If I just want clamps removed is it a still tubal reversal?

Yes, however the tubal ligation that was performed (there are 5-6 common techniques and many less common ones) 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.

Will my doctor tell me that day if tubal reversal surgery can be done or not?

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 are not able to be corrected surgically. 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.

What is the cut off age for having tubal reversal surgery?

We will not consider performing surgery on anyone older than 44. 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.  It is generally expected that pregnancy rates above age 40 are low, having nothing to do with success at opening the fallopian tubes.  Your doctor will talk to you about the expected chances of pregnancy at your age.

What are the chances of me having a baby?

In general, for best candidates, it is 75%. However, there are many things that must be taken into account, such as how the 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, ovulation or her husband’s sperm count are preventing success following tubal reversal surgery.

How do they do the tubal reversal, will the incision be as wide as a c-section?

No. 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 (2 ¼ inches) than a c-section incision. It is small enough to be safe and comfortable to go home the same day.

It is difficult to give an absolute cut-off for weight but about 200 pounds tends to be the upper limit of what can be accomplished with a “mini-laparotomy.” It certainly depends on how tall a woman is and how her fat is distributed. Some overweight women have very thin waists but large hips and legs and a mini-laparotomy could still be accomplished. A physical exam is important.  Sending us a photo {jody.halloran@rmscva.com} in a bathing suit or underwear and bra can often help us determine if you are a candidate if over 200 pounds.

Why do they do an ultrasound during the consult?

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 no other problems that might lower success following tubal reversal, such as fibroids (myomas) or cysts.  Measurements made of the ovaries (antral follicle count) also are very useful for predicting a woman’s fertility.

Is the tubal reversal outpatient surgery or do I have to spend the night?

Almost always the tubal reversal surgical procedure is an outpatient surgery, regardless of what approach is taken.  The mini-laparotomy incision is much smaller than a c-section (about 2 ¼ inches in length) 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 dame day.  For a mini-laparotomy, rarely the incision may have to be made larger is a woman has an unexpected amount of scar tissue inside her belly or the abdominal wall is thicker than expected.  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 determine 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 (mini-laparotomy) to be made.  But, it depends on how your weight is distributed.