Tubal Ligation (Sterilisation) Reversal

We have achieved a 40% take-home baby rate for women aged 40-45; and 80-90% in the younger women.

Using our procedure, women less than 40 with fertile partners have been shown to have 80-90 % successful outcome (Petrucco, 1999).

Women over 40 years of age have reduced fertility and are usually advised that IVF is necessary to become successfully pregnant rather than surgery. We have proven this is a misconception having achieved significantly better results with surgery when compared to IVF. Australia wide IVF results indicate a cumulative live birth rates of 10-21 % (1 to multiple cycles – newest ANZARD data – MJA 7/8/2017) for women at 40 or older.

With the low pregnancy rates per cycle of IVF treatment for women over the age of 40 (or younger women with poor ovarian reserve), such that multiple cycles of IVF treatments needed for average success often unachievable for financially, psychological or physically reasons. Successful reversal will permit women with expected low IVF success rates to have unlimited number of attempts, the latter is highly important in achieving the ultimate successes of 40% in this group of women with the oldest at age 47 (Petrucco & Silbert MJA 3/9/2007).

The Procedure

Having performed several hundred microsurgical tubal re-anastomosis using small open incisions we now find that almost all procedures can be performed laparoscopically.

Advantages

Endoscopic surgery has many inherent advantages:

• Microsurgical principles can be maintained with camera magnification allowing fine suturing to be used.
• Operating in a closed abdominal cavity avoids drying of internal organs which are minimally handled thus preventing scar tissue formation.
• The use of irrigating fluid to keep tissues moist ,avoidance of surgical packs all lead to less traumatic surgery and quicker postoperative recovery.
• The field of vision is superior to older methods so that other abnormalities such as scar tissue or the commonly encountered condition “endometriosis” can be treated at the same time.
• Both animal and human studies have shown that the laparoscopic approach is superior in reducing scar tissue formation following surgery when compared to open surgery. (Lok 2003).

Results and Success Rates

The success rates from tubal reversal are exceptional is excellent with 90% to 98% of women who undergo the operation achieving open Fallopian Tubes. For women less than 40 with fertile partners have been shown to have 80-90 % successful outcome when “clips” or “rings” were used for sterilisation (Petrucco 1999). Reversal of more destructive methods “cut & tie” and “cautery” give less optimal results because of greater damage to the fallopian tubes resulting in a shorter tube after rejoining.

For the average woman undergoing tubal reversal 55-90% achieve pregnancy (table below showed results from some of bigger studies open and laparoscopically).

The most important factor influencing the pregnancy related success rate is female age. The older you are, the lower the chance of a successful pregnancy. This is due the declining number of normal eggs within your ovaries as you get older. In addition, increasing age also increases the chance of miscarriage and the possibility of having a baby with a genetic problem such as Down syndrome.

Should pregnancy not occur by 12 months following the operation the chance of subsequent pregnancy starts to fall considerably.