Q&A: Tubal Reversal Surgery

A question and answer session about tubal reversal with Dr. Gary S. Berger

How is tubal reversal surgery performed and is it safe outside the hospital?

Although tubal sterilization is considered by many physicians to be permanent and irreversible, in most cases microsurgical tubal anastomosis can restore normal tubal function. Microsurgery has traditionally been performed in the hospital, but with advances in surgical and anesthetic techniques, tubal reversal is performed safely and effectively in the outpatient setting.

What is the pregnancy rate after outpatient tubal reversal?

In several recent studies of patients who have undergone outpatient tubal reversal performed by Dr. Berger at Chapel Hill Tubal Reversal Center, the pregnancy rate was 70 percent for patients with at least 1 year of follow-up. The highest pregnancy rates were among women whose sterilization operations had been performed by clip, ring, ligation, or bipolar coagulation. The lowest pregnancy rate was found among patients with multiple site monopolar tubal coagulation. Pregnancy rates were also related to the lengths of normal tube after the reparative surgery and patients' age.

How can I find out what sterilization method was used in my case?

Request a copy of your operative report from the physician who performed your surgery or from the medical record department in the facility where it was performed. If tubal segments were removed, request a copy of the pathology report as well. The pathology report will document the lengths of the tubal segments that were removed.

How does tubal reversal compare to IVF with regard to effectiveness and cost?

Pregnancy rates after IVF vary throughout the US, but average between 20 to 25 percent per treatment cycle according to the latest national data. These rates are for a single treatment cycle. In contrast, the pregnancy rate after sterilization reversal is a long-term rate, since there is a probability that pregnancy will occur naturally every month following tubal repair. The cost of tubal ligation reversal by Dr. Berger is less than the average cost of an IVF treatment cycle. With a higher long-term pregnancy rate and lower cost, tubal reversal is the best treatment, except for women who have undergone multiple site monopolar tubal coagulation.

How does tubal reversal compare to IVF with regard to risk?

The risk associated with tubal reversal is the risk of ectopic pregnancy (10-15 percent). The risks of IVF are ovarian hyperstimulation syndrome, multiple pregnancy (30 percent), and possibly an increased risk of ovarian cancer. Overall, the risk associated with outpatient tubal reversal is less than the risk associated with IVF.

What approaches can be used for outpatient tubal reversal?

Tubal reversal can be performed through a small open incision (mini-laparotomy) just above the pubic bone or through laparoscopy. In my experience, the mini-laparotomy approach is superior because it allows more precision in microsurgical suturing technique than the laparoscopic approach. Recovery time is similar for the two different approaches.

What is the chance that the tubes will become blocked again after the reversal operation, and if they do what treatment options are available?

Studies at Chapel Hill Tubal Reversal Center show that the chance of re-occlusion of the tubes after reversal surgery is less than 5 percent. In such cases, patients are offered the option of repeat surgery without a professional fee.

When choosing a doctor to perform my surgery, how many procedures should I expect him to have performed to be considered an expert?

As with any procedure, the more experience the doctor has the better. Ask the doctor about pregnancy and complication rates among the patients he or she has treated. This is more meaningful than discussing rates reported in the medical literature by different specialists and among different patient populations. Ask if your doctor specializes in reproductive surgery and if he or she is a member of the Society of Reproductive Surgeons. Another source of information is The Directory of Fertility Specialists in The Couple's Guide to Fertility: The Newest Scientific Techniques to Help You Have a Baby.

How long should I wait to try to become pregnant, and what tests should be performed when I become pregnant after tubal reversal?

Patients can begin trying to conceive after the menstrual period following their tubal reversal. When menstruation is delayed, it is important to have a pregnancy test and, when positive, to have the serum HCG level measured as it rises. In normal pregnancy, the HCG levels double every 2-3 days. Once serum HCG is 1500 mIU/dL or above, vaginal ultrasound examination should identify an intrauterine gestation sac. If a gestation sac is not seen in the uterine cavity, ectopic pregnancy should be suspected. Early treatment of ectopic pregnancy with Methotrexate is recommended to avoid the risk of tubal rupture.

Where can I find out more information about outpatient tubal ligation reversal?

http://www.tubal-reversal.net/

Gary S. Berger, M.D., is medical director of Chapel Hill Tubal Reversal Center, Chapel Hill, N.C., clinical associate professor of obstetrics and gynecology and adjunct associate professor of maternal and child health, University of North Carolina. He is a coauthor of The Couple's Guide to Fertility. During the past 27 years, Dr. Berger has performed over 3000 outpatient tubal reversals. A free videotape of his procedure as shown on The Learning Channel is available at Dr. Berger's Tubal Reversal website.

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