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

Patient Population

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 – the only medical facility exclusively for tubal ligation reversal – located in Chapel Hill, North Carolina.

Where Patients Came From

The women came from throughout the United States and from 23 foreign countries. The following map shows the geographic distribution of the resident locations of the US patients.

Figure 1. Where Patients Came From For Tubal Reversal Surgery

Tubal Reversal Pregnancy Report 2009
Table Of Contents:

• Overview
• Study Method
• Patient Population – States (this page)
• 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 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

Tubal Reversal Surgery – How to choose the best doctor

When women begin researching tubal reversal surgery, there are several questions that are frequently asked. These questions are typically based on the differences that become apparent when they compare various facilities and doctors.

“How do I choose a doctor?” Considering the number of choices, it is one of the most important questions to consider before a woman moves forward with planning her tubal reversal procedure. Training, experience, availability, and patient support can vary greatly between doctors and facilities.

Most women who research the option of tubal reversal surgery after a tubal ligation are interested in how many reversal procedures the doctor has performed. Many reproductive surgeons have performed a tubal reversal procedure, but few perform the procedure routinely and even fewer limit their practice to this specialty. In the case of tubal reversal surgery, experience is an important factor in predicting the outcome of the procedure. Chapel Hill Tubal Reversal Center is the only medical facility specifically for tubal ligation reversal surgery. Dr. Gary Berger performs 4 reversals a day and has performed more than 7000 reversal procedures in his career.

Another question women frequently ask is whether the doctor uses the dye technique or a stent to ensure the tubes are open following surgery. The use of the dye technique is not the most accurate indicator regarding whether the tubes are open following tubal repair to allow conception. The stent technique is the better approach in our opinion to avoid any doubt. The stent is sterile and does not pass through the cervix. The stent not damage the tubes, and it ensures that they are open so a dye test is not necessary. With the stent technique used by Dr. Berger, there is no question regarding tubal patency following surgery, which puts the woman in a much better position for achieving pregnancy following surgery.

A common question during the process of researching tubal reversal facilities is whether the doctor uses permanent or absorbable suture to repair the fallopian tubes and whether he or she reconnects each of the tubal layers. While some doctors may suture all of the tubal layers, Dr. Berger uses permanent suture and sews the muscular and outer serosal layers together. He does not place suture in the inner endothelial layer as this may increase the risk of scar formation within the tubal lumen. In Dr. Berger’s opinion, this is the best approach. Comparing doctors’ data regarding pregnancy outcomes is the best way to assess their techniques since high pregnancy rates are a clear indication that the techniques are successful.

Ultimately, the most frequently asked – and most important – question regarding tubal reversal surgery is, “What are the doctor’s success rates”. Since pregnancy and its outcome are the primary concerns of most women who choose the reversal procedure, the answer to this question should be based on accurate statistical data. On the Internet, claims about tubal reversal pregnancy rates are often made without supporting information or documentation – such as a description of the patient population, study method, and follow-up interval. At Chapel Hill Tubal Reversal Center, Dr. Berger and his staff do everything possible to obtain and report this information on an ongoing basis. This allows them to remain informed about the number of pregnancies achieved and what their outcomes were after tubal reversal and to answer questions and guide patients who are waiting to become pregnant.

The decision to undergo surgery to restore fertility after a previous sterilization is a serious one for any couple. Where to go for surgery and with whom care will be entrusted is an important part of that decision. Potential patients should expect that they have been given detailed, accurate information regarding costs and recovery times, as well as careful analysis and reporting of accurate statistics regarding pregnancy and birth rates. This is referred to as “evidence based medicine” and is consistent with the mission of Chapel Hill Tubal Reversal Center. It is one of the many reasons why the facility has become known as the best place to have tubal reversal surgery.

Nearly 500,00 women undergo tubal ligation surgery in the United States every year. Of those women, as many as one-fourth will change their mind and desire more children after tubal ligation leading to questions about the possibility of tubal reversal surgery.

The most common question women have as they research the option of tubal reversal surgery is whether the surgery will be successful. The success of the surgery depends on several factors, including a woman’s age, the type of sterilization, and the length of tube remaining after the reversal procedure. One way to determine the outcome of the reversal surgery is through a review of the operative report from the tubal ligation. Based on this information, the tubal reversal surgeon is able to make an interpretation regarding the type of sterilization a woman has had and estimate the amount of tube that may have been damaged during the procedure. Tubal reversal specialist, Dr. Gary Berger, is a reproductive surgeon who limits his practice to tubal reversal surgery. Two-thirds of Dr. Berger’s patients become pregnant in an average of 10 months after their reversal procedure.

Another priority issue is tubal reversal cost. One reason for the increased costs quoted by some facilities is the lengthy operating time due to lack of experience with the procedure. This often means that the woman is hospitalized for several days, with significant added costs as a result. Dr. Berger has developed a low-cost, outpatient reversal procedure that has resulted in the most tubal reversal babies born worldwide. With short operating times (approximately one hour) and no overnight hospital stay required, tubal reversal cost is kept to a minimum. Dr. Berger also offers an all-inclusive fee for the reversal procedure, there are no unexpected or “hidden” costs.

Potential reversal patients often ask whether the length of time since the tubal ligation will affect the outcome of the surgery and, fortunately, the answer is no. The damage that is done to the tubes at the time of the sterilization does not worsen over time, so the length of time since the tubal ligation does not specifically affect pregnancy rates. However, age does play a factor so pregnancy rates should be viewed by age if a number of years have passed before tubal reversal surgery is performed. Fortunately, women age 40 – 42 have pregnancy rates of approximately 50% following surgery with Dr. Berger at Chapel Hill Tubal Reversal Center.

Recovery times can vary greatly between doctors and facilities, and this issue is usually mentioned as an important factor in choosing a doctor for surgery. Although everyone recovers at a different rate, most of Dr. Berger’s patients return to work in 5 – 7 days following surgery and are back to the majority of their usual activities within 7 – 10 days. Tubal reversal performed by Dr. Berger usually takes less than an hour. Minimizing operating time is important, since longer anesthesia and surgery times are associated with increased complication rates and recovery from surgery. Compare this to the standard approach for tubal reversal surgery where operating times of 3 – 4 hours can result in hospitalization for several days, a recovery period of 4 – 6 weeks, and unnecessary hospitalization costs.

Dr. Berger’s successful and safe reversal procedure has been featured on television on The Discovery and Learning Channels. Chapel Hill Tubal Reversal Center is a medical facility exclusively for tubal ligation reversal. Dr. Gary Berger is recognized as the tubal reversal doctor with the most experience with this procedure. Although tubal reversal is not right for everyone, Dr. Berger can repair the fallopian tubes in 98% of women who have had a tubal ligation and want to have another baby. These are two of the many reasons why women come from all over the US and abroad to have Dr. Berger perform their tubal ligation reversals.

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.