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Tubal Reversal

Tubal ligation reversal (microsurgical tubal reanastomosis) utilizes microsurgical techniques to open and reconnect the fallopian tube segments that remain after a tubal ligation procedure. Typically there are two remaining segments, the proximal tubal segment that emerges from the uterus and the distal tubal segment that ends with the fimbria.

Can your tubes be untied?

Your first step is to contact the hospital where your tubes where tied and request the Operative Report and Pathology Report from your tubal ligation.  Hospitals may retain records for long periods of time depending on the state. Upload Your Records Here

Without records, the physician must determine surgery eligibility by what you remember about the procedure. There is no test to determine how your tubes where tied, the condition of the tubes or how much tube length remains. This may only be determined at the time of surgery. 

How Your Tubes Might Be Tied

Pomeroy Tubal Ligation

is usually performed following delivery in the postpartum period via a small, subumbilical incision. A knuckle of the tube is grasped with an instrument and a suture is tied around the knuckle. The knuckle is then resected and this portion is sent to pathology. Reversal of Pomeroy Tubal Ligation is very successful.

Falope Ring Ligation

is performed via surgery known as laparoscopy. A rubber silastic band is applied across a small knuckle of tube to occlude the tube. There is no resection of tube and no pathology report. Reversal of Falope Ring Ligation is very successful.

Hulka or Filshie Clip Ligation

is performed via laparoscopy. A plastic clip is applied across the tube. Hulka or Filshie clips result in minimal damage to the tubes. There is no resection of the tube and no pathology report. Reversal of Hulka or Filshie Clip Ligation is very successful.

Bipolar & Monopolar Cautery Ligation

is performed via laparoscopy. An instrument is applied across the tube and the tube is cauterized or burned. A moderate to large amount of the tube may be damaged. There is no resection of the tubes and no pathology report. If the tube is cauterized in only one location, successful repair is possible. If the tube is cauterized in multiple locations, the likelihood of a successful reversal is very low.

Fimbriectomy

is performed via laparoscopy or through an abdominal incision. The distal end (fimbria) is removed. This portion of the tube is sent to pathology and a pathology report should be available. If the fimbria are removed, IVF (in-vitro fertilization) is recommended. 

Essure

is a coil that is embeded into the fallopian tube, creating scar tissue and ultimately, blockage. After years of side effects, adverse reactions and lawsuits, Essure is being removed from the market for sterilization effective the end of this year.  IVF is recommended for anyone with Essure only if no portion of the device is within the uterine cavity.

Anatomy

The Fallopian tubes are paired muscular canals which extend from the lateral corners of the uterus to the ovaries.

Each tube is 10 to 12 cm in length and is divided into four segments:

  • Interstitial portion which extends through the uterine muscle wall
  • Isthmic portion which is very narrow and muscular
  • Ampullary portion is the longest segment with a thin muscular wall
  • Infundibular portion is the terminal end of the fallopian tube

Anatomy of women's reproductive system

Physiology

The fallopian tube is where the egg is fertilized by the sperm. The sperm enters the uterus following intercourse, travels through the isthmic portion of the tube and ascends to the ampullary segment of the tube. The egg enters the infundibular or fimbriated end of the tube after being released from the ovary and descends into the tube. Fertilization of the egg occurs in the ampullary segment of the tube and over the next 3-5 days, as the embryo grows and develops, it travels back down the tube, enters the uterus, implants, and pregnancy is established.

Advanced Maternal Age Factors can affect a woman’s ability to successfully conceive. AMH (Anti-Mullerian Hormone) blood testing is recommended for women age 40 and above. This specialized blood test evaluates your ovarian reserve (eggs remaining) and hormone levels. The percentage of conception following a reversal is highest for women under the age of 35. By around the age of 42 there is typically less than a 5% chance of successful conception. In these cases, IVF (in-vitro fertilization) is typically recommended. 

Semen Analysis testing is recommended for all male partners to ensure no male factor is present that may interfere with your ability to successfully conceive following surgery.