Women who have had a prior tubal ligation can choose to undergo a tubal reversal if they desire to have more children. Tubal reversal surgery is not right for everyone, especially when compared with the risks, benefits and cost of IVF. However, if a patient prefers this method of fertility restoration, it remains a viable option if performed by a surgeon that is experienced in microsurgical techniques.
What is involved in a tubal reversal?
The tubal reversal procedure is performed using an open (small c-section like incision) or a minimally-invasive approach using the da Vinci® Surgical system. The newest technique for reconstructing the tubes involves the use of robotic arms which are introduced through small laparoscopic incisions. The da Vinci® Robot is a $1.5 million surgical computerized assistant which is used in a hospital setting. While the operating time with the robot is slightly longer, the recovery time for the patient is measured in days rather than weeks after standard microsurgical anastamosis.
da Vinci® Surgical system benefits:
- Same-day discharge from hospital to your home
- Faster recovery
- Small incisions
- Less post-operative pain
- Less risk of wound infection
- Faster return to daily activities
- State-of-the-art technology
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?
One way to determine if tubal reversal surgery is a good option for you is to obtain a copy of your operative report from your tubal ligation. This information will allow the physicians at Fertility Specialists of Texas 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.
If you cannot get a copy of your operative report, our physicians may 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, we will review your prior records as well as perform a pelvic ultrasound. This visit will last approximately an hour and we will discuss your options and details of the procedure.
What are the other options if you are not a candidate for tubal reversal?
The alternative to a tubal ligation reversal is in vitro fertilization (IVF), and depending on the type of tubal reversal that you had done, this may provide a higher chance of success without the need of surgery. This involves taking medications to stimulate your ovaries to produce eggs which are then fertilized by your partner’s sperm and placed in the uterus. IVF is a less invasive option that results in a shorter average time to pregnancy, as well as a lower risk of ectopic pregnancy.
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