If I just want clamps removed is it still tubal reversal?
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.
Is Essure reversal possible? Will the physician tell me that day if it 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. 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.
What is the cut off age for having this done?
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.
What are the chances of me having a baby?
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 husband’s sperm count are preventing success following tubal reversal surgery.
How do they do the procedure, will I be cut like a c-section?
No. If a woman is not significantly overweight it can usually be done outpatient 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. It is hard to give an absolute cut-off for weight but about 180-200 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.
If a woman is too heavy for the procedure, weight loss is always the best option prior to surgery. In general, unless a woman is quite tall, women over 200 pounds often have an abdominal wall thickness that is too large for the usual small incision (mini-laparotomy) to be made. But it depends on how tall you are and how your body fat is distributed. If you are over 200 pounds it means the surgery will need to be postponed. We will recommend an amount of weight that will need to be lost prior to undergoing the procedure.
Why do they do an ultrasound during the consult?
We do an ultrasound 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.
Is it outpatient surgery or do I have to spend the night?
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 there is scar tissue encountered 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.