Q: What is a tubal ligation?
A: Tubal ligation is a commonly performed sterilization procedure. Also called "tying your tubes" or "getting your tubes tied". There are a variety of ways in which the procedure can be performed (clips or rings to occlude portion of the tubes, small segments of the fallopian tube is cut off or electrocautery). Sometimes a tubal ligation is performed at the same time as a cesarean section and is called a Pomeroy procedure. During this procedure, a small section of the tube is actually cut out and the ends are tied off with suture material. A less commonly performed procedure is a fimbriectomy. During this procedure, the ends of the tube are completely removed. Because the fimbria is an essential part of the tube, this procedure is irreversible.
Q: What is a tubal reversal?
A: Most tubal reversals are done using an open technique. This means making a 2-3 inch incision in the abdomen in a bikini-like fashion. The abdomen is opened and using a microscope the ends of the tubes are reconnected (tube-to-tube reanastomosis). The procedure normally takes 2 hours and after the procedure you will spend a couple of hours in the recovery room and will be sent home that day. In some less common cases, you may decide to spend the night in the hospital.
Q: Are tubal reversals covered by insurance?
A: You will need to verify with your particular insurance company, but 95% of the time it is not a covered procedure and you will have to pay the entire amount out of pocket. Tubal reversals can range from as little as $5,000 to as much at $8,000 depending on physician charges, facility charges and any additional tests (such as lab work or other tests).
Q: What are the steps for a tubal reversal?
A: You must obtain copies of all the post operative and pathology reports from the doctor who performed the tubal ligation and send them to prospective doctors who perform tubal reversals for review. Once you have chosen a doctor that you feel comfortable with, follow his/her advice. Sometimes the doctor will require the male to have a semen analysis before performing the tubal reversal. (This is to prevent the female from undergoing surgery if there is a problem with the male until the problem is corrected.)
Q: What kind of doctor do I look for?
A: You want a doctor who performs micro reproductive surgery. OB/GYN F.A.C.O.G or a Reproductive Endocrinologist.
Q: What tests should I expect to have prior to tubal reversal?
A: The basic tests performed include a pelvic exam, a check of basal body temperature (BBT) charts and the monitoring of some baseline hormone levels, such as prolactin and progesterone levels during the luteal phase. In addition, a postcoital test (PCT) or diagnostic laparoscopy may be performed. Some doctors may require a complete CBC and hormone panel to rule out menopause. Depending on the type of ligation you had, you may also have to undergo an HSG to determine if you have enough tube left.
Q: How long is the hospital stay?
A: This depends upon inpatient or outpatient surgery and your doctor. Most tubal reversals are performed outpatient and are home the same day.
Q: What is the recovery time for a tubal reversal?
A: This depends upon the patient's tolerance for pain and possibly unforeseen complications. Most women are fully recovered in 3-4 weeks. Your activity will be restricted for at least the first week.
Q: Does the procedure hurt?
A: Some women compare the pain to that of a c-section and some experience little or no pain at all.
Q: How big is the incision?
A: Generally 3-5 inches across the abdomen. If you have had a previous c-section, they will go in through the same incision.
Q: How will the incision be closed?
A: Normally staples, stitches, surgical glue, or an adhesive are used to close the incision.
Q: What can I expect the incision to look like?
A: The first time you look, it may be red or pink in color. It may even appear to be puffy. As long as it isn't bleeding and you don't have a fever, you should be fine.
Q: Is it normal for the incision to become numb?
A: It is very normal.
Q: What can I expect my cycles to be like after the tubal reversal?
A: Most women do not see a change in their cycles from pre-TR to post-TR. Some women experience shorter and lighter cycles and vice versa.
Q: When can I return to work?
A: Generally within one to two weeks when no heavy lifting is involved. Otherwise expect 4-6 weeks.
Q: When can we begin trying to conceive?
A: Some doctors say as soon as you feel like it and others say wait 4-6 weeks. Ask the opinion of your doctor.
Q: Is it okay to become pregnant the first or second month after the reversal?
A: Yes. There is no relation between miscarriages and tubal reversals. Most miscarriages in tubal reversal women is due to a hormonal deficiency.
Q:What is the normal length of the fallopian tubes before a tubal ligation?
A: 10-12 centimeters (some women may have longer or shorter tubes)
Q: What is the length of tube needed to conceive?
A: Most doctors say at least 4cm, but there have been successful full term pregnancies with less.
Q: What are the success rates of a tubal reversal?
A: Factors that can determine how successful a reversal can be include the length of the fallopian tubes after repair, patient age and method that was used for the ligation. There must be three to four centimeters of fallopian tube for pregnancy to occur. If the patient had no problems becoming pregnant prior to tubal ligation, and the reversal is successful, the patient should be able to conceive. At your consultation, the Dr will attempt to give you a better idea of what to expect regarding your chances of conception after your reversal.
Q: Will I need to do anything special after I get pregnant?
A: Yes. After a tubal reversal, the chance of ectopic pregnancy is higher so your Dr will want to know right away of any positive pregnancy test. They will then have you come in for blood tests to check your HCG levels every 2-3 days until your levels reach 1500 IU where they can then do a transvaginal sonogram to identify a (hopefully) uterine pregnancy.
This information is not intended to be used as medical advice. Use only as a reference.
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