• Tubal Reversal FAQ's (commonly asked questions)
• What is a Tubal Reversal?
• How do I know if a Tubal Reversal is an option for me?
• Tubal Reversal Surgery Advances
• How Is Tubal Ligation Reversal Performed?
• Tubal Reversal Surgery vs. In Vitro Fertilization (IVF)

WHAT IS TUBAL REVERSAL?
The fallopian tube is the small tube that connects the ovary with the uterus. The human egg is fertilized in the fallopian tube and travels down this tube to implant in the uterus. The tube also allows sperm to travel from the vagina to the egg that ovulated. Pregnancy can be prevented if the fallopian tube is surgically blocked. Surgical sterilization is accomplished in a woman by tying, cutting or burning the fallopian tube. This is considered a permanent procedure, but can be reversed surgically in some, but not all cases by a SRM physician.

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HOW DO I KNOW IF A TUBAL REVERSAL IS AN OPTION FOR ME?
The factors that go into whether a tubal reversal is right for you are:

1. Age (<40)
2. Type of ligation (an operative report and pathology report from the facility it was done is BEST)
3. Where the blockage on the tube is (determined based on an HSG what is this?)
4. Your partner's sperm parameters (determined by a semen analysis)
5. Hormone levels, specifically day 2-4 FSH and estradiol (checked when age > 30)
6. Whether or not your uterus is normal with an ultrasound on initial visit.

All of this initial evaluation can be initiated by our practice and is strongly recommended, but not required. Our fertility experts can determine based on the above workup, whether a tubal reversal is a good idea. On your initial visit with SRM, your SRM MD will discuss these tests with you in more detail and how to perform them.

You can choose to have the above tests performed prior to your visit with written reports brought with you on that initial consultation to expedite the process. It is STRONGLY recommended that if the HSG is done at an outside facility, you have the FILMS brought with your first visit so the SRM MD can view them.

To make an appointment with an SRM physician, please call 206-301-5000 or apply online.

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TUBAL REVERSAL SURGERY ADVANCES
The first microsurgical reverse tubal ligation procedures were performed in 1977. Prior to then, tubal reversal surgery success rates were low, typically ranging from 20 to 30 percent. Microsurgical advancements, which included the use of magnification, improved surgical instruments, and smaller sutures, specially-trained microscopic surgeons (SRM physicians) now, can achieve pregnancy rates better than 50 percent. Tubal reversal surgery still involved a large bikini incision coupled with a four- to five-day hospital stay and a six-week recovery period.

Understandably, these factors discouraged many patients from choosing to reverse tubal ligation.

In the years since the advent of microsurgical reanastomosis, reproductive surgeons have further refined and improved this procedure. Current techniques for tubal reversal allow the procedure to be done in the hospital with an overnight stay in the hospital, rapid recovery with discharge home with oral pain medications and a quick home recovery period (typically seven to 10 days away from work) with incision healing with absorbable sutures. The size of the incision is primarily dictated by patient weight.

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HOW IS TUBAL LIGATION REVERSAL PERFORMED?
It is a 2-3 hour surgical procedure done in the operating room under general anesthesia. The surgery requires a small bikini incision in your lower belly. Most patients are able to recover quickly and leave the hospital after an overnight stay. Our physicians are experts in this procedure by their extra training in microsurgery. This procedure requires extra training that a general obstetrician/gynecologist may not have experience in, unless they have had additional training in microsurgical technique.

Microsurgical tubal reanastomosis is usually performed using a procedure called a mini-laparotomy. A 6-8 inch "bikini" incision is made just below the pubic hairline and above the pubic bone.

Using magnification to enlarge the image of the fallopian tubes with an operating microscope, the blocked ends are reopened surgically. The tubes are precisely realigned using a tubal stent and then reconnected using microsurgical sutures. The abdominal incision is closed with absorbable stitches and the patient stays overnight for expected discharge home the next morning.

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TUBAL REVERSAL SURGERY VS. IN VITRO FERTILIZATION (IVF)
An alternative to tubal reversal is in-vitro fertilization (IVF). IVF is also available at our center. Your SRM MD can further detail whether or not IVF or tubal reversal is better based on the above workup. IVF involves the daily administration of fertility injections over a two- to four-week period, coupled with numerous visits to monitor the patient’s response.

At the appropriate time, the eggs are harvested from the woman by placing a needle through the vagina and into the ovary. This egg retrieval procedure also drains follicular fluid from the ovaries. On the day of egg retrieval, the husband’s sperm is combined with the patient’s eggs in a culture dish in the laboratory.

The progression of the fertilized eggs, called embryos, is monitored over a period of several days. The embryos are transferred back into the patient’s uterus by placing a small tube through the cervix. Typically one to four embryos are transferred, depending on the patient’s age. Extra embryos, which are not transferred, may be frozen at the couple’s desire for use in the future.

The success rate is quite good for IVF, particularly for young patients and normal sperm. However, when couples are unsuccessful, they must begin the process again, which is costly. IVF also entails an increased risk for multiple gestations (high risk for twin or triplets). Additionally, some couples may not have the time or desire to make multiple visits to the clinic, which is required for IVF. Some of the steps in the IVF process may be uncomfortable or unpleasant for some people. For some patients, tubal reversal is preferable to IVF.

Despite the drawbacks outlined above, IVF remains the best option for patients for whom tubal reversal is not possible. IVF may also be indicated over tubal reversal when other significant fertility factors are present, such as severe sperm abnormalities, diminished ovarian reserve, or age over 40 years of age.

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HOW MUCH DOES IT COST?

Approximately $11,500, which includes the surgeon fee, anesthesia, and facility fee. This does not include the initial consultation and tests that are recommended but not required. Please call 206-301-5000 or on-line to speak to one of our financial counselors for more details.

Revised May 8, 2008