REVERSAL OF FEMALE STERILISATION (LAPAROSCOPIC TUBAL REJOIN)
Women over 40 years of age have reduced fertility and are usually advised that IVF is necessary to become successfully pregnant rather than surgery. We have proven this is a misconception having achieved significantly better results with surgery when compared to IVF. Australia wide IVF results indicate a live birth rate of 5-10 % for women 40-42 and 2-5 % for older women.
We have achieved a 40 % take home baby rate for women aged 40-45.
Using our procedure, women less than 40 with fertile partners have been shown to have 80-90 % successful outcome when “clips” or “rings” were used for sterilisation (Petrucco 1999). Reversal of more destructive methods “cut & tie” and “cautery” give less optimal results because of greater damage to the fallopian tubes resulting in a shorter tube after rejoining.
Laparoscopic (telescope) assessment at the commencement of surgery usually confirms that rejoining is possible so that same day discharge can still be achieved. The distal part of the fallopian tube must be at least 3.5 cms for the reversal procedure to be successful.
When the terminal part of the fallopian tube has been removed (fimbriectomy) sterilisation cannot be reversed. Sterilisation procedures using uterine plugs such as “Essure” or similar devices causes intense scar tissue formation and close the opening to the uterus permanently and cannot be reversed.
Having performed several hundred microsurgical tubal re-anastomosis using small open incisions we now find that almost all procedures can be performed laparoscopically.
Endoscopic surgery has many inherent advantages:
- Microsurgical principles can be maintained with camera magnification allowing fine suturing to be used.
- Operating in a closed abdominal cavity avoids drying of internal organs which are minimally handled thus preventing scar tissue formation.
- The use of irrigating fluid to keep tissues moist ,avoidance of surgical packs all lead to less traumatic surgery and quicker postoperative recovery.
- The field of vision is superior to older methods so that other abnormalities such as scar tissue or the commonly encountered condition “endometriosis” can be treated at the same time.
- Both animal and human studies have shown that the laparoscopic approach is superior in reducing scar tissue formation following surgery when compared to open surgery. (Lok 2003).
OFTEN ASKED QUESTIONS
“Is ectopic pregnancy a significant risk?”
In our experience the risk of ectopic pregnancy has not been higher than expected following reversal surgery when clips or rings were used for sterilization. Higher than normal ectopic rates have been found following cut & tie and cautery sterilisation procedures.
“Does my partner need to be tested before reversal?”
Males should have an up to date semen assessment even with proven paternity. Very abnormal results may indicate the need to consider IVF rather than reversal surgery.
“How soon can I try to conceive?”
You can try as soon as you feel physically fit and may conceive the same month of the reversal procedure without increasing the chance of miscarriage or other complications.
“How do I know that my tubes are open again?”
If you have not conceived after six months of trying an x-ray of the fallopian tubes will be performed to reassure you that the tubes are open.
“What other complications are associated with reversal surgery?”
Endoscopic surgery may be associated with complications such as haemorrhage, infection, and damage to pelvic and abdominal organs and clotting in leg veins. The risk of these is low and will be fully discussed. You will also be given reading material that will enable you to be fully informed before signing a surgical consent form prior to surgery. Instructions to be observed following surgery will also be given to you before discharge.