Tubal Reversal Pregnancy Study 2009

Pregnancy Rates By Fallopian Tube Lengths

The fallopian tube lengths remaining after a tubal ligation procedure are important determinants of the chances of getting pregnant after tubal reversal surgery. (Normal fallopian tube length before a tubal ligation is approximately 10 cm or 4 inches.)

Tubal segment lengths are measured routinely during surgery at Chapel Hill Tubal Reversal Center. The average length of the two fallopian tubes after repair was correlated with the likelihood of pregnancy after tubal reversal (Table 6). Women with longer tubal lengths had higher pregnancy rates than women with shorter lengths following tubal reversal. Women with tubal lengths of 7.5 cm or longer had a pregnancy rate of 77%. The pregnancy rate declined as tubal length decreased, but even women with the shortest tubes (less than 2.5 cm) became pregnant (38%).  Although previously unreported in the medical literature, it became apparent during this study that a repaired fallopian tube of any length can result in pregnancy. Based on reports by women with only 1 fallopian tube, we now know that tubal lengths as short as 1 cm can result in a normal pregnancy.

Tubal Ligation Method And Tubal Length

When tubal ligation method and average tubal lengths are taken into account simultaneously, it becomes clear that the amount of fallopian tube remaining after a sterilization procedure is the more important factor predicting the chances of getting pregnant after tubal reversal surgery (Table 7). This makes sense, since the less damage that occurs to the fallopian tube during a sterilization procedure, the more remains to be able to function normally once the tube has been surgically repaired.

Tubal Reversal Pregnancy Study 2009
Table Of Contents:

• Overview
• Study Method
• Patient Population – US States
• Patient Population – Age and Tubal Ligation Procedures
• Pregnancy Rates by Age and Method
• Tubal Reversal Pregnancy Rates by Tubal Lengths (this page)
• Pregnancy Outcomes
• Tubal Reversal vs. IVF
• About Pregnancy Statistics

Pregnancy Outcomes After Tubal Reversal

Tubal Reversal Pregnancy Report 2009

Pregnancy Outcomes After Tubal Reversal At Chapel Hill Tubal Reversal Center

Pregnancy Outcomes By Age

Table 8 shows the relationship between age and pregnancy outcome following tubal ligation reversal at Chapel Hill Tubal Reversal Center. With increasing age, the percentage of pregnancies resulting in births declined due to an increasing percentage of miscarriages. Among women under age 35, over half of pregnancies resulted in birth or ongoing pregnancy while one third miscarried. The birth rate declined and the miscarriage rate increased significantly for women ages 40 and older. The overall ectopic pregnancy rate for all patients (14%) was higher than that found in the general population of women who have not had a tubal ligation, which is approximately 3%. The ectopic pregnancy rate after tubal reversal surgery may be overestimated, since some early pregnancy losses were reported as ectopic pregnancies when serum HCG levels did not rise normally but without confirmation of the diagnosis by ultrasound or laparoscopy. In the case of very early pregnancy loss, the actual site of the pregnancy (uterine or ectopic) is unknown. Whether there is an increased risk of miscarriage associated with tubal reversal is unclear. The miscarriage rate reported in the general population ranges from approximately 20% to 50% depending on a woman’s age and how early pregnancy testing is performed.

Pregnancy Outcomes By Tubal Ligation Method

Table 9 shows the relationship between the tubal ligation method and pregnancy outcomes. Tubal ligation reversal after tubal clips (Hulka clip, Filshie clip) has the best outcome of all tubal ligation methods, with the highest birth rate (69%) and lowest miscarriage rate (25%) and ectopic pregnancy rate (6%). Reversal of tubal rings (Falope ring, Yoon ring) has the second best outcome, followed in order by ligation/resection and coagulation. These findings are almost certainly related to the minimal damage to the fallopian tube caused by tubal clips and rings.

Pregnancy Outcomes By Fallopian Tube Length

Longer tubes are associated with better pregnancy outcomes than shorter tubes (Table 10). Among women with average fallopian tube lengths measuring 7.5 cm or longer, 61% gave birth or had an ongoing pregnancy. Birth rates declined while miscarriage and ectopic pregnancy rates increased with shorter tubal lengths.

Tubal Reversal Pregnancy Study 2009
Table Of Contents:

• Overview
• Study Method
• Patient Population – US States
• Patient Population – Age and Tubal Ligation Procedures
• Pregnancy Rates by Age and Method
• Pregnancy Rates by Tubal Length
• Pregnancy Outcomes (this page)
• Tubal Reversal vs. IVF
• About Pregnancy Statistics

Pregnancy and Birth Rates After Tubal Reversal vs. IVF

Tubal Reversal Pregnancy Study Report 2009

About Tubal Reversal Pregnancy Statistics

Gary S. Berger, MD
Medical Director

What To Believe

Claims about the chances of getting pregnant after tubal reversal are often made without supporting documentation such as the number and characteristics of the patient population, study method, and length of follow-up after surgery. These are essential for understanding the basis of pregnancy rates. Statistics must be based on specified numbers of patients for any characteristic, such as age or tubal sterilization method. Most internet sites about tubal reversal do not provide any data at all. Although a doctor can say that his patients have a high success rate, supporting documentation is needed to know whether the claim is valid. The accuracy of any claim of success rates should be questioned in the absence of detailed information.

Evidence Based Medicine

The only way a doctor can truly know what the pregnancy and outcome statistics are for his or her patients is to maintain ongoing patient contact about the outcomes of treatment and record the information systematically in an analytical database. At Chapel Hill Tubal Reversal Center, nurses enter information into an electronic patient database at the patient’s registration, the surgical procedure, and all post-operative communications between patients and staff. Patients are contacted routinely by our nurses during the first year after their tubal reversal procedures.

Chapel Hill Tubal Reversal Center Database

The comprehensive follow-up database at Chapel Hill Tubal Reversal Center is unique. We know of no other doctor or medical facility with a follow-up system and database that can provide such accurate statistics about the chances of getting pregnant after tubal reversal and the outcomes of the pregnancies that occur.

Limitations And Possible Under Reporting

Although we encourage patients to inform us when they have a positive pregnancy test, not all pregnancies are ascertained. Some patients become lost to follow-up after surgery. This occurs when someone moves or changes email address and telephone numbers but does not provide their new contact information to us. In these cases, we may not find out about the long term outcomes of their tubal reversal procedures unless they complete the Pregnancy Report Form each time they conceive. We know that not all patients adhere to this protocol. From the women who do remain in contact with us over the long term, however, it is clear that new pregnancies continue to occur as time passes after surgery. The pregnancy rates reported in this study, therefore, are minimal estimates of the cumulative pregnancy rates for patients at Chapel Hill Tubal Reversal Center.

Tubal Reversal Pregnancy Report 2009
Table Of Contents:

• Overview
• Study Method
• Patient Population – US States
• Patient Population – Age and Tubal Ligation Procedures
• Pregnancy Rates by Age and Method
• Pregnancy Rates by Tubal Length
• Pregnancy Outcomes
• Tubal Reversal vs. IVF
• About Pregnancy Statistics (this page)

Weekly Pregnancy Announcements From Chapel Hill Tubal Reversal Center Patients

Tubal Reversal Pregnancy Report 2009

Patient Population and Characteristics

The study population consisted of 5,046 women who underwent tubal reversal surgery from July 2000 through June 2008 at Chapel Hill Tubal Reversal Center.

Women’s Ages

The women in the study ranged in age from 20 to 51 (Figure 1). The mean average was 34 years of age.  Approximately three-fourths of the women were in their 30s.

Figure 1. Age Distribution of Study Population

Years of Age

Tubal Ligation Methods

The type of tubal ligation that was performed is an important factor affecting the outcome of  tubal reversal surgery. The most common method involved tying and cutting out a segment of the tube (ligation/resection). The second most common method was tubal coagulation (burning the tubes) followed in frequency by mechanical occlusion with tubal clips or rings. Other procedures, including fimbriectomy (removing the end of the fallopian tube) were the least common. In cases where the patient’s operative report of the tubal ligation was not available, the method was classified as unknown.

Tubal Reversal Pregnancy Report 2009
Table Of Contents:

• Overview
• Study Method
• Patient Population – US States
• Patient Population – Age and Tubal Ligation Procedures
• Pregnancy Rates by Age and Method
• Pregnancy Rates by Tubal Length
• Pregnancy Outcomes
• Tubal Reversal vs. IVF
• About Pregnancy Statistics

Pregnancy Rates At Chapel Hill Tubal Reversal Center

Tubal Reversal Pregnancy Report 2009

Pregnancy Rates At Chapel Hill Tubal Reversal Center

From July 2000 to June 2008, 5046 women underwent tubal ligation reversal at Chapel Hill Tubal Reversal Center. The operative techniques of microsurgical tubal anastomosis, tubouterine implantation, and salpingostomy were used as appropriate to each patient’s situation, and often these techniques were combined in a single case. Including all women’s ages, methods of tubal ligation, and operative techniques used for tubal reversal, the overall pregnancy rate was 66% based on 3317 pregnancies reported during this 8 year interval.The following tables show pregnancy rates specific for age, method of tubal ligation, and remaining tubal lengths available for repair and the interaction between these factors.

Pregnancy Rates By Age

As expected, younger women had higher pregnancy rates than older women. The pregnancy rate after surgery ranged from 80% for women under 30 to 31% for women 40 years of age and older (Table 3).

Pregnancy Rates By Tubal Ligation Method

Reversal of tubal clip procedures had the highest pregnancy rate (75%), followed by tubal rings (72%), coagulation (66%) and ligation/resection (63%). Patients with other or unknown methods of tubal ligation had the lowest pregnancy rate (54%).

Pregnancy Rates By Age And Method

Pregnancy rates taking into account both age and tubal ligation method are shown in Table 5. The highest pregnancy rate (90%) was reported by women under 30 years of age who had reversal of a previous clip method of sterilization. Of the two variables, age is more predictive than tubal ligation method regarding the likelihood of becoming pregnant after reversal surgery.

Tubal Reversal Pregnancy Study 2009
Table Of Contents:

• Overview
• Study Method
• Patient Population – US States
• Patient Population – Age and Tubal Ligation Procedures
• Pregnancy Rates by Age and Method (this page)
• Pregnancy Rates by Tubal Length
• Pregnancy Outcomes
• Tubal Reversal vs. IVF
• About Pregnancy Statistics

Pregnancy Rates By Tubal Lengths

Tubal Reversal Pregnancy Study Report 2009

Gary S. Berger, M.D.
Reproductive Surgeon

Overview

Tubal reversal is the most successful treatment for women wanting to get pregnant after having a tubal ligation. This report presents detailed pregnancy statistics from over 5000 patients at Chapel Hill Tubal Reversal Center. It is the largest study ever reported about tubal ligation reversal, pregnancies, and pregnancy outcomes.

Introduction

The desire to have a baby after a tubal ligation is common for women in second marriages, following the loss of a child, wanting to restore their bodies to be whole again, and for a variety of other reasons.

Most people are not aware that tubal ligation – usually considered a permanent method of birth control – can be reversed through low cost, one hour outpatient surgery. Even many doctors think mistakenly that treatment by in vitro fertilization (IVF) is needed for women who want another baby after having a tubal sterilization. The results from this study show that tubal reversal at Chapel Hill Tubal Reversal Center is successful for most women wanting to get pregnant after having their tubes tied.

Tubal Reversal – The Alternative to Treatment by IVF

Information is widely available about in vitro fertilization (IVF) results in the United States from the Centers for Disease Control (CDC). Tubal reversal pregnancy and birth statistics, however, are difficult to find and generally have been based on small numbers of patients under special study conditions. This report analyzes pregnancy rates and pregnancy outcomes for a very large population of women (5,046) who had tubal reversal procedures at Chapel Hill Tubal Reversal Center. This is the most detailed study of tubal reversal surgery available on the internet or in medical publications.

Tubal Reversal Pregnancy Study 2009

Table of Contents:

• Overview (this page)
• Study Method
• Patient Population – US States
• Patient Population – Age and Tubal Ligation Procedures
• Pregnancy Rates by Age and Method
• Pregnancy Rates by Tubal Length
• Pregnancy Outcomes
• Tubal Reversal vs. IVF
• About Pregnancy Statistics

Weekly Pregnancy Report Forum

FOR IMMEDIATE RELEASE: June 19, 2008

Defining hope at Chapel Hill Reversal Center

Reproductive surgeon and tubal reversal expert leads the way in tubal reversal field.

CHAPEL HILL, N.C. – At Chapel Hill Tubal Reversal Center, Dr. Gary Berger understands that hope is not just a word to the hundreds of women who come to his center each year. Hope is what they find in him.

When Amanda Nelson first decided to have a tubal ligation in 1997, she never imagined she would find herself in Chapel Hill, North Carolina, 4,000 miles away from her home in Cumbria, England about to undergo a tubal ligation reversal.

“I had been married for a number of years when my marriage broke down,” said Amanda. “I had two boys to look after, so I waited a year and then went ahead with my tubal ligation. At the time, the thought of having children with a different father didn’t appeal to me.”

Like Amanda, many women who come to Chapel Hill Tubal Reversal Center have faced life changes such as divorce, loss of a child or remarriage.

“Years went by, and then I met David. He had no children and happened to mention he would like one of his own some day,” said Amanda. “It took me awhile to think about it, but decided to look up having the operation.”

They began searching online for tubal reversal specialists. Their search brought them to the Chapel Hill Tubal Reversal Center Web site and Dr. Gary Berger.

Over the past 26 years, Dr. Gary Berger has performed over 7,000 tubal reversals as a one-hour, outpatient operation. Recognized as a leader in the field, Dr. Berger has been featured on The Learning Channel and Discovery Health.

Patients come to Chapel Hill from across the United States and abroad to have him perform the procedure. Using microsurgical techniques he developed and refined, Dr. Berger can successfully repair the fallopian tubes in 98 percent of the women who want their tubes untied.

Most women are typically discharged from the facility within two hours after surgery. And most resume normal activities within five to 10 days. This outcome is far better for patients than the standard approach to tubal ligation reversal that requires hospitalization for several days, longer recovery times and unnecessary hospital costs.

To learn more about Dr. Gary Berger and his team at Chapel Hill Tubal Reversal Center, visit www.tubal-reversal.net.

Lisa D. Hourmouzis, RN
Chapel Hill Tubal Reversal Center Nurse
Tel 919.968.4656
LisaH@tubal-reversal.net

FOR IMMEDIATE RELEASE May 26 2008 (Chapel Hill, NC)

Almost every publication about tubal ligation stresses that it is a permanent method of birth control. The public, and even most doctors, believe this to be true. Although tubal sterilization is intended to be permanent, the procedure can be reversed by an experienced tubal microsurgeon in over 95% cases.

Doctors say that tubal ligation is a permanent method birth control because it cannot be discontinued easily such as stopping the use of birth control pills or patch, removing an IUD, or barrier contraceptives. In the past, reversing a tubal ligation procedure involved complicated in-hospital surgery with its attendant high cost ($15,000 to $35,000). Dr. Gary Berger, Medical Director of Chapel Hill Tubal Reversal Center, has developed an outpatient tubal reversal procedure that results in surgery that is easy to undergo and avoids the expense of hospital charges. This has reduced the cost of tubal ligation reversal to less than $6000. This is approximately half the cost of a single treatment cycle with in vitro fertilization (averaging $12,000 in the US).

There are some methods of female sterilization that are not reversible. These include complete removal of the fallopian tubes (total salpingectomy) and extremely destructive methods of partial salpingectomy that do not leave two segments to repair. An example of the latter is when only a short portion of the tube is attached to the uterus and the remaining segment contains only fimbrial tissue with no tubal muscle or opening. In this case, the fimbrial tissue alone cannot be rejoined successfully to the uterine segment of tube. Fortunately, these are unusual occurrence. In cases where there is a sufficient length of tube attached to the uterus, it can be opened and be able function normally even without the fimbrial end. This is called ampullary salpingostomy. This technique is useful in reversing a fimbriectomy (removal of the fimbrial or ovarian end of the fallopian tube).

Reviewing the operative report from a tubal ligation procedure usually will indicate how destructive the procedure was. Pathology reports, when available, also can provide additional information beyond what is contained in the operative report. When there are questions about whether or not tubal repair is possible in a specific case, diagnostic laparoscopy can be performed to examine what remains of the fallopian tubes. If there are sufficient segments to repair, tubal reversal can be done during the same operation while the patient is under anesthesia.

There are many different ways to block the fallopian tubes for tubal sterilization: ligation and resection (tying and cutting), tubal clips or rings, and electrocoagulation (burning). No matter how the procedure is done, the end result is closure or occlusion of the fallopian tube. This prevents sperm from reaching an egg. The easiest method of tubal ligation to reverse is the “clip” procedure. The Hulka Clip was developed in the 1970s by Dr. Jaroslav Hulka, a professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill. The tubal ring also is an excellent method for reversing. The clip and ring procedures tend to damage the least amount of the fallopian tube and leave behind long segments to repair. The overall pregnancy rate is 65% at one year following reversal of tubal clip procedures and increases for younger women to 87% for women less than 30 years of age. The pregnancy rate after tubal reversal surgery continues to rise with the passage of time because once the tubes are open pregnancy can occur any month. Many women who have undergone tubal ligation reversal have added several babies to their families.

Tubal ligation and resection (removal) of a portion of the fallopian tube is the most frequent method of blocking the tubes. This involves tying a segment of tube and removing it. There are many variations of this technique. The tubal ligation procedure described by Dr. Ralph Pomeroy a century ago is still the most commonly used today. Experience shows that 98% of these procedures are now reversible and approximately two-thirds of women with a Pomeroy tubal ligation become pregnant following tubal ligation reversal.

With a specialized procedure such as tubal ligation reversal, the surgeon’s experience is the most important factor in predicting success from the operation. Depending on the patient’s type of tubal ligation and condition of the remaining tube after ligation, the techniques of tubal reparative surgery vary among patients. Having an experienced tubal reversal specialist perform the operation is essential, particularly if a woman has a difficult situation due to short or missing tubal segments, fimbriectomy, or has inherent disease of the tubes.

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References

http://www.tubal-reversal.net/blog/2007/tubal-ligation/tubal-ligation-not-permanent.html
http://news.tubal-reversal.net/pregnancy-study-2007-method.htm

Books, Magazine Articles, TV Broadcasts, Blogs and Study Reports

Press Release – New Tubal Reversal Doctor Dr. Charles Monteith has begun a 6 month fellowship program in tubal reversal surgery at Chapel Hill Tubal Reversal Center. Upon completing this program he will have participated in over 100 tubal reversal procedures and will become certified as a tubal reversal surgeon.

Press Release – September 2007 – Chapel Hill, North Carolina physician dedicates practice to restoring fertility in women who have undergone previous tubal ligation surgery.

Tubal Reversal Pregnancy Study Report 2007. The largest study of tubal reversal pregnancies and outcomes ever performed is a prospective cohort study of 3,139 patients at Chapel Hill Tubal Reversal Center.

Press Release – Tubal Reversal Study 2005. Comprehensive report presents data and statistics regarding pregnancies and their outcomes among 2692 women who had their tubal reversals performed by Dr. Berger between 2001 and 2004. This is the largest and most definitive study in existence on the outcome of tubal reversal surgery.

Press Release – Chapel Hill Tubal Reversal Center Releases 500th Baby Testimonial. Patient reports second pregnancy following tubal ligation reversal surgery by Dr. Gary S. Berger.

Dr Berger’s Article About Tubal Reversal In The Health And Medicine Section Of Squidoo.com – One of the recent additions to the Chapel Hill Tubal Reversal Center Website is this link to Dr Berger’s article about Tubal Reversal in the Health and Medicine Section of Squidoo.com. This is an important article for anyone who wants to learn more about outpatient tubal ligation reversal.

The Operation – Discovery Channel production featuring the outpatient surgical techniques of Gary S. Berger, M.D. – a pioneer in tubal ligation reversal surgery. Originally aired as part of the series, “The Operation”, the film has also been featured on “The CBS Early Morning Show”. “The Operation” provides detailed information and live footage as Dr. Berger restores fertility after tubal ligation through a comfortable and affordable one-hour outpatient procedure. Available free as a videotape or DVD.

Tubal Ligation Reversal on Blogspot – Daily news and blog about tubal reversal, the outpatient surgery that restores fertility allowing women to become pregnant and have more babies after a tubal ligation.

Conceive Magazine – It seemed like a good idea at the time…but if you have been surgically sterilized and you’d now like to be pregnant again, here’s what you need to know. Conceive Magazine article, “Changing Your Mind” features Gary S. Berger, M.D. and Chapel Hill Tubal Reversal Center.

M.D. News Magazine– The article, “Outpatient Tubal Ligation Reversal – Fertility Restored Through One Hour Outpatient Surgery” features Gary S. Berger, M.D., Medical Director of Chapel Hill Tubal Reversal Center.

The Couple’s Guide to Fertility – Dr. Gary S. Berger and Dr. Marc Goldstein —specialists in male and female reproductive treatment — thoroughly examine the causes of infertility, the tests you may undergo, and the state-of-the-art treatments that can help you to have a baby, including tubal reversal surgery. The book is now in its third edition.

Tubal Reversal – Our Journeys – A collection of true stories from women who have undergone tubal reversal surgery that brings alive what the journey is really like through the eyes of those who have lived it.