Reconstructive Tubal Surgery as an Alternative to Assisted Reproductive Technology after Tubal Sterilization: Experience in a Secondary Belgian Care Center

Abstract

Objective: The goal of this research was to evaluate fertility outcomes after laparoscopic tubal anastomosis for reversal of tubal sterilization, and assess this procedure's place as an alternative to assisted reproductive technology (ART). Materials and Methods: This retrospective cohort study was conducted between January 1, 2011 and mid-May 2017. Data were collected retrospectively from patients with tubal clips, who underwent laparoscopic tubal anastomosis performed by a specific surgeon during the study period, in a secondary Belgian medical unit. Results: Twenty-three patients underwent reversal surgery with a follow-up time ranging from 4 months to 6 years. The patients' ages were between 29 to 42 (average: 35.6 years; standard deviation [SD]: 3.2) at the time of the surgery. Average surgery duration was 104.2 minutes (SD: 26.4; range: 64-157 minutes). No intraoperative or postoperative complications were reported. A 61% spontaneous pregnancy rate was achieved (100% <30 years; 42.8% 30-34 years; 66.6% 35-39 years; and 66.6% ≥ 40 years). Average time to conceive was 171 days (SD: 194.5; range: 10-743 days). Of the patients who became pregnant after the surgery, 42.8% reported 2 or more pregnancies. Also reported were: 11/25 live births (44%); 7/25 early miscarriages (28%); 1/25 ectopic pregnancies (4%); 3/25 abortions (12%); and 3 ongoing pregnancies (12%). Conclusions: Bilateral tubotubal anastomosis is effective for women wanting to restore their fertility after tubal sterilization and should be proposed as an alternative to ART. Randomized controlled trials comparing in vitro fertilization with tubotubal anastomosis are needed in order to lead to a conclusion. (J GYNECOL SURG 34:115)