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Moon HS, Joo BS, Kim SG, Nam KI, Koo JS. Where Microsurgical Tubal Reanastomosis Stands in the In vitro Fertilization Era. Gynecol Minim Invasive Ther 2024; 13:71-78. [PMID: 38911303 PMCID: PMC11192280 DOI: 10.4103/gmit.gmit_43_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/25/2023] [Accepted: 08/18/2023] [Indexed: 06/25/2024] Open
Abstract
Among various options of contraception, bilateral tubal ligation (BTL) remains the most frequently used method for women worldwide even at present. However, up to 30% of those who undergo BTL eventually change their minds and wish to conceive again for a variety of reasons, such as a change in marital status or simply wanting more children. In this case, we can either approach it surgically with tubal re-anastomosis (TA) or by in vitro fertilization (IVF)-embryo transfer. Despite the many advantages of TA which lead the American Society of Reproductive Medicine Committee Opinion to recommend it as the primary choice of treatment in posttubal ligation infertility in 2012, IVF is widely being chosen as the first-line treatment nowadays. This study will review the efficacy of TA in various aspects, including pregnancy rate, cost-effectiveness, feasibility, and accessibility, based on review of the literature and our experience. Through this study, we intend to provide a basis for gynecologists to consider TA as the first option in women who wish to conceive again after BTL in this day and age of IVF.
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Affiliation(s)
- Hwa Sook Moon
- Department of Obstetrics and Gynecology, Center for Minimally Invasive Surgery and Treatment, Good Moonhwa Hospital, Busan, Korea
| | - Bo Sun Joo
- Reproduction Aging Center, The Korea Institute for Public Sperm Bank, Busan, Korea
| | - Sang Gap Kim
- Department of Obstetrics and Gynecology, Center for Minimally Invasive Surgery and Treatment, Good Moonhwa Hospital, Busan, Korea
| | - Kyung Il Nam
- Department of Obstetrics and Gynecology, Center for Minimally Invasive Surgery and Treatment, Good Moonhwa Hospital, Busan, Korea
| | - Ja Seong Koo
- Department of Obstetrics and Gynecology, Center for Minimally Invasive Surgery and Treatment, Good Moonhwa Hospital, Busan, Korea
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Peregrine J, McGovern PG, Brady PC, Ginsburg ES, Schlaff W. Restoring fertility in women aged 40 years and older after tubal ligation: tubal anastomosis versus in vitro fertilization. Fertil Steril 2020; 113:735-742. [PMID: 32228877 DOI: 10.1016/j.fertnstert.2020.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 01/31/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Jamie Peregrine
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
| | - Peter G McGovern
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women's Health, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Paula C Brady
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York; Columbia University Fertility Center, New York, New York
| | - Elizabeth S Ginsburg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - William Schlaff
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Goldberg JM, Falcone T, Diamond MP. Current controversies in tubal disease, endometriosis, and pelvic adhesion. Fertil Steril 2019; 112:417-425. [DOI: 10.1016/j.fertnstert.2019.06.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/07/2019] [Accepted: 06/17/2019] [Indexed: 12/20/2022]
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Godin PA, Syrios K, Rege G, Demir S, Charitidou E, Wery O. Laparoscopic Reversal of Tubal Sterilization; A Retrospective Study Over 135 Cases. Front Surg 2019; 5:79. [PMID: 30687715 PMCID: PMC6333701 DOI: 10.3389/fsurg.2018.00079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/17/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives: To evaluate the pregnancy and delivery rates of laparoscopic tubal reanastomosis. Study Design: From 2003 to 2013, 135 laparoscopic tubal reversals were performed according to the four stitch technique. The parameters studied, included positive pregnancy test, miscarriage, ectopic pregnancy, termination of pregnancy, term delivery, post-operative time to conception, post-operative hysterosalpingography, and spermogram. Results: From the 135 patients operated, 93 fulfilled the inclusion criteria. The age of patients varied from 27 to 47 years old. All ages combined, positive β-HCG blood sample rate was 75.3% (95% CI: 65.0–83.4%) and term delivery 52.7% (95%CI: 42.1–3.0%). The age-adjusted pregnancy and delivery rates were as follows:
27–35 y.o. (n = 23) 95.7% (95%CI: 76.0–99.8%) and 73.9% (95%CI: 51.3–88.9%), 36–39 y.o. (n = 40) 77.5% (95%CI: 61.1–88.6%) and 47.5% (95%CI: 31.8–63.7%), 40–42 y.o. (n = 19) 68.4% (95%CI: 43.5–86.4%) and 52.6% (95%CI: 29.5–74.8%), 43–47 y.o. (n = 11) 36.4% (95%CI: 12.4–68.4%) and 27.3% (95%CI: 7.3–60.7%).
Conclusions: In our series the pregnancy and delivery rates after laparoscopic reversal of tubal sterilization is estimated at 75.3 and 52.7%, respectively. For women with tubal sterilization and no other infertility factors, reanastomosis can restore anterior natural fertility related to age. Laparoscopic reversal should be proposed systematically to patients and performed by well-trained laparoscopists, avoiding potentially the inconvenient and adverse outcomes of an IVF treatment. Although, it may seem a more cost-effective technique compared to robotically assisted reversal, a prospective randomized trial could answer this question.
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Affiliation(s)
- Pierre Arnaud Godin
- Department of Obstetrics and Gynecology, St-Vincent Clinic, Rocourt, Belgium
| | - Konstantinos Syrios
- Department of Obstetrics and Gynecology, St-Vincent Clinic, Rocourt, Belgium.,Department of Obstetrics and Gynecology, Mitera Hospital, Athens, Greece
| | - Gwennaelle Rege
- Department of Obstetrics and Gynecology, St-Vincent Clinic, Rocourt, Belgium
| | - Sami Demir
- Department of Obstetrics and Gynecology, St-Vincent Clinic, Rocourt, Belgium
| | - Efstratia Charitidou
- Department of Mathematics, National Technical University of Athens, Athens, Greece
| | - Olivier Wery
- Department of Obstetrics and Gynecology, St-Vincent Clinic, Rocourt, Belgium
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Maskens M, Jouret M. Reconstructive Tubal Surgery as an Alternative to Assisted Reproductive Technology After Tubal Sterilization: Experience in a Secondary Belgian Care Center. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mathilde Maskens
- Department of Obstetrics and Gynecology, Centre Hospitalier de Wallonie Picarde, Tournai, Hainaut, Belgium
| | - Mathieu Jouret
- Department of Obstetrics and Gynecology, Centre Hospitalier de Wallonie Picarde, Tournai, Hainaut, Belgium
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Jama-Alol KA, Bremner AP, Pereira G, Stewart LM, Malacova E, Moorin R, Preen DB. Declining rates of sterilisation reversal procedures in western Australian women from 1990 to 2008: the relationship with age, hospital type and government policy changes. BMC WOMENS HEALTH 2017; 17:117. [PMID: 29178950 PMCID: PMC5702088 DOI: 10.1186/s12905-017-0470-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Female sterilisation is usually performed on an elective basis at perceived family completion, however, around 1-3% of women who have undergone sterilisation elect to undergo sterilisation reversal (SR) at a later stage. The trends in SR rates in Western Australia (WA), proportions of SR procedures between hospital types (public and private), and the effects of Federal Government policies on these trends are unknown. METHODS Using records from statutory state-wide data collections of hospital separations and births, we conducted a retrospective descriptive study of all women aged 15-49 years who underwent a SR procedure during the period 1st January 1990 to 31st December 2008 (n = 1868 procedures). RESULTS From 1991 to 2007 the annual incidence rate of SR procedures per 10,000 women declined from 47.0 to 3.6. Logistic regression modelling showed that from 1997 to 2001 the odds of women undergoing SR in a private hospital as opposed to all other hospitals were 1.39 times higher (95% CI 1.07-1.81) and 7.51 times higher (95% CI 5.46-10.31) from 2002 to 2008. There were significant decreases in SR rates overall and among different age groups after the Federal Government interventions. CONCLUSION Rates of SR procedures in WA have declined from 1990 to 2008, particularly following policy changes such as the introduction of private health insurance (PHI) policies. This suggests decisions to undergo SR may be influenced by Federal Government interventions.
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Affiliation(s)
- Khadra A Jama-Alol
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Alexandra P Bremner
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Louise M Stewart
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Eva Malacova
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.,School of Public Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Rachael Moorin
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.,School of Public Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - David B Preen
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
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van Seeters JAH, Chua SJ, Mol BWJ, Koks CAM. Tubal anastomosis after previous sterilization: a systematic review. Hum Reprod Update 2017; 23:358-370. [PMID: 28333337 DOI: 10.1093/humupd/dmx003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 01/31/2017] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Female sterilization is one of the most common contraceptive methods. A small number of women, however, opt for reversal of sterilization procedures after they experience regret. Procedures can be performed by laparotomy or laparoscopy, with or without robotic assistance. Another commonly utilized alternative is IVF. The choice between surgery and IVF is often influenced by reimbursement politics for that particular geographic location. OBJECTIVE AND RATIONALE We evaluated the fertility outcomes of different surgical methods available for the reversal of female sterilization, compared these to IVF and assessed the prognostic factors for success. SEARCH METHODS Two search strategies were employed. Firstly, we searched for randomized and non-randomized clinical studies presenting fertility outcomes of sterilization reversal up to July 2016. Data on the following outcomes were collected: pregnancy rate, ectopic pregnancy rate, cost of the procedure and operative time. Eligible study designs included prospective or retrospective studies, randomized controlled trials, cohort studies, case-control studies and case series. No age restriction was applied. Exclusion criteria were patients suffering from tubal infertility from any other reason (e.g. infection, endometriosis and adhesions from previous surgery) and studies including <10 participants. The following factors likely to influence the success of sterilization reversal procedures were then evaluated: female age, BMI and duration and method of sterilization. Secondly, we searched for randomized and non-randomized clinical studies that compared reversal of sterilization to IVF and evaluated them for pregnancy outcomes and cost effectiveness. OUTCOMES We included 37 studies that investigated a total of 10 689 women. No randomized controlled trials were found. Most studies were retrospective cohort studies of a moderate quality. The pooled pregnancy rate after sterilization reversal was 42-69%, with heterogeneity seen from the different methods utilized. The reported ectopic pregnancy rate was 4-8%. The only prognostic factor affecting the chance of conception was female age. The surgical approach (i.e. laparotomy [microscopic], laparoscopy or robotic) had no impact on the outcome, with the exception of the macroscopic laparotomic technique, which had inferior results and is not currently utilized. For older women, IVF could be a more cost-effective alternative for the reversal of sterilization. However, direct comparative data are lacking and a cut-off age cannot be stated. WIDER IMPLICATIONS In sterilized women who suffer regret, surgical tubal re-anastomosis is an effective treatment, especially in younger women. However, there is a need for randomized controlled trials comparing the success rates and costs of surgical reversal with IVF.
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Affiliation(s)
- Jacoba A H van Seeters
- Department of Obstetrics and Gynaecology, Amphia Hospital, Langendijk 75, 4819 EV Breda, The Netherlands
| | - Su Jen Chua
- Robinson Research Institute, School of Paediatrics and Reproductive Health, Norwich Centre, 55 King William St, North Adelaide SA 5006, Australia
| | - Ben W J Mol
- Robinson Research Institute, School of Paediatrics and Reproductive Health, Norwich Centre, 55 King William St, North Adelaide SA 5006, Australia
| | - Carolien A M Koks
- Máxima Medical Center, De Run 4600, 5504 DB Veldhoven, The Netherlands
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Declining rates of sterilization procedures in Western Australian women from 1990 to 2008: the relationship with age, hospital type, and government policy changes. Fertil Steril 2016; 106:704-709.e1. [PMID: 27172400 DOI: 10.1016/j.fertnstert.2016.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe trends in age-specific incidence rates of female sterilization (FS) procedures in Western Australia and to evaluate the effects of the introduction of government-subsidized contraceptive methods and the implementation of the Australian government's baby bonus policy on FS rates. DESIGN Population-based retrospective descriptive study. SETTING Not applicable. PATIENT(S) All women ages 15-49 undergoing an FS procedure during the period January 1, 1990, to December 31, 2008 (n = 47,360 procedures). INTERVENTION(S) Records from statutory statewide data collections of hospitals separations and births were extracted and linked. MAIN OUTCOME MEASURE(S) Trends in FS procedures and the influence on these trends of the introduction of government policies: subsidization of long-acting reversible contraceptives (Implanon and Mirena) and the Australian baby bonus initiative. RESULT(S) The annual incidence rate of FS procedures declined from 756.9 per 100,000 women in 1990 to 155.2 per 100,000 women in 2008. Compared with the period 1990-1994, women ages 30-39 years were 47% less likely (rate ratio [RR] = 0.53; 95% confidence interval [CI], 0.39-0.72) to undergo sterilization during the period 2005-2008. Adjusting for overall trend, there were significant decreases in FS rates after government subsidization of Implanon (RR = 0.89; 95% CI, 0.82-0.97) and Mirena (RR = 0.81; 95% CI, 0.73-0.91) and the introduction of the baby bonus (RR = 0.70; 95% CI, 0.61-0.81). CONCLUSION(S) Rates of female sterilization procedures in Western Australia have declined substantially across all age groups in the last two decades. Women's decisions to undergo sterilization procedures may be influenced by government interventions that increase access to long-term reversible contraceptives or encourage childbirth.
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Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. Fertil Steril 2015; 103:e37-43. [DOI: 10.1016/j.fertnstert.2015.03.032] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 03/23/2015] [Indexed: 01/03/2023]
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Hirshfeld-Cytron J, Winter J. Laparoscopic tubal reanastomosis versus in vitro fertilization: cost-based decision analysis. Am J Obstet Gynecol 2013; 209:56.e1-6. [PMID: 23583214 DOI: 10.1016/j.ajog.2013.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/17/2013] [Accepted: 04/08/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Regret after tubal ligation continues to be a problem. After tubal ligation, couples have the option of tubal surgery or in vitro fertilization (IVF). STUDY DESIGN Using decision analysis techniques, we compared cost-effectiveness of tubal reanastomosis by tubal type vs tubal surgery or in vitro fertilization (IVF) for 3 separate age groups of women: <35 years of age, 35 to 40 years of age and >40 years of age. Tubal techniques was divided into type A, those with more favorable prognosis because of the likelihood of having a more significant length tube at time of reanastomosis and type B, those with a worse prognosis of success. We incorporated delivery costs to address the impact of high order multiples in IVF. Data were extracted by studies available in the literature. All costs were adjusted to 2012 US dollars. One-way and 2-way sensitivity analyses were performed. RESULTS The laparoscopic reanastomosis of type A dominated the other groups, because it was more effective and less costly then type B and IVF. However, when women were >40 years old with a history of type B, IVF was favored when its costs were at the lower limit. CONCLUSION The most cost-effective choice for a woman desiring pregnancy after tubal ligation is laparoscopic reanastomosis after a prior clip or ring tubal ligation for women ≤40 years old. It is also the most cost-effective for the oldest cohort, assuming IVF costs are greater than $4500.
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Moon HS, Joo BS, Park GS, Moon SE, Kim SG, Koo JS. High pregnancy rate after microsurgical tubal reanastomosis by temporary loose parallel 4-quadrant sutures technique: a long long-term follow-up report on 961 cases. Hum Reprod 2012; 27:1657-62. [DOI: 10.1093/humrep/des078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Committee opinion: role of tubal surgery in the era of assisted reproductive technology. Fertil Steril 2012; 97:539-45. [DOI: 10.1016/j.fertnstert.2011.12.031] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 12/19/2011] [Indexed: 11/23/2022]
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Schepens JJ, Mol BW, Wiegerinck MA, Houterman S, Koks CA. Pregnancy outcomes and prognostic factors from tubal sterilization reversal by sutureless laparoscopical re-anastomosis: a retrospective cohort study. Hum Reprod 2010; 26:354-9. [DOI: 10.1093/humrep/deq326] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hunter T, Hart R. Endoscopic surgery for female infertility: a review of current management. Aust N Z J Obstet Gynaecol 2010; 49:588-93. [PMID: 20070705 DOI: 10.1111/j.1479-828x.2009.01098.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tamara Hunter
- King Edward Memorial Hospital, Perth, Western Australia, Australia
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