Tubal Reversal Blog ‘tubal segments’

Preparation for tubal ligation reversal surgery is the same for all patients regardless of age.  Any person considering  ‘untying tied tubes‘ should read this article to understand how to arrange and schedule a tubal ligation reversal.

This is the sixth article in a series dedicated to women considering alternatives for pregnancy and tubal ligation reversal after the age of 40.

The previous article describes the risk of having a tubal reversal surgery and the first article of our series is  Tubal Ligation Reversal After the Age 40 | Introduction.
Read the rest of this article and comment on it. »

Patients often ask when they should have a hysterosalpingogram (HSG) to see if their fallopian tubes are open after tubal reversal surgery.

When to Have an HSG

Wait for at least 6 to 12 months after a tubal reversal procedure for this test of tubal patency. An HSG carries a risk of infection and often does not give conclusive results. It is best to give yourself a chance to become pregnant rather than rushing to have an HSG. Most patients conceive within this time frame and will avoid the need for an unnecessary and possibly misleading or harmful procedure.

Preparing for an HSG

To avoid unnecessary risks, an HSG should be performed only after menstruation is over and before ovulation occurs. Having an HSG after the time of ovulation may interfere with a pregnancy - before a pregnancy test can detect that conception has occurred. To minimize the risk of infection, use a betadine vaginal douche the evening before and the morning of the scheduled procedure and ask your doctor for a prophylactic antibiotic prescription. 600 mg of ibuprofen taken one hour before the HSG will minimize its discomfort.

What to Look For in an HSG

You can ask to watch the results on the fluoroscopy screen while the dye is being injected into the uterus.

At first, the dye will fill the uterine cavity. It is essential that the dye actually enter the fallopian tubes up to the point where the anastomosis was performed. Often, this does not occur due to spasm of the sphincter between the uterus and tubes (shown by the arrows) or from mucus or calcium deposits in the proximal tubal segments.

If the dye passes through the anastomosis sites, the fallopian tubes are open. Most radiologists do not consider the x-ray to show tubal patency (openness) unless dye spills into the abdominal cavity. When this happens, the diagnosis of tubal patency is conclusive.

We often see x-rays where dye has passed through the tubal  anastomosis site, but has not yet spilled into the abdominal cavity. This is due to an insufficient amount of dye being injected into the tubes. The radiologist may mistakenly believe the tube is blocked when in reality it is open.

Send Your X-Rays To Me

In order to be certain about whether an HSG demonstrates tubal patency, tubal occlusion, or is inconclusive, please instruct the radiologist to send the x-ray films to me to interpret. Having documented the anatomy and measurements of the fallopian tube segments during tubal reversal surgery, I can compare the x-ray findings with each patient’s operative report. This allows me to give the most accurate interpretation of HSG results.

Dr. Berger’s Comment

Hysterosalpingography is a widely available procedure to examine tubal anatomy. Unfortunately, it is often performed or interpreted inaccurately. An HSG also has risks as well as discomfort and cost. It is best to wait for at least 6-12 months after a tubal reversal procedure to have an HSG. Most patients will become pregnant after tubal reversal within a year and can avoid the problems associated with HSGs. Preparing properly for an HSG and sending the x-ray images to me will minimize the risks and errors associated with a hysterosalpingram.

Why Some Patients Choose To Have Screening Laparoscopy

Tubal ligation procedures vary in the severity of injury occurring to the fallopian tubes. Although most tubal ligations are reversible, there are some cases where tubal reversal is not possible. If the operative report from your tubal ligation indicates there may be a problem in repairing the remaining tubal segments, or if you cannot get a copy of your operative report, you may be interested in the screening laparoscopy option offered at Chapel Hill Tubal Reversal Center.

With this option, your surgery begins with diagnostic laparoscopy to examine your fallopian tubes. If tubal repair is possible, tubal reversal is performed immediately while you are under anesthesia. That way you do not have to undergo anesthesia and surgery on two separate occasions.

If tubal reversal is not possible, the operation is concluded with just the diagnostic laparoscopy. There is an additional charge of $1000 to add the screening laparoscopy, but with this option you will receive almost half of the total surgery fee in refund should tubal repair not be performed. The “laparoscopy package” is excellent insurance in situations when the method of tubal ligation is unknown.

Screening laparoscopy is available to patients with a Body Mass Index (BMI) under 30 who are interested in more assurance regarding the outcome of the reversal surgery. It is recommended – but not required – in cases where the amount of tube remaining is questionable, such as after monopolar tubal coagulation at multiple sites along the tube.

If you have questions about the laparoscopy option, you can discuss them with Dr. Berger and the Tubal Reversal nurses during your preoperative consultation.