Tubal ligation reversal (tubal reanastomosis)
If you have had a tubal ligation (tubal sterilisation) and want to conceive there are essentially two options.
a) Tubal ligation reversal (tubal reanastomosis). This is surgery to excise (cut out) the blocked portion of your tubes and rejoin (reanastomose) these portions, resulting in open tubes.
b) IVF – to bypass your blocked tubes.
The decision on whether to proceed with tubal reanastamosis or IVF is influenced by a number of factors including your (and your partner’s) past reproductive history, your age, the number of children you wish to have as well as personal preference. These issues will be discussed at your initial appointment and the pros and cons of both IVF and microsurgical tubal reanastomosis will be detailed.
I offer both IVF and microsurgical tubal reanastomosis. I will take into account your individual circumstances when I advise you on your best option.
Having said this, for many couples a tubal reversal is preferable to IVF – Tubal reversal is a single operation, usually requiring just one night in hospital then giving you a chance of pregnancy every ovulation.
You will have a general anaesthetic. Surgery begins with a laparoscopy (“keyhole surgery”) – a small incision is made in your navel and a camera is inserted into your abdomen allowing me to visualise your tubes. As long as tubal reversal is possible (see below) a small (@ 3cm) incision is made at about your pubic hair line. The remainder of your operation is “open” (no longer keyhole) using a microscope and microsurgery.
Your tubes will be cut back on either side of the tubal ligation site until they are open and these open ends microsurgically rejoined (the sutures are finer than a human hair). Most women are ready to leave hospital the morning after surgery.
You can start trying to conceive after your next period.
When is tubal reversal not possible?
The majority of tubal ligations involve clips being placed on the tubes or a small part of the tube being removed (“cut and tied”). If this is the case reversal is usually feasible. Rarely the tubes (or their essential outer ends, “fimbria”) have been removed. If this is the case reversal will not be possible and your surgery will not proceed past the laparoscopy.
Tubal reversal can be done laparoscopically – why don’t I do this?
Using microsurgery allows a more precise rejoining of your tubes than laparoscopy. There are a number of studies indicating laparoscopic reananstomosis may have equivalent (not better) subsequent pregnancy rates to open microsurgery. Laparoscopic surgery usually involves less recovery time and smaller incisions than open surgery and so may be regarded as “less invasive”. However, with the technique I use your abdominal wound is very small (if you are thin it may be as small as 2cm) and so recovery time is excellent and comparable to laparoscopy. Therefore, with my surgical technique, you get the advantage of precise microsurgery with minimal wound length and so usually quick recovery with only an overnight hospital stay.
What are your chances of success?
The overwhelming majority of women will achieve tubal patency after microsurgical tubal reanastomosis. Your chance of pregnancy is influenced most strongly by your age. The younger you are, the better your chance. Having said that, if you are over 40 years of age, in my opinion (and that of numerous medical papers), tubal reversal surgery gives you a better chance of pregnancy than even multiple IVF cycles and, if you are over 44 IVF virtually never works, but natural conceptions do occur.
How much does it cost?
Tubal reversal now has a Medicare item number. This means both Medicare and your health fund will contribute to your costs. Your out of pocket costs will vary according to whether or not you have private health insurance. If you do have private health insurance your particular insurance company, your level of cover and your agreed “excess” will all influence your out of pocket cost. A detailed preoperative quote is provided to all patients.
Telephone or email my rooms if you would like to make an appointment to discuss your options for having a baby after tubal ligation.