Tubal reversal surgery is a procedure performed to reattach the two separated segments of fallopian tube in a woman who has previously undergone a tubal ligation. The goal of the surgery is to reapproximate the healthy tubal segments with as little scar formation as possible in order to restore a woman’s fertility. The surgery is performed using microsurgical techniques to suture the two segments of tube together. The surgery is generally done via an abdominal incision, and thus most women require a hospital stay of at least 1-3 nights.
For women who have undergone a previous tubal ligation and who desire another pregnancy, there are two options to consider. The first is a tubal reversal surgery. The second is to undergo in vitro fertilization (IVF), where the fallopian tubes are, in essence, bypassed.
For women who are considering a tubal reversal surgery, there are four important factors that your physician will discuss with you:
- Sperm quality: Before a woman undergoes a tubal reversal surgery, her partner should have a semen analysis performed in order to ensure that he has normal sperm count and function. If sperm quality is poor, then a couple would have better success at pregnancy by undergoing IVF.
- Tubal status: Length of the remaining fallopian tube and the way in which the previous tubal ligation was performed will dictate how successful a tubal reversal surgery will be. In general, it is ideal to have at least 4 cm of fallopian tube remaining, as those with less tubal length tend to have lower pregnancy rates. For women considering a tubal reversal surgery, it is important to provide your physician with a copy of the operative report from your tubal ligation so that he/she can determine what type of surgery you had and how much tubal length may remain.
- Female age: Pregnancy rates naturally decline with age, and thus tubal reversal surgery will be more successful in younger women. Generally, natural pregnancy rates in women 43 years or older are very low, and thus women in this age range would be discouraged from undergoing tubal reversal surgery. Women between the ages of 38-42 should carefully consider their options, as pregnancy rates in this age range will be substantially lower than those of younger women.
- Female egg quality and quantity: Often, women are encouraged to undergo testing of their ovarian reserve, which measures egg quality and quantity. Decreased ovarian reserve will decrease the success of tubal reversal surgery. This testing generally involves measuring FSH and estradiol levels or performing an antral follicle count (a specialized ultrasound) on the 3rd day of a woman’s menstrual cycle.
The success rates of tubal reversal surgery is approximately 75 percent in women younger than age 35. As mentioned above, success rates decline with increasing age as a result of the natural decline in fertility.
Risks associated with tubal reversal surgery are two-fold. First, there are risks related to the surgery itself, which include bleeding, infection, damage to nearby organs that may require further surgery to repair, and anesthetic risks. After the surgery is complete, there is an increased risk of an ectopic or “tubal” pregnancy. The chances of this occurring are about 10 to 15 percent. Generally, women who undergo tubal reversal must be followed very carefully in the beginning of their pregnancy to ensure that it is not an ectopic pregnancy.