A tubal reversal is a procedure to reconnect the fallopian tubes in a woman who has previously undergone surgical sterilization, known as tubal ligation. In a tubal reversal operation, the surgeon removes the portion of each fallopian tube that has been blocked or cut. Once the damaged portion has been removed, the tubes are reconnected to form a complete, open fallopian tube. The fallopian tube is the passageway through which the released eggs travel and meet with a man's sperm and become fertilized.
A tubal reversal, also known as tubal reanastomosis, is usually performed when a woman wants to try to achieve pregnancy after undergoing a tubal ligation. In many cases, surgery for tubal reversal is successful. However, a number of factors can affect the success of the procedure. Estimates vary, but health experts approximate somewhere between 50 to 75 percent of tubal reversals are successful in reopening the fallopian tubes. However, the success rate may be much lower.
A tubal reversal is the only procedure that can open the fallopian tubes.
Good candidates for this procedure include women who have : -
Adequate tubal segments remaining
No other significant fertility problems such as non-viable eggs or ovulation dysfunction
A partner whose sperm analysis is normal
No other health conditions that might prevent pregnancy
A successful tubal reversal does not guarantee pregnancy. In addition, the surgery is expensive and may not be covered by medical insurance. Women who have a tubal reversal are at increased risk for ectopic pregnancy. For this reason, many health experts recommend that sterilized women consider in vitro fertilization as an alternative to tubal reversal.
About tubal reversal
A tubal reversal is a procedure to undo a tubal ligation, which is the surgical sterilization of a woman. Also known as tubal reanastomosis, the procedure is usually performed when circumstances have changed and a woman wishes to have a child.
In women of childbearing age, one egg (ova) from an ovary moves into the fallopian tube each month. There, the egg can be fertilized by a man's sperm produced in ejaculation during sexual intercourse. Once the egg has been fertilized, it travels down into the uterus (the hollow, muscular cavity in a woman's pelvis) and implants in the uterine wall, where it develops into a fetus. In a tubal ligation, the fallopian tubes are separated or sealed shut to prevent the sperm from reaching and fertilizing the egg.
Each year, about 17 percent of U.S. women aged 15 to 44 years have a tubal ligation, according to the Centers for Disease Control and Prevention (CDC). In some cases, a woman may change her mind and decide to have the procedure reversed. Common reasons for seeking a tubal reversal include change in marital status, death of an offspring or husband, or young age at the time of the procedure (e.g., younger than age 30). In the past, tubal reversal usually meant major surgery. However, advances in surgical techniques now make outpatient surgery an option for many women.
In a number of cases, surgery to reverse a tubal ligation can be successful. Estimates vary, but depending on circumstances, health experts estimate the success rates to be anywhere from 25 to 75 percent.
Factors that influence the likelihood of reopening the fallopian tubes include : -
Technique used during tubal ligation : - Women whose tubes were blocked off or clamped with clips or rings are more likely to have a successful reversal than women whose tubes were cauterized (closed using electric heat) or who had a large section of the tube removed. Many experts say that at least 1 inch of healthy tube must remain if tube reconnection is to be successful.
Age : - Women who are younger are more likely to experience a successful reversal of a tubal ligation. Women over 40 years of age who desire to have children may want to consider in vitro fertilization (IVF) instead of a tubal reversal. IVF involves removing mature eggs from the woman's ovary, fertilizing them with donated sperm and then surgically implanting the eggs into the woman's uterus. This procedure does not require fallopian tubes. However, IVF is expensive and is not guaranteed to work.
Woman's reproductive health : - Pelvic diseases such as scarring or endometriosis may affect the success of the tubal reversal.
The experience of the physician performing the surgery : - Tubal reversal is a delicate operation requiring highly specialized skill. The more experience the physician has, the better the outcome is likely to be. Patients should ask their surgeon about pregnancy and complication rates in patients treated in the past.
A tubal reversal is the only procedure that can open the fallopian tubes.
Good candidates for the procedure include women who have : -
Adequate tubal segments remaining
A partner whose sperm analysis is normal
No other health conditions that might prevent pregnancy
However, a successful tubal reversal does not guarantee pregnancy. In most cases, women who have a successful tubal reversal typically become pregnant within the first year after the reversal. Women who have a tubal reversal are at increased risk for ectopic pregnancy (pregnancy that develops outside the uterus). For this reason, many health experts recommend that sterilized women consider IVF as an alternative to tubal reversal.
In addition, tubal reversals are usually expensive and are not typically covered by medical insurance. The same is true for in vitro fertilization.
Before the tubal reversal procedure
A woman considering a tubal reversal must first determine if she is eligible for the procedure. In some cases, the initial sterilization may have prevented any hope of reversal. For example, a sterilization technique known as fimbriectomy involves removal of the end of the fallopian tube. This type of sterilization generally cannot be reversed. In addition, reversal may be difficult if sterilization was achieved through cauterization (using electric heat). This type of sterilization may damage more of the fallopian tubes, resulting in a greater difficulty with reconnection.
To determine a woman's eligibility for the procedure, the physician will obtain a medical history of the patient and perform a physical examination. The physician will review information from the original tubal ligation procedure to gain insights into the likelihood of a successful reversal. The physician will also determine from blood tests if the woman's hormone levels are adequate for egg production from the ovaries.
Patients can request a copy of the operative report from the physician who performed the surgery, or from the medical records department at the facility where the procedure took place. If segments of the fallopian tubes were removed during surgery, it might be helpful for the patient to request a pathology report that records the lengths of the tubal segments that were removed.
Tests are typically ordered to assess the state of the fallopian tubes before performing the procedure. Physicians generally believe that at least 1 inch of healthy tube must remain if tube reconnection is to be successful.
Tests used to examine the fallopian tubes include : -
Hysterosalpingogram : - An x-ray that assesses the state of the fallopian tubes. In this procedure, dye is injected into the uterus. If the fallopian tubes are open, the dye will fill the tubes before spilling into the abdominal cavity. This can help the physician determine whether the tubes are blocked.
Laparoscopy : - A procedure that uses a long, slender tube with a camera on the end called a laparoscope. The laparoscope is inserted into the abdomen through an incision so the fallopian tubes can be examined.
Candidates for tubal reversal must not have any other health conditions that may prevent pregnancy, including age-related factors such as menopause. The method used for the original sterilization and the presence of any scar tissue in the pelvis also may be factors that prevent a woman from having a successful tubal reversal. Finally, the woman's partner will have his sperm count tested to ensure that he is physically capable of fathering a child.
If a woman is approved for tubal reversal surgery, the procedure should be scheduled during the week following her period. She should follow all of the preparatory recommendations made by her physician. These may include not eating or drinking anything after midnight on the day of the surgery. In addition, patients may be asked to briefly alter their medication routine.
During and after the tubal reversal procedure
Both local and general anesthesia may be used during a tubal reversal. The procedure may be completed on an outpatient basis, although in some cases it requires a hospital admission. A tubal reversal is usually performed using one of two techniques:
Minilaparotomy. A small incision (1 to 3 inches long) is made below the navel and the physician raises a portion of each fallopian tube to repair it.
Laparoscopy. The patient's abdomen is inflated with gas (carbon dioxide), which helps the surgeon locate the fallopian tubes. A small incision is made below the navel, and a laparoscope is inserted into the abdomen. Instruments are inserted into the same incision or a separate incision and the tubes are repaired.
Magnification and microsurgical techniques are used to repair the fallopian tubes. The ends of the tubes are cut to expose the inner, open space of the tube, called the lumen. These openings are then fused using a microscope and very fine suture material. The size of these sutures is smaller than the width of a human hair. After the tubes have been reattached, the outer covering (serosa) of tubes is sutured together over the top of the inner tube.
Surgery can take anywhere from two to six hours to complete. Patients are often discharged from the hospital the following day, but the patient may need several weeks to fully recover.
Patients will generally remain in the hospital for several hours following the procedure. In some cases, a hospital stay may be required. Once discharged, patients should follow their physician's advice in regard to any dietary, activity or medication restrictions following surgery. In most cases, recovery will take anywhere from a few days to a few weeks.
A woman can begin trying to conceive following the first menstrual period that occurs after the reversal procedure. Because women who have tubal reversals are at increased risk for ectopic pregnancy, it is important to perform a pregnancy test whenever a woman's period is late.
If the home pregnancy test indicates a positive result, the woman should schedule a visit with her physician, who can perform a blood test to check for a hormone called human chorionic gonadotropin (HCG) that builds up early in a woman's pregnancy. When this hormone reaches a determined level (1,500 milli-international units per milliliter or above), a vaginal ultrasound can be performed to look for the presence of an intrauterine gestation sac. If this sac is not present, an ectopic pregnancy is strongly suspected and the woman will require medical attention.
Potential risks with tubal reversal
Risks associated with a tubal reversal include those generally associated with surgery (including bleeding and infection) and use of anesthesia (including reaction to the anesthetic).
Other risks include : -
Formation of scar tissue
Increased risk of ectopic pregnancy
There is a small chance that the tubes will become blocked again following a tubal reversal.
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