Tubal Ligation Reversal at Fertility Specialists of Texas
Women who have had a prior tubal ligation can choose to undergo a tubal reversal if they desire to have more children. While tubal reversal surgery is not right for everyone, it remains a viable option if performed by a surgeon that is experienced in microsurgical techniques. One way to determine if tubal reversal surgery is the best options for you is to obtain a copy of your operative report from your tubal ligation. This information will allow Dr. Goldstein to determine the type of sterilization that was performed. A copy of your operative report can be obtained from your doctor or from the hospital where your tubal ligation was performed. This can be done by completing our Medical Records Release Form and faxing it to the medical records department of the hospital where your tubal ligation was done.
What is involved in a tubal reversal?
The tubal reversal procedure is performed via a minilapartomy (small incision) in the hospital. Dr. Goldstein performs all of his tubal reversal in a hospital setting. While intra-operative complications are very rare, it’s much safer to have abdominal surgery in a hospital setting with enhanced facilities rather than a "free standing clinic" which is much more limited. You will stay in the hospital overnight following the tubal reversal and discharged the following day.
Microsurgical techniques are used through the operating beginning with a small "bikini" incision. To minimized poster operative pain, the use of self-retraining retractors is avoided. Patients are typically discharged from the hospital the following day to resume normal activities within one to two weeks depending on the patient’s job.
Estimated Tubal Reversal Costs:
Facility Fee: $ 3000.00
Surgeon’s Fee $ 3000.00
Anesthesia: $ 500.00
Total fee: $ 6500.00
These fee exclude the initial consultation fee and pelvic ultrasound performed on your first visit as well as semen analysis required for your partner. Fertility Specialists of Texas must be prepaid two weeks before the surgery. All fees are based on prepayment only.
What is the procedure for a tubal reversal?
Tubal ligation reversal utilizes microsurgical techniques to open and reconnect the fallopian tube segments that remain after a tubal ligation procedure as seen below.
Typically there are two remaining segments, the proximal tubal segment that emerges from the uterus, and the distal tubal segment that ends with the fimbria next to the ovary. Tubal ligation reversal (microsurgical tubotubal anastomosis) connects these segments.
What are the factors that are used in deciding if a tubal ligation reversal makes sense?
The male partner needs a sperm test prior to decision making about tubal reversal vs. IVF after tubal ligation. Other important factors that need to be considered are female age, tubal status ( type of tubal ligation), egg quantity and quality and other pelvic conditions that may make the surgical options less successful, i.e Multiple surgeries, Endometriosis, etc.
What is the procedure to determine if you are a candidate?
A consultation with Dr. Goldstein will need to be made at his office at Presbyterian Hospital of Dallas or at the Frisco location at Baylor Medical Center of Frisco. Please attempt to have your operative report and pathology report as this provides information as to the type of tubal ligation and amount of tube that may be remaining after the reversal. If you cannot get a copy of your operative report, Dr. Goldstein will perform a laparoscopy prior to performing the tubal reversal to evaluate if there is adequate tube remaining to complete a tubal reversal.
At your initial visit, Dr. Goldstein will review your prior records as well a perform a pelvic ultrasound. This visit will last approximately an hour and Dr. Goldstein will discuss with you your options and details of the procedure.
How do I schedule the procedure?
If you decide that you would like to undergo a tubal reversal, then Dr. Goldstein will schedule a preoperative visit where we will review again that process of tubal reversal and you will sign your operative consents. One half of the professional fee is required at the time that the procedure is scheduled and the remaining is required two weeks prior to the actual date of the procedure.
What are the types of tubal ligations?
Pomeroy tubal ligation
Commonly performed at the time of C-section or day following vaginal delivery. The technique involves removing 1/2 to 1 inch from the tube. The amount of tube removed can be determined by reviewing the pathology report. This type of tubal ligation has the highest rate of success for reanastomosis.
Laproscopic Tubal Ligation with Fulguration
This procedure is the most popular method of laparoscopic tubal ligation. The tube is grasped between the two ends of the forceps. It would be used if you had a tubal ligation several months after a vaginal delivery or cesarean section. The adjacent sites of the tube, may be coagulated as well which can result in loss of approximately 2-3 cm of fallopian tube.
This method involves is performed during a laparoscopy whereby the middle of the tube is grasped and pinched off using either a silastic rubber band or a metal clip.
It is important to know the type of tubal ligation performed, as this can assist Dr. Goldstein in determining the probability of success of a tubal reversal. The alternative to a tubal ligation reversal is in vitro fertilization, and depending on the type of tubal reversal that you had done, this may have a higher chance of success without the need of surgery.
What are the other options if you are not a candidate for tubal reversal?
An alternative to tubal reversal is IVF. This involves taking medications to stimulate your ovaries to produce egg which are then fertilized by your partners sperm and placed in the uterus. Fertility Specialists of Texas and Dr. Jerald Goldstein have pregnancy rates through IVF that are some of the highest in the nation and therefore, IVF may be the right decision for you after reviewing your options.
