Treatment

Tubal Reversal

Tubal reversal (untying tubes) refers to a surgical procedure that restores patency of the fallopian tubes after their ligation. The procedure is highly successful, with average pregnancy rates in the 60-70% range, being even higher in younger patients and lower in an older population. The success of the procedure is based on the couple’s fertility potential, the type of ligation performed (clip, ring, cutting, tying, burning, removal of the tube), and the amount of tube left and the health of the fimbria.
Expected cummulative pregnancy rates by age and method of tubal occlusion:

Age Pregnancy rate (%) Clip/Ring (%) Burning/Resection (%)
<30 80s 80-90 75-80
30-34 70s 70-80 70-75
35-39 60s 60-70 60-75
>39 30s 30-40 20-30

During the presurgical consultation we will review your history and surgical/pathology record from the tubal ligation, if available.  We will also assess your ovarian reserve and order a semen analysis to help determine your fertility potential after the reversal.

We perform tubal reversal using microsurgical instruments via a 1.5-2 inch incision at the pubic hairline (bikini incision). The surgery usually lasts 1-3 hours and patients can go home on the same day of the surgery.  Surgery is performed in a private hospital which offers the best in safety, state of the art equipment, and nursing/anesthesia support.

Patients return 1-2 weeks after surgery for a postoperative check. In most cases, pregnancy can be pursued 4 weeks after the procedure and most patients conceive within 6-8 months. Once pregnant, close monitoring of the pregnancy with HCG levels is required until an intrauterine pregnancy is confirmed by sonogram. If no pregnancy occurs after 6-12 months of trying, a hysterosalpingogram (HSG) is performed to evaluate the patency of the tubes.

Successful outcome of  tubal reversal is dependent on the condition of the remaining tubes and the presence of any scarring due to previous pelvic infection or surgery. When necessary, a laparoscopy may be performed to assess tubal length and the overall pelvic anatomy before proceeding with the reversal.  In most cases, both tubes can be reconnected; however, in some situations, only one tube may be healthy enough to be fixed, and rarely, neither tube can be repaired even with the best surgical effort. If only one tube is patent after surgery, it may take a longer time to achieve pregnancy although the pregnancy rates may be the same as if 2 tubes are patent.

The incidence of ectopic pregnancy (pregnancy outside of the uterus) is higher than in the normal population after this type of tubal surgery (10% vs 2%). To reduce the risk of an undetected ectopic pregnancy, a urine pregnancy test should be performed after a missed period, and if positive, should be followed with serial serum HCG levels until the location of the pregnancy is confirmed by ultrasound. If a tubal pregnancy is detected early, it can be successfully treated with methotrexate without the need for surgery.

Risks of tubal reversal surgery:

  • Ectopic pregnancy (10%)
  • Bleeding
  • Infection
  • Injury to adjacent organs
  • Anesthesia complications
  • Inability to perform or complete the surgery
  • Inability to attain pregnancy after surgery

    • Tubal reversal or IVF ?

  • If more than one pregnancy is desired, tubal reversal may be a better option for some women
  • For women of age >40 or those with very low egg reserve, tubal surgery can be an appropriate choice
  • Tubal reversal carries a much smaller risk of multiple gestation than IVF
  • If other surgical procedures are necessary, they can be performed at the same time of the reversal
  • In cases of severe male factor,  IVF is the only option
  • Time to conception may be faster with IVF, but cumulative pregnancy rates after reversal can be higher than IVF
  • If scarring of the pelvic cavity is anticipated as a result of previous abdominal surgery or pelvic  infection, IVF may be a better choice

    • Cost:

    Our practice model is designed to provide the most cost-effective fertility care as possible, and this is why patients have traveled from throughout the USA and abroad to take advantage of our very affordable IVF program.  In a similar fashion, we have negotiated with the Baylor Irving-Coppell Surgical Hospital an excellent package for our patients needing tubal reversal.

    For our self paying patients, a flat fee of $6200 will cover:

  • Preoperative, surgical and postoperative services at Irving-Coppell Surgical Hospital
  • Anesthesia fee
  • Surgeon’s fee – 2 surgeons experienced in microsurgical technique
  • Postoperative visit

    • For out of town patients, we have arranged discounted rates with the Hilton Garden Inn Hotel which is situated just across the street from our clinic and the hospital.

    Check List:

  • Surgical record of tubal ligation and pathology report of the surgery (if available)
  • Labs for infectious diseases – GC/Chlamydia, HIV, Hepatitis B and C
  • Obstetrical panel that includes CBC, blood type, and rubella antibody
  • Semen analysis with antisperm antibody screen
  • Ultrasound to rule any out other need for surgery (such as endometriosis and fibroids) and to check for antral follicles (to assess ovarian reserve)

    • Before Surgery:

  • An initial consultation and complete examination are required
  • Two weeks before surgery avoid NSAIDs such as aspirin and ibuprofen (Tylenol is fine)
  • The day prior to surgery, eat light meals preferably a liquid diet
  • Nothing by mouth after midnight the day before surgery
  • You will be given further preoperative instructions by the nursing team

    • Surgery and Recovery:

  • Size of the incision – About 4 cm (1.5 – 2 inches) depending on patient size
  • Length of surgery – 1 to 3 hours
  • Length of hospitalization – None, usually able to go home the same day
  • Recovery time – Approximately 1 week off work for most patients
  • Activity after surgery – May lift up to equivalent of a gallon of milk and no driving during the first 2 weeks

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