RISKS OF
TUBAL REVERSAL SURGERY

Tubal Ligation Reversal

Main Risk

No surgical procedure or medical treatment is without risk. The main risk of tubal ligation reversal surgery is not surgery, but rather the increased risk of ectopic (tubal) pregnancy. An ectopic pregnancy is any pregnancy, which attempts to implant and grow at any location outside of the uterus. The most common location of an ectopic pregnancy is within the fallopian tube.

Any woman can have an ectopic pregnancy. The risk of ectopic pregnancy in the general population is less than 3%. The risk of ectopic pregnancy is increased after any condition that disturbs the normal function of the fallopian tube. Even when the fallopian tubes are perfectly repaired and open after reversal surgery the risk of ectopic pregnancy is increased.

The chance of ectopic pregnancy after tubal reversal is approximately 10%. If an ectopic pregnancy is not detected early then tubal rupture can occur if the pregnancy is allowed to grow within the tube without treatment.

More information Tubal reversal risks: An easy explanation

Our Recommendations After Reversal Surgery

We propose a several step management plan to monitor our patients for the increased risk of ectopic pregnancy.

1. We advise our patients to have close follow-up with their local physicians after reversal surgery and before pregnancy occurs.
2. We will help facilitate our patient’s appointment with their local physician by sending a letter with our recommendations and a copy of the operative report soon after surgery. We will also provide patients with the same information.
3. We ask patients to report pregnancies to our office as soon as they are detected.
4. We encourage patients to see their local doctor soon after they detect pregnancy in order to begin early pregnancy monitoring.
5. We recommend an early vaginal ultrasound as soon as the early pregnancy monitoring suggests a pregnancy should be visualized.
6. If early monitoring diagnoses an ectopic pregnancy then we recommend medical treatment with Methotrexate medication, which can minimize the risk associated with ectopic pregnancy.

Early Pregnancy Monitoring

Decreasing Risk of Ectopic Pregnancy

The best way to determine the location of an early pregnancy is with blood testing for the pregnancy hormone (quantitative serum HCG). Using this testing the location and health of an early pregnancy can often be determined before a pregnancy is seen during an ultrasound exam.

We recommend monitoring your early pregnancy with quantitative serum HCG blood tests every 48 hours and having a vaginal ultrasound exam when your HCG (pregnancy hormone) level reaches 2000. This testing should be started soon after you first detect pregnancy and can be stopped as soon as the location of the pregnancy is determined.

When the pregnancy hormone level reaches 2000, a vaginal ultrasound exam will show a gestational sac (early pregnancy) within the uterus in a normally developing intrauterine pregnancy.

If your ultrasound exam does not reveal a pregnancy inside your uterus, you should have a repeat HCG level and have another vaginal ultrasound exam within 2 or 3 days. Sometimes the early pregnancy may not be seen until HCG level is about 2500 depending upon the quality of the equipment and experience of the person performing your ultrasound examination.

If the early pregnancy is not seen inside the uterus when the HCG level is above 2000, then the pregnancy is abnormal and likely to be either a tubal pregnancy or a pregnancy that will eventually miscarry.

Because the risk of tubal pregnancy is approximately 10-15% after tubal surgery, it is important to notify your obstetrician-gynecologist and follow the Early Pregnancy Monitoring protocol to determine the location and health of the early pregnancy.

A tubal pregnancy cannot lead to a live birth and must be treated. Following the recommended Early Pregnancy Monitoring Protocol is the best way to minimize the risk of tubal rupture, preserve the health of your fallopian tubes, and avoid surgery to remove the tubal pregnancy.

Reason for Early Pregnancy Monitoring

The rationale for early pregnancy monitoring is to prevent a tubal pregnancy from progressing to the point of rupturing the fallopian tube. Rupture of the fallopian tube results in internal bleeding and requires emergency surgery, often resulting in loss of the fallopian tube. In the absence of ultrasound evidence of an intrauterine pregnancy, early treatment with Methotrexate is recommended to end the tubal pregnancy pregnancy. After Methotrexate administration, serum HCG levels should be monitored until the HCG level returns to less than 10 mIU/dL.

Early Pregnancy Monitoring: Key Concepts

The key concepts to understanding HCG pregnancy hormone testing and ultrasound exams are:

• In a normal pregnancy the HCG levels should double every 48 hours
• In a normal pregnancy the pregnancy should clearly be seen inside the uterus when the HCG level is above 2000
• If the HCG levels are not doubling or the pregnancy is not seen inside the uterus when the HCG levels are above 2000 then the pregnancy is abnormal, possibly in the fallopian tube, and will not lead to a live birth