Tubal Reversal Pregnancy Report 2009

Study Method

Prospective Study

This is a prospective observational study of 5,046 women who had tubal reversal surgery from July 2000 through June 2008 at Chapel Hill Tubal Reversal Center – an outpatient facility exclusively for tubal ligation reversal. This ongoing study was begun in 2000 with the development of a computerized database to record information for subsequent analysis. Patients who had tubal reversals prior to the initiation of the database are not included in this study report. The study cut off date of June 2008 was chosen to allow for at least one year of follow-up for all patients in the present analysis and report.

Information about pregnancies is collected through the Center’s ongoing patient follow-up protocol. Patients are asked to notify the Tubal Reversal Center staff when a pregnancy occurs by completing an online Pregnancy Report Form. All women reporting pregnancies are contacted by staff nurses to determine the outcome of each pregnancy. The information is entered into the center’s electronic patient database for subsequent statistical analyses.

Tubal Reversal Techniques

The tubal reversal procedures were performed using outpatient mini-laparotomy surgical and anesthetic techniques that minimize tissue injury, blood loss, anesthesia time, postoperative pain, and recovery time. Dr. Berger explains these advanced techniques in a video recording of the surgery entitled Outpatient Tubal Reversal. This video has been shown on “The Operation” television series broadcast on Discovery,The Learning Channel (TLC), and the CBS Early Show.

The tubal reversal operations for these 5,046 women included the following techniques depending on the requirements of each patient:

• tubal anastomosis
• salpingostomy
• tubouterine implantation

Tubal Reversal Pregnancy Rate

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.

Subsequent pages in this report break down this overall pregnancy rate for all patients into more specific pregnancy rates based on age, type of tubal ligation, and the remaining tubal lengths available for repairing. These statistics will help women wanting to get pregnant after a tubal ligation. With this information, they can make informed decisions based on their chances of getting pregnant after tubal reversal that are specific to their age and method of tubal ligation.

Tubal Reversal Pregnancy Report 2009
Table Of Contents:

• Overview
• Study Method (this page)
• 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

DVD of “The Operation” Shows Dr. Berger’s Tubal Reversal Procedure Step-by-Step

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