Tubal Reversal Blog ‘burned tubes’

History of Tubal Sterilization

The first tubal sterilization method was tubal ligation and resection, reported in 1881! Ligation and resection- or ‘tying tubes’ was the most common surgery for sterilization until the advent of laparoscopic surgery in the mid 1900’s. As laparoscopic surgery became more popular, electrocoagulation (electrical burning) of the fallopian tubes became a popular method of female sterilization.

Tubal Electrocoagulation Results in Burned Tubes

The first description of laparoscopic electrocoagulation, in 1962, used a type of electrical current termed monopolar current – hence the term monopolar tubal coagulation. This sterilization procedure uses electric current to destroy part of the fallopian tube. The burned part of the tube turns into scar tissue and the remaining tubal segments are separated and blocked. This was a very popular form of laparoscopic sterilization from 1970 until the early 1980’s.

Although monopolar electrocautery is a very effective form of tubal sterilization, studies showed that it had a higher complication rate than for electrocoagulation using bipolar current, where the damage to the fallopian tube (or other structures) is more easily restricted. Sterilization procedures done by monopolar current are gradually decreasing and being replaced with bipolar current. Monopolar cautery, however, is still used for tubal sterilization by some doctors.

Can Burned Tubes Be Repaired?

Patients often ask whether burned tubes can be repaired. In most cases, monopolar electrocoagulation sterilization procedures can be reversed. The success of reversal is dependent on the amount of fallopian tube that has been damaged by the electrocautery. This information is usually available in the tubal ligation operative report. When in doubt, a screening laparoscopy can be performed. Approximately 50% of patients at Chapel Hill Tubal Reversal Center will become pregnant after a reversal of a monopolar coagulation sterilization procedure.

Many people, including doctors, have been told that tubal sterilization is permanent and irreversible. Although monopolar tubal coagulation is intended to be permanent, this procedure is usually revesible. The best place for women to have their tubes ‘untied’ when they have been burned is Chapel Hill Tubal Reversal Center – the only medical facility that specializes in reversal of tubal ligation.

Submitted by Dr. Charles Monteith

Tubal Ligation by Coagulation or Cauterization

Bipolar tubal coagulation is a popular method of female sterilization in the United States. This tubal ligation method is usually performed through laparoscopy. With the bipolar (two-poles) coagulator, the fallopian tube is grasped between two poles of electrical conducting forceps and electrical current is passed through the tube between the two ends of the forceps. Damage to the tube is limited mainly to the small segment between the forceps. Burning two or three adjacent sites is common and generally results in the loss of a few centimeters of the fallopian tube. Bipolar tubal cauterization can be successfully reversed in almost all cases.

Monopolar tubal coagulation is less common than bipolar coagulation tubal ligation. With monopolar forceps, electrical current spreads further along the length of the fallopian tube. Consequently, monopolar cautery tends to damage more of the fallopian tube than bipolar cautery. In many cases, the tube is also cut after it has been coagulated.

When monopolar coagulation is applied to a single site of the tube, tubal reversal can be performed without the need for further diagnostic tests. If multiple sites of the fallopian tube have been burned with the monopolar technique, we offer a screening diagnostic laparoscopy to evaluate the tubal lengths before proceeding to reparative surgery. The screening laparoscopy option is discussed further on our website.

Tubal Coagulation Reversal Success

Each year Chapel Hill Tubal Reversal Center publishes updated statistics about pregnancy rates and pregnancy outcomes among all of the women who have had tubal reversal procedures performed by Dr. Berger. The data for women who had tubal coagulation sterilizations, presented in the table below, are from our Tubal Reversal Pregnancy Study Report 2007.

Pregnancy Rates of Our Tubal Reversal Patients

The overall pregnancy rate after tubal reversal for women with tubal coagulation procedures is 68% for patients at Chapel Hill Tubal Reversal Center. To calculate the pregnancy rate, the number of women who have become pregnant is divided by the total number who underwent a tubal reversal procedure. The following table shows the numbers and pregnancy rates according to womens’ ages at the time of their tubal reversal surgery.

Pregnancy Rates After Tubal Coagulation Reversal

Conclusion

Tubal coagulation methods of tubal ligation can be successfully reversed in most cases. The pregnancy rate after tubal reversal varies with a woman’s age at the time she has her tubal reversal procedure. The pregnancy rate is 85% for women in their twenties, 74% for those ages 30-34, 64% for women in the 35-39 year age group, and 35% for women 40 years of age or older.