Tubal Reversal

What is a tubal reversal?

During a tubal ligation reversal, the health care provider removes the blocked segment of the fallopian tube and reconnects the remainder of the fallopian tubes to allow pregnancy. If the tubal ligation reversal is successful, eggs are once again able to move through the fallopian tubes to the uterus for fertilization and sperm are able to travel up the fallopian tubes to join the egg. Tubal ligation procedures that cause the least amount of damage to the fallopian tubes are the most likely to allow successful tubal ligation reversal.

Is a tubal reversal right for me?

There are 2 options for women who have had a previous tubal ligation who desire to have more children:

1. Tubal reversal surgery or
2. In Vitro Fertilization

Choosing which option is best for you may be difficult but the below factors are evaluated to decide which option would give you the highest chance of success. Dr. Smith will consider the following factors to determine if a tubal ligation reversal will be effective, such as:

• Your age, weight and body mass index
• Your overall health
• The type of tubal ligation procedure performed
• The extent of the damage to your fallopian tubes (burning of the fallopian tubes causes the most damage and therefore may be the most difficult to repair)
• Remaining tubal length
• The condition of the end of the fallopian tubes, near the ovaries (fimbria)
• Egg quality
• Partner’s sperm count

The first thing you will need is a copy of the operative and pathology report from your tubal ligation procedure. (Not all tubal ligation procedures will have a pathology report only those tubal ligation procedures where a piece of the tube was cut out, will have a report from the pathology department). With this information Dr. Smith will be able to approximate your chance of a successful tubal reversal procedure. Things that are associated with a higher chance of success are:

1. After the tube is put back together the tubal length should be greater than 4 cm for a better success rate. Generally if a portion of the tube was removed, the pathology department will measure the piece cut out. Using this information Dr. Smith can estimate how long your tube will be after your tubes are put back together. If this length will be less than 3 cm then the probability of conceiving will be less.
    
2. The type of tubal ligation performed will determine your success with a reversal. Procedures that burn the tubes or remove the ends of the tubes are less successful.

Other factors to take in to consideration are age of the patient, weight of the patient, egg quality tests and sperm count on the partner.

To test the egg quality an FSH, estradiol and AMH level on day 2 or 3 of the menstrual cycle should be obtained within 3 months of the surgical procedure. Only women with good quality eggs will have good success. (This is true for both IVF and the tubal reversal.)

An antral follicle count is also useful and this is an ultrasound to evaluate the “fertility of the ovary”. The higher the antral follicle count the better chance of success.

A semen analysis is beneficial to assess the chance of conception from the male perspective.

Saline Infusion Sonography or Hysterosalpingography to assess the uterine cavity

Weight plays an important role. If your BMI is greater than 35, than your chance of success with IVF or the tubal reversal is lower.

Are these pre-tests necessary?

Without performing these tests it’s hard to determine your chance of success. You could be paying thousands of dollars for a reversal procedure that has less than a 10% chance of success. I have seen patients that have had their reversal done without checking the partner’s sperm count. These patients then come to our office to figure out why they are not conceiving. Evaluation reveals that the sperm count is so low that the chance of natural conception is less than 1%. This patient will need IVF to conceive. If this couple was counseled appropriately before the tubal reversal (and did the pre evaluation testing) they could have saved themselves thousands of dollars. Additionally, RMFC recently saw a woman who did not get her egg quality tested before her tubal reversal. When this 39 yo woman did not get pregnant after 6 months of trying her OBGYN doctor tested her egg quality. Her blood test showed she was peri-menopausal with little chance of ever conceiving (with IVF or tubal reversal). She wasted the $7000 she spent on the reversal. BE SMART DO THE TESTING AND GET ALL THE INFORMATION YOU NEED TO PICK THE BEST OPTION FOR YOU. In the long run this could save you thousands of dollars.

If you are interested in a tubal reversal procedure the best thing to do is get the records from your tubal ligation procedure (operative report and pathology report) and send them to OUR office for review. Fax these records to 303-999-3878. Please call when you fax these records to make sure they have arrived, then schedule a New Patient Appointment to obtain the screening tests. If the screening tests appear that the chance of success is good, your surgery will be scheduled. Below are the Prepay charges* for tubal reversal procedures performed at Parker Adventist Hospital.

Costs for a tubal reversal with Dr. Smith at Parker Adventist Hospital:

Physician Fee: $2500

Hospital Fees: (the below hospital fees do not include charges for pathology, radiology, anesthesia and will be charged as additional fees based on the service provided)

• Operation and up to one night stay $4180.00
• Operation and up to 2 nights stay $4510.00
• Operation and up to 3 nights stay $4950.00
   

*All fees must be paid 10 days prior to the procedure to receive the pre pay discount. The anesthesia fee for the tubal reversal procedure is $1000, if the payment is received 10 days prior to the tubal reversal procedure, otherwise standard anesthesia charges (per minute of surgery) will apply. Payment for anesthesia is collected at Rocky Mountain Fertility Center, but a separate check, made out to Guardian Anesthesia is needed. All patients must contact Parker Adventist Hospital to prepay for the hospital portion of the procedure.