Labrador, Australia (PressExposure) June 01, 2008 -- Almost every publication about tubal ligation stresses that it is a Permanent method of birth control. The public, and even most doctors, believe this to be true. Although tubal sterilization is intended to be permanent, the procedure can be reversed by an experienced microsurgeon in over 95% cases.
Doctors say that tubal ligation is a permanent method birth control because it cannot be discontinued easily such as stopping the use of birth control pills or patch, removing an IUD, or barrier contraceptives. In the past, reversing a tubal ligation procedure involved complicated in-hospital surgery with its attendant high cost (up to $35,000. An outpatient tubal reversal procedure has been developed that results in surgery that is easy to undergo and avoids the expense of hospital charges. This has reduced the cost of tubal ligation reversal to less than $6000. This is approximately half the cost of a single treatment cycle with in vitro fertilization (averaging $12,000 in the US).
There are some methods of female sterilization that are not reversible. These include complete removal of the fallopian tubes (total salpingectomy) and extremely destructive methods of partial salpingectomy that do not leave two segments to repair. An example of the latter is when only a short portion of the tube is attached to the uterus and the remaining segment contains only fimbrial tissue with no tubal muscle or opening. In this case, the fimbrial tissue alone cannot be rejoined successfully to the uterine segment of tube. Fortunately, these are unusual occurrence. In cases where there is a sufficient length of tube attached to the uterus, it can be opened and be able function normally even without the fimbrial end. This is called ampullary salpingostomy. This technique is useful in reversing a fimbriectomy (removal of the fimbrial or ovarian end of the fallopian tube).
Reviewing the operative report from a tubal ligation procedure usually will indicate how destructive the procedure was. Pathology reports, when available, also can provide additional information beyond what is contained in the operative report. When there are questions about whether or not tubal repair is possible in a specific case, diagnostic laparoscopy can be performed to examine what remains of the fallopian tubes. If there are sufficient segments to repair, tubal reversal can be done during the same operation while the patient is under anesthesia.
There are many different ways to block the fallopian tubes for tubal sterilization: ligation and resection (tying and cutting), tubal clips or rings, and electrocoagulation (burning). No matter how the procedure is done, the end result is closure or occlusion of the fallopian tube. This prevents sperm from reaching an egg. The easiest method of tubal ligation to reverse is the "clip" procedure. The Hulka Clip was developed in the 1970s by Dr. Jaroslav Hulka, a professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill. The tubal ring also is an excellent method for reversing. The clip and ring procedures tend to damage the least amount of the fallopian tube and leave behind long segments to repair. The overall pregnancy rate is 65% at one year following reversal of tubal clip procedures and increases for younger women to 87% for women less than 30 years of age. The pregnancy rate after tubal reversal surgery continues to rise with the passage of time because once the tubes are open pregnancy can occur any month. Many women who have undergone tubal ligation reversal have added several babies to their families.
Tubal ligation and resection (removal) of a portion of the fallopian tube is the most frequent method of blocking the tubes. This involves tying a segment of tube and removing it. There are many variations of this technique. The tubal ligation procedure described by Dr. Ralph Pomeroy a century ago is still the most commonly used today. Experience shows that 98% of these procedures are now reversible and approximately two-thirds of women with a Pomeroy tubal ligation become pregnant following tubal ligation reversal.
With a specialized procedure such as tubal ligation reversal, the surgeon's experience is the most important factor in predicting success from the operation. Depending on the patient's type of tubal ligation and condition of the remaining tube after ligation, the techniques of tubal reparative surgery vary among patients. Having an experienced tubal reversal specialist perform the operation is essential, particularly if a woman has a difficult situation due to short or missing tubal segments, fimbriectomy, or has inherent disease of the tubes.