Tubal Ligation Reversal

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Surgical tubal ligation is a common form of contraception. It's a process by which a woman's fallopian tubes are essentially closed off (sometimes referred to as "tied"), preventing the meeting of sperm and ovulated egg. Tubal ligation is performed for women who have given birth to all the children they think they will want in their lifetime.

What happens when that woman later changes her mind and wants to bear more children?

According to expert Dr. Donald Galen, women have the options of in vitro fertilization (IVF) or microsurgical tubal reanastomosis (MTR), both of which can be highly successful.

Galen, who practices at the Reproductive Science Center of the San Francisco Bay Area, is a pioneer in the use of advanced microsurgical techniques to reverse tubal ligation including the daVinci Surgical System which utilizes a robotic arm to perform the most minimally invasive surgery. Dr. Galen performed what is believed to have been the first MTR in the U.S. with the daVinci system, the benefits of which include much smaller incisions and less soreness.

The majority of Galen's MTR patients do not access the robotic arm system, however, because of its higher cost due to location within a hospital, and the fact that success rates for pregnancy are comparable with other microsurgical techniques.

Galen often hears from women who've been told by their ob/gyn's that "re-opening their fallopian tubes is impossible. I think there's just a lack of awareness even among gynecologists of the tremendous success we can have." He reports being able to re-open fallopian tubes for over 90 percent of his patients, and most of them will later conceive. RSC averages an 80 percent pregnancy rate for women under the age of 39 following MTR.

There are some cases that don't respond as well to MTR, notably patients who've had a particular tubal ligation technique called fimbriectomy, in which a portion of the fallopian tube has actually been removed. Interestingly, many patients seeking tubal reversal are not aware of which specific type of tubal ligation was performed in their case. Galen says that while some physicians performing ligations are sensitive to the need for patient education, others just happen to use whichever technique they are most comfortable using. Fortunately, because fimbriectomy in particular is completely irreversible, it is seldom used for tubal ligation.

Woman who are older may need more reproductive assistance than merely MTR because of the impact that normal aging has on egg quality. While clinics may vary in their limits, RSC of the Bay Area will not perform MTR on women older than 43 years.

"Any woman who comes to see us for MTR is told about all of her options to achieve pregnancy," says Galen. "We'll review the operative report of her previous surgeries, check her egg quality through blood tests, and screen her partner with semen analysis. It may be that a patient's situation would be better treated using IVF without tubal reversal." Given a choice, most patients choose MTR, Galen says, for several reasons: for the potential likelihood of being able to conceive more than once again, because they don't want to use fertility enhancing medications, and because they want a more natural conception experience.

After a successful MTR, physicians will recommend that a couple wait approximately a month before attempting to conceive, to allow for adequate healing. Galen also recommends women use over-the-counter ovulation prediction kits to increase their chances of conception, and if the patient is in her mid to upper 30's, the use of clomiphene citrate (brand name, Clomid or Serophene) may help quicken the time to conception. Most of his MTR patients become pregnant within six months after surgery.

Galen warns that because of the extremely delicate nature of fallopian tubes and their functioning, a high level of skill and expertise is warranted for successful surgery. He recommends that patients seek a specially-trained surgical physician who is published and has documented outcome data.

Requests for tubal reversal are quite common -- most of Galen's patients are in their mid-30's and have one or more children, and most are attempting conception within a second marriage. In some cases, though, requests for MTR come from couples who have simply changed their minds and wish to add to their family biologically. Galen notes that statistics indicate that the younger a woman is when she has tubal ligation performed, the much greater the chances are that she'll request a surgical reversal later.

See a fertility specialist now
We're a national network of over 100 fertility specialists. All our specialists can help with tubal reversals.

Dr. Donald Galen, infertility specialist and tubal reversal surgeon. Reproductive Science Center of the San Francisco Bay Area, fertility clinic.