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

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 Study Report 2009

Pregnancy And Birth Rates: Tubal Reversal vs. IVF

Women who want to get pregnant after a tubal ligation have two treatment options: tubal ligation reversal or in vitro fertilization (IVF). To compare the success of these two treatments, the tubal reversal pregnancy statistics from Chapel Hill Tubal Reversal Center can be compared with the latest available national IVF statistics (National Summary and Fertility Clinic Reports).

During 2006 in the United States, 99,199 IVF cycles using fresh non-donor eggs or embryos were begun. Of these, 34,719 (35%) resulted in pregnancy and 28,404 (29%) resulted in live birth deliveries. Pregnancy rates after tubal reversal and after IVF were compared based on the age categories reported in the National Summary and Fertility Clinic Reports (Figure 3). The pregnancy rate after tubal reversal was higher than after IVF within every age group.

Figure 3. Pregnancy Rates After Tubal Reversal vs IVF

Tubal Reversal

IVF

Age

Similarly, birth rates were higher after tubal reversal at Chapel Hill Tubal Reversal Center than after IVF for women of all ages and the differences increased with increasing maternal age (Figure 4).

Figure 4. Birth Rates After Tubal Reversal vs IVF

Tubal Reversal

IVF

Age

Comparing Tubal Reversal and IVF

Tubal reversal surgery differs from IVF in significant ways. The chances of getting pregnant after tubal reversal continue each month following the surgery. The pregnancy rate after tubal reversal, therefore, continues to increase over time and more than one pregnancy and birth can result from a sterilization reversal procedure. With treatment by IVF, the outcome is immediate. If pregnancy does not occur, then a couple must decide whether or not to go through the treatment process again. Since the chances of getting pregnant after tubal reversal are cumulative over time, this procedure results in higher pregnancy and birth rates than after an IVF cycle.

Tubal Reversal Pregnancy Study 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
• Comparison Of Tubal Reversal vs. IVF (this page)
• About Pregnancy Statistics

Comments About Tubal Reversal Pregnancy Statistics

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 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 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