Tubal Reversal Gives Mothers Hope
A tubal reversal (or tubal reanastamosis) is a surgical procedure intended to open blocked fallopian tubes. The procedure is performed in patients who have previously undergone a surgical sterilization procedure such as a tubal ligation (tubes tied), tubal fulguration (burning of the tubes), clip or ring placement (Filshe or other), or some other “permanent” contraception procedure.
All of the sterilization techniques result in permeant damage to a 2-3 centimeter segment of fallopian tube. This damage prevents sperm and egg from meeting, and thus, fertilization cannot occur.
At Los Angeles Reproductive Center, we use highly refined techniques to perform the tubal reversal procedure. Through a mini-laparotomy (a small incision in the abdomen just above the pubic hair line) we gently open the abdomen to evaluate the uterus, tubes and ovaries. Once we identify the damaged portion of fallopian tube, we isolate that section and precisely remove (surgically excise) it, while preserving and protecting the surrounding tissue. Next, the remaining, healthy portion of the tube is tested with blue dye (chromopertubation) to confirm it is patent.
Once the remaining, healthy portions of tube are confirmed to be patent, we use precise microsurgical techniques to attach the end of one healthy portion of tube to the end of the other healthy portion of tube. Because the openings in the tubes are so small, we will often use specialized magnifying lenses to better visualize the perfect reattachment site. Ultimately, four very small stitches are placed between each segment of tube creating one newly open healthy tube. These steps are performed on each side and are usually followed by a second dye test (chromopertubation) to ensure complete patency. Next, the abdomen is reevaluated to make sure that there is no bleeding and all of the organs are gently returned to their original positions. The abdomen is thoroughly washed of all blood clots and then closed in several layers. Finally, the patient is awakened from anesthesia and taken to the observation area for recovery. The procedure usually takes about 90 minutes to complete.
For the next 1-2 hours, the patient stays in the recovery area under the watchful eye of a nurse. Once fully awake, stable and comfortable, the patient is sent home with a friend or family member. A follow-up visit in our office is scheduled 2-3 days later. Generally, most people find that the day after surgery is moderately uncomfortable, but by the second day, people often report feeling “pretty good.” Often, patients take 5-7 days off of work for recovery, but it can be different for each individual. We will work with you and your employer to be sure that you receive the time off that you need.
Starting with the next period, we recommend that patients attempt to become pregnant using timed intercourse with an ovulation kit or other method. Importantly, prior to surgery, we recommend that a semen analysis be performed in addition to other testing, which depends on each patient’s specific situation.
If there is no pregnancy within six months, we usually advise patients to have a hysterosalpingogram (HSG) to ensure that the tubes remain open (patent). Over the past five years, surgeons at LARC have been able to repair at least one tube in more than 90% of patients. In most of these cases, both tubes were successfully repaired.
While we are very proud of our excellent success with repairing tubes, it is very important to remember that age still plays the biggest role in determining the chances for conception. For this reason, our physicians always discuss options such as IVF, prior to proceeding with a tubal reversal procedure.
At LARC, we are uniquely positioned to discuss the tubal reversal procedures. Because we offer both IVF and tubal reversals, we can provide a non-biased opinion for each patient based on their needs and history.
If you have any questions about tubal reversal, please contact us. We are happy to discuss tubal reversal with you further.
Drs. Nurit Winkler and Marc Kalan of Los Angeles Reproductive Center are a unique fertility clinic focused on treating patients like family and built upon the principles of communication, compassion, warmth, openness, and service that accompanies an exceptional pregnancy rate. Contact us today to schedule an appointment.