Bilateral Tubal Anastomosis
Otherwise known as a BTA or bilateral tubal ligation.
Tubal ligation is a generic term used to refer to several different types of procedures to interrupt the fallopian tubes in order to prevent pregnancy. In the true sense of the word, a ligation is a procedure in which the tubes were tied with suture. The various types of tubal interruption procedures are described below.
This is a procedure performed just after delivery or during a cesarean section. During this procedure, the surgeon takes a portion of the fallopian tube out after securing the blood vessels with suture. There are several techniques for this type of tubal ligation. The names of these techniques include a modified Pomroy and a Parkland. Less common techniques include an Irving, or a Uchida tubal ligation. The exact differences are more of technical interest and don’t make much difference except in the case of the less commonly performed procedures.
This type of procedure is performed laparoscopically in most cases. An electromagnetic current is used to “burn” the fallopian tubes. When the tube heals, there is a gap in the middle portion of the fallopian tube. Some surgeons will cut the burned segment to verify the tube is completely burned. There is debate over the necessity of this extra cutting step. Often-times, patients are told their tubes were cauterized. Cautery is not an accurate description in this setting but it is fair to say the result – burning of the tubes – is essentially the same. Some patients are also told their tubes were “cut, tied, and burned”. The duration of “burning ” and the amount of tube that was destroyed is the most important factor when considering tubal reversal surgery.
This procedure involves the placement of stretchable bands around the mid-portion of the fallopian tube. The tube is constricted by the bands and dies. Simply removing the bands will not restore the tube to normal function. This procedure tends to destroy less of the fallopian tubes and lends itself to an easier reversal procedure in most cases.
The most common type of clips used are Hulka clips. These are clamp-type devices that are compressed on the fallopian tube. In an effort to reduce the chance of failure, many surgeons will place multiple clips on the tube. If applied properly, a single clip in the middle of the fallopian tube is adequate for contraception. Properly placed clips are also fairly easy to reverse in most cases.
This is a fairly new technique of inserting a Dacron containinig coid within the fallopian tube. Scar tissue usually invades into the coil and becomes densely attached to the Dacron. These coils can not easily be removed. Generally, a tubal reversal will not adequately correct the damage caused by an Essure. The portion of the coil protruding into the uterine cavity may cause a problem with a pregnancy conceived through In Vitro fertilization. There are instances where pregnancy has been possible using IVF.
Tubal Ligation Reversal
Will it work for me?
The success of the procedure depends on several factors. Among the most important factors are the amount of healthy tube remaining, location of the tubal damage, and age. Other factors, such as ovulation and sperm counts, should also be taken into consideration.
As women age, there is a sharp decline in fertility that starts to occur around age 36. Chances of pregnancy usually remain reasonable until women approach the age of 40. Direct comparison of tubal reversal success to IVF success is not accurate. Women seeking IVF for other reasons have experienced infertility and are known to have a decreased chance of getting pregnant. Women with tubal ligations have not gotten pregnant because of their surgical procedure. Most of these women are not infertile when the tubes are opened. With this information, it is fairly safe to assume that in women with a previous tubal ligation, the chances of pregnancy will be higher with IVF or tubal reversal than for women having IVF for infertility. To read more about advanced maternal age effects please click here.
The tubal fulguration procedure has the highest potential to destroy excessive lengths of fallopian tubes. If the damage is too near the fimbria (finger-like portion of the fallopian tube), the procedure can also damage the fimbria beyond the point of repair. If any of the tubal interruption procedures are performed without excessive damage to the tube, most all tubal ligations can be reversed. Excessive scar tissue around the site of the procedure can also cause problems with fertility and the potential to adequately repair the tube. In most cases, the scar tissue can be removed. If too much of the fallopian tube is removed or destroyed, the repaired tube can be too short to facilitate a pregnancy. This is because the embryo reaches the uterus too early in its development. While pregnancy may be reduced in this setting, it can still occur.
Before a woman has tubal reversal surgery her male partner should have a semen analysis. Low sperm counts can prevent a pregnancy from occurring. In the setting of a low count and no obvious cause that can be corrected, the couple should consider In Vitro Fertilization (IVF) with intracytoplasmic sperm injection (ICSI) as an alternative to a tubal reversal.
For a pregnancy to take place, a woman will need to produce eggs. If a woman is beyond the age of 42, the likelihood of producing good quality eggs is very low. Women who have irregular menstrual cycles may have insulin resistance or polycystic ovarian syndrome (PCOS). This can be corrected but may affect your chances of getting pregnant. Your doctor will want to address these issues with you before proceeding with pregnancy.
Your overall health and obstetrical history are important to consider before proceeding with a tubal reversal. Factors such as uterine fibroids or a history of previous preterm delivery may have a significant impact on your ability to successfully carry a pregnancy to term. You will need a complete medical history evaluation prior to having a tubal reversal so that any issues that are found can be discussed.
The success of the surgery will depend on the tubes remaining open. Surgeons experienced in tubal reversal surgeries will generally have very high rates of tubal patency (tubes remaining open). Scar tissue formation at the site of the tubal reversal can be minimized but not completely prevented. Outside of the situations presented above, pregnancy chances can approach 80-90%. Among women not getting pregnant, it is not uncommon to find that the fallopian tubes are still open. These women may have another cause for their infertility and an appropriate investigation should be conducted.
Tubal Reversal vs. In Vitro Fertilization
There are many factors to consider when comparing a tubal reversal versus In Vitro Fertilization (IVF). Directly comparing pregnancy rates from tubal reversals and IVF is not a fair comparison. Women seeking IVF are often infertile from one of many possible causes. Women seeking a tubal reversal are usually not infertile. They haven’t been able to get pregnant due to their blocked fallopian tubes. However, it is reasonable to consider both procedures as a way to get pregnant. Several factors will need to be considered when making a final choice. A woman’s age, her partner’s semen analysis, and cost are all important factors. The factors that can affect the success of tubal reversal procedures should be reviewed carefully. Both options should be available to you and your doctor should assist you in making an informed choice.
Low Semen Analysis
Tubal Reversal Surgery
Roughly $8500 with our competitive package pricing.
Complex procedure with longer recovery.
80% or more over 1-2 years (if all tests and circumstances are within normal standards)
Needed after pregnancy.
May decrease pregnancy rates.
Affects pregnancy rates. May cause a delay of critical time if close to age 40.
Surgery is considered to be more difficult and with higher risks of wound infections. Weight may interfere with ovulation and pregnancy success.
In Vitro Fertilization
Can range from 13,500+
Simple Procedure to collect eggs. Requires 2-3 weeks of medications.
50+% per try for women with tubal factor infertility. May have frozen embryos for later use.
Tubes are still blocked
IVF with ICSI can overcome low sperm counts.
Affects pregnancy rates. Increasing egg numbers may cause pregnancy sooner. Allows for genetic testing of embryos with PGD.
Multiple clinic visits.
Weight less of a factor and ovulation usually controlled with medications.
- Dr. Zeringue has years of experience with helping patients achieve lasting weight loss with diet modifications. Patients seeking either procedure will be advised accordingly. This advice is provided as a part of your initial consultation.
Personal preference is often a very important factor in deciding which procedure is right for you. It is wise to keep an open mind about both procedures before meeting with your doctor. Dr. Zeringue will discuss both procedures with you. The discussion will cover the different advantages of both procedures. Having the option to choose which procedure meets your personal desires as well as maximize your chances of getting pregnant is very important. Your questions are always welcome.