Tubal Ligation Reversal

Some women who have had previous tubal ligation desire reversal for the purpose of having more children. In fact, regret following a tubal ligation is a fairly common condition ranging between 2-26% of patients in various studies. Several risk factors for regretting having a tubal ligation have been identified including age under 30 at the time of the tubal ligation, change in marital status following the sterilization and death of a child.

Several factors are helpful in predicting who is likely to achieve a pregnancy following tubal ligation reversal. The younger a women is at the time of her tubal ligation reversal, the more likely it is to be successful in terms of achieving a pregnancy. Other infertility factors including a low sperm count may also affect pregnancy rates following surgery. The type of tubal ligation that was performed also plays a role in how easy it is to reverse. Finally, skill of the surgeon is also important as technique plays a critical role in ultimate success. All University of Iowa surgeons performing tubal ligation reversal are fellowship trained in this area of surgery and are experienced (should be experienced) with the procedure.

Prior to performing a tubal ligation reversal, several evaluation steps are required.

1. We will need the operative and pathology report from the time of the tubal ligation.
2. We will ask for a sperm count from the partner.
3. We may consider a test called a hysterosalpingogram (HSG) which is a x-ray test which can tell us the length of the remaining tube following the tubal ligation.

Types of Surgeries Performed for Tubal Ligation Reversal

Ligation Reversal by Laparotomy:
This involves making an incision in the abdomen, excising the blocked portion of the tubes and reanastamosing or "hooking together" the remaining normal tube. This surgery generally requires 1-2 days in the hospital and approximately 4 weeks of recovery time.

Tubal Ligation Reversal by Mini Laparotomy:
Select women who are within 20% of their ideal body weight can have a tubal ligation reversal done by mini laparotomy. In contrast to surgery by laparotomy, the mini laparotomy uses a much smaller incision with a length of approximately 6 cm. This type of surgery can be done with a much shorter hospital stay and recovery time is also quicker.

Tubal Ligation Reversal by Laparoscopy:
We are performing laparoscopic tubal ligation reversal using robotic assistance. This approach leads to shorter hospital stays and faster recovery time.

Tubual Ligation Reversal by Robotic Surgery

Outcomes to be Expected

Tubal patency rate should be approximately 90% and pregnancy rate should be approximately 60% in the first year after the surgery. The major risks of a tubal ligation reversal include failure of the procedure and ectopic pregnancy also known as a tubal pregnancy. The ectopic pregnancy rate is approximately 5-8% following tubal anastomsis surgery and this generally requires removal of the fallopian tube if it occurs.

Other Options to Consider

The other option for pregnancy in women who have had a tubal ligation is the use of in vitro fertilization. Your physician will discuss with you the relative pros and cons of this approach for treatment of infertility.

Costs

Unfortunately, insurance companies rarely cover the costs of tubal ligation reversal or IVF in the case of a previous tubal ligation. Therefore, frequently, costs are out-of-pocket for the patient. We are currently requiring a down payment of approximately $12,300 prior to the performance of the surgery. Alternatively, a guarantee from your insurance company that they will cover the costs would also be acceptable. The CPT code number is 58750. Use this number when asking your insurance company if they cover this procedure. As costs for procedures periodically change, please contact our Financial Counselor at (319) 356-3145 for the most current approximations.