Tubal ligation is the most commonly used method of contraception for women over age 30. It is also known as “permanent sterilization.” In women the procedure is called tubal ligation and in men it is called vasectomy. These procedures are known in lay terms as “tying your tubes.” Couples choose to undergo one of these procedures when they no longer desire fertility, yet want to avoid the need for contraception methods which must be used continuously or at least vigilantly. In women the procedure involves obstructing the mid-portion of the fallopian tube, which is the duct through which the egg must travel to reach the uterus. Once the tube is obstructed, the sperm cannot reach the egg to fertilize it. Various methods have been used to ligate, “tie-off,” tubes. These include elastic bands, small metal clips, suture, and electrocautery. The sterilization procedure may be performed at the time of cesarean section, within two days of a vaginal delivery, or beyond 6 weeks after delivery. Unless the tubal ligation is done at the time of a cesarean section, it requires a small incision in or near the lower part of the navel.
In men the sterilization procedure is performed by making a small incision in the upper part of the scrotum and tying off the vas deferens, which is the duct that transports the sperm from the testicle.
Unfortunately many people who have undergone such a sterilization procedure later regret it. One published survey found that half of all women who had their tubal ligation performed prior to the age of 30 later wished that they could have more children again. Ten percent of men desire reversal of their vasectomy. Life’s situations change. Sometimes after divorce or the death of a spouse, a person decides to remarry. It is common to want to share a genetic child with the new partner, especially when the new partner has no children of his or her own. In other situations it’s not a new marriage that causes the regret. Rather, the same husband and wife may decide they would like to have more children either due to a tragic loss of a child or because their financial situation has improved.
Fortunately there is hope for most of these couples. The two most popular solutions to this dilemma are sterilization reversal surgery and in-vitro fertilization (IVF). Each of these two options has its advantages and disadvantages. It’s up to the individual couple to decide which option best fits their lifestyle once they understand the medical pros and cons.
Sterilization reversal surgery for the woman is highly successful if a sufficient length of tube remains on both ends of the ligation. Often the operative report from the tubal ligation procedure is useful in identifying candidates who do not have a good chance for successful reversal. Even with a reassuring operative report approximately 10% of cases for tubal reversal surgery cannot be performed due to unexpected findings in the pelvis at the time of the intended reversal surgery. These findings include scarring of the fimbriated end of the tubes or absence of the fimbria. The fimbria are the tiny finger-like structures that sweep the egg into the tube from the ovary. Traditionally this surgery has been performed through a 4 inch “bikini-cut” incision requiring overnight hospital stay and avoidance of work for 4 weeks.
I perform all tubal reversal surgeries by the minimally invasive laparoscopic technique with just 4 small “key hole” incisions, each a quarter-inch. Patients go home the same day and return to work in a week or less. I have been doing tubal reversal regularly since 1997 and completed a course on Advanced Laparoscopic Surgical Skills for Tubal Anastomosis at the MOET Institute. Very fine suture material is used to reconnect the tubes. Typically 4 or more sutures are used depending on the diameter of the tube.
Usually the chance for a successful pregnancy within one year of the surgery is 70% for women under the age of 40. Women between the ages of 40 and 44 have a pregnancy rate that is half of that. An advantage of tubal reversal over IVF is that if you successfully conceive a pregnancy you can usually go on to have even more pregnancies if you desire. Of course this could also be a disadvantage if you only want to have one more child and don’t want to have to worry about using contraception again. Another disadvantage is that there is a 10% incidence of tubal pregnancy following surgical reversal.
If your medical insurance doesn’t cover the tubal reversal procedure (and most don’t) the total cost to you is $6850 including anesthesia, etc.
There is a new hysteroscopic tubal sterilization procedure for women, approved in 2002, which is not reversible by surgery. It uses the Essure device. Women who change their minds after the Essure device has been placed can still conceive with in vitro fertilization.
Vasectomy reversal for the man has a reasonably good success rate. The doctors at our center do not perform this surgery, but we can refer you to a highly-trained urologist. The success rate declines steadily with increasing passage of time since the vasectomy.
Advances in medical science have indeed made it possible to have another child following a sterilization procedure. In our next article, we will discuss In-Vitro Fertilization.
For more information, please call South Jersey Fertility Center at (856) 596-2233 or visit www.sjfert.com.