Authors and Affiliations: Tae Ki Yoon, Hae Ree Sung, Hyung Gon Kang, Sun Hee Cha, Chung No Lee, and Kwang Yul Cha; CHA General Hospital and Pochon CHA University (Seoul, Korea).

Journal: Fertility and Sterility, Volume 72, Number 6, pp. 1121-1126.

Summarized by Christine M. Schroeder, Ph.D.

Women who desire no additional children often elect to undergo tubal sterilization. Although tubal sterilization is a permanent and effective means of contraception, about one percent of women who undergo it will subsequently seek to have it reversed.

Tubal reversal is accomplished via microsurgical techniques and has traditionally been done via laparotomy Microsurgical instruments have improved sufficiently, however, that reversal can now often be accomplished via laparoscopy, which is less invasive and allows quicker recovery time. Reversal via laparoscopy, however, is more technically demanding and requires a higher level of surgical skill.

The purpose of the current study was to evaluate the outcome of tubal reversal in patients and determine which factors influenced post-reversal pregnancy rates. Participants were 202 women with a mean age of 35 years (ranging from 27 to 45), who had an average of 1.7 children prior to to undergoing sterilization. Sterilization had been accomplished in 100 patients via Fallope ring and via electrocautery in 53 cases, with the remainder of patients undergoing a variety of less common techniques. An average of 8.5 years elapsed between the time of the original surgery and the reversal, with a range of two to 21 years.

Prior to reversal, patients underwent:

• Hysterosalpingogram
• Pelvic ultrasound
• Partner semen analysis
• Diagnostic laparoscopy, if the method of sterilization was unknown

All procedures were set up so that, if accomplishing reversal via laparoscopy was determined to be non-feasible, the procedure could immediately be converted to laparotomy.
One hundred eighty-six patients were followed for a minimum of 12 months after surgery (the remainder were lost to follow-up), and analyses were conducted to examine the effects of the following variables on post-surgery pregnancy rates:

• Original method of sterilization used
• The location of the tube where reconstruction was carried out
• Post-surgery tubal length
• Whether other pelvic pathologies were discovered and removed during surgery
• Whether one or both tubes were restored to function
• The age of the patient at surgery

Ninety-eight of the 186 patients delivered healthy infants during the follow-up and 31 had ongoing pregnancies at the close of the study. Analyses of the above variables (which took all factors into account simultaneously) indicated two significant effects, age at surgery and whether one or two tubes were successfully repaired:

• Among patients aged 25 to 29 years, the pregnancy rate was 100 percent; 30 to 34 years, 91.9 percent; 35 to 39 years, 79.5 percent; and 40 to 45 years, 70.6 percent.
• Patients who only had one tube successfully reversed had a pregnancy rate of 60 percent, compared to 87 percent for patients who had both tubes successfully reversed.

Based on these results, the authors concluded that in the hands of a skilled and experienced surgeon, a laparoscopic approach to tubal reversal is an effective protocol. They also concluded that, in many cases, the success rates of tubal reversal are far superior to IVF (another treatment of choice for women with tubal sterilization who are now interested in fertility), suggesting that it may be a preferable approach for many patients, especially in view of the fact that tubal reversal does not carry the elevated risk of multiple pregnancy that IVF does.