The Center for Assisted Reproduction does tubal reversals in our ambulatory surgical center. A tubal reversal is an outpatient surgical procedure which involves reconnecting a woman's fallopian tubes once they have been "tied" (tubal ligation). Various methods can be used to perform a tubal ligation. The chances of achieving a pregnancy following a tubal reversal depend on the method used to "tie" the tubes.

There are several methods of tubal ligation including:

• Application of a ring or clip to occlude the tube.
• Removal of a portion of the fallopian tube.
• Fulgration or burning a portion of the tube.

Of the methods listed, application of a ring or clip to the tube offers the best outcome following tubal reversal as it involves the least amount of tubal damage.

The second method, removal of a portion of the fallopian tube, is most commonly utilized immediately following delivery (post partum). Typically only one to two centimeters of fallopian tube are removed from the middle of the tube. This type of ligation is generally amenable to reversal but is dependent on the length of fallopian tube removed at the time of ligation. An estimate of the length of tube that was removed can be obtained from the pathology report which is generated at the time of tubal ligation.

Infrequently, a partial salpingectomy or the removal of the fimbriated end of the fallopian tube may be used as a method of sterilization. The fimbriae are finger-like projections of the fallopian tube that move over the surface of the ovary and are critical in picking up the egg at the same time of ovulation. This type of tubal ligation can be reversed by making new openings in the ends of the tubes. Pregnancy rates with this procedure are somewhat lower than with a traditional tubal reversal.

Tubal reversals are usually done using a procedure called a mini laparotomy. Depending on the type of tubal ligation that was used, it may be necessary to perform a laparoscopy at the time of the tubal reversal to assure that adequate tubal length is present for reversal. Laparoscopy requires a small, one centimeter, incision in the navel through which a lighted telescope can be placed to view the uterus, tubes and ovaries. This adds ten to twenty minutes to the procedure. If adequate tubal length is present to be reconnected, a four centimeter (approximately 2") "bikini" incision is made just below the pubic hairline and above the pubic bone. Using magnification to enlarge the image of the tubes, the tubes are reconnected. The skin is closed with stitches which will reabsorb, therefore, there are no staples to remove. The patient is discharged home the same day as the surgery.

What tests do I need before I can have my tubal reversal done?

In general, only a recent semen analysis (within 1 year) from your current partner is needed. if possible a copy of the operative report and pathology report should also be given to your doctor so that the most appropriate surgical approach can be planned. If you have had a fimbriectomy performed, a hysterosalpingogram (x-ray of the tubes) may be helpful.

How big will my incision be?

The incision is approximately a four to five centimeter (2") "bikini" incision just inside the pubic hair line. We use suture to close the skin which is reabsorbed by the body over six to eight weeks.

How soon can I go back to work after surgery?

This depends on what you do for a living. In general, most patients who have jobs which are sedentary and do not involve heavy lifting, can return to work in five to ten days. If you have a more rigorous job, ask your doctor what is appropriate for your situation.

When do I need to see my doctor after surgery?

You should arrange a post-op visit approximately two weeks after tubal reversal surgery so that the findings and future treatment plan can be reviewed. Certainly, if you have any problems prior to that visit, you should call your doctor.

How soon can I try to get pregnant after my tubes are put back together?

You can begin to attempt pregnancy the next cycle after surgery.

How long does it take to get pregnant?

Most patients achieve pregnancy within six months of tubal reversal surgery. However, occasionally it can take as long as one year.

If I get pregnant after having my tubes reconnected, could it be a tubal pregnancy?

This is possible, but unlikely. The incidence of ectopic pregnancy following tubal reversal is three to five percent. If you are at least two days late for your menstrual period after your reversal, you should call our office for a pregnancy test.

What risks are associated with tubal reversal?

There are three risks associated with tubal reversal. These include the risk of:

• Injuring a blood vessel resulting in bleeding
• Complications associated with anesthesia.
• The possibility of infection.