(Fort Worth Fertility)
(Fertility)
(Fort Worth)
(817-348-8145)
Tubal ligations are a commonly performed sterilization procedure in women. There are a variety of ways in which this can be done. Laparoscopic procedure using electrocautery, clips or rings to occlude the proximal portion of the tubes is a common method to block tubes. Clips and rings cause a crush injury so that a small segment of fallopian tube has a blood supply cut off and over time will die. What is left is a missing piece of the tube close to where the tube implants to the uterus (referred to the proximal end). Once a small segment of tube has died, the clip or ring will remain. Another commonly used method is cautery. During cautery, a small segment of tube is grasped with a bipolar grasping forceps and electrical current is passed through it until the tube is literally fried. This usually results in approximately 2-3 cm of tubal destruction. This segment of the tube also dies and the end result is a missing segment of the tube.
Sometimes a tubal ligation is performed at the same time of a cesarean section. This usual procedure done with a cesarean section is called a Pomeroy procedure. During this procedure, a small section of the tube is actually cut out and the ends are tied off with suture material. A less commonly performed procedure is a fimbriectomy. During this procedure, the ends of the tube are completely removed. The fimbria is an essential part of the tube and if this is performed there is no chance of repairing the tube.
There are surgeons who specialize in microsurgical techniques such as our practice. If a tubal reversal is to be considered, first of all, the important thing is to identify how much of the initial tubal ligation was performed. With clips or rings, there is usually enough tube left for the surgeon to work with and repair the fallopian tubes. Tubal cautery tends to cause more damage to the tube; however, in many cases these tubes are also amenable to repair. The important thing is for the surgeon to identify that there is at least 4-5 cm of fallopian tube to work with (average length of fallopian tube is 6-10 cm). If there is any doubt regarding whether a tubal reversal could be considered, we will first perform a laparoscopy to evaluate the quality and length of tube remaining and if there is a sufficient length of tube, proceed with the tubal reversal.
Most tubal reversals are done using an open technique. This means making an approximately 2-3 inch incision in the abdomen in a bikini-like fashion. The abdomen is opened and using a microscope the ends of the tubes are reconnected to each other (tube-to-tube reanastomosis). The procedure normally takes 2 hours. After the procedure, you will spend a couple of hours in the recovery room and will be sent home that day. In some less common cases, you may decide to spend the night in the hospital. As the surgical procedure is not covered by your health plan, the decision to spend the night in the surgical facility will be an added expense.
Success rates of this procedure are partially dependent on the technique that was originally used to occlude your tubes, our expertise, and your age. Age has a significant effect on fertility.
Overall, for women under the age of 35 if the procedure goes smoothly, the chance of becoming pregnant may be as high as 60% - 80% over a 2-year period. Because of the age effects on fertility for older women, success rate is lower. All things to consider of course are male factors. Before having a tubal reversal, it is always important to do a semen analysis, as the sperm quality can seriously affect fertility as well. Other appropriate tests may include ovulation tests and tests for ovarian reserve.
At your first visit with us, we would like to review the operative note from your tubal ligation. Often times, we are able to locate the pathology report, which determines the length of tube that was removed.
We ask patients to do a pregnancy test as soon as they have missed a period, and inform us of all positive pregnancy tests. The main risk of tubal ligation reversal is ectopic pregnancy, which occurs in 10% of pregnancies after tubal surgery. Detected early, an ectopic or tubal pregnancy can be treated medically to avoid damage to the fallopian tube and the need for additional surgery. When a woman has a positive pregnancy test, we repeat blood serum HCG tests twice a week and perform a vaginal ultrasound when the HCG level reaches 1500 to look for the pregnancy sac.
The success of tubal ligation reversal depends primarily on the length of the fallopian tubes after repair, patient age, method that was used for the ligation. There must be three to four centimeters of fallopian tube for pregnancy to occur. Prior to reversal, it is helpful for the patient to supply us with a copy of the surgical note from the initial tubal ligation procedure. If portions of the tubes were actually removed, a pathology report is also helpful.
If the patient had no problems becoming pregnant prior to tubal ligation, and the reversal is successful, the patient should be able to conceive. At your consultation we will attempt to give you a better idea of what to expect regarding your chances of conception after your reversal.
The other option would be in vitro fertilization. In vitro fertilization is the process by which fertility drugs are used to stimulate the ovaries to produce a number of eggs. Eggs are grown in little capsules of fluid called follicles, which can be monitored by ultrasound. Usually 10 days of fertility drugs are required to stimulate the ovaries. When the eggs are mature, they are retrieved by ultrasound guidance. An ultrasound probe is used in the vagina with a needle along side of it to aspirate the eggs. The eggs are then fertilized in a laboratory using the partner's sperm. Fertilized eggs are called embryos. Embryos are usually cultured in a special incubator for 2-5 days and then the best quality of embryos are placed back into the uterus by a procedure called an embryo transfer.
The success rates of in vitro fertilization are directly proportional to age. For healthy women under 35 with 2 embryos put back into the uterus, the chances for a successful pregnancy are 55%. As women get older, success rates do start declining. By age 40, the success rate is closer to 30 or 40%. The risk of multiple pregnancies with in vitro fertilization is related to the number of embryos that are put back into the uterus. In most cases for women under 35, two embryos were replaced for the most part limiting the risk of multiple pregnancies to twins. As women get older, because the competence of embryos starts declining, an extra 1 or 2 embryos may be transferred to compensate for this fact and improve pregnancy rate, which improves the chance of pregnancy.
The decision to have a tubal reversal or in vitro fertilization, consideration should include the following:
There are therefore pros and cons choosing in vitro fertilization or tubal reversal. The main advantage of having a tubal reversal is that once it has been done, there is an ongoing chance of pregnancy every month. The success rates of both tubal reversal and in vitro fertilization are higher in the younger age group.
There is no formula to give the right answer. It is important to discuss these options carefully with your partner and our staff.
Surgeon’s Fee $3,000 (including assistant surgeon)
Anesthesia Charge $800
Facility Fees $2,200
Total Estimated Fees $6,000
In addition this fee includes follow-up care
Initial Office Visit $400
This visit includes an examination and a pelvic ultrasound examination.
Fort Worth Fertility must be paid by check, money order or credit card at least 7 days prior to surgery or surgery will be cancelledFees may be subject to change without notice
I had my tubal reversal in June 2006 and 18 months later we have our little Kourtney. Words cannot express how grateful my family and I are to Dr. Kaufmann." Joan W. and Family
My tubal reversal baby is here! He was born 11-9-07. Please thank Dr Kaufmann." Lisa P.
It took me only 4 months to get pregnant after my tubal reversal." Susan and Johnny H.