Tubal ligation, commonly referred to as having your tubes tied, is a general term used for a surgical procedure of the fallopian tubes to cause occlusion or blockage to prevent pregnancy from occurring. Tubal ligation prevents pregnancy by blocking passage of sperm through the fallopian tube to reach the egg and also prevents the egg from reaching the uterus. Tubal ligation is considered to be a permanent method of sterilization and most women who undergo this procedure are told it is permanent.  Fortunately, having your tubes tied does not have to be permanent.  With Dr. Gary Berger’s microsurgical tubal ligation reversal procedure, fertility can be restored during a short outpatient procedure. 

What Is Tubal Reversal Surgery?

Tubal ligation reversal involves microsurgical techniques to open and reconnect the fallopian tube segments that remain after a tubal ligation procedure.  Usually there are two remaining fallopian tube segments  – a proximal segment that emerges from the uterus and the distal segment that ends with the fimbria, next to the ovary.  The procedure that reconnects these separated parts of the fallopian tube is called microsurgical tubotubal anastomosis, or tubal anastomosis for short.

Other terms used to describe the procedure are:

• Microsurgical Reanastomosis
• Microsurgical Tubal Reversal
• Microsurgical Tubal Repair

Is Tubal Reversal Surgery Right For You

There are several different ways for a doctor to tie someone’s tubes.  In order for tubal reversal to be successful, there needs to be enough healthy tube remaining for the repair.  In a comprehensive study on outcomes following tubal reversal surgery, Chapel Hill Tubal Reversal Center reported that 74percent of their patients with the clip or ring methods became pregnant after undergoing the reversal procedure.  Women with the coagulation technique had a 65 percent chance, while 62 percent of the women with the ligation/resection method reported pregnancies after the reversal.

The natural fertility rate declines as woman age.  As with any pregnancy, conceiving after a reversal is more likely if a woman is younger.  A woman can still become pregnant after age 40 if she is still ovulating and having periods, but it becomes more difficult.

Choosing A Tubal Reversal Doctor

It is important to determine how many tubal reversal procedures a doctor has performed.  Experience is the most important factor to consider when choosing a reversal doctor and may ultimately determine whether surgery will be performed if a woman has a difficult situation due to short tubes, missing tubal segments, fimbriectomy or inherent diseases of the tubes.  While most doctors would be unwilling – or unable - to perform a reversal in one of these situations, a doctor with significant experience performing tubal reversal surgery should be able to repair the tubes in most cases, regardless of the type of sterilization that has been performed.  It is a good sign if the doctor specializes specifically in tubal reversal surgery.

It is also desirable if the doctor performs tubal reversals on an outpatient basis, which reduces cost and also avoids the risks of hospitalization, such as possible infection with hospital-acquired bacteria. 

Success Rates

Ultimately, the most important question regarding tubal reversal surgery is, “what are the success rates?”  Since pregnancy and its outcome are the primary concerns of most women who choose the reversal procedure, the reversal pregnancy rates a doctor quotes should be based on accurate statistical data collected through thorough patient follow-up. On the Internet, claims about tubal reversal pregnancy rates are often made without supporting information or documentation - such as a description of the patient population, study method and follow-up interval. Any doctor may say that his patients have a particular success rate, but supporting the claim with actual data involves considerable effort. Performing such a follow-up study requires keeping an accurate record of patients and their findings, as well as maintaining ongoing patient contact to determine the outcomes of treatment. That is the only way a doctor can actually know what the pregnancy and outcome statistics are for his patients. Without this detailed type of information, the accuracy of any claim of success rates should be questioned.  

Alternative Treatments

The other option available to women who have undergone tubal ligation surgery and then desire more children is in-vitro fertilization (IVF). In most cases, tubal reversal surgery has higher success rates, and is more affordable than IVF.  IVF is a treatment that involves several steps leading up to the recovery of eggs from a woman’s ovaries followed by placement of each of these eggs into a Petri dish together with her partner’s sperm. The joining of the egg and sperm (fertilization) occurs outside the body while the eggs and sperm are kept in an incubator. Successfully fertilized eggs (embryos) are placed back into the woman’s uterus several days later. With IVF, medications must be administered and a minor surgical procedure performed each time pregnancy is attempted. Costs for IVF can range from $8,000 to $20,000 depending on geographical location and facility.  According to The Centers for Disease Control (CDC), in the United States during 2004, pregnancy rates from IVF were approximately 34 percent and live birth rates were approximately 27 percent.

Based on these statistics - for most women -  tubal reversal surgery is the most successful and most cost-effective treatment option for pregnancy after a previous sterilization.