Reproductive Endocrinology and Infertility
Infertility - Reversal of Tubal Ligation

Surgical reversal of a previous tubal ligation (also known as "untying the tubes") is one of the most effective tubal reconstructive surgeries available, especially if the tubal ligation was performed with clips or rings. In these cases, the tubes remain open after surgery 70 to 80 percent of the time, and intra-uterine pregnancy rates are 60-70%. As with any type of tubal surgery, the reversal of a tubal ligation increases the women’s risk of a tubal pregnancy. The surgery is less successful if the tubes were cut (burned) using an electrocautery instrument or if other pelvic disease such as scaring or endometriosis is present. The age of the woman is also an important factor that influences success rates. Reversal of tubal ligation is performed by laparotomy (major surgery) using magnification and microsurgical techniques and should only be performed by surgeon with extensive experience in this procedure. The actual tubal ligation reversal is a lengthy and exacting procedure requiring a microscope and very fine suture material. Patients are generally discharged from the hospital the next day, but full recovery and return to work will take several weeks.

If a woman is considering this surgery, her physician may review the operative and pathology notes from the initial tubal ligation. Further information may also be gained from an HSG. Finally, if any doubt exists that the procedure can be successfully performed, the physician may perform a diagnostic laparoscopy before performing the tubal reversal.

Repair of Damaged Tubes

Infertility due to damaged fallopian tubes is common. Fortunately, when the tubal damage is mild to moderate, modern surgical techniques can often help to achieve pregnancy. Most tubal surgeries are now being performed as outpatient procedures through the laparoscope, thus minimizing recovery time and expense. For women with severe or surgically uncorrectable tubal disease, in vitro fertilization offers the best chance of achieving pregnancy. Although women with infertility due to tubal factors once had a poor prognosis, today they have a good chance of experiencing the joys of parenthood.