Tubal Reversal Blog ‘pregnancy after tubal reversal’

Any pregnancy can have a genetic abnormality. With increasing age the risk of a genetic abnormality increases. As a result, older mothers may have more of a need to consider genetic testing in pregnancy.

This  article provides basic information on genetic testing for our patients who become pregnant after having their tubes untied. This is a continuation of our series by the tubal reversal doctors at Chapel Hill Tubal Reversal Center dedicated to women over the age of 40 who are considering tubal ligation reversal.
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Denita and her husband Kareem share an inspirational story. Together they are a testament to how odds can be overcome after having a tubal ligation reversal. Denita became pregnant after tubal reversal at the age of 40.

She agreed to share her story with readers of our Tubal Reversal Blog. Read the rest of this article and comment on it. »

Tubal Ligation Reversal or In vitro fertilization (IVF)?

Is tubal reversal or IVF the better treatment for women who have had their tubes tied (tubal ligation procedure) and now want to become pregnant again?

The choice between IVF or tubal reversal must be made by couples who have had their tubes tied and are considering more children. This is a constant question asked by patients to our staff and to participants of the Tubal Reversal Message Board.

This series was written to help women evaluate and compare tubal ligation reversal surgery with the alternative treatment of IVF. This article compares the success of IVF compared with the success of sterilization reversal (tubal ligation reversal).

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Tubal ligation is a surgical procedure that blocks the fallopian tubes to prevent pregnancy. Many people commonly refer to tubal sterilization as having their ‘tubes tied’. The more correct medical term is tubal occlusion (occluding or closing the tube), because not every fallopian tube is ligated or tied when it is closed. There are many different ways to perform a tubal ligation, but all the procedures cause some destruction of the fallopian tubes. There are many ways to perform a tubal ligation: tying and cutting, cauterizing (burning) and clipping or banding the fallopian tubes are the most common techniques.

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Women come from all over the world to Chapel Hill Tubal Reversal Center for tubal reversal surgery. It is natural, and appropriate, for them to ask what their chances will be for pregnancy after a tubal reversal procedure performed by Dr. Berger. This important question about the anticipated benefit should be asked of any doctor before undergoing elective surgery. When answering questions about pregnancy after tubal reversal, we provide detailed information including pregnancy rates and their supporting data.

What Is The Success of Tubal Reversal?

There is only one way this question can be answered, and it requires ongoing follow up with patients to learn the results of their tubal reversal procedures. At Chapel Hill Tubal Reversal Center, we take this task to heart. Our nurses contact patients repeatedly during the first year after their surgery. When a patient informs us of a new pregnancy, we ask her to complete a Pregnancy Report Form. From this information, we provide a summary on the Weekly Pregnancy Reports Forum. The Weekly Pregnancy Report lists the age, date of tubal reversal, date of positive pregnancy test, method of tubal ligation, and tubal lengths after tubal repair for each pregnant woman. Additional comments about these pregnancies are shown in the Pregnancy Announcements.

Our various pregnancy information forums allow people to see the results from tubal reversal surgery performed by Dr. Berger on an current basis. The reports are not “filtered” to show only successful pregnancies. They include information about miscarriages and ectopic pregnancies as well. We want people to be fully informed about all of the possible outcomes after tubal reversal. One of our missions at Chapel Hill Tubal Reversal Center is to provide complete and accurate information about all aspects of tubal reversal surgery!

Pregnancy and Baby Testimonials

Some patients send us messages accompanied by photos after they have delivered their babies. These are spontaneous reports. Although we don’t ask patients to send us testimonials, we love receiving and reading them! They are added to the Testimonials section of our site for others to enjoy as well. Currently there are about 700 testimonial pages.

Testimonials Pages

When a patient sends us a birth announcement and photo to be added to Pregnancy and Baby Testimonials, we update an index page so that there is a link at the top of the page to the newest baby testimonial. The index page is what visitors see first when they click on any link to Testimonials. This page has brief quotes with a link to the full testimonial for each patient. We limit the index page to about 30 summaries. To see previous testimonial index pages, click the “Next” link at the bottom of the page. This will show the immediate prior group of testimonial quotes and links. Currently there are 48 testimonial index pages. To see a listing of all the testimonials, look at the Testimonials Site Map.

Our patients share so many different stories about their pregnancies and deliveries after their tubal reversal procedures. Most people don’t realize how many testimonials there are (689 as of January 13th, 2008. The testimonial number is shown in the “bread crumb” at the top left hand side of the page.) To protect patients’ privacy, only the first initial of the last name is shown. Many women include their email addresses and are happy to correspond with others about their experience here.

Pregnancy and Birth Statistics After Tubal Reversal

Since pregnancy and its outcome are the primary concerns of most women who come here for a reversal procedure, we do everything possible to obtain and report this information on an ongoing basis. This keeps us informed about the number of pregnancies and what their outcomes were after tubal reversal. It also allows us to answer questions and guide patients who are waiting to become pregnant. This takes the efforts of a dozen nurses each day, in addition to their care of patients who are preparing for and undergoing surgery. No other medical facility has undertaken this effort.

As a result of the efforts of our staff and patients, we are able to perform careful analysis and report accurate statistics regarding pregnancy rates and births rates after tubal reversal procedures performed by Dr. Berger. This is referred to as “evidence based medicine”. It is consistent with our mission, and is one of the many reasons why Chapel Hill Tubal Reversal Center has become known as the best place to have tubal reversal surgery.

If you have had your tubes tied and would like to become pregnant again, tubal reversal surgery is probably the best option for you. Tubal ligation reversal is the most successful and cost-effective way to become pregnant for 98% of women who have had a tubal ligation and now want to have another baby.

What Is Your Age?

The natural fertility rate declines with age. Pregnancy rates after tubal reversal, therefore, are highest for younger women.  Although pregnancy rates are lower for older women, you can still become pregnant after age 40 if you are ovulating and have periods.

Dr. Berger has kept detailed records of his patients and has compiled a comprehensive follow-up study on pregnancy after tubal reversal for all of his patients. His patients under 30 have a 77% pregnancy rate after having a tubal reversal procedure. The pregnancy rate is 72% for women ages 30-34 , 62% for women 35-39, and 34% for those 40 years of age and older after tubal reversal surgery performed by Dr. Berger.

What Type of Tubal Ligation Did You Have?

There are several ways that a doctor can tie a woman’s fallopian tubes. Women with the ring or clip method of tubal ligation have a 74% pregnancy rate after undergoing tubal reversal surgery. Women with the tubal coagulation technique have a 65% pregnancy rate, while women with tubal ligation and resection methods have a 62% probability for pregnancy after reversal surgery.

If you aren’t sure what type of tubal ligation you had, don’t worry! You can get a copy of your operative and pathology reports relating to your tubal ligation, and fax them to Chapel Hill Tubal Reversal Center at (919) 967-8637. Please attach the Fax Cover Sheet so we can reach you when your records arrive. Dr. Berger will review the operative report at no charge and we will contact you regarding possible outcomes for you following reversal surgery.

How To Choose The Best Tubal Reversal Doctor?

The most important question to ask is how many tubal reversal surgeries the doctor has performed. The more experience the doctor has, the better your outcome will be. Dr. Berger has the most experience with this operative procedure of any reproductive surgeon in the world and has performed more than 6,000 tubal reversals! He is considered by other medical professionals in the US and abroad to be the best tubal reversal doctor.

Also ask if the doctor performs tubal reversals on an outpatient basis. Outpatient tubal reversal reduces cost and avoids the risks of hospitalization, such as infection with hospital-acquired bacteria. Chapel Hill Tubal Reversal Center is the only center worldwide that is dedicated exclusively to outpatient tubal ligation reversal, and Dr. Berger is the only doctor who specializes in and limits his practice to outpatient tubal reversal surgery.

I Will Be Happy To Assist You

If you would like additional information or would like to schedule your tubal reversal procedure, please feel free to contact me. You can reach me from 8 am to 8 pm Eastern Time at (919) 656-8204 or by e-mail at JuliaS@tubal-reversal.net. I will be glad to answer any questions you might have!

Submitted by Julia Smith, RN
Nurse Administrator

Tubal Ligation by Falope Ring and Hulka Clip

The Falope ring and Hulka clip are occlusive methods of tubal ligation. They block the fallopian tubes, but no tubal segments are clamped, removed, or burned. The Falope ring is also referred to as the tubal ring or tubal band. It constricts a segment of the fallopian tube very tightly, like an extra strong rubber band.

The Hulka clip is a miniature clamp placed across a very small (2-3 mm) segment of the fallopian tube. Another clip method besides the Hulka clip is the Filshie clip. The clips are similar except that the Hulka clip is made out of silastic and the Filshie clip is made out of metal. Occlusive methods of tubal ligation are predictably the best in terms of reversal since they damage such a tiny segment of the fallopian tube.

In contrast to the Pomeroy method, these occlusive devices are applied through a laparoscope. (Laparoscopy involves making a small incision below the belly button.) Many doctors prefer to apply tubal rings or clips when performing a tubal ligation on young women in recognition of the greater likelihood that a tubal reversal may be wanted in the future. Studies have shown that tubal ligation regret and the desire for tubal ligation reversal is more common when a tubal sterilization is performed among women in the twenties than among older women.

Tubal Clip and Ring Reversal Success

Each year Chapel Hill Tubal Reversal Center publishes current 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 rings or clips shown in the table below is 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 clips or rings is 76% for patients at Chapel Hill Tubal Reversal Center. In the table below, the first column shows ages groups. The second column shows the number of women in each age group who had a tubal reversal. The third column shows the number of women in that group who became pregnant and the last column shows the percentage of women who became pregnant (the pregnancy rate) after their reversal procedures.

Pregnancy Rates After Tubal Reversal of Clips/Rings

Highest Pregnancy Rates After Tubal Reversal

The highest tubal reversal pregnancy rates are seen among women who have reversal of tubal clips or tubal rings. For women in their twenties, the pregnancy rate was 87%. The pregnancy rate ranged from 83% to 73% for women in their thirties. Among women age 40 or older, the pregnancy rate was significantly lower (47%), reflecting the decline in natural fertility with age. These pregnancy rates among our tubal reversal patients are similar to the pregnancy rates for women who have never had a tubal ligation to begin with.

Pomeroy Technique of Tubal Ligation and Resection

The most common type of tubal ligation is the Pomeroy procedure, named after Dr. Ralph Pomeroy who described it in 1930. The Pomeroy method involves picking up a segment of the fallopian tube to create a knuckle, placing a tie or ligature with absorbable suture around its base, and then cutting off the knuckle of tube above the tie. As the suture dissolves, the 2 remaining tubal segments separate from each other.

“Modified” Pomeroy Techniques

Interestingly, Dr. Pomeroy did not publish his technique in the medical literature but simply demonstrated it to other doctors. Some of them subsequently published the technique, but with modifications.

Currently, many doctors use the term modified Pomeroy procedure when they describe the tubal ligation they have performed in a patient’s operative report. Each doctor seems to have his or her own way of operating and there are many variations from the original method. Some doctors use absorbable suture, while others use permanent sutures that do not dissolve. Some doctors place more than one tie around the tube and many doctors also burn or cauterize the tubal ends.

A tubal ligation operative report is useful as a guide but does not predict exactly what the remaining tubal segments will be at the time of a reversal procedure. Fortunately, Pomeroy tubal ligation and its modifications are usually excellent in terms of reversibility.

Pomeroy Tubal Ligation Reversal Success

At Chapel Hill Tubal Reversal Center, we keep a record of all patients’ tubal reversal operations, including the tubal ligation method, the remaining tubal segment lengths, and other important findings at the time of surgery. Since we maintain long term follow-up with our patients, we are able to provide accurate statistics about pregnancies and their outcomes after tubal reversal surgery. Here are some of the pregnancy statistics for women who have had a Pomeroy type of tubal ligation.

Pregnancy Rates of Our Tubal Reversal Patients

The overall pregnancy rate after Pomeroy tubal ligation reversal is 70% for patients at Chapel Hill Tubal Reversal Center. The table below shows pregnancy rates according to women’s ages at the time of tubal reversal. The first column shows ages by 5 year groupings. The second column shows the number of women in each age group who had a tubal reversal. The third and fourth columns show the number and the percentage of women who became pregnant after their reversal procedure. The data shown in this table come from our Tubal Reversal Pregnancy Study Report 2007.

Here is how the pregnancy rate is calculated: The number of pregnant women (column 3) divided by all women in that age category who had reversal surgery (column 2) times 100 equals the percentage of women who became pregnant (column 4). A doctor has to know all of this information in order to be able to state what the success rate is for his patients.

Pregnancy Rate By Age After Pomeroy Tubal Reversal

Good News About Pomeroy Reversal

The good news is that for women under age 40, two-thirds to four-fifths will become pregnant following a tubal reversal procedure. Even for women age 40 and over, approximately 4 out of 10 will conceive another pregnancy. From the follow-up data that we have for our tubal reversal patients, there is good reason for optimism when reversing a Pomeroy tubal ligation.