TUBAL REVERSAL PREGNANCY STUDY:
A DECADE OF OBSERVATIONS
Outcomes After Tubal Reversal
Births, Miscarriages, & Ectopic Pregnancies By Age
Table 7 shows the relationship between the age of reversal patients and outcome of tubal reversal pregnancies after tubal ligation reversal at our facility. With increasing age, the percentage of pregnancies resulting in births declined due to an increasing percentage of miscarriages. Among women under age 35, over half of pregnancies resulted in birth or ongoing pregnancy, while one third miscarried and 13% were ectopic (suspected or documented). The birth percentage was lowest and the miscarriage percentage highest for women 40 and older.
Whether there is an increased risk of miscarriage associated with tubal reversal is unclear. The miscarriage rate reported in the general population ranges from approximately 20% to 50% depending on a woman’s age and how early pregnancy testing is performed.
Ectopic pregnancies were more frequent than in the general population of women who have not had a tubal ligation, which is approximately 3%. Ectopic pregnancy after tubal reversal surgery may be overestimated, since some early pregnancy losses were reported as ectopic pregnancies when serum HCG levels did not rise normally and the pregnancies were interrupted with Methotrexate treatment. In these cases, it is not known whether the pregnancy was in the uterus (“blighted ovum”) or outside the uterus (ectopic). These are sometimes referred to as pregnancies of unknown location.
Table 7. Pregnancy Outcomes by Age
|<30||1128||614 (54%)||368 (33%)||146 (13%)|
|30-34||2823||1473 (52%)||931 (33%)||419 (15%)|
|35-39||2262||1079 (48%)||848 (38%)||335 (15%)|
|40+||443||169 (38%)||216 (49%)||58 (13%)|
Pregnancy Outcomes By Tubal Ligation Method
Table 8 shows the relationship between the tubal ligation method and pregnancy outcomes. Tubal ligation reversal after tubal clips (Hulka clip, Filshie clip) has the best outcome of all tubal ligation methods, with the highest percentage of births (70%) and lowest percentage of miscarriages (25%) and ectopic pregnancies (6%). Reversal of tubal rings (Falope ring, Yoon ring) has the second best outcome, followed in order by ligation/resection and coagulation.
These findings are almost certainly due to the minimal damage to the fallopian tube caused by tubal (Hulka or Filshie) clips.
Table 8. Pregnancy Outcomes by Tubal Ligation Method
|Clip||660||459 (70%)||164 (25%)||37 (6%)|
|Ring||1070||601 (56%)||357 (33%)||112 (11%)|
|Ligation/resection||2616||1254 (48%)||949 (36%)||413 (16%)|
|Coagulation||1872||805 (43%)||733 (39%)||334 (18%)|
Pregnancy Outcomes By Fallopian Tube Lengths
Longer fallopian tube segments are associated with better pregnancy outcomes than shorter tubes (Table 9). Among women with average fallopian tube lengths measuring 7.5 cm or longer, 65% of cases gave birth or had an ongoing pregnancy by the end of the study period. The percentage of births decline as miscarriages and ectopic pregnancies become more common with shorter tubal lengths. As discussed previously, the tubal lengths that remain after tubal ligation indicate the amount of damage caused by the sterilization procedure. The greater the amount of normal fallopian tube remaining, the better the chance of it functioning normally after tubal reparative surgery.
Table 9. Pregnancy Outcomes by Tubal Lengths (cm)
|7.5+||684||447 (65%)||187 (27%)||50 (7%)|
|5.0-7.4||3621||1964 (54%)||1216 (34%)||441 (12%)|
|2.5-4.9||1932||771 (40%)||787 (41%)||374 (19%)|
|<2.5||97||24 (25%)||45 (46%)||28 (29%)|
The complete Tubal Reversal Pregnancy Study: A Decade of Observation can be viewed by using the following links: