- How does female age affect success?
- What is the preferred method of tubal reversal surgery? Laparoscopic or mini laparotomy?
- How do success rates compare to IVF?
- How long after the tubal reversal before I can become pregnant?
- What are my chances of having a baby?
- Am I more likely to have a "tubal pregnancy" after a tubal reversal?
- What if my tubes cannot be repaired?
- Can surgery be successful If my tubes were blocked using the Essure or Adiana method?
- What do I do if I think I am pregnant after the tubal reversal?
- What do I do if I have not conceived after tubal reversal?
Younger women have a higher pregnancy rate per cycle and thus more time to attempt natural conception after a tubal reversal than older women. As women age, the quality and quantity of their eggs decline and older women (>34) have lower pregnancy rates per cycle with less time to attempt natural conception after tubal reversal.
As egg quality and quantity declines, the chances that IVF will be successful are decreased. If tubal reversal is not successful within the first 1-2 years, IVF may not be a future option for older women due to decreasing egg quality, unless an egg donor is used. Per cycle success rates for IVF are significantly higher than per cycle success rates for tubal reversal surgery.
Laparoscopic tubal reversal is the preferred method because it requires a much shorter recovery time, reduces postoperative pain and may result in less scarring. Tubal reversal via mini-laparotomy requires a 4-5 inch incision in the abdomen at the pubic hair line which leads to more post-surgical pain. Recovery from laparoscopic tubal reversal requires less than one week whereas mini-laparotomy can require 2-4 weeks. Laparoscopic tubal reversal surgeries are usually conducted as outpatient procedures while mini laparotomy may be done either as an inpatient or in select patients as an outpatient.
Tubal reversal and IVF success rates are affected by many patient specific factors. In optimal conditions, in women under 35, pregnancy rates up to 65-70% within 2 years of the tubal reversal can be achieved. IVF success rates can exceed 50% per cycle with cumulative rates over 90% after 4 IVF attempts for appropriate candidates.
Most patients can begin to attempt pregnancy the next cycle after the surgery.
Success rates vary widely dependent upon numerous factors such as patient age, how the tubes were tied, coexisting fertility issues, male partner’s fertility, and others. In general, good candidates under 35 years of age can expect tubal reversal pregnancy rates between 65-70% within two years of the tubal reversal surgery. .
The incidence of tubal pregnancy after is reported by different clinics to be between 3% and 10%. Once pregnancy has been confirmed by an hCG blood test, a vaginal ultrasound should be conducted within 2.5 weeks from the missed menses to confirm the pregnancy is in the uterus and not the tube.
There are several many different techniques that can be employed to reconnect the tubes. In some cases, the tube can even be connected directly to the uterus (usually IVF is a better option). If the tubes were severely damaged during the tubal ligation, and cannot be reconnected, the best option is in vitro fertilization. Success rates vary but in appropriate candidates approach 50% per cycle with cumulative pregnancy rates after 4 cycles of greater than 90%.
Can surgery be successful If my tubes were tied using the Essure or Adiana method?
Essure and Adiana provide permanent sterilization by blocking the proximal portion of the fallopian tube including the opening into the fallopian tube from the uterus. This portion of the fallopian tube runs through the muscular portion of the fallopian tube. These methods are currently very popular as they do not require laparoscopic surgery and can usually be performed in the office.
Surgery is much more difficult due to the fact that a portion of the uterine wall needs to be opened and insertion of a more distal portion of the tube into the uterine wall/cavity in order to establish patency. Tubal blockage after surgery is more common in this type of surgery. While some very experienced surgeons are offering tubal reversal as an option after Essure or Adiana sterilization methods, it is the predominant view of infertility specialists that IVF offers much higher pregnancy rates with less risk of uterine rupture and ectopic pregnancies. We do not currently recommend tubal reversal after Essure or Adiana sterilization.
First obtain a home pregnancy kit and confirm that it is positive. Call Reproductive Care Center and schedule an immediate appointment to evaluate the levels of hCG (blood pregnancy test) and a serum progesterone level (helps to determine the risk of ectopic). A vaginal ultrasound will be ordered when appropriate to insure the pregnancy is in the uterus and not the fallopian tube.
We recommend evaluation 12 months after tubal reversal if less than 35 years of age, 6 months if between age 30-39 and after 3 months if over the age of 39. We initially recommend obtaining a hysterosalpingogram (HSG) to determine if the fallopian tubes are open. If the tubes are blocked, IVF is recommended. If at least 1 tube is open consideration should be given to further evaluation and possible treatment options to increase fecundity (chance for conception per month) such as ovulation enhancement and/or artificial insemination.