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Tubal Reversal

Approximately 20% of women use tubal sterilization as birth control. It is very effective and less than one percent of patients conceive spontaneously afterwards. It is common that the OB/GYN that performs the tubal sterilization counsels the patient about the permanency of the procedure and that if she decides to get pregnant again she may need IVF or a tubal reversal. Other pages on our web site have extensive educational information about IVF. In this page we will review the important aspects of tubal reversal surgery. Dr. Donahue has performed these successfully over the past 15 years.

Changes in marital or relationship status often lead patients to request tubal reversals. Several factors have been associated with increased regret concerning the initial decision to have tubal sterilization. These include younger age (i.e., <25 years of age have more regret than >29 years of age), less information provided about alternative forms of birth control, and less information given about the procedure itself and its permanent nature.

Pregnancy rates have been reported in the 50 % to 80 % range over a 1-3 year period of observation. The factors that are associated with better results include younger age, less duration of sterilization (i.e. ≤ 8 years better than > 8 years), lower body mass index (BMI; ≤ 25 kg/m2 better than > 25 kg/m2 ) and longer length of fallopian tube when reconstructed (> 4 cm better than ≤ 4 cm). The type of anastomosis (i.e. isthmic-isthmic, isthmic-ampullary, ampullary-ampullary) may not be as important compared to total tubal length. If the ampullary region is wider, the pregnancy rates may be higher.

The type of surgical approach may include laparotomy (i.e. bikini incision) with microsurgery or laparoscopy (i.e. belly-button) surgery. The pregnancy rates are probably very similar, though there are not well-controlled large randomized trials comparing the two approaches. There were some studies suggesting a lower pregnancy rate with the laparoscopic approach, however the studies were small. Studies have shown similar pregnancy rates with either one or two tubes reconstructed. In general, we prefer to have some distal tube to connect, though patients with fimbriectomies (i.e. removal of distal tube) have been reported to be about 30% with 5 years of observation.

The pre-operative testing may include a cycle day#3 FSH level to assess ovarian reserve, semen analysis or hysterosalpingogram. If the patient has a high day #3 FSH level, ovarian reserve may be diminished and the pregnancy rates may be lower. If the partner has a low sperm count, IVF-ICSI may be a better option. The hysterosalpingogram may show the length of the proximal tube and also the presence of uterine polyps or uterine cavity defects. It is very important that we review the operative report and to have the pathology report if parts of the tube was excised. After consultation with Dr. Donahue you will be able to determine if tubal reversal is a viable option.

The cost of tubal reversal:

Surgical fee: $4700
Hospital/Anesthesia: $4000 (Community Hospital North Surgery Center)
Total: $8700

Please email Dr. Donahue with any questions. Phone consults may be scheduled by calling 317-865-0411. Generally we perform laparotomy with microsurgical approach and 23 hour short stay at the surgery center.
 

 

 

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