What is Reverse Tubal Ligation?

Reverse tubal ligation - or more properly, tubal ligation reversal - is a procedure to get tubes untied for women who desire a pregnancy after tubal ligation. There are actually several procedures that can be used to untie tubes after the tubes have been tied.

Techniques of Reverse Tubal Ligation

There are 3 main techniques that can be used for reversing tubal ligation.

1. Tubal anastomosis
2. Tubal implantation
3. Salpingostomy (Fimbriectomy Reversal)

Tubal Anastomosis

Tubal Anastomosis

The most common method for untying tubes is the reverse tubal ligation procedure of tubal anastomosis. Anastomosis refers to joining two body parts, and tubotubal anastomosis is joining two tubal segments together. Most techniques that tie tubes result in two separate tubal segments, so the simplest way to get tubes untied in these cases is with the anastomosis procedure. 

For more details about untying tubes via tubal anastomosis, see the topic on Tubal Reversal by Tubal Anastomosis on the Tubal Reversal Blog and the description of Microsurgical Tubal Anastomosis on the Chapel Hill Tubal Reversal Center website.

What is the Cost of Untying Tubes?

Reverse tubal ligation is usually described as extremely expensive, ranging from $10,000 to $30,000. The tubal anastomosis procedure to untie tubes costs $5900 at Chapel Hill Tubal Reversal Center. Because it is done as outpatient surgery and performed four times a day, the cost savings is passed on to the women who want kids after tubal ligation.

Watch Dr. Berger Untie Tubes

The tubal reversal operation by Dr. Berger has been featured on television - this video clip on YouTube is 3 minutes long. To watch the entire operation, you can order a free video or DVD of tubes untied.

Other Methods to Untie Tubes

Tubal implantation and salpingostomy are less frequent techniques to untie the tubes after a tubal ligation. For descriptions of these techniques, see the topic on Tubal Reversal by Tubal Implantation and Tubal Reversal by Salpingostomy on the Tubal Reversal Blog or Read the section on Reversal Illustrations on the Chapel Hill Tubal Reversal Center website.

Tubal Anastomosis at the Uterine Cornua

Tubouterine anastomosis is a tubal reversal procedure that is intermediate between tubotubal anastomosis and tubouterine implantation. It is also called cornual anastomosis because the tube is joined to the cornual area of the uterus with this operation. The cornu is the area where the fallopian tube normally emerges from the the uterus.

When Is Tubouterine Anastomosis Performed?

Tubouterine anastomosis is performed when there is a healthy tubal segment near the ovary, but no segment remains attached to the uterus, following a tubal ligation procedure. It is also performed when a tubal segment attached to the uterus is scarred and has no open lumen.

An incision is made into the uterus at the cornu to find the opening of the fallopian tube tube as it passes through the uterine muscle. If an opening is found, the tubal segment that remains is rejoined to the uterus at this site.

Case Histories

The topic of tubouterine anastomosis is a timely one. During the past week, 2 patients undergoing tubal reversal surgery at Chapel Hill Tubal Reversal Center required this operative procedure. In one case, each fallopian tube had been coagulated or burned next to the uterine cornu, leaving no segment attached to the uterus. The other patient had developed the condition known as salpingitis isthmica nodosa in the portion of the fallopian tube between the uterus and the a Falope ring. In both cases, tubal reversal was able to performed with the technique of tubouterine anastomosis.

Dr. Berger’s Comment

Frequently, patients have been informed by doctors who are not specialists in tubal ligation reversal that their fallopian tubes cannot be repaired after a tubal ligation. This is especially true when the proximal segments of the fallopian tubes are missing or diseased. But there are a variety of surgical techniques that can be used during tubal reversal surgery by a doctor who is an experienced tubal reversal surgeon. This is one of the advantages patients have when they come to Chapel Hill Tubal Reversal Center for their tubal reversal procedures.

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

About Me

Sometimes patients ask about my background and why I became a tubal reversal doctor. (It’s a fair question, since I ask them what made them decide to have a tubal reversal.) I usually tell them about my first year after medical school when I was an intern in medicine at Duke University Hospital taking care of critically ill and dying patients. That is when I decided to devote my medical career to assisting with the beginning of life rather than its ending.

Influential Teachers

The first tubal surgery that I assisted in was during my first year of residency in obstetrics and gynecology at Johns Hopkins Hospital in 1970. At the University of North Carolina where I completed my residency, Dr. Jaroslav Hulka (the inventor of the Hulka clip) taught me the basic principles of tubal reversal surgery. In 1976, I went to Europe to learn tubal microsurgery from Dr. Robert Winston. Dr. Winston’s microsurgical method was an advancement but also a major operation of several hours duration resulting in hospitalization for 5 days or more.

My goal was to make tubal reversal easier to undergo and less costly for the patient. This was accomplished by combining the best principles of gyn surgery, microsurgery, and plastic surgery techniques. I had the great fortune of operating for many years with the renowned plastic surgeon, Dr. Erle Peacock, author of the surgical text entitled “Wound Healing”.

Outpatient Tubal Reversal

By the mid-1980s, I developed the outpatient surgical approach to tubal ligation reversal that I use - and continue to improve upon - to this day. What was a major and expensive in-hospital operation with prolonged recovery became a comfortable outpatient procedure that is affordable for most couples. It is the most gentle operation that exists for restoring tubal anatomy and has resulted in the birth of more babies in the world than any other tubal reconstructive operation.

Anyone who is interested in seeing how I perform outpatient tubal ligation reversal can watch the entire operation that was recorded on video and shown on Discovery and TLC. In this video, each step of the procedure is described as it is performed.

My Viewpoint

I have been fortunate to have had the best teachers in the world in the art of surgical technique as it applies to the fallopian tube. Specializing in tubal reversal surgery over the past 30 years has allowed me to assist more than 6000 couples in the beginning of life with the safest, most comfortable, and most successful tubal reversal operation.