What are the risks when tubal reanastamosis is done and what are the chances of conceiving? #915/12

I’m 36 years old, mother of 2 boys (12 years and 9 years). Both were delivered cesarean and after my second child I had undergone sterilization (at the age of 27). Now I wish to have a baby. Kindly advise what are the risks involved in reanastamosis and what are the chances of conceiving.

 

Thank you!



My comments:

 

Spontaneous recanalization following tubal sterilization is rare.

 

Here is a fair amount of information on reversal of tubal sterilization:

 

  1. It is sometimes impossible to reverse tubal sterilization.
  2. If this is what you want to attempt try to find a physician who has extensive experience reversing tubal sterilization and how often he or she has been successful and the reversal procedures have led to a deliveries. This would give you part of the answer to your question. Experience always improves the results of a surgical procedure.
  3. I suggest that you contact your local or state Planned Parenthood people and find out about the local scene.
  4. Early in the process you might want to check with your insurance folks. 
  5. The operations vary so much in price. They all cost lots.
  6. Any chance you could discuss this with the clinician who did the procedure?
  7. I am not an expert in the subject about which you are seeking information.  But here are some data from the book Contraceptive Technology and from the organization, ENGENDERHEALTH that does come from experts:

 

Desire for Pregnancy Following Tubal Sterilization

Sterilization should be considered permanent, but even with careful counseling, some women will have a change in personal circumstance and desire more children. In vitro fertilization or microsurgical tubal reversal can be considered to attempt pregnancy following transabdominal sterilization. Success is not guaranteed with either approach.

 

The Essure device is, by design, placed in the uterine cornua, and therefore patients are not candidates for traditional microsurgical reversal. In addition, a 6 to 10 mm portion of the coil remains protruding into the uterine cavity after the device is placed, which could be detrimental both to the success of the in vitro fertilization (IVF) procedure and to the pregnancy, if achieved. Pregnancy outcome data on IVF with the Essure device in place is not currently available. At this time, Essure should be considered an irreversible method of female sterilization.[i][i]

 

The choice between IVF and tubal surgery to achieve pregnancy following tubal sterilization is dependent on multiple factors, including the age of the woman at the time of treatment, severity of the tubal damage and remaining tubal length, as well as other fertility factors. With careful case selection and meticulous surgical technique, reasonable pregnancy rates can be achieved following microsurgical reversal of tubal sterilization.[ii][ii]

 

Surgery, especially major abdominal surgery, carries operative risks as well as risks due to anesthesia. Ectopic pregnancy is more common among pregnancies occurring after surgical reversal of female sterilization. Ectopic pregnancy rates range from 1 % to 7%—higher rates can be observed in specific anatomical situations.63 Nonetheless, sterilization reversal may be appealing for younger women, couples who desire more than a single additional pregnancy, or those who are not comfortable with IVF. Both IVF and reversal surgery are costly and are often not covered by health insurance. Finally, those couples utilizing tubal reversal surgery may have the need for future contraception. A large Canadian study showed that 23% of women obtaining tubal reversal following sterilization went on to obtain a subsequent sterilization.[iii][iii]

 

 

According to ENGENDERHEALTH: “A REVIEW OF MANY STUDIES REVEALS THE CHANCE OF SUCCESSFUL PREGNANCY TO BE ROUGHLY 50%. In actual practice they point out that this percentage is probably much lower.

Certainly I hope you will be advised by a clinician with extensive experience doing tubal reanastomosis operations.

I am sure that you and he are considering whether you have any inclination to consider adoption?  What are your husband or partner’s thoughts about adoption?

Are you ovulating fairly regularly?

 

Does all the above help or is it just too much information (TMI)?  Good luck!

 

To learn more about the advantages and disadvantages of tubal sterilization, go to our website: www.managingcontraception.com and click on Choices.  You can also order this wonderful new educational book from our website or by calling 404-875-5001.  Do you have your copy yet?

 

Key Words:  cesarean, sterilization, pregnant, recanalization, conceiving, spontaneous, extensive experience, reversing, surgical procedure, Planned Parenthood, insurance, expensive, Contraceptive Technology, Engenderhealth

 

Reference:

Pollack AE, Thomas LJ, Barone MA. Female and male sterilization IN Hatcher RA, Trussell J, Nelson AL, Cates Jr. W, Stewart FH, Kowal D. et al Contraceptive Technology 20th edition: pages 369-370: Ardent Media Inc. 2012

Posted 10-1-2012, Updated 10-6-2012, January 21, 2013



[i][i] Ledger W. Implications of an irreversible procedure. Letter to the editor: Fert Steril 2004.08.005

[ii][ii] Lee D, Patton P. Tubal surgery and treatment of infertility. GO 04 Vol 5/ Chap 106 Reproductive Endocrinology, Infertility, Genetics.

[iii][iii] Trussell J, Guilbert E, Hedley A. Sterilization failure, sterilization reversal, and pregnancy after sterilization reversal in Quebec. ObstetGynecol 2003;101:677-84.

 

 



Skills

Posted on

January 21, 2013