Tubal Reversal

For women who regret having their tubes tied, the tubal reversal procedure can offer a good alternative to IVF, which for some patients can provide an average cumulative pregnancy rate of up to 80% a year after surgery.

Our IVFMD fertility specialists are among the few surgeons who perform tubal reversal surgery in the Dallas Fort Worth area.

How is the surgery performed?

We perform tubal reversal using microsurgical instruments via a 1.5-2 inch incision at the pubic hairline (bikini incision). The tubes are first identified and freed of any adhesions from the previous tubal ligation. The blocked ends are then resected and reattached to each other under the microscope to ensure the tubes are correctly aligned and perfectly sealed. A blue dye is then injected into the uterus and the end of the tubes are observed for spillage of dye.

The surgery usually lasts 1-3 hours and patients can go home on the same day after a short stay in the recovery area.

What is the cost of tubal reversal?

Surgery is performed at the Baylor Scott & White Surgical Hospital of Las Colinas which offers the best in safety, state of the art equipment and nursing/anesthesia support. We have negotiated with the hospital an affordable package for outpatient tubal reversal of $6,500.00 which will cover:

• Initial consultation and evaluation with the surgeon in the clinic
• Preoperative, surgical and recovery care at the hospital
• Anesthesiologist’s fee
• Surgeon’s fee
• Postoperative visit in the clinic

How successful is tubal reversal?

The success of the procedure is dependent upon the age of the woman, the type of tubal ligation (clip, ring, cutting, tying, burning, part of the tube removed), the amount of tube remaining and the health of the fimbria. The 12-month cumulative pregnancy rates by age and method of tubal occlusion are as followed:

Since the successful outcome of tubal reversal is dependent upon the condition of the remaining tubes and the presence of any scarring due to previous pelvic infection or surgery, a laparoscopy may sometimes need to be performed to assess tubal length and the overall pelvic anatomy before proceeding with the reversal.

In most cases both tubes can be reconnected; however, in some situations only one tube may be healthy enough to be fixed, and rarely, neither tube can be repaired even with the best surgical effort. If only one tube is patent after surgery it may take you a longer time to achieve pregnancy.

What are the risks of tubal reversal?

The most prevalent risk of tubal reversal is an increased incidence for ectopic pregnancy (pregnancy outside of the uterus), which is 10% vs 2% for the general population. To reduce the risk of an undetected ectopic pregnancy, a urine pregnancy test should be performed after a missed period. If positive, the pregnancy should be followed with serial serum HCG levels until the location of the pregnancy is confirmed by ultrasound. If a tubal pregnancy is detected early it can be successfully treated with methotrexate without the need for surgery. Listed below are the main risks associated with tubal reversal:

  • Ectopic pregnancy (10%)
  • Surgical risks such as bleeding, infection and injury to adjacent organs
  • Anesthesia complications
  • Inability to perform or complete the surgery (due to inadequate tubal length, severe pelvic adhesions, etc)
  • Inability to attain pregnancy after surgery

What are the steps?

Before Surgery:

Initial Consultation– During the consultation, which can be conducted via telephone, we will review your medical and surgical history and go over the medical records if they are available. Questions regarding the operation can also be answered to your satisfaction.
A semen analysis is required before surgery because in case of severe male factor (very low sperm concentration or low motility) IVF is the only option. Your egg reserve will also be checked to make sure that you can still conceive using your own eggs.
Preoperative evaluation– This is when you will meet us in person and undergo a physical exam. Our nurses will also review with you the preoperative and postoperative instructions.
Two weeks before surgery please avoid NSAIDs such as aspirin and ibuprofen (Tylenol is fine).
The day prior to surgery please consume only light meals (preferably a liquid diet such as soup) and nothing by mouth after midnight.

Surgery and Recovery:

The operation usually lasts 1-3 hours under general anesthesia. The size of the Bikini incision is about 4 cm or (1.5-2 inches). Afterwards you will stay in the recovery area for several hours before being discharged during the afternoon.

  • Most patients will do well with oral medications for pain and nausea. The prescriptions are provided during the preoperative visit.
  • Most patients will need about 1 week off from work and 2 weeks without driving.
    You will return to the clinic a week after surgery for postoperative check.
  • In most cases pregnancy can be pursued 4 weeks after the procedure and most patients will conceive within 6-8 months.
  • Once pregnant you will need close monitoring of hCG levels until an intrauterine pregnancy is confirmed by sonogram.
  • If no pregnancy occurs after 6-12 months of trying, you may need a hysterosalpingogram (HSG) to evaluate the patency of the tubes.

Tubal reversal or IVF?

  • In cases of severe male factor, IVF is the better option.
  • In case of pelvic adhesions from multiple abdominal surgeries (2 or more prior C-sections, myomectomy) or previous history of pelvic infection (PID, hydrosalpinx) or ectopic pregnancy, IVF is a better choice.
  • Essure causes occlusion of the tubal portion that lies deep within the uterine wall, thus making it inaccessible for surgical repair without cutting into the uterine wall. Thus, for patients who had placement of Essure, IVF is a much better option.
  • In 2007 a large European retrospective study showed that women aged 37 or younger attained a higher cumulative pregnancy rate with tubal reversal than with IVF. In contrast, women at age 38 or older had better chance to conceive with IVF.

F.A.Q.

More Answers

 

Is there a weight requirement for tubal reversal?

Yes, for best results, you should try to have your Body Mass Index below 35. Women who have BMI higher than 35 have increased risks of poor wound healing, infection and pulmonary embolism after surgery. 

Is there an age limit for tubal reversal?

Yes, we don’t perform tubal reversal after age 42 when the chance of live birth is only 1-3%, too low to justify the cost and risks of surgery.

If I had 2 C-sections would I be a good candidate for tubal reversal?

In our experience, if you have 2 or more abdominal surgeries, tubal reversal will be less successful due to the presence of pelvic adhesions. Therefore, if you had 2 C-sections or a myomectomy and a C-section, you will have better results with IVF than with surgery.

If I had a myomectomy would I be a good candidate for reversal surgery?

Abdominal myomectomy in which 3 or more tumors are removed can be associated with pelvic adhesions that can make it difficult for the tubes to pick up the egg from the pelvis. In addition, if there is a C-section following a prior myomectomy, tubal reversal likely will be less successful due to the high likelihood of severe pelvic scarring.

If I have low egg reserve is tubal reversal a good option?

IVF provides the fastest way to pregnancy so IVF may be a better choice if you have low ovarian reserve. However, if your egg reserve is too low for IVF to be cost effective, tubal reversal is a good choice. You need only 1 good egg to become pregnant the natural way!

Does tubal reversal hurt?

To minimize pain, we infiltrate the skin with local anesthetics before making the incision. During the first few hours you may feel some pain but there will be medications that make it more tolerable. You will feel steadily better with time.

After surgery how long should I wait before considering IVF?

If you fail to conceive 6-8 months after surgery, we recommend that you have a HSG to check your tubes. You only need 1 tube to become pregnant, but if both tubes are occluded you should consider IVF.

Does insurance cover tubal reversal?

Most insurance plans do not cover tubal reversal although some may cover IVF after tubal ligation. Our business department can help you understand your benefits.

Is there a money back guarantee program?

No. However, for patients who fail to conceive 1 year after tubal reversal surgery, we do provide a significant discount for IVF.

Is financing available?

Yes, we work with several programs that can provide you loans to help pay for the surgery.