Tubal Surgery

The fallopian tubes are an essential part of the reproductive system, as they transport the egg from the ovaries to the uterus and the sperm to the egg after intercourse or intrauterine insemination. The tube is commonly the site where the egg is fertilized. Tubal damage or scarring is the culprit in about 20-25% of infertility patients seeking treatment. The body creates scar tissue as a defense against endometriosis or previous pelvic inflammatory disease (PID) or after pelvic surgery. The scar tissue can block the tubes or damage to the cilia that move the egg down the tubes. When a tube is blocked at the end, it can accumulate fluid- this condition is called hydrosalpinx. Patients who undergo IVF that have this condition and will generally have lower pregnancy rates than other women without blockages. The belief is that the fluid that accumulated can go back into the uterus and interfere with implantation of the uterus. It is highly recommended that patients with hydrosalpinx have that section surgically removed or cauterized before undergoing treatment. In most cases, this can be done laparoscopically with minimal recovery time.

Many women who feel they are finished with childbearing will choose to have a tubal ligation in order to have a “guaranteed” method of sterilization. However, due to personal circumstances, some of these women decide they would like to have the tubal ligation reversed. In many cases it is possible to surgically reconnect the fallopian tubes (tubal re-anastomosis) after a previous tubal ligation and the pregnancy rates as a result reversals range from 25% to 80%, depending on age of the patient, her ovarian function, and type of ligation that was done. The reversal procedure is done through a small “bikini type” incision (4-6 inches) in the lower abdomen. Using an operating microscope or special operative lenses that magnify the site,, the tubes are opened and extremely fine sutures are used to microsurgically reconnect the segments. Most patients can go home in the same day of surgery and are fully recovered in about 4- 6 weeks. Because the tubes may not behave normally, there is an increased risk of ectopic pregnancy after surgery and therefore these patients are closely monitored for this possibility.