Tubal Reversal Blog ‘implantation’

Tubal blockage or tubal occlusion (the medical term) is the reason that tubal ligation prevents pregnancy. The blockage of the fallopian tube prevents joining of the sperm and egg and prevents eggs from being able to reach the uterine cavity. In the case of tubal sterilization, tubal blockage is intentional. Tubal blockage may also occur due to disease conditions and result in involuntary infertility. Tubal blockage, whether intentional or from disease,  can be corrected with reconstructive tubal surgery.

Facts about Tubal Blockage

Tubal blockage affects millions of women in the US and hundreds of millions worldwide. More than 10 million women in the US, and more than 100 million worldwide, have had a tubal sterilization. There are approximately 6 million infertile couples in the US. It is estimated that 10-20% (600,000 to 1.2 million) cases of infertility may be due to tubal disease. In the majority of cases, tubal occlusion due to disease is caused by pelvic inflammatory disease (PID), an infection of the fallopian tubes (salpingitis) and sometimes the ovaries and pelvic cavity. PID is  “silent”, unrecognized, or misdiagnosed in many and perhaps in the majority of cases.

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Tubal Reversal Procedures

There are 3 types of tubal reversal procedures:

• anastomosis
• implantation – (this blog topic)
• salpingostomy

Implantation of Fallopian Tubes

Implantation of the fallopian tube is inserting the tube through a new opening into the uterus. Tubouterine implantation is correct medical terminology, but it is also called tubal implantation, uterotubal implantation, or uterine implantation.

Most tubal ligation operations leave two fallopian tube segments that can be reconnected. In some cases, only one tubal segment remains that is separated from the uterus and the portion of the tube within the uterine muscle is blocked as well. This is most likely to occur when a tubal ligation has been performed by monopolar tubal coagulation applied to the tubal segment next to the uterus. In this situation, tubal implantation is required as the tubal reversal procedure.

How I Perform Tubal Implantation

Tubal implantation is performed by making an incision through the uterine muscle. The incision is carried down into the uterine cavity. The tubal segment that has been separated from the uterus is opened and passed down until its proximal end is inside the uterine cavity. Before implanting the tube in the uterus, a suture is placed through the open end that goes inside the uterus. This suture is used to anchor the fallopian tube within the uterine cavity.

When the tube has been anchored inside the uterine cavity, sutures are placed in the uterine muscle around the implanted tube. Care must be taken to close the uterine incision sufficiently to allow healing, but not so tightly that it compresses or constricts the implanted tube. Tubal implantation is a more difficult operation to perform than tubal anastomosis. Tubal implantation accounts for 1% of tubal reversal procedures at Chapel Hill Tubal Reversal Center.