The type of tubal ligation procedure has a lot to do with the likelihood of a successful reversal. While there are some minor variations to the different types of sterilization, there are essentially three major methods in current use:
1. Pomeroy method. This procedure is the typical "cut and tie" method. It is typically done at the time of a C-section or on the first day after a vaginal delivery; however, it can also be done months or years later. To tell if this technique was used, look for a 1-2" incision generally below the navel that was used to remove a portion of the tube. This method usually involves cutting about Ĺ-1" from the center of the fallopian tube and tying off the cut ends. The main advantage of this method is the remaining tube is left in good physiologic health. The major potential disadvantage is the surgeon may have cut out a large section of the tube and thus lower the chances of a successful reversal. Overall, women who have been sterilized using the Pomeroy method are the second most likely group to have successful reversals.
2. Laparoscopic cauterization. This procedure is done at any time other than delivery. This method involves inserting a small telescope just below the navel. The tube is grasped in the middle and usually about Ĺ-1" is cauterized or burned until the tube turns white. This technique offers many advantages for the purposes of sterilization as it is a quick and easy outpatient procedure that most women fully recover from within a day or two. Unfortunately, in terms of sterilization reversal, this method leaves us with some deleterious effects. The heat from the cauterization spreads both up and down sometimes destroying the majority of the tube. If you have been sterilized using this technique, donít be discouraged as even the majority of these patients are able to conceive.
3. Laparoscopic banding, clamping or clipping. These procedures are all very similar. Like the laparoscopic cauterization type of procedure, they are done at times other than delivery. These methods involve inserting a small telescope just below the navel. The tube is grasped in the middle and a silastic (rubber) band; Hulka clip or metal clip is used to pinch off a very small part of the tube. The last two devices are similar to putting a clothespin on the tube and squeezing it off. After several days, the pressure of the device causes the tube to separate into two parts. The advantage of this procedure is that the tube is left in wonderful condition both from the standpoint of amount of tube remaining and the superb physiologic state of the tissue. In fact, there are really no disadvantages to this procedure as the surgeon is less likely to remove too much tube, and it yields the highest rates for successful reversals.
Before surgery to reverse a tubal ligation, you will need to obtain a copy of the operative report and pathology report from the doctor who performed the procedure or the facility where the procedure was performed. The simplest way to get these two reports is either to write or go to the medical records department where the procedure was done and ask that they give the reports to you or send them to us that day. If your name has changed since your sterilization, have them put your current name on the reports so we will be able to identify them as belonging to you.
SEMEN ANALYSIS (for men only)
Prior to performing the reversal, evaluation of the male fertility status is essential. This is accomplished by doing a semen analysis.
THE ACTUAL SURGERY
Previously the procedure was done by performing a laparotomy, or cut in the abdomen above the hair line. We are now performing this robotically by laparoscopy. This method limits the size of the incisions and maintains the normal position of the tube while performing the anastomosis. The recovery time is less with the patient returning to work within 4-10 days. It is also an easier and more successful procedure for women who are heavier.
CHANCES OF SUCCESS
Many things go into conceiving other than just the quality of your fallopian tubes. Age, state of health, regularity of periods, quality of cervical mucous, quality of your partnerís sperm, previous venereal infections and previous surgeries, can affect your ability to become pregnant. As mentioned before, the amount of tube removed or destroyed and the type of sterilization procedure are also important. Women who have been sterilized using the same technique may have different likelihoods of success with a reversal. Under ideal circumstances in a young patient, the range of success with a Pomeroy reversal is about 60-70%, with a banding procedure higher, and with a cautery procedure lower; however, the specifics of your case may affect these percentages.
The main risk of tubal reversal is a long-term risk of tubal pregnancy which occurs in approximately 10% of pregnancies after tubal surgery. If detected early, a tubal pregnancy can be treated medically to avoid damage to the fallopian tube and the need for additional surgery.
Your ability to conceive begins right away. If you have not been successful in 3-4 cycles, an HSG (X-ray of the uterus and fallopian tubes) will be performed to check the status of your tubes.