Tubal Sterilization Reversal at NWEPS
Starting in 2020, we are proud to offer tubal sterilization reversal procedures at Northwest Endometriosis and Pelvic Surgery. Using the most advanced microsurgical techniques available, our surgical technique will optimize the likelihood of successful reversal and achieving a pregnancy.
Why would I want a tubal reversal?
Every year, tens of thousands of women have permanent sterilization procedures, believing that they no longer wish to conceive in the future. While these procedures can be a great way to ensure that no further pregnancies occur, the reality we know is that up to 30-40% of women who have sterilization will change their mind in the future and consider having another child.
While sterilization is intended to be permanent, tubes can actually be reconnected in a substantial portion of sterilized patients using microsurgical reconnection (reanastamosis).
In this world of highly successful In Vitro Fertilization cycles, many infertility physicians push IVF as the best way to achieve pregnancy after sterilization. But for many women, reversal of sterilization can be an excellent option for restoring fertility without the costs and discomforts of IVF. Most sterilizations procedures are amenable to outpatient reversal at costs far lower than even a single IVF cycle.
How are tubal reversals performed at NWEPS?
We perform tubal sterilization reversal in an outpatient surgery center using a 4-5 cm incision in the bikini line. This approach allows the usage of an operative microscope, dramatically magnifying the surgical field and allowing very precise placement of very fine sutures to perfectly line up the tubal edges. We use this technique because it is clear that very precise realignment of the tubal edges is critical to a successful procedure.
How long does it take to recover?
Patients are treated with a long acting local anesthetic during surgery, allowing them to return home the same day as surgery. Patients will have significant soreness for several days after surgery, which will slowly resolve over 2-3 weeks. While we use a very small incision of 4-5 cm, it is still an incision in the abdomen that will take a few weeks to recover from.
NWEPS is a national expert center for minimally invasive surgery. Why don't you perform this surgery laparoscopically?
It is true that we basically perform every other surgery we offer through minimally invasive techniques. In this case, we operate through a small open incision because we feel strongly that this is the technique most likely to restore fertility.
The laparoscopic technique is faster to recover from than an open procedure, but in our opinion is inferior in its ability to consistently bring the tubal ends together in a precise fashion. For example, in a laparoscopic technique one needs to use 5-0 suture in a single layer. With an open technique, we can use 7-0 or 8-0 suture, which is dramatically thinner, and can place two layers of sutures. The open procedure also allows the surgeons to sit with their hands steady, strongly promoting very precise micro-suturing, something just not achievable laparoscopically.
How successful is tubal reversal technique?
It is impossible to give a single success rate, as every procedure is different. That said, there are several characteristics of a given case that promote success.
1. The more healthy tube there is to repair, the more successful the repair will be. That it, if the surgeon that did the sterilization only removed a small portion of tube, its much easier to repair successfully.
2. The specific technique used for the sterilization matters. Small partial salpingectomies, Filshie Clips, and Falope Rings are relatively better to repair. A cauterization procedure or a partial salpingectomy that removed a large amount of tube is less successful to repair. A total salpingectomy procedure cannot be repaired at all.
Based on the data using similar techniques to our, success rates can be as high as 70-80%, though with unfavorable characteristics it will be lower than this. Success also depends on maternal fertility factors such as age and egg quality , as well as male factor concerns such as sperm quality, number, and motility.
In our eyes, success means there is at least one tube that is open 6 months after surgery, and preferably two tubes. At that point, it is up to factors other than the surgery to influence whether or not a pregnancy occurs.
Prior to any procedure, we assess the factors involved to be able to determine the appropriateness of the case and likelihood fo success.
How much does tubal reversal surgery cost?
Our professional fees for tubal reversal surgery are $4500. Additional fees will be a facility fee in the outpatient surgery center an anesthesia fees. Total fees will be approximately $8000, which may vary based on the length and the complexity of the case.