Factors Affecting Pregnancy Rates after Microsurgical Reversal of Tubal Sterilization

Abstract

The aim of this study was to determine the prognostic factors and pregnancy rates after microsurgical reversal of tubal sterilization. Patients undergoing tubal anastomosis from 2001 to 2008 were included. Relevant data were extracted from their medical records. Pregnancy outcomes were ascertained by responses to mailed questionnaires and telephone contact. A total of 98 patients were identified. We found that the mean duration of follow-up was 67 ± 28 months. Fifty-five patients conceived (pregnancy rate 62.5%; 95% confidence interval [CI] 52 to 72.8%). Of these, 50 were intrauterine and 5 were tubal pregnancies. Life-table analysis estimated cumulative pregnancy rates to be 30.7%, 39.8%, 49%, and 53.7% at 6, 12, 18, and 24 months after reversal, respectively. Age at the time of reversal was the only significant prognostic factor multivariate model. We concluded that age of the patient at the operation is the most important prognostic factor.

Tubal Sterilization Reversal: Is There Any Role in This Modern Era of Art?

“…12 In our patients higher intrauterine pregnancy rates were achieved in isthmus-isthmus anastomosis. The cumulative conception rates were 30.7%, 39.8%, 49%, and 53.7% at 6, 12, 18, and 24 months after recanalization, respectively [10]. Whereas in current study it was 21%, 42.2%, 26.3% and 10.5% which is slightly lower than shown in literature.…”

“…Of these, 90.9% were intrauterine and 9.09% were ectopic pregnancies. 10 In another study intrauterine pregnancy was 96.66%, tubal pregnancy 3.33%, term viable pregnancy 96.55% and spontaneous abortion 3.45%. 13 Survey of literature shows that in a study pregnancy and live birth rates were similar between laparoscopy and open surgery.…”

“…Multiple studies emphasize that age is a major prognostic factor. 1,9,10 They believe that conception rate is reciprocal to the patient's age. The results are comparable as in our study 75% of the patients who got pregnant were less than 30 years of age.…”

Contraceptive Use and the Risk of Ectopic Pregnancy: A Multi-Center Case-Control Study

“…The insignificant increased risk of EP among women who underwent tubal sterilization reversals may be caused by the small proportion of previous contraceptive users in this study. Some studies have reported a high incidence of EP, ranging from 3.8%–7.7%, among those who had undergone tubal reanastomosis [55] – [57] . This finding can be attributed to potentially relevant factors, including the type of previous sterilization procedure, the surgical reversal technique used, and the discrepancy in diameter between the proximal and distal tube [55] , [56] .…”

“…Some studies have reported a high incidence of EP, ranging from 3.8%–7.7%, among those who had undergone tubal reanastomosis [55] – [57] . This finding can be attributed to potentially relevant factors, including the type of previous sterilization procedure, the surgical reversal technique used, and the discrepancy in diameter between the proximal and distal tube [55] , [56] . However, the high risk of EP following contraceptive failure in women who undergo tubal sterilization may be caused by the altered structure of the fallopian tube and impaired embryo-tubal transport [58] , and these results are in agreement with the results of other case-control studies that included a pregnant control group [32] , [59] .…”