Effectiveness of bilateral tubotubal anastomosis in a large outpatient  population

Gary S Berger; John M Thorp Jr; Mark A Weaver

doi:10.1093/humrep/dew038

Reproductive Surgery Sterilization and Reversal

Effectiveness of bilateral tubotubal anastomosis in a large outpatient population

Berger GS, Thorp JM Jr, Weaver MA

Published May 2016 Human Reproduction (Oxford, England), 31(5), 1120-1125

DOI 10.1093/humrep/dew038 PMID 26980770 PMC PMC4840024

RRM Academy Synopsis

69% of 6692 women became pregnant after tubal sterilization reversal

In 6692 women, 69 out of 100 became pregnant after outpatient tubal sterilization reversal. This prospective cohort from one surgical center also found 35 out of 100 had at least one live birth. Results varied with age and sterilization method.

Key Findings

4633 of 6692 women (69%) reportedly became pregnant during follow-up. Cumulative pregnancy incidence was 41% at 6 months (95% CI 40% to 42%) and 58% at 12 months (57% to 59%).
Pregnancy percentages ranged from 82% for women under 30 to 38% for women aged 40 or older at reversal (P < 0.001).
Pregnancy percentages were 76% after ring/clip sterilization, 68% after ligation/resection and 67% after coagulation (P < 0.001).
2314 women (35%) had at least one live birth during follow-up. Age and method groups ranged from 63% (under 30, ring/clip) to 8% (40 or older, coagulation).
Of 7275 reported pregnancies, 34% ended in miscarriage and 13% were ectopic. Births made up 39%, and 14% were still ongoing.

Interpretation

This cohort study followed women who had tubal sterilization reversal at one surgical center in Chapel Hill, North Carolina. Surgeries took place from 2000 to 2013. Age and sterilization method were linked to pregnancy and live birth. The authors note that some pregnancies and ectopic pregnancies may not have been fully reported. Larger studies could confirm how age and method affect reversal success.

RRM Context

Restorative reproductive medicine treats the cause of infertility. The authors say IVF clinicians largely stopped offering sterilization reversal, with no evidence behind that shift. They found only one trial of the surgery, comparing two types of magnification. Cochrane reviews found no trials comparing reversal with IVF. IVF bypasses the tubes. Reversal surgery repairs them.

Our editorial summary of this paper, not the article's abstract.

Abstract

Study Question

Is bilateral tubotubal anastomosis a successful treatment in an outpatient patient population?

Summary Answer

For women wanting children after tubal sterilization, bilateral tubotubal anastomosis is an effective outpatient treatment.

What Is Known Already

With the current emphasis in reproductive medicine on high technology procedures, the effectiveness of female surgical sterilization reversal is often overlooked. Previous clinical studies of tubal sterilization reversal have been mostly retrospective analyses of small patient populations.

Study Design, Size, Duration

A cohort of women who underwent outpatient bilateral tubotubal anastomosis from January 2000 to June 2013 was followed prospectively until December 2014 to determine the proportions of women undergoing the procedure who became pregnant and who had live births. Data were collected at the time of pregnancy. Differences in pregnancy rates and live birth rates associated with age, race and sterilization method were evaluated.

Participants/Materials, Setting, Methods

A total of 6692 women, aged 20-51 years, underwent outpatient bilateral tubotubal anastomosis.

Main Results and the Role of Chance

The crude overall pregnancy rate was 69%. The crude overall birth rate was 35%. Results varied according to age at sterilization reversal and the method of sterilization. Women under 30 years of age at reversal of ring/clip sterilizations had an 88% pregnancy rate and 62% birth rate. Pregnancy and birth rates declined as age increased at sterilization reversal. Coagulation sterilization reversals resulted in the lowest rates of pregnancies and births. Ligation/resection reversals had intermediate success rates.

Limitations, Reasons for Caution

Limitations of our study include probable underreporting of pregnancies based on patient-initiated reports; possible errors in the reporting of pregnancies or early miscarriages that may have been based solely on home pregnancy tests; and probable over-reporting of the diagnosis of ectopic pregnancies. We identified age and sterilization method as being associated with subsequent pregnancy, however, in order to be considered predictive, the associations would need to be validated in an independent second prospectively studied group of representative patients. Finally, we also included patients in the study population who had additional surgical procedures performed at the time of tubotubal anastomosis (e.g. uterine myomectomy, fimbrioplasty, ovarian cystectomy and adhesiolysis), factors that could result in differences in pregnancy statistics in our study versus other patient populations.

Wider Implications of the Findings

The results of this study can help inform patients and clinicians about this low technology alternative to IVF.

Study Funding/Competing Interests

None.

Trial Registration

N/A.

Read the guide

Fertility-Preserving Surgery: Restorative, Specialist, and Conventional Approaches Compared

Topics

Reproductive Surgery › Sterilization and Reversal › Sterilization Reversal · Infertility › Tubal Factor › Proximal Tubal Obstruction

Gary S Berger, John M Thorp Jr, Mark A Weaver

G Berger, Jack Thorp, J Thorp, M Weaver

PMID 26980770 26980770 DOI 10.1093/humrep/dew038 10.1093/humrep/dew038 Berger et al. 2016, Berger 2016