Reversal of Tubal Ligation: What Are The Success Rates?

I am 35-years-old and thinking about having a tubal ligation reversal. Please tell me about this procedure and its rate of success.

Question:

Tubal Ligation and Reanastomosis (Reversal) The most common forms of tubal ligation amenable to reversal are the Pomeroy tubal ligation performed soon after delivery through a minilaparotomy incision or at the time of Cesarean section and laparoscopic occlusion via: bipolar cauterization; endocoagulation; and Fallope ring, Hulka clip or Filshie clip placement.

Reversal of sterilization is more successful after mechanical occlusion than after electrocoagulation. Electrocoagulation tends to destroy a greater segment of the tube. Prior to considering a reanastomosis, your microsurgeon will want to assess the type of sterilization procedure performed and the chances of a successful reanastomosis. A BBT chart or some other indication of ovulation and a current semen analysis are also obtained to insure that their are no other potential infertility issues.

Reanastomosis in appropriately selected candidates usually results in patency (opening) of the reconnected Fallopian tubes in more than 85 percent of the cases. A pregnancy rate of 70 to 75 percent in the first year is anticipated. The alternative to renanastomosis is in vitro fertilization (IVF). The highest per cycle pregnancy rates for in vitro fertilization in women less than 35 occur in patients infertile solely because of tubal ligation. When considering the option of reversal versus IVF, one must consider carefully the costs of both procedures including cryopreservation of additional embryos in IVF, recovery times and the number of additional children desired.

Because a tubal reanastomosis is elective surgery, most insurance plans do not cover this procedure. Reanastomosis procedures are done in a variety of ways and the microsurgeon will provide anticipated patency rates, pregnancy rates in the first year and ectopic pregnancy rates (since women undergoing this procedure are at higher risk of ectopic pregnancy).

The reanastomosis procedures are most successful when performed by an individual trained in microsurgery and someone who performs these procedures regularly.

Recommendation

Keep a BBT chart to document ovulation, obtain a semen analysis and consult with an experienced microsurgeon and local SART-compliant IVF program to determine the most cost-effective option for your situation and desires for further children.

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