Tubal Ligation Reversal
Female reproductive surgery repairs fertility problems that cannot be treated with medication. It enables accurate diagnosis of infertility issues and may also eliminate the need for more advanced treatments, including in vitro fertilization (IVF) and other assisted reproductive technology (ART) procedures. Many causes of infertility, including fibroids, cysts, polyps, adhesions, endometriosis, tubal blockage, hydrosalpinx and certain birth defects can be treated surgically through one or another of the following procedures.
Tubal Ligation Reversal (Tubal Reanastomosis)
Tubal ligation is a procedure in which the fallopian tubes are tied, cauterized (burned and or cut using an electrical current), or sealed with a clip or ring. It is usually considered a permanent method of birth control. Sometimes however, a woman changes her mind and requests a tubal reanastomosis. A tubal reanastomosis is a procedure that reverses the tubal ligation; a surgical procedure that prevents pregnancy by closing off the fallopian tubes. Tubal ligation reversal reconnects the fallopian tubes so that a woman has a chance of becoming pregnant.
Candidates for Tubal Ligation Reversal
There are several factors that determine whether a woman is a candidate for tubal ligation reversal:
- Extent of damage to the fallopian tubes
- Age and weight
- Remaining tubal length
- Fertility factors, such as egg and sperm quality
A complete physical exam is given to the woman and her male partner (if there is one) to determine whether tubal ligation reversal has a chance of succeeding. A hysterosalpingogram, which checks the remaining length and function of the fallopian tubes may be performed. To rule out infertility issues in the male partner, semen analysis may be performed.
The Tubal Ligation Reversal Procedure
Tubal ligation reversal is performed with the patient sedated under general anesthesia. It may be an outpatient or inpatient procedure and typically takes about 2 to 3 hours. A small incision is made in the abdomen to expose the uterus, fallopian tubes and ovaries. Bands or clips used to block the tubes are removed and the viable portions of the tube are reattached using very fine absorbable stitches.
Recovery from Tubal Ligation Reversal
Recovery from tubal ligation reversal takes 1 to 2 weeks. Painkillers to ease discomfort during the recovery period are prescribed. The patient can bath 2 days after the procedure, but should avoid straining or rubbing the incision site for 1 week. The patient should also refrain from sexual activity or strenuous lifting for 4 weeks. A follow-up appointment may be necessary to ensure that the patient is healing properly. Another hysterosalpingogram may be needed in 3 to 4 months to determine whether the fallopian tubes are working properly.
Risks and Considerations of Tubal Ligation Reversal
There are several factors that must be considered prior to undergoing tubal ligation reversal. For one, it is costly and insurance does not typically cover it. Additionally, because tubal ligation reversal is a form of abdominal surgery, it has risks that include the following:
- Damage to nearby organs
- Reaction to anesthesia
The success of tubal ligation reversal varies because for pregnancy to be achieved, there must be an adequate length of healthy and functional fallopian tube for a fertilized egg to travel to the uterus. Moreover, pregnancy rates differ when the tubal ligation reversal involves tubes that were originally ligated using cautery due to internal lateral damage to the tube. Also, the anatomic location on the tube that is reconnected as well as the technique and whether the surgeon uses a microscope for precise suture placement, can impact on overall success rates. Unfortunately, there is no guarantee that a reconstructed tube will be functional. Depending on these patient and related factors, pregnancy rates following tubal ligation reversal can vary greatly.