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Fertility After A Tubal Ligation

Posted Sep 25 2009 3:34pm
Several times a month I am asked about tubal reversal surgery. Performing a tubal reversal is actually something of a vanishing art among reproductive endocrinologists. Personally, it has been over 10 years since I last did one and if a patient really wants to pursue this option, then I refer them to Dr. Gary Berger in Chapel Hill, NC. Dr. Berger has a great set-up for doing tubal reversals and his price is hard to beat along with his level of experience. And I do not receive any kick-backs from Dr. Berger. In fact, I am sending business out the door, but I really believe that it is not appropriate for a patient to pay more to have me do this surgery when she can have it done for less with a guy who can put tubes back together in his sleep. This surgery is often done with the operating microscope and requires steady hands as all movements are greatly magnified under the scope.

During medical school I asked a famous RE how he kept his hands so steady? “Well, John” he replied, “the key is to have sex the night before the surgery!” “Yeah, “ the resident told me later, “his wife is getting pretty sick of him doing so many tubal repairs!” So with that bit of gossip, let’s turn to that great repository of knowledge: 100 Questions and Answers about Infertility for the Question of the Day.

29. If I had my tubes tied, can I have them untied?

Fertile women who have had their “tubes tied” (tubal ligation) may do very well and achieve pregnancy with tubal reparative surgery. Pregnancy rates of 70% to 80% are noted in women who undergo a tubal reversal procedure, depending on their age, the type of tubal ligation procedure performed, and the presence (or absence) of other infertility factors.

Most often, this repair (tubal reanastamosis) requires a laparotomy, which involves opening of the abdomen. This major surgery requires 2 to 4 weeks for recovery, and most insurers do not cover it. Some physicians have reported good success with laparoscopic tubal reanastamosis, but this approach can be more technically challenging. As a consequence, most female patients choose to undergo a nonsurgical IVF procedure instead. Studies have shown that IVF is usually more cost-effective than surgical reanastomosis of the fallopian tubes. Specifically, if the surgery fails to establish a pregnancy, then IVF may be necessary anyway.
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