Microsurgical reversal of tubal sterilization

Fluoroscopically guided transcervical fallopian tube recanalization of post-sterilization reversal mid-tubal obstructions

PURPOSE

To assess the technical success and early outcome of fluoroscopically guided transcervical fallopian tube recanalization (FTR) in mid-tubal occlusion following sterilization reversal surgery.

METHODS

From July 1995 to January 1998, patients with greater than 12 months secondary infertility underwent hysterosalpingography (HSG). FTR was performed in proximal or mid-tubal occlusion. Cases of FTR in mid-tubal occlusion were included in this study. Technical success (defined as complete tubal patency) using a standard guidewire and hydrophilic glidewire, the number of patients with at least one patent tube, and the intrauterine and ectopic pregnancy rates were determined.

RESULTS

Twenty-six infertile patients with previous sterilization reversal underwent HSG. Eight of 26 (31%) patients (mean age 32 years, range 23-37 years), had attempted FTR for mid-tubal occlusion at the site of surgical anastomosis. Fourteen tubes were attempted as there were two previous salpingectomies. Technical success was achieved in eight of 14 (57%) tubes attempted, resulting in five of eight (62%) patients having at least one patent tube. At follow-up (mean 18 months, range 12-28 months) in these five patients there was one intrauterine pregnancy. There were no ectopic pregnancies.

CONCLUSIONS

FTR in mid-tubal obstruction in infertile patients following sterilization reversal surgery is technically feasible and may result in intrauterine pregnancy. In this small group there was a lower technical success rate and lower pregnancy rate than in unselected proximal tubal occlusion.

A report on 387 cases of microsurgical tubal reversals

OBJECTIVE

To survey what factors influence the pregnancy outcome in an effort to improve the pregnancy rate (PR) after microsurgical reversal of tubal sterilization.

DESIGN

Retrospective clinical study.

PATIENT(S)

Three hundred eighty-seven patients who had microsurgical tubal reversal between March 1982 and January 1994.

INTERVENTION(S)

Postoperative pregnancy outcomes were determined by telephone, letters, and direct interviews.

RESULT(S)

Pregnancy outcomes were identified in 94.1% of the total patients. The overall PR was 91.6%, of which 3.9% spontaneously aborted and 1.7% were ectopic. The probability that pregnancy occurred within the first 12 months was 0.80. The median interval from the tubal reversal to pregnancy was 5.34 months. The pregnancy success rate after reversal of Falope ring sterilization was statistically significantly higher than in the other groups. Patients with reversed tubal length > or = 7 cm had a statistically significantly higher PR than those with < 7 cm.

CONCLUSION(S)

The overall probability of pregnancy was 0.89. The tubal length reconstructed after tubal reversal and the type of sterilization performed previously were the important factors affecting the PR.

Microsurgical reversal of tubal sterilization: a report on 1,118 cases

OBJECTIVE

To review and evaluate a series of patients who underwent microsurgical anastomosis of previously sterilized fallopian tubes.

DESIGN

Retrospective clinical study.

SETTING

Tertiary care academic center.

PATIENT(S)

In the 134-month span from January 1980 to February 1991, 1,118 women were evaluated for microsurgical reversal of previous tubal sterilization.

MAIN OUTCOME MEASURE(S)

Clinical characteristics of patients, pregnancy rates (PRs), and factors influencing the outcome.

RESULT(S)

Of 1,118 patients, 633 (56.6%) had been sterilized by laparoscopic cautery. Loss of children was a leading reason for requesting tubal reversal. The mean interval between tubal sterilization and reversal was 51.9 months. Nine hundred twenty-two (82.5%) patients were followed up for > 5 years. The overall PR after microsurgical tubal anastomosis was 54.8% (505 of 922) with a delivery rate of 72.5% (366 of 505), and the estimated anatomical success rate was 88.2% (814 of 922). There was no statistically significant difference in the PR or in the interval from tubal reversal to conception among the different operative procedure groups. In addition, no statistically significant difference in the PR was observed regardless of the postoperative tubal length. However, the interval from operation to pregnancy decreased significantly as the postoperative tubal length increased. The pregnant patients (n = 505) were younger and had a longer postoperative tube than the nonpregnant patients (n = 417); these differences were statistically significant.

CONCLUSION(S)

The pregnancy rate after microsurgical reversal of tubal sterilization was not significantly correlated with the method and duration of sterilization, the operative procedure, or the postoperative tubal length.

Reversal of sterilisation by the railroad technique

OBJECTIVE

To show that a simple, easily learned and relatively inexpensive method of reversal of sterilisation provides good results.

DESIGN

Retrospective observational study.

SETTING

An NHS Trust Hospital.

SAMPLE

Sixty-seven women aged 19 to 39 years who underwent reversal of sterilisation between January 1984 and December 1993.

MAIN OUTCOME MEASURES

Pregnancy rate following reversal; rate of ectopic pregnancy.

RESULTS

Thirty-four women (51%) had intrauterine pregnancies after reversal of sterilisation; intrauterine pregnancy rate in women who had been sterilised with rings or clips was 64%. Five women (7.5%) had ectopic pregnancies.

CONCLUSION

This technique provides results that compare favourably with those of microsurgery. It offers hope to couples who do not meet the restrictive criteria for microsurgery and in vitro fertilisation and should appeal to purchasing authorities.

Government-funding program on reversal of tubal sterilization

Three hundred and sixty-one women were provided government-funded sterilization reversal services with the technique of microsurgery. A large majority of reasons (89.8%) for requesting reversal surgery was a loss of children, and the mean interval between sterilization and reversal was 28.7 months. Two hundred and seven (69.7%) of 297 follow-up cases have experienced term delivery or intra-uterine pregnancy and 5 cases were ectopic pregnancy. The largest number of reversal clients (63.3%) were sterilized by the laparoscopic unipolar coagulation technique and the next largest group (24.2%) was sterilized by the laparoscopic banding technique. The highest pregnancy rate (77.8%) was shown in clients who had undergone laparoscopic banding technique while the lowest (65.9%) was the group of laparoscopic unipolar coagulation. A more than 60% of the clients became pregnant within 6 months of their reversal surgery, with the shortest interval being 1 month, the longest 39 months, and the mean 7.6 months. A large majority of the successful cases, 81.6%, were pregnant within 1 year of their reversal surgery.