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Fallopian Tube Reversal And Infertility: Correct Time To Reach Out To A Fertility Expert?

Fallopian Tube Reversal And Infertility: Correct Time To Reach Out To A Fertility Expert?
Tubal ligation reversal surgery is performed to undo a tubal ligation.

Fallopian tubes can be blocked due to some underlying disease process or they can be ligated as a family planning procedure. All you need to know about tubal ligation reversal surgery.

Written by Editorial Team |Updated : March 23, 2023 1:31 PM IST

Fallopian tubes are the components of the female reproductive system that connect the ovaries and the uterus. The fallopian tube acts as a pathway for the eggs to travel towards the sperms after they are released from the ovary at the time of ovulation, roughly in the middle of the menstrual cycle. They are also the site where the eggs and sperms fuse to form the embryo.

When a fallopian tube becomes blocked, it restricts the sperm from reaching the eggs, as well as blocks the passage of the already fertilized egg to the uterus. Tubes can be blocked due to some underlying disease process or they can be ligated as a family planning procedure. According to several studies, a tubal ligation as a contraceptive method has been performed on one out of every five women over the age of 25 years. Tubal Ligation Reversal (Tubal Reanastomosis) involves re-joining previously cut/blocked and tied fallopian tubes using laparoscopic surgery.

What is tubal ligation reversal?

Tubal ligation reversal surgery is performed to undo a tubal ligation. A tubal ligation reversal reconnects or reopens your tubes, allowing eggs and sperm to unite and conceive. It is a treatment to restore your fertility for couples wanting to consider parenthood later in life. Tubal reversal is also referred to as tubal reversal and tubal sterilization reversal. The success rate for conceiving after tubal reversal is around 70 per cent for women under the age of 35 and around 30per cent for women in their early forties.

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The most recent tubal reversal surgery methods require only one day of surgery and seven days of bed rest afterwards. Patients are required to undergo a hysterosalpingogram (HSG) about 3 months after surgery to check the status of the tubes. A HSG is a diagnostic test that uses x-ray technology to show the flow of dye through the uterus and Fallopian tubes. It determines whether there are any remaining blockages in the tubes that could prevent pregnancy.

Factors to consider before undertaking this procedure

Age: The ideal age for women undertaking fallopian tube reversal and infertility treatment should be under 40 years. For women under the age of 35, fallopian tube reversal is considered as the best treatment approach whereas, for women above 40 years of age, IVF followed by embryo transfer is recommended.

BMI and other reproductive conditions: This procedure is best suited for people with a BMI of 32 or less. Other factors such as Irregular periods, uterine fibroids, pelvic scarring, endometriosis, and fibroids may influence the decision to proceed with this treatment.

Male Partner's fertility: A sperm analysis for the male partner is an important step in determining whether to use IVF or tubal reversal surgery. If the sperm quality is good then the couple are advised to go ahead with this procedure. However, if the sperm quality is poor, then IVF has a better scope for success.

Egg Quality: Some women experience a decrease in egg quantity or quality earlier in life than expected. As a result, the woman's "ovarian reserve" should be tested before deciding whether to proceed with tubal reversal. An ovarian antral follicle count, ovarian volume, and day 2 AMH levels are the common tests to assess ovarian reserve.

Medical history: A detailed analysis of the medical history including your previous pregnancies, tubal ligation surgery, and any other pelvic surgeries is required before moving forward with Fallopian Tube Reversal. Based on medical history and test results, the fertility specialist may order blood tests and other necessary imaging procedures.

What types of tubal ligation can't be reversed?

Two factors determine whether or not tubal reversal surgery can be performed successfully. One is sufficient healthy tissue on each end of the tube to reconnect it and the other is that ability of the reconnected tube to function properly. Thus, assessment of the tubes at the time of surgery is essential.

The fallopian tube must be at least 4 inches long for a woman to be eligible for a successful pregnancy after the reversal procedure. Furthermore, for the best results, the remaining ends of the tubes after ligation should be of equal dimension.

The fimbria are delicate, fluffy structures at the tube's end that pick up the egg when it is released from the ovary during ovulation. If the fimbriated end of the tube is damaged or removed, the chances of reversal are slim. Moreover, Some women undergo tubal reversal surgery with extremely short tubes. As a result, the chances of a subsequent pregnancy are slim.

At times, even when the tubes are successfully reattached, scarring of the tissue can occur, interfering with the flow of the tube. Unfortunately, not all patients have tubes that can be rejoined. Patients whose fimbriae (fallopian tube ends) were removed during ligation are ineligible for the reversal.

The article is contributed by Dr Aneesha Grover, Infertility Specialist in Gurugram, Nova IVF Fertility.

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