So you never imagined wanting to have another baby after 'tying' your tubes. Well, you are not alone. Between 5-20% of women who have undergone a permanent sterilization with a tubal ligation experience regret. Women at increased risk for regret are those who underwent the procedure at a young age, and those who have re-married, particularly if their new partner does not have children of his own.
Since the fallopian tube naturally serves as the meeting place between sperm and an egg, women with a tubal ligation cannot conceive because this interaction is prevented. Prior to the advent of assisted reproductive technologies (ART) such as in vitro fertilization (IVF), women who wished to have a baby after a tubal ligation had to undergo a specialized microsurgical procedure whereby the tubal ligation was reversed: a tubal reversal (also known as microsurgical tubal reanastomosis). Over the years, surgical techniques were perfected as they became less invasive, more efficient, and more successful.
However, as IVF became available, patients with a prior tubal ligation were now offered an even less invasive and successful alternative to tubal reversal. In IVF, a woman undergoes ovarian stimulation with hormones to produce multiple eggs. The eggs are harvested from the ovaries and fertilized in the laboratory with the partner’s sperm, to create embryos. A few days later, a select number of embryos are transferred (implanted) into the woman’s uterus to achieve pregnancy. Therefore, the IVF process completely bypasses the fallopian tubes to achieve egg fertilization and pregnancy, without having to resort to surgery.
As IVF popularity increased over the past 3 decades, the tubal reanastomosis procedure was largely abandoned over time. In fact, many Reproductive Endocrinology and Infertility university teaching programs around the country no longer offered tubal reanastomosis training to their fellows, leaving a handful of experts with the expertise to perform the procedure. Despite this, tubal reanastomosis remains a safe, effective, successful and simple way to restore fertility in women with a prior tubal ligation, with the following basic advantages:
· 1-2 hour safe outpatient procedure with rapid recovery (no hospitalization required)
· No hormone injections needed to achieve pregnancy
· Multiple gestation is highly unlikely
· High success rates with relatively low cost (more cost effective than IVF in most cases)
· More natural and less stressful way of achieving pregnancy compared with IVF
Tubal reversals are most often performed through a “mini-laparotomy”. In this procedure, a small incision is made in the lower abdomen (along the “bikini line”), or through a prior cesarean section scar, and the uterus and fallopian tubes are reached. Scar tissue, and any clips or bands at the site of the prior tubal ligation, are carefully removed. Next, under microscopic visualization, the two portions of each tube are sutured back together (reanastomosed) using specialized microsurgical instruments and very fine suture material. A technique called chromopertubation, performed at the time of the tubal reversal, confirms that the reanastomosis was done successfully. After allowing one month for the tubes to completely heal, couples are instructed to begin trying to conceive. Success rates can be as high as 70% within one year of trying.
Despite often having major advantages over IVF, a tubal reversal procedure is not suitable for everyone with a prior tubal ligation. It is important that patients consult with a tubal reversal expert in order to determine eligibility prior to performing the procedure.
