Tubal Reanastmosis (Tubal Reversal)

Many women who have had their tubes tied (tubal ligation) later change their minds and want to have children. These women have two options:

1. a surgical procedure to reverse tubal ligation (tubal reversal/tubal reanastomosis)
2. in vitro fertilization (IVF).

Our Experience and success rates: We have been performing tubal reversals for more than two decades with a very high rate of success. In more than 90% of our cases, postoperative x-ray confirms that the fallopian tubes are open, and 67% of our patients become pregnant within one year after their tubal reversal. Our rates are very competitive. We offer a package that includes physician fee, anesthesia fee, and hospital fee for about $7,000.

About the procedure: A tubal reversal is a microscopic surgical procedure requiring an incision. Tubal ligation can be done in several ways. Some methods are more easily reversed than others. In Kentucky, most laparoscopic tubal ligations are done by cautery (or burning). Occasionally, fallope rings or Hulka clips are placed on the tubes laparoscopically or a postpartum Pomeroy procedure is done. A Pomeroy procedure removes 1 - 2 cm from the center of the tube, leaving the two ends intact.

Laparoscopy is used to discover the method of tubal ligation and to evaluate the remaining segments of the tube. If repair is possible, an incision can be made and the tube reconnected at that time. The operating time is usually 45- 60 minutes per fallopian tube. The entire surgical time is two to three hours. An overnight stay in the hospital is required, and recuperation at home takes 10 to 14 days. There is a 5% permanent risk for ectopic pregnancy after this procedure unless the tubes are re-tied. A patient who has a successful conception and does not want to have more children should consider contraception.

Other options: Women who have had tubal ligation procedures may also choose IVF. Eggs are taken after medications have been used to stimulate the ovaries. Once the eggs have matured, an office procedure called an ultrasound-guided needle aspiration is used to remove them from the ovary. The eggs are fertilized, and embryos are allowed to grow in culture. The healthiest embryos are placed into the uterus. Other embryos can be frozen for future use.

Considerations: Before a woman has either of these options, she should have blood testing to determine whether she has an adequate supply of eggs. Aging causes a natural decline in ovarian function. Success rates with IVF rival those of tubal reversal procedures. Risks and benefits of each procedure must be evaluated.