Tubal Reversal Blog ‘tubal implantation’

A recent discussion on the Tubal Reversal Blog was about the Ethics of Tubal Ligation. This was regarding a patient who had been sterilized when she was 24 years old and had no children. She changed her mind in her thirties and came to Chapel Hill Tubal Reversal Center for a reverse sterilization procedure. Her fallopian tubes had been electrocoagulated extensively and the reversal operation was a difficult one to perform, requiring tubal implantation into the uterine cavity.

One of today’s patients is a 26 year old who had a tubal ligation at age 22 and had never had children. The doctor who performed her tubal ligation first applied Falope rings to the tubes, then proceeded to burn them in several locations. In her case, tubal reversal was not possible at all. During her operation, I wondered why any doctor would perform such a destructive type of tubal ligation for a young woman with no children. The Falope ring alone would have been sufficient to prevent pregnancy, yet allow reversal at a later time if she changed her mind about having children. Fortunately, she has the option of treatment by IVF. Still, why would a doctor perform an operation that essentially destroyed the tubes in such a young woman when there are a variety of other less destructive procedures for performing a tubal ligation? Is this ethical medical treatment?

I am very interested in what others think about this issue. Please leave your comments!!

More about Tubal Ligation Ethics

Submitted by Gary S. Berger, M.D.

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.