilization can be performed through a minilaparotomy incision, however, due to the length of operating time, patients usually need to spend one to two days in the hospital to recover. Unlike laparoscopy, where patients can be expected to resume all normal physical activities without restriction within 48 hours of surgery, minilaparotomy patients must be restricted from lifting and exercising for two weeks after surgery. Patients usually require slightly more pain medication after tubal reanastomosis, than after laparoscopic procedures. After leaving the hospital, patients are allowed to drive, walk, use stairs, and have no dietary restrictions.
The success of this type of surgery is dependent upon several factors. Foremost of these is the amount of fallopian tube remaining after the sterilization. If at least 4 centimeters of healthy tube is present then pregnancy rates of 60 - 85% are not uncommon. The amount of tube remaining can usually be determined by having one of our physicians review the operative report from your sterilization operation. If your surgery involved the use of cautery or burning the fallopian tube your chances of getting pregnant after this operation may be less, and in these cases, patients would more likely achieve pregnancy by undergoing In Vitro Fertilization (IVF).
Another extremely important factor in determining the success of tubal reanastomosis is the expertise of the surgeon. The surgeons at Georgia Reproductive Specialists have undergone two year subspecialty training in the area of tubal microsurgery as well as the advanced assisted reproductive technologies such as IVF.
You need to be aware that if you become pregnant you may be at high risk for ectopic pregnancy (i.e. tubal pregnancy). An early pregnancy test and ultrasound evaluation can help make the diagnosis. Frequently, early therapy (with either surgery or medication) can save the involved fallopian tube.
If you do not desire more than one pregnancy, Georgia Reproductive Specialists can offer another option that may be more cost effective. In Vitro Fertilization involves the use of powerful fertility drugs to stimulate the ovary to make multiple follicles that contain eggs. The patient then undergoes an outpatient procedure using local anesthesia and ultrasound where the eggs are removed from the ovary. The male partner's sperm are added to the eggs in a petri dish and the eggs are checked for fertilization after 18-24 hours. During a simple office procedure that requires no anesthesia, the embryos are then placed into the uterus. Any excess embryos can be frozen (cryopreserved) and replaced at a later date. IVF does not require hospitalization, and does not involve the pain and/or recovery time associated with tubal reanastomosis.
Pregnancy rates with IVF have been rapidly improving, and now the cost of this process is at least equal to and in many cases less than the cost of tubal surgery especially when you consider your lost time at work after inpatient surgery.
This review has provided you with general overview only. If you have further questions please feel free to contact Georgia Reprodctive Specialsists for further details.