Microscopic Tubal Reconstruction
Treatment For Reversal Of Tubal Ligation
Or Tubal Obstruction
At the Fertility & Gynecology Center, reproductive surgeries are performed to help restore or maintain pregnancy. Dr. Ramirez is experienced in minimally invasive procedures and has been doing tubal reinastomosis (reversing “tied tubes”) via laparotomy and microsurgically via laparoscopy for over 16 years. When a woman who wishes to have tubal reconstructive surgery comes to our office, Dr. Ramirez will begin with a detailed consultation with the patient and her partner, if applicable. Regardless of age, a complete evaluation (see Infertility Evaluation) is done to eliminate the possibility of other infertility factors. Some of those factors may include: maternal age, surgical risk, and ectopic pregnancy risk.
Generally the patient has two choices:
- Proceed with tubal reconstruction
- Proceed with IVF (in vitro fertilization)
Tubal ligation reversal (reanastomosis) is a surgical procedure, which can restore the function of fallopian tubes, which have been blocked by a previous sterilization operation. Reversal operations are performed using microsurgical techniques, in which microscopes or loupes are used to visualize and bring together the very narrow hollow center portion of the fallopian tubes. Microsurgery also uses very thin suture materials, the smallest possible incisions, specially designed instruments and non-traumatic tissue handling techniques. Patients go home the same day. This would allow the patient to attempt pregnancy naturally, but in general, pregnancy rates are not as good as a normal tube and are age dependent.
Repair for tubal ligations offers pregnancy rates from 10% – 80%, with the chance of an ectopic pregnancy post reanastomosis as high as 20%. Tubal anastomosis is appealing to those who desire reversal or are not comfortable with the second option, IVF. The disadvantages are the need for major surgery, potential complications and the eventual need for contraception. With tubal reconstructive surgery, achieving a pregnancy may take up to 2 years after the operation. This can be a factor to consider for patients older than 35 years. A lower success rate at getting pregnant in aging women may be the deciding factor in pursuing assisted reproductive techniques instead, such as IVF.
Tubal obstructions at the end of the tube are much harder to treat surgically. This particular problem is caused by scar tissue or adhesions from pelvic infections, endometriosis, or prior surgery. The patient is counseled regarding the severity of the adhesions and the possibility that they will reform even after surgically removed. Additionally, the damage that caused the obstruction also may affect the internal working of the tube. Pelvic infections can cause significant damage to the cilia along the inside of the tube. These “tiny hairs” help the eggs and sperm to move along the tube. Surgically opening tubes that have may have ciliar damage is unfavorable, since the tube still may not work. The patient will be under the erroneous impression that she will conceive, when in reality the damage remains and the risk of her having an ectopic pregnancy will be very high.
The option to proceed with IVF will be discussed after the evaluation is completed. With IVF, a pregnancy can occur within 6 weeks of commencing the treatment. The cost/benefit of pursuing surgery versus IVF is an important consideration. Many patients believe surgery is more cost effective than IVF when in fact, IVF treatment is almost identical in cost. If the patient pursues tubal surgery and is unsuccessful at getting pregnant and may have to utilize IVF, then the cost can be almost double.