Tubal surgery is sometimes performed to reverse a previous tubal ligation (tied tubes). Tubal reanastomosis (surgically “reconnecting” the tubes”) is a reversal of tubal sterilization performed using either microsurgical tubal surgery techniques (laparoscopy) or laparotomy. Dr. Halina Wyczyk and Dr. Cynthia Sites, at Baystate Reproductive Medicine, are the only reproductive surgeons in western Massachusetts offering microsurgical tubal reversal.
In the state of Massachusetts, health insurance will not cover tubal reversal surgery, which presently costs approximately ten thousand dollars.
Tubal surgery to reconnect the tubes is more complex than tubal ligation. Tubal ligation involves tying, clipping, banding, or burning of the fallopian tubes. Tubal reanastomosis involves the use of very thin micro sutures to carefully reconnect the tubes. This type of tubal surgery requires the use of an operating microscope, or another magnifying source, to visualize the fallopian tubes, so it may take from two to three hours to perform.
Tubal surgery can be performed through a small incision (mini-laparotomy); however, due to the length of operating time, patients need to spend one night in the hospital to recover.
Tubal surgery via mini-laparotomy requires that patients be restricted from lifting and exercising for at least two weeks after surgery. Patients usually require pain medication after surgery for a few days.
The success of tubal reversal surgery is dependent upon several factors. One is the amount of fallopian tube remaining after the sterilization. If at least 4 centimeters of healthy tube is present after Fallopian tubes are put back together, then pregnancy is more likely to occur. The amount of tube remaining can usually be determined by reviewing the operative report from the tubal ligation operation.
If the tubal ligation surgery involved the use of cautery or burning of the fallopian tube, then the pregnancy rates after tubal reversal surgery may be lower. Many patients are more likely to achieve pregnancy by undergoing In Vitro Fertilization (IVF).
Patients who are older than 38 may be encouraged to undergo IVF rather than tubal surgery. Additional tests such as a hysterosalpingogram to evaluate the uterine cavity, hormonal tests and sperm evaluation will also be needed. Age is a significant factor for successful tubal reversal surgery. Younger women can attempt multiple natural intercourse cycles after tubal reversal surgery whereas older women may be limited by declining egg quality.
Tubal surgery may present a higher risk of ectopic pregnancy (i.e. tubal pregnancy) compared to IVF. An early pregnancy test and ultrasound evaluation can help make the diagnosis. Frequently, early therapy (with either surgery or medication) can save the involved fallopian tube.