A diagnostic laparoscopy is generally done first to confirm that tubal repair is possible. Subsequently, a two to three inch incision is made at the top of the pubic bone. This is sometimes known as a bikini incision. All subsequent micro-surgical repair is done through this incision.

When the fallopian tubes are blocked in the middle of the tube, which is most common with a tubal ligation, the coagulated or blocked part of the tube is removed and the ends are sewn together. This is know as an end-to-end anastomosis.

If the tubal ligation is done near the fimbriated end of the tube, this end can be surgically opened and tacked back. Although this may result in a shortened tube, if pregnancy does not occur naturally a follow up procedure of tubal transfer can be done in order to achieve pregnancy. This is a procedure where the eggs are recovered from the ovary, mixed with the partner's sperm and placed back into the fallopian tube.

The last place of tubal blockage, secondary to a tubal ligation, is the point where the tube enters the uterus. At this place, the blockage commonly requires what is know as a reimplantation. This procedure involves making a new opening into the uterus and reimplanting the fallopian tubes into this opening and threading a stint or plastic tube through both fallopian tubes and into the uterus. This allows the tubes to remain open while they are healing in their new position in the uterus. Three months later, the stint is removed in the office with minimal discomfort.

Any of these procedures can be done under general anesthesia or a spinal block. There are several advantages of a spinal block. One is that it avoids general anesthesia and other than some sedation, you can stay awake during the surgery. The second advantage of a spinal block is that at the time of injecting the medicine used for the spinal, one can also induce spinal morphine. The use of spinal morphine gives you approximately 18 hours of pain relief after the surgery. The surgery itself takes approximately two to three hours. We recommend a 24 -hour short stay in the hospital and approximately a two-week recovery time before you can return to work. In all cases other than when a stint is placed, you may attempt pregnancy with the first cycle after surgery.

Statistically and monetarily in cases of tubal blockage, micro-surgical repair gives the greatest chance of success. It has been suggested that in-vitro fertilization with ultrasound guided egg recovery can be done in cases of tubal blockage in order to avoid surgical risks. At approximately $6,000 per attempt and an overall success rate of 10-15 percent, it seems reasonable that if tubal repair were possible that it would be the treatment of choice. Our overall success rate with the reversal of sterilization as quoted in the first paragraph is approximately 50-70 percent with an average of 63 percent live birth rate. This variation in success is based solely on the length of tube remaining at the time of surgery.

Finally, prior to surgery, we would like to have a complete semen analysis on your partner. This is to assure you that your partner is fertile and subsequently you will have the greatest chance of achieving pregnancy after your micro-surgical reversal of sterilization.