Tubal Ligation Reversal

A tubal ligation reversal is an operation that affords a woman who has had a tubal ligation a chance at pregnancy again. The desire to have a baby after a tubal ligation is common for women in second marriages, following loss of a child, or a change in circumstances. Tubal ligation reversal surgery utilizes microsurgical techniques to open and reconnect the fallopian tube segments that remain after a tubal ligation procedure. Typically there are two remaining segments, the proximal tubal segment that emerges from the uterus, and the distal tubal segment that ends with the fimbria next to the ovary. Tubal ligation reversal (microsurgical tubotubal anastomosis) connects these segments. Other terms used to describe this procedure are microsugrical tubal reanastomosis, microsurgical tubal reversal or microsurgical tubal repair.

If you have had a tubal ligation we can help you determine if tubal reversal is right for you.

Tubal Reversal Versus IVF
Tubal Reversal is an outpatient surgery performed under general anesthesia through a small bikini incision. The tubes are reconstructed using microsurgery in a one to two hour procedure. The risk of the procedure is minimal and most patients can return to work five to seven days following the surgery. In vitro fertilization (IVF) is otherwise known as 'test tube baby,' and has helped infertile couples conceive and bear children for over two decades. It was originally developed to help couples overcome tubal factor infertility such as tubal ligation, but has become useful in treating other factors, such as immunological problems, unexplained infertility, and male factor infertility. IVF is basically a four-step process. First you take medications to make multiple follicles (eggs) begin to develop on your ovaries. This step is referred to as ovarian stimulation, or superovulation. Step two involves monitoring follicular growth by ultrasound, to determine egg growth and uterine lining development. When it is determined that the follicles and the uterine lining are appropriately mature, a trigger injection of Human Chorionic Gonadotropin is then administered. Thirty-six hours later, the third step begins with retrieval of the eggs by ultrasound-guided-needle aspiration, an in-office procedure. A sperm specimen is then washed and prepared for insemination. The washed sperm is then placed in a dish with the eggs, and they are placed in an incubator for 18 hours. After 18 hours, the embryos are observed for normal fertilization. They are then incubated for further development into multi-cell embryos. The fourth and final step involves transferring the embryos into the uterine cavity via a tube inserted through the cervix. The number transferred varies with the desires of the patient. Additional embryos may be frozen and stored for future use.

Tubal Reversal vs. IVF Comparison
  Tubal Reversal IVF
1. Cost $6,500 - $7,000 $10,000 - $20,000
2.  Medications No Yes
3.  Multiple Pregnancy No Yes
4.  Ectopic Pregnancy Yes Yes
5.  Additional Children Yes No
6.  Ethical Dilemmas No Yes
7.  Success up to 70 % 30 % per cycle
8. Length Procedure 1-2 hours Several Weeks


Detailed Explanations:
The cost of tubal reversal surgery is around $6,000. Each attempt at IVF costs from $10,000 to $20,000 depending upon the center performing the procedure.

IVF requires subcutaneous and intramuscular injections for a period of four to six weeks. The risk of the medication may include ovarian hyperstimulation syndrome and allergic reaction. There is controversy on whether these medications may be associated with an increased risk of developing ovarian cancer.

There is no increased risk of having a multiple pregnancy following successful tubal reversal surgery. However, the risk of twins following IVF is approximately 30% and that of triplets or more is 5%.

There is a 5-10% risk of a tubal pregnancy following tubal reversal surgery and a 1% risk following IVF.

Following successful tubal reversal surgery, a woman can have additional children at no additional expense. Following successful IVF, additional children require additional IVF cycles.

Ethical and religious dilemmas are considerable with IVF. These may include doing IVF itself, the disposal of excess fresh or cryopreserved embryos and fetal reduction for high order multiple pregnancies. Tubal reversal allows natural conception to occur. Most reports state that the success of tubal reversal surgery equals or exceeds IVF. The IVF procedure requires months of preparation, and weeks of injections, blood tests, ultrasound examinations prior to oocyte retrieval and embryo transfer.

The tubal reversal procedure takes 1 - 2 hours to perform and 5 - 7 days for recovery. The IVF procedure requires weeks of preparation including injections, blood tests, and serial ultrasound examinations.

Dr. Robert Smith is serving the communities of Fort Worth, Arlington, Grand Prairie, Haltom City, Richland Hills, Weatherford, Stephenville, Keller, Waco, Granbury, Burleson, Crowley, Cleburne, Mansfield, Benbrook, Mineral Wells, Glen Rose, Hurst, Bedford, Axle, Lake Worth, Hillsboro, Euless and Decatur.


Successful Outcome from Essure Tubal Sterilizaction Reversal
The Essure micro-inserts are intended to be used for permanent sterilization; however, due to regret and the desire for future pregnancies, many have inquired if I could remove the Essure.

I have performed multiple reversal procedures during the course of my tenure at Texas Health Huguley Hospital in Fort Worth, Texas over the past thirty six years. The women I have seen have had all varieties of tubal ligation methods. On multiple occasions, due to tubal damage from blockage, I have had to do tubouterine implantation on some of the reversal.

Mrs. Graciela Escobar presented to my office on March 4, 2013 requesting that if at all possible she would like for me to remove the Essure that she had had inserted in March 2011. I informed her that there was limited clinical data on reversals after the Essure has been placed. On March 27, 2013 I agreed to attempt to perform a reversal for her. (To my knowledge, this was the first time that the Essure sterilization procedure had been reversed in the Dallas/Fort Worth Metroplex). I cut out the device from the cornual (uterine muscle) portion of the uterus and then implanted the remaining fallopian tube into the new opening created into the uterine cavity. The fallopian tube was reattached to the uterus by splitting the tube and suturing half to the front and the other half of the split portion to the back portion of the uterine cavity.

On April 22, 2014, Mrs. Graciela Escobar delivered a baby boy by cesarean-section. Because of the weakness near to top of the uterus she had been informed, prior to the Essure reversal that all future pregnancies should be delivered by cesarean-section.

     
dr. robert smith burleson