How is tubal ligation reversed at our center?
Our practice was among the early pioneers of outpatient tubal reversal surgery.
In the 1970’s female sterilization reversal was performed in hospitals, surgery times exceeded three (3) hours, self-retaining retractors were routinely used, and patients were hospitalized for several days. This made tubal reversal surgery a major production and unaffordable for many.
Mini-incision Tubal Ligation Reversal
We began performing tubal reversal surgery in an outpatient ambulatory setting in 1996. We perfected our techniques and streamlined our approach such that most reversal surgeries are sixty (60) to ninety (90) minutes. We made smaller incisions and minimized the use of self-retaining retractors. Our patients now enjoy the benefits of shorter operating times and quicker recoveries with much less pain than the more traditional approach to tubal reversal surgery.
We have been able to keep the tubal reversal surgery affordable and successful.
Type of Tubal Ligations Reversed
We are able to reverse over 98% of the tubal ligations among all the patients who have surgery at our center. These women all have a chance at natural conception and pregnancy.
***Click on each ‘+’ section below for more information.***
A common method of tubal ligation is Filshie or Hulka clip tubal occlusion. Tubal clip ligations are often performed six (6) weeks or more after pregnancy and delivery. These procedures or often performed laparoscopically (small camera inserted through the belly button). Occasionally tubal clips can also be applied directly to the tubes during a c-section.
Tubal clips cause blockage of the tube by exerting pressure on a small section of the tube. This causes the blood supply to that area to decrease and the tissue undergoes changes which result in the tube healing closed and separating. The tubal clips serve no function after the tubal ends have closed and separated.
Tubal clips are an excellent tubal ligation method for reversal and reversal of clips often provides the highest chance of pregnancy success. Why?
Compared to other tubal ligation methods, fallopian tube clips only damage a very small portion of the fallopian tube when they cause tubal blockage. It is technically easier to rejoin the tubal segments because the sections of fallopian tube are more similar in size.
When we repair a clip tubal ligation we are often more certain the remaining fallopian tubes will be healthy and long. In comparison to other tubal ligation methods, the performance of clip tubal ligation is more similar among doctors than ligation and resection (cutting and tying) or coagulation (burning). This means the technique is fairly consistent among doctors and the reversal results are more predictable.
Many mistakenly believe reversing clips is as simple as just removing the clip and the tube will be reopen. Unfortunately it is not quite that easy. The clips have to be removed, the closed ends opened, and the tubal ends rejoined using microsurgical techniques.
Pregnancy success after reversal of tubal clips can be as high as 80%.
Tubal ring tubal ligation is also a common method of tubal ligation which causes minimal damage to the fallopian tubes. Tubal clips are often applied during a laparoscopic (small camera inserted in the belly button) procedure.
Similar to tubal clips, tubal rings are an excellent method for tubal reversal.
Tubal rings cause blockage of the fallopian tube in a manner similar to tubal clips. Tubal rings do damage slightly more of the fallopian tube than tubal clips but this does not seem to adversely impact pregnancy success rates after reversal.
As with tubal clips, reversal of tubal rings cannot simply be performed by removing the rings. The rings cause the tubal ends to heal closed and the ends will separate. To reverse the effects of tubal rings, the rings must be removed, the tubal ends reopened, and the fallopian tube ends rejoined with microsurgical techniques.
Pregnancy success after reversal of tubal rings can be as high as 80%.
When tubes are cut and tied during a tubal ligation the more correct term for this method is ligation (tying) and resection (to remove by cutting). This is a very common method of tubal ligation when performed during a c-section or within the first 24 hours after a vaginal delivery.
Although most people are aware of the concept of cutting and tying tubes very few people actually understand the exact reasons for each step. A small segment of the tube is tied first before it is cut. The purpose of the suture is to prevent bleeding. The tube will then be cut to cause physical disruption of the fallopian tube. The suture will eventually be absorbed and the closed ends of the tubes will separate.
Ligation and resection methods are reversible and with good success but this method is more dependent on the different techniques of individual doctors. Some doctors remove minimal amounts of tube and others may remove larger amounts, the ends of the tubes, and, in rare cases, both tubes in their entirety.
It is helpful for us to review the operative and pathology reports of these types of tubal ligation so we can determine both the technique and the amount of tube removed by a patient's doctor.
Pregnancy success after reversal of ligation and resection averages 66%.
Tubal coagulation is also known as tubal burning. Although this method sounds like an extreme way to cause tubal blockage it is very common, despite popular opinion, is also very reversible if the doctor did not burn too much of the tube.
Tubal coagulation exists in two forms: bipolar and monopolar coagulation. Bipolar is the most common type and is the least destructive of the two.
Tubal coagulation is often performed during a laparoscopic procedure (camera inserted through the belly button). It is very typical for a doctor to perform a one (1) to two (2) cm burn or to burn the tube in 3 (three) adjacent spots.
Burned tubes can often be successfully repaired but this method is dependent on the technique of individual doctors. Some doctors will coagulate small amounts and other will coagulate larger amounts. Some will coagulate the tube close together
Pregnancy success after reversal of tubal coagulation averages 66%.
Essure is a newer sterilization procedure which causes occlusion (blockage) of each fallopian tube from the inside.
During the Essure procedure a micro-insert device composed of two coils is inserted into the very opening of each fallopian tube from inside the cavity of the uterus. The micro-insert device causes scar tissue to form inside the fallopian tube and this causes permanent blockage of each tube.
We were the first physicians in the world to publish case reports on successful pregnancy after outpatient Essure reversal. Essure can be reversed by surgically removing the coils and then re-inserting the remaining healthy fallopian tube into the cavity of the uterus.
The chance of pregnancy after reversal of Essure sterilization is approximately 35%.