Tubal Ligation Reversal

Introduction

We at Tepeyac Family Center seek to provide the opportunity, with the aid of the Divine Physician, to help heal persons in body, soul and spirit. We feel compelled to offer women the option of tubal ligation reversal because we operate with the greater goal of aiming to help make families whole again.

Deciding to undergo tubal ligation reversal surgery entails more than a physical reversal of the reproductive system; the surgery symbolizes the couple’s spiritual reversal of faith in changing their orientation to acceptance of new life.

We have revived this art (which has been obscured in recent years by the popular explosion of IVF) by partnering with a local fertility specialist.

Tubal ligation reversal is the repair of tied or blocked fallopian tubes that previously underwent tubal ligation. The procedure is performed to restore fertility.  There are several types of tubal ligation procedures and the type of procedure affects the ability and risk of undergoing the reversal surgery.

Tubal ligation reversal provides to women who have had their tubes tied the possibility to conceive children again. The procedure offers hope to those individuals who wish to re-open themselves to life for whatever reason, be it a change in heart or life circumstances.

Who is a Candidate for Tubal Ligation Reversal?

Women who underwent a bilateral tubal ligation within the last five years (and now want it reversed) are possible candidates. The reversal procedure is surgical, and as such, carries the usual risks of surgery and anesthesia. It is also expensive, and very few insurance policies cover the cost. There is a recuperation period which lasts usually four to six weeks. The decision to undergo tubal ligation reversal should be based on several factors which include the desire for children, the individual woman’s overall health, the risks undertaken with the procedure, and the likelihood of success. Couples should arrive at this very important decision only after an extensive period of discernment.

There is no need to undergo surgery to obtain God's forgiveness, but rather Christ's spiritual healing is always available through genuine contrition and a true repentance. If you are Catholic, you can find forgiveness in the Sacrament of Penance. Tepeyac Family Center encourages individuals who are in the process of discerning tubal ligation reversal also to consider visiting with a Catholic priest for further counseling with the decision.

Tepeyac Family Center understands the process for reversing tubal ligation is very personal and can be very emotional. In addition to surgery, some couples choose to abstain from relations during the fertile time of the woman's cycle as they practice NFP. Some make it their mission to spread the Bible's teachings on these issues so that others will not choose to undergo tubal ligation. Such behaviors become physical reminders to the couple that they are now accepting Christ's Truth with regard to family life.

What Factors Determine the Likelihood of Success?

The success of tubal ligation reversal surgery depends on many factors which include a woman's age, the amount of time since her procedure was done, the type of surgery performed, whether or not cautery was used, and the length of the remaining tubes. (Cautery is the burning or scarring of tissue with very hot or cold instruments). The best way to determine these things is to obtain your operative report. At Tepeyac Family Center we have "Release of Medical Records" forms, or you can download one from our website's Patient Forms section. In some cases, it may be helpful to obtain a hysterosalpingogram, which is a tubal dye X-ray study to determine proximal tubal lengths. Sometimes couples undergo a semen analysis, which is obtained in conjunction with normal relations during which the husband wears a condom with a hole in it, which leaves their act of relations open to life. Each case is unique, just as is each woman. Throughout the evaluation and surgery, we respect the dignity of each human life.

What is Tubal Ligation?

Tubal ligation is the general term used to describe any surgery that closes the tubes in order to prevent pregnancy. The term "tying tubes" conjures up a picture of tying the tubes much like tying the laces of a shoe. If this is the case, the question then becomes why can't they simply be untied? In order to answer that question, it is necessary to learn what actually happens in the procedure known as tubal ligation.

Types of Tubal Ligations

1. Pomeroy Technique:
This is the most common procedure used to ligate and remove a portion of the tube. It was first described over 100 years ago by Dr. Ralph Pomeroy. It is often performed after a baby is delivered, either by cesarean section or vaginally. First a knuckle of tube is tied with an absorbable suture.

Next the tubal section in the knuckle is cut and removed. Within a few days, the peritoneum, a cellophane-like tissue that lines the organs of the abdominal and pelvic cavities, grows over the cut ends of the fallopian tubes. As the suture dissolves, the cut ends of the fallopian tubes separate. The peritoneal covering and the separation of the segments prevents them from re-attaching to each other. Usually there is no cautery used in this procedure.

2. Tubal Ligation with Falope Ring:
The Falope ring is a small silastic band placed around a knuckle of tube in much the same way as was the suture in the Pomeroy technique. As the ring contracts due to its elasticity, it constricts the tube which is caught in the ring, and blocks the tube. Deprived of its blood supply, the tubal segments separate in a similar fashion to that in the Pomeroy technique. This procedure is performed laparoscopically, and it involves no cautery.

3. Tubal Ligation with Hulka Clip:
The Hulka clip is a metal, spring loaded clip used to mechanically obstruct the tube. The procedure involves placing the Hulka clip around the isthmic segment of the tube. Since the clip is only 7 mm wide, it causes the least amount of tubal damage of all the techniques. This procedure is performed palaroscopically, and it involves no cautery.

4. Bipolar Tubal Ligation:
Bipolar tubal ligation is the most popular form of laparoscopic sterilization performed on women. In this method, the isthmic segment of the tube is grasped between two poles of electrical conduction forceps. Electrical current is then passed through the tube between the two poles of the forceps. Unfortunately, this procedure results in thermal damage beyond the width of the forceps itself. Therefore, we do not attempt to reverse sterilizations performed in this manner.

Microsurgical Tubal Ligation Reversal:

Also known as tubal anastomosis, this is a procedure that is performed with the aid of a microscope using sutures too thin to see with the naked eye. This technique varies little whether coagulation, clip, rin, or Pomeroy technique was used for the sterilization.

A diagnostic laparoscopy is first performed to ascertain if the anatomy is appropriate to proceed. This procedure involves placing a small scope through the umbilicus into the abdominal cavity and inspecting the reproductive organs. Particularly of interest is the presence of adhesions, and tubal length. Best results are obtained when the repaired length is at least 5 cm. The scope is then removed. If the conditions are favorable, then a very small incision, also called a "bikini cut," is made horizontally, just above the pubic bone. In an effort to minimize post-op discomfort, access is gained to the reproductive organs without the use of retractors, and local anesthetics are used liberally. The uterus and tubes are then gently elevated out of the pelvis, and the repair begins.

You will then recover in the office briefly. Most patients return home within 2 hours, and may resume normal activity within several weeks. Couples may leave themselves open to achieve a pregnancy soon afterwards.

Pregnancy After Tubal Ligation Reversal:

We ask that as soon as you become pregnant, please contact us. We like to follow you closely, given the fact that approximately 10% of pregnancies after tubal ligation reversal are ectopic, or located in the tube. We follow beta HCG levels, and when it is appropriate, perform a vaginal ultrasound to confirm an intrauterine pregnancy. We very much enjoy caring for our patients throughout pregnancy and delivery. However, if the pregnancy is ectopic, then definitive treatment is undertaken. Either way, we continue to care for you after your tubal reversal.

Cost & Inquiries:

Please email Tepeyac Family Center, info@tepeyacfamilycenter, for the latest cost information.
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