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

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.