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  • Title: Microsurgical reversal of tubal sterilization: a report on 1,118 cases.
    Author: Kim SH, Shin CJ, Kim JG, Moon SY, Lee JY, Chang YS.
    Journal: Fertil Steril; 1997 Nov; 68(5):865-70. PubMed ID: 9389817.
    Abstract:
    OBJECTIVE: To review and evaluate a series of patients who underwent microsurgical anastomosis of previously sterilized fallopian tubes. DESIGN: Retrospective clinical study. SETTING: Tertiary care academic center. PATIENT(S): In the 134-month span from January 1980 to February 1991, 1,118 women were evaluated for microsurgical reversal of previous tubal sterilization. MAIN OUTCOME MEASURE(S): Clinical characteristics of patients, pregnancy rates (PRs), and factors influencing the outcome. RESULT(S): Of 1,118 patients, 633 (56.6%) had been sterilized by laparoscopic cautery. Loss of children was a leading reason for requesting tubal reversal. The mean interval between tubal sterilization and reversal was 51.9 months. Nine hundred twenty-two (82.5%) patients were followed up for > 5 years. The overall PR after microsurgical tubal anastomosis was 54.8% (505 of 922) with a delivery rate of 72.5% (366 of 505), and the estimated anatomical success rate was 88.2% (814 of 922). There was no statistically significant difference in the PR or in the interval from tubal reversal to conception among the different operative procedure groups. In addition, no statistically significant difference in the PR was observed regardless of the postoperative tubal length. However, the interval from operation to pregnancy decreased significantly as the postoperative tubal length increased. The pregnant patients (n = 505) were younger and had a longer postoperative tube than the nonpregnant patients (n = 417); these differences were statistically significant. CONCLUSION(S): The pregnancy rate after microsurgical reversal of tubal sterilization was not significantly correlated with the method and duration of sterilization, the operative procedure, or the postoperative tubal length. A retrospective analysis was conducted of the records of 1118 women who underwent microsurgical reversal of a previous tubal sterilization at Seoul (Korea) National University Hospital during 1980-91. The mean age at the time of reversal request was 31.8 years and the mean duration of sterilization was 51.9 months (range, 3-185 months). The average number of living children was 1.2. The majority (56.6%) had been sterilized by laparoscopic cautery. Major reasons for the request for reversal were loss of children (50.8%), remarriage (27.3%), and desire for sons (21.5%). Of the 992 women (82.5%) followed for more than 5 years, 505 (54.8%) achieved a total of 585 pregnancies; 366 (72.5%) of women who achieved pregnancies had a live birth. The estimated anatomical success rate was 88.2% Mean age was significantly lower in the pregnant than the nonpregnant group (30.9 versus 31.6 years), but mean duration of sterilization had no impact. The pregnancy rate was not associated with the method of tubal sterilization; however, there was a significant difference in the postoperative tubal length between pregnant and nonpregnant women (6.7 versus 6.5 cm). Despite the lack of significant correlation between the sterilization method and the success rate, Silastic Yoon's rings and Hulka clips appear to offer the greatest likelihood of tubal sterilization reversal because tissue damage is minimized.
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