Fertility Treatment

 

Tubal Reversal or Sterilization Reversal

Tubal ligation is performed as a permanent form of birth control. Fortunately, most types of tubal ligation are reversible, usually with excellent results. There are many reasons to reverse a tubal ligation, such as remarriage, or simply the desire to have more children after thinking you were through with childbearing. Tubal reversal is not a treatment for pelvic pain that appears after a tubal ligation.


One of the most important factors to determine if your tubal ligation can be reversed is to find out how yours was performed.

 The best way is to get a copy of the operation note from your tubal ligation. You should be able to get a copy of the report either from the doctor who performed it or the hospital/surgery center where it was performed. You should try to get a copy before your initial visit with Dr. Gehlbach.
There are some cases where the operation note is not available; your knowledge of how the doctor performed the tubal ligation is important.

  • Tubal ligations that are performed with fallope rings, clips, or in the first several days after childbirth usually destroy the least amount of tube and have the best chance for reversal.
  • Tubal ligations that are performed by cautery (“burning the tubes”) may have lower pregnancy rates because they may have destroyed too much of the tubes.

The success of a tubal reversal depends on three main factors: your age, the length of the fallopian tubes after the tubal ligation, and the presence of any other fertility factor, such as a low sperm count or irregular menstrual cycles.

For women under age 35, pregnancy rates can be as high as 70%; for women in their early 40’s, it is approximately 30%. The optimal length of fallopian tubes is at least 5 cm (2 inches) after reconnection.
Dr. Gehlbach performs tubal reversals as an outpatient through a small incision in the lower abdomen, typically 2-3 inches across. Through that incision he is able to reconnect both fallopian tubes. He injects dye into the uterus and tubes as he is performing the tubal anastomosis to make sure that the tubes are connected and open following the procedure. The surgery usually takes about 2 hours to perform, after which you will be in the recovery room for another hour or two until you have recovered from the anesthetic.

At your initial consultation, Dr. Gehlbach will review your medical history and perform a physical examination. He will discuss how the procedure is performed, recommend any pre-op testing, and discuss alternatives to surgery. He will recommend a semen analysis for your partner, which can be performed prior to your surgery date.


One of the alternatives to tubal reversal is in vitro fertilization (IVF).

This is a nonsurgical fertility treatment for women with blocked tubes. It involves stimulation of the ovaries with fertility shots, removal of eggs from your ovaries by ultrasound guidance of a needle, fertilization of the eggs with your partner’s sperm, and placement of one or more of the embryos into your uterus.

IVF is more successful than tubal reversal when there is an extremely low sperm count or if too much of the tubes were destroyed by the tubal ligation. IVF has pregnancy rates that are similar to tubal reversal, but it usually is more expensive.

One of the risks of tubal reversal is ectopic (tubal) pregnancy. Approximately 10-15% of pregnancies following tubal surgery are located in the fallopian tube. An ectopic pregnancy can be a life-threatening condition: it can result in internal bleeding and even death. Fortunately most ectopic pregnancies are detected early and treated successfully with medication and/or surgery. Dr. Gehlbach follows all of his patients when they conceive following tubal reversal to make sure that the pregnancy is in the uterus, and not in the tube.