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 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