Who is a good candidate for a tubal reversal surgery?
A tubal reversal (tubal reanastamosis) is an excellent way for women who have previously had a tubal ligation, to regain their fertility. The procedure is quick, safe and when performed by the right surgeon, highly successful. Unfortunately, not everyone is a good candidate for this procedure. Depending on a patient’s age, medical/ surgical history, body mass index, plus a host of other factors, she may be better suited for alternative treatments. This blog post will explore the characteristics that make for a good tubal reversal candidate.
At our Los Angeles based fertility practice, the Center for Fertility and Gynecology, we take pride in the fact that we offer both surgical fertility treatments like tubal surgery as well as assisted reproductive techniques like in vitro fertilization. Because we offer both options, patients know they are getting an unbiased opinion as to their best fertility treatment option.
Potential tubal reversal patients should bear the following factors in mind to help decide if tubal reversal is for them.
Age is the single most important factor for the success of any fertility treatment. As we get older, our ability to get pregnant diminishes. When considering tubal reversal, women 40 years of age and greater should also consider IVF. The benefit of IVF in this setting is the chance to optimize fertility faster than one could with surgery. On the other hand, a successful tubal reversal provides a chance to become pregnant each month as opposed to the single chance of IVF.
Ovarian Reserve (FSH, AMH, antral follicle count);
The reason that fertility diminishes with increasing age is that the ovarian reserve diminishes as we age. Importantly, there are even some younger women who have diminished ovarian reserve. When considering a tubal reanastamosis, ovarian reserve should be measured through hormone testing and/ or ultrasound even in women under 40 years of age. If the ovarian reserve is low, IVF may be a better option.
Type of tubal ligation;
Most standard tubal ligations can be successfully repaired. This includes sterilizations performed with Filshie clips, Fallope rings, the Pomeroy method and tubal fulgurations. Sterilization procedures that include fimbriectomy (removal of the end of the tube), fulguration of more than 3 cm of tube, or a Hysteroscopic approach (endometrial ablation or Essure) are less likely to be successfully repaired. Further, patients who do not know which type of sterilization they had, or those without access to their operative reports are at slightly higher risk for having an unsuccessful procedure.
Medical/ Surgical history;
Women with extensive scarring inside their abdomen are poorer candidates for tubal reanastamosis surgery. Scaring can distort pelvic anatomy and make it impossible to re-attach the tubes. Scarring can come from multiple abdominal surgeries like C-sections, appendectomy, or ectopic pregnancies. Further, women with prior pelvic infections from gonorrhea, chlamydia or PID as well as those with endometriosis are also at risk for extensive pelvic scarring.
Body mass index is a method of measuring a person’s weight relative to their height. As the BMI increases, the surgery becomes more technically difficult. Ideally, a candidate’s BMI is 25 or lower. 25-30 is still acceptable, but once the BMI becomes greater than 30, cases are considered on an individual basis.
In addition to the above, a host of other factors are important when considering tubal reversal. To find out more information about tubal reversal, and if you are a good candidate for the procedure, contact us, we would be happy to speak with you.