Microsurgical Reanastomosis of the Fallopian Tubes for Reversal of Sterilization

Grunert, George M.; Drake, Terrance S.; Takaki, Norman K.

doi:10.1097/00006254-198202000-00024

Cited by 13 publications

(6 citation statements)

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“…Although it is done as a permanent method of sterilization, due to unforeseen circumstances, 1%–3% of these women subsequently demand reversal of sterilization. [ 4 ] There are no studies from the country trying to look at the rate of successful recanalization procedures based on the type of sterilization performed.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic tubal sterilization reversal and fertility outcomes

Jayakrishnan¹,

Baheti²

2011

J Hum Reprod Sci

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PURPOSE:The purpose of the study was two-fold. Firstly it was to assess the suitability for tubal recanalization and factors predicting successful laparoscopic recanalization. Secondly, it was to analyze the fertility outcomes and factors affecting the pregnancy rate following laparoscopic tubal recanalization.MATERIALS AND METHODS:A retrospective chart review of prospectively followed-up 29 women at a tertiary care center seeking tubal sterilization reversal between May 2005 and February 2010 were included.RESULTS:In 14 (48.3%) women unilateral tubes were suitable and in only 3 women (10.3%) bilateral tubes were suitable. All cases with laparoscopic tubal sterilization were suitable, whereas all cases with fimbriectomy were unsuitable for recanalization. In 6 (20.7%) cases salphingostomy was performed as an alternative procedure to tubal reanastomosis. The overall pregnancy rate was 58.8%. In cases with sterilization by Pomeroy's method, 4 out of 10 (40%) conceived, whereas for laparoscopic tubal ligation cases 6 out of 7 (85.7%) conceived (P=0.32). None of the patients with final tubal length <5 cm conceived (P=0.03). Comparing the age at recanalization, in women ≤30 years, 71.4% conceived, as compared with 50% when age of women was more than 30 years (P=0.37).CONCLUSIONS:The important factors determining the success of recanalization are technique of sterilization and the remaining length of the tube after recanalization. The gynecologist must use an effective technique of sterilization to minimize the failure rates, but at the same time, which causes minimal trauma, and aim at preserving the length of the tube so that reversal is more likely to be successful, should the patient's circumstances change.

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Section: Introductionmentioning

confidence: 99%

Laparoscopic tubal sterilization reversal and fertility outcomes

Jayakrishnan¹,

Baheti²

2011

J Hum Reprod Sci

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“…A study by Mukherjee et al, 11 showed that death of all children was the most common reason (91.8%) for reversal of sterilization, which coincides with the study by Jain et al, 8 where 70% of women sought reversal for death of all children. This observation is in contrast to Western countries where the most common indication was remarriage or divorce seen in 80-90% of the cases as per Grunert et al 12 Biswas and Mondal opined that death of a male child (53.5%) in a male dominated society makes the couple to try once more and solicit a sterilization reversal. 6 In the study by Promila et al, death of a male child (64.2%) was the major reason for sterilization reversal.…”

Section: Discussionmentioning

confidence: 74%

Evaluation of Pregnancy Outcome and Influencing Factors of Microsurgical Tubal Recanalisation as a Reversal of Tubal Ligation in a Tertiary Hospital

Naskar¹,

Gharami²,

Mandal³

et al. 2022

Asian J Med Sci

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Background: Tubal microsurgical recanalization is a procedure which restores the fertility in women who have undergone sterilization voluntarily, thinking that her family is complete. However due to unforeseen circumstances, 1–3% of these women subsequently demand reversal of sterilization. Aims and Objectives: This study aims to evaluate the pregnancy rate after reversal surgery and to find out the various factors that influence the success of tubal microsurgical recanalization. Materials and Methods: The current study was hospital-based retrospective one involving 48 women undergoing reversal of sterilization at the department of gynecology and obstetrics in tertiary hospital, Kolkata, during the period of 3 years, from July 2015 to June 2018. The women were followed up for a period of 1 year by telephonic contact. Women seeking tubal recanalization was in age group of 20–35 years with normal ovulation and normal semen analysis. Women, >35 years old, anovulation, with obvious pelvic inflammatory disease, endometriosis or fibroid were excluded, women with any contraindications to pregnancy or surgery and any male factor infertility also excluded from the study. Results: Out of 48 study subjects, intrauterine pregnancy was achieved in 27 cases (93.1%)), 2 patients (6.9%) had ectopic pregnancy. Out of 27 intrauterine pregnancies, 4 had abortions (13.8%), 3 (10.3%) are ongoing pregnancies, and 20 patients had live birth (69%). Conclusion: Tubal microsurgery offers good chances of pregnancy outcome which is favored by the age below 30 years, interval between sterilization and its reversal <4 years, isthmo-isthmic anastomosis, reconstructed tubal length being more than 6 cm, and type of previous sterilization were by Pomeroy’s method.

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“…The reasons for the range in success rate for each procedure is unclear, but is is reasonable to postulate that factors other than the actual reconstruction are playing some role in pregnancy outcome. These factors might include the operator's surgical expertise and experience, the degree of preoperative patient screening and selection, the preoperative condition 21 Crane and Woodruff 37 O'Brien et al 38 Ozaras 39 Arronet et al 6 Young et al 40 Grant 1 Lamb and Moscovitz 41 Williams 42 Umezaki et al 43 David et al 44 Palmer 45 Wheeless 16 Peterson et al 22 Siegler and Kontopoulos 24 Rock et al 46 Diamond 17 Jansen 47 Levinson 23 Fayes and Suliman 14 24 Silber and Cohen 25 Fayez and Suliman 14 Total 27 Gomel 15 Diamond 17 Winston 48 Silber and Cohen 25 McComb and Gomel 49 Grunert 50 Henderson 35 Meldrum 51 Winston 5 Fayez and Suliman 14 Von Arras et al 52 Total (of subtotal reported) of the oviducts (pathologically and functionally diseased tubes versus focal occlusion of otherwise normal tubes due to iatrogenic sterilization), and the total length of remaining normal oviduct following surgery. Furthermore, the method of reporting resulting pregnancies lacks appropriate standardization, with some investigators presenting data as a total pregnancy rate (including multiple gestations among single patients), while others adhere to a first conception criterion.…”

Section: Results Of Different Surgical Approachesmentioning

confidence: 99%