Tubal Ligation Reversal

Introduction

Tubal ligation is a common method women choose as permanent contraception since it offers women the freedom of not worrying about their reproductive future. However, an increasing number of women are requesting the reversal of previous tubal sterilization.

The potential of the reversibility of a tubal ligation has to be studied with infertility screening processes, a series of studies doctors perform to make sure you are suitable for the procedure.

This article will review tubal ligation reversal, the surgical procedure, its benefits and complications, indications, and the success rate.

What is tubal ligation?

Contraceptive options for individuals and couples range from barrier methods to short and long-term reversible birth control. Sterilization is a permanent option that involves blocking, sealing, or cutting the fallopian tubes to prevent the union of the egg with the spermatozoid.

Data from the National Survey of Family Growth indicate that from 2006 to 2010, 30.2% of married couples chose tubal ligation as the contraceptive method in the United States.

This method is often considered permanent, but advances in medicine have made it possible to reverse the procedure for those seeking to conceive again.

What is tubal ligation reversal?

Tubal ligation reversal is a surgical procedure performed to reconnect the fallopian tubes to enable the passage of eggs from the ovaries to the uterus.

This procedure is done under general anesthesia, where the surgeon makes small incisions in the abdomen to assess the fallopian tubes’ condition, eliminate any scar tissue or blockages, and reattach the healthy tubal segments with fine sutures.

Surgical procedure

Preoperative studies

Before the procedure, patients are interrogated, looking for individual risk factors, examined, and investigated. In addition, detailed counseling of both husband and wife is done to explain that the procedure will only be done if the tubes are suitable for the reconnection and if the remaining healthy tube length is adequate. Also, a discussion about the success rate, the complication after the procedure, and other alternatives like in vitro fertilization (IVF) will be done before the surgery.

Baseline infertility studies are performed for both women and men before the surgery to rule out other factors contributing to infertility, such as low sperm quality.

Tubal ligation reversal procedure

This surgery is usually performed by laparoscopy under general anesthesia. The first step is to evaluate the tubes’ status to discern if they are suitable for the procedure. Depending on this factor, a unilateral or bilateral recanalization is performed or, in some cases, not done at all. Any blocked tube segment or with too much scar tissue is removed. An end-to-end tubal reconnection is performed with a two-layer closer to ensure the best match of both ends.

Postoperative follow-up

Patients are discharged on the first or second day of surgery. They are asked to return for a follow-up after two weeks and three months or earlier if needed. These patients are usually checked out for a period of 3 years after the reversal surgery is performed.

After the successful recanalization, patients are advised to try for conception for the subsequent two cycles.

If the procedure was not performed because of the unsuitability of the tubes, talks about IVF or adoption should be done.

What is the success rate of tubal ligation reversal?

The pregnancy rate after a tubal ligation reversal ranges between 50-80%. However, the potential for a reversal of a fallopian tube ligation is a complex conduit. The success of the tubal reconstruction depends on restoring function as close to normal. The restoration of patency alone does not ensure the occurrence of ovum pick-up and transport, sperm transport, or tubal secretory activity.

The success or failure of the tubal ligation reversal will be dictated by the following:

The presence or absence of fimbria: If there are no fimbriae, reversal is deemed unsuccessful.

The presence or absence of peritubal adhesions: Adhesions (scar tissue) interfere in ovum pick-up.

The length of the remaining tube: if less than 3 cm of the tube is left, failure can be anticipated.

The diameter of the tubal segments to be reconnected: If two segments of widely differing diameters are reconnected, it adds complexity to the procedure.

The number of reanastomosis needed in each oviduct: The abrupt ending on the rugae at the site of the reanastomosis can lead to entrapment of the egg and ectopic pregnancy. Also, repair attempts on both ends of the same tube may yield poor results.

Who can be a good candidate for tubal ligation reversal?

Age: Like every woman, chances of getting pregnant reduce with age. Older age is associated with lower pregnancy rates and higher risks of miscarriage and having a baby with congenital disorders.

Other infertility causes: If the patient suffers from uterine fibroids, endometriosis, or irregular periods, chances are reduced after a tubal ligation reversal.

Partner’s sexual health: The partner’s fertility can influence whether the woman is a good candidate for surgery.

Tubal ligation procedure:

One of the most common sterilization procedures are bilateral salpingectomy and bilateral fimbriectomy. In both cases, loss of fimbriae interferes with the success of the reversal procedure.
Mid-tubal destruction combined with tubocornual suture is frequently irreparable.
Laparoscopic electrocoagulation with or without tubal resection usually leaves a tiny proximal stump and varying amounts of ampullary tissue, meaning both the remaining length and the difference in diameter affects the possibility of success of the reconnection of the tube.
The single most common procedure, Pomeroy’s, conserves the fimbria and sufficient length, deemed a theoretically successful reversal.
Tubal ligation procedures performed with clips or ring ties are easier to reverse and have a better success rate.

Fallopian tube length: The surgeon needs adequate healthy tube segments to reconnect them successfully.

What are the complications of tubal ligation reversal?

The complications that may occur after the surgery are:

Infection
Bleeding
Blood clots
Allergic reaction to anesthesia
Damage of other organs during the procedure

The most significant risk after a tubal ligation reversal is the increased risk of ectopic pregnancy (when a fertilized egg implants in the fallopian tube instead of the uterus). However, it is still low if the procedure is done correctly.

Considerations

Before deciding on performing a tubal ligation reversal, the women should consult a reproductive specialist or gynecologist experienced in fertility procedures. It is also advised to know which tubal ligation procedures were performed before. This enables physicians to estimate the success rate.

Frequently asked questions about tubal ligation reversal

How long do I have to be on rest?

It may vary from person to person. The general advice is to do minimal activities, such as walking for two weeks. Make sure to follow the instructions from your doctor.

What do I do if I have problems after surgery?

If after the surgery you have any complications described before, you should contact your surgeon to explain your concerns. If your physician deems it necessary, they will call you for a consultation.

How long after tubal ligation reversal surgery do I have to wait before I can try to conceive?

Unless advised by your surgeon, you can try to conceive after the next two cycles. Although some professionals suggest waiting at least 6 months, this is why you should ask your physician because this may vary from person to person.

What if my tubal ligation can't be reversed?

If your tubal ligation can't be reversed or after the surgery, there is little possibility of conception. You can always take into consideration IVF, a procedure where the egg and the sperm are fertilized outside the womb and then placed into the uterus.

Conclusions

Tubal ligation reversal is a surgical procedure that offers hope to women who have previously undergone a sterilization procedure and now desire to conceive again, restoring their fertility by reconnecting the remaining healthy segments of the fallopian tubes.

This procedure allows the egg to travel from the ovaries to the uterus. Its success rate depends on different factors, such as the presence of fimbriae, peritubular adhesions or tubal length, and the diameter of the healthy tubes.

Candidates for this surgery will undergo careful evaluation and consultation with a reproductive specialist or an experienced gynecologist specialized in fertility procedures to assess the suitability of the reversal surgery.

Although complications such as infection, bleeding, and ectopic pregnancy can occur, this surgical procedure has low risks if done correctly.

Finally, women should make an informed decision and the selection of an experienced and skilled surgeon if they are considering undergoing this procedure.

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