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Tubal Reversal: Why It Isn’t for Everyone

by - 08.01.2019 | Infertility

For millions of women, tubal ligation-also referred to as having your tubes “tied”- is a wonderful option for long lasting birth control. No more worrying about contraceptives!  And tubal ligation surgery has an extremely high rate of success, meaning only about 1%-2% of women become pregnant in the years following their procedure.

However, as life progresses, some women find themselves yearning to restore their fertility. Certain circumstances, such as the loss of a child, or a divorce, and remarriage, or simply wanting another baby to add to the family, can cause this change of heart. When that happens, couples often begin considering tubal reversal surgery.

While tubal reversal surgery does have a fair rate of success, it’s not always for everyone. The surgery itself can be costly, and it doesn’t come with a money-back guarantee. You may endure the pain of a tubal reversal procedure, only to find out you need to pursue other avenues for growing your family, such as IVF. Depending on the type of tubal ligation you had, your age, and other factors, you may, or may not, be a viable candidate for tubal reversal surgery.

What is A Tubal Reversal?

A tubal reversal procedure begins with an assessment of your tubes. If there is enough tube to reconnect, and your tubes are in healthy shape, the surgery can take place. Tubal reversal is performed microscopically or under significant magnification and it’s minimally invasive.

Through a small incision through the lower abdomen, the pelvic area is reached and the tubes are then exposed, ends opened up and reconnected by sutures. This is all done while you are under general anesthesia. Although the surgery lasts 2 hours, you are typically good to go home the same day, to recover.

Your recovery time can be as long as 2 weeks, and you should follow the post-operative instructions to the letter. Once you doctor has given you the “all clear” you are allowed to return to normal activities, including sex.

The Odds of Your Success

Success rates for reattachment, and the odds of a woman who has undergone the tubal reversal procedure becoming pregnant, are highly dependent on age. For those women under 35, the odds are highest, at 50-70% success, for one year of trying following surgery. For women who are 35-40 years old, your odds drop to 50%. Those women who are over 40 have the lowest success rate, coming in at 20-30%. It’s important to note that age does have a direct impact on your fertility, whether or not you have had tubal ligation.

Other factors which can contribute to your ability for success are:

  • The type of tubal ligation that was performed. Some tubal ligations are irreversible.
  • The condition of the remaining fallopian tube. Some procedures compromise more of the fallopian tube than others, or the development of too much scar tissue has affected your fallopian tubes.
  • Your body mass index is a factor. The more obese you are, the lower your success rate.
  • Health conditions, such as immune-suppressive disorders, can hinder fertility. However, this would also be a factor, when combined with other risks, even if you didn’t have a tubal ligation.
  • Your partner’s sperm count will contribute to your ability to become pregnant, even if your fallopian tubes are successfully reattached.
  • Ovulation problem or PCOS can be an issue. Once your tubes are re-connected, you may still need to take medications to induce your ovulation in order to become pregnant.

Risks Involved in Tubal Reversal

Risks involved with tubal reversal surgery are uncommon and some of them include bleeding, infection, separation of the wound and anesthesia related risks. In a young healthy individual, these risks are very low.

There are some risks to becoming pregnant after tubal reversal surgery. One of the more serious complications that can occur is the increased possibility for an ectopic pregnancy. An ectopic pregnancy is one in which the fertilized egg attaches outside of the uterus. This most often occurs inside the fallopian tube. Not only is the pregnancy non-viable, but an ectopic pregnancy can be life-threatening.

Ectopic pregnancies occur in roughly 1-2% of pregnancies. In women who have had tubal reversal done, the odds increase to as high as 4-8%. This is the most dangerous complication to tubal reversal.

When Are You Not a Candidate for Tubal Reversal

Whether you discover you aren’t a good candidate for tubal reversal, whatever the reason, or you decide the surgery isn’t for you, there is an alternative. In-vitro fertilization (IVF) has proven highly successful for those women who have compromised fallopian tubes, including those who have had a tubal ligation. This is especially true for women over the age of 40.

IVF results in a significantly higher success rate compared to tubal reversal on a monthly basis. Typically, the success rate of tubal reversal after 12 months of trying corresponds to the monthly pregnancy rate accomplished with IVF, thus making IVF a significantly better option for those who had their tubes tied. Nevertheless, some patients may still prefer to conceive naturally which makes tubal reversal a viable option.

The main challenge is to find a provider who can perform this type of a surgery as fellowship training programs for reproductive endocrinology and infertility no longer offer this type of training routinely, except for a very few programs in the country. Dr. Bayrak, the medical director of LA IVF fertility clinics who trained at the prestigious University of Southern California Reproductive Endocrinology and Infertility fellowship program, has vast experience in such surgeries and continues to perform tubal reversal procedures for patients coming from out of town and state.

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