Yes, however the tubal ligation was performed (there are 5-6 common techniques and many less common ones) it has caused scarring in the tube that is blocking the sperm from swimming up the tube to find the egg. The removal of this blockage is called a tubal reversal. In the case of “clamps”, they are a method to crush the tube and cause damage that leads to permanent scarring. When the clamp is taken off the scar tissue still blocks the tube.
If we are provided with the operative report and pathology report (if pieces of the tubes were taken out) then we should be able to make plans that day. There are situations where a woman’s tubes have been cauterized in multiple places (burned extensively) or the end of the tube, called the fimbria, are cut out. Often these tubes cannot be corrected surgically and IVF is the best treatment choice.
In these cases In Vitro Fertilization (IVF) is usually the best option. Of note, we always recommend a husband/partner get a semen analysis prior to the tubal reversal surgery. A few times a year we make plans to do tubal reversal surgery but cancel them due to a very low sperm count for the male partner. This usually leads to the couple pursuing IVF with ICSI instead- which is much more successful in this case.
There is no specified cut-off. However, when we meet we will have a realistic discussion of how likely it is to work. This takes into consideration many things, age is one of them.
In general, for best candidates, it is 75%. However, there are many things that must be taken into account, such as how tubal ligation was performed, age of the woman, sperm count of the man, other medical problems, etc. It’s also important to understand that over 90% of the time one or both tubes are open after surgery, but that doesn’t mean you will necessarily get pregnant. Some tubes do not function well because of the missing segment from the tubal ligation and the scar tissue that develops with healing after tubal ligation reversal. In other circumstances a woman’s age or her husbands sperm count are preventing success following tubal reversal surgery.
Not usually. If a woman is not significantly overweight it can usually be done through a small incision called a “mini-laparotomy”. This incision is much smaller than a c-section incision. It is small enough to be safe and comfortable to go home the same day.
If a woman is significantly overweight or there is concern about significant scar tissue inside her belly then a “laparoscopic” approach may be recommended. This is a minimally invasive technique using a camera and long-handled instruments placed through ports in the abdominal wall. See our laparoscopic tubal reversal (hot link) video for more details. It is difficult to give an absolute cut-off for weight but about 200 lbs tends to be the upper limit of what can be accomplished with a “minilaparotomy.” Laparoscopic techniques tend to be able to accommodate women up to 250lbs without much difficulty. It certainly depends on how tall a woman is and how she distributes her fat. Some overweight women have very thin waists but large hips and legs and a minilaparotomy or laparoscopic approach could still be accomplished. A physical exam is important.
We frequently do one to make sure the uterus is small enough to be accessed through a minilaparotomy incision. Measurements of the uterus and ovaries are also made that can be helpful in planning the best surgical approach and to assure there are not other problems that might lower success following tubal reversal, such as fibroids (myomas) or cysts. Measurements made of the ovaries also are very useful for predicting a woman’s fertility.
Almost always, the tubal reversal surgical procedure is outpatient surgery, regardless of what approach is taken. The minilaparotomy incision is much smaller than a c-section incision and laparoscopic incisions are only 2-10mm in size. So, incisions are small enough to be safe and comfortable with oral pain medications to go home the same day. For a minilaparotomy, rarely the incision may have to be made larger if a woman is has an unexpected amount scar tissue inside her belly. If the incision needs to be enlarged to be able to remove scar tissue and safely complete the surgery, then the size of the incision will whether you need to spend the night in the hospital. This is quite unusual but is noted because transfer to the hospital and cost of an overnight stay would not be included in the package price.
In general, women over 200 pounds have an abdominal wall thickness that is too large for the usual small incision (minilaparotomy) to be made. But it depends on how tall you are and how your body fat is distributed. If you are over 200 pounds then a laparoscopic approach will be offered up to 250lbs. Above 250 lbs the doctor will need to do a physical exam and an ultrasound to determine if a laparoscopic approach is still reasonable without weight loss prior.
Understanding the tubal ligation procedure.