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Tubal reversal
surgery, also known as microsurgical tubal reanastamosis, has
been a common surgical therapy for decades. Until in
vitro fertilization (IVF) became routine and successful,
tubal reversal surgery was very common.
Over the last 5 years,
or so, the success rates for IVF at highly-successful programs
have nearly reached that of tubal reversal surgery in the best
candidates. Because of this tubal reversal surgery has become
much less common nationally.
Therefore, it is important that
any woman considering tubal reversal surgery also be counseled
about the benefits and drawbacks of IVF as compared to tubal
reversal surgery. In the most ideal circumstances, every woman
considering tubal reversal surgery would be counseled at a program
that offered both options with high success rates.
Despite some benefits of IVF, there are a number of excellent
reasons a woman with a previous tubal ligation may desire
a tubal reversal surgery rather than undergoing IVF. In the
case of a patient desiring more than one child, tubal reanastamosis
is more cost-effective. Many patients prefer to conceive "naturally"
rather than requiring the technological complexity of IVF.
Although considered quite safe, unresolved issues remain regarding
the possibility of increased risks of some birth defects related
to babies conceived from IVF. Increased incidence of multiple
gestations is also more easily avoided with tubal reanastamosis.
A key issue for high-quality patient care is to counsel the
patients appropriately about who is a good candidate for tubal
reversal surgery, as compared to IVF, and be able to give
informed recommendations. Keep in mind the saying, "If
all you have is a hammer every problem looks like a nail."
If your practitioner only offers tubal reversal then you may
not get the most informed and objective perspective. In some
cases IVF would be more likely to result in pregnancy. Success
for tubal reversal surgery is quite variable and depends on
such things as how the fallopian tubes were "tied",
the time since the surgery, the sperm count of the male partner,
and the length of the remaining fallopian tubes. Tubal reversal
has a higher risk of ectopic pregnancy also. So, pregnancy
rate is lower than delivery rate. Keep in mind also that "tubal
patency" after surgery (the tubes being open after surgery)
does not mean you can become pregnant. Delivery rate of a
baby following surgery (not tubal patency rates or even pregnancy
rates) is all that is important to couples.
An advantage for patients who come to the Reproductive Medicine
and Surgery Center is the faculty. In addition to extensive
experience performing these procedures, Drs. Bateman and Williams
Co-Direct the MJH In Vitro Fertilization Program. Drs. Bateman and Williams are subspecialty
certified in infertility (Reproductive Endocrinology and Infertility)
by the American Board of Obstetrics and Gynecology. Dr. Bateman
founded the IVF program in Charlottesville, VA, in 1986 and
has been performing tubal reversal surgery since 1980. Dr. Williams
joined Dr. Bateman in 2001 and also regularly performs tubal
reversal surgery.
Our tubal reversal fee is very competitively priced. The full
amount is paid approximately two weeks prior to the date of
your surgery and will include the physician, anesthesia, and
facility fee. Our office is responsible for paying the facility
and anesthesiologist. The total cost for this procedure if performed
in an outpatient setting is only $5926.00. Unfortunately, we
do not offer payment plans for this procedure. Most insurance
carriers will not cover the initial office visit to see the
physician to discuss tubal reversal. The new patient consult
is under $350. You will be expected to pay this fee at the time
of your visit.
However, if you schedule surgery, the money that
you paid for your consultation will be applied to the surgery
balance. To schedule a new patient appointment to discuss your
options, please call 434-654-8520. If you have any questions
regarding financial matters, please ask for Jody. Many options are available to help patients afford fertility treatments.
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. These are not able to be corrected surgically.
In these cases In Vitro Fertilization (IVF) is the only reasonable
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 instead- which
is much more successful in this case.
ere
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 all comers, 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 work well because
of the surgery to block them followed by surgery to reopen
them. 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. The incision may have to be made larger if a woman
is significantly overweight or there is scar tissue inside
her belly. It is hard to give an absolute cut-off for weight
but about 180 lbs tends to be the upper limit of what can
be accomplished with a “minilaparotomy.” 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 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 mini-laparotomy 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.
Usually it is outpatient surgery. 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. The incision may have
to be made larger if a woman is significantly overweight or
there is scar tissue inside her belly. The size of the incision
usually determines whether you need to spend the night in
the hospital. Most women can go home the same day the surgery
is performed.
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