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Fig 4. Schematic showing damaged fallopian tubes because of pelvic inflammatory disease (PID). The left tube has formed a hydrosalpinx; and the right is engulfed in peritubal adhesions.
Fig 5. Operative laparoscopy, during which an adhesion is being divided (adhesiolysis)
In women, sterilization for family planning is usually done through an operation called tubal ligation, which is usually carried out through the laparoscope. The aim of the operation is to block the tubes and prevent the sperm and egg from meeting each other.
The vast majority of people are very happy with sterilization. Nevertheless, there are a few women who are very distressed afterwards and would do almost anything to get things undone. The commonest reason why such women regret sterilization is because their child dies or because they have remarried and wish to bear their new husband's child.
If there is a reasonable amount of tube remaining, even if only on one side, then it may be possible to perform tubal microsurgery to rejoin the tubes. On the whole, the more the tube which has been left undamaged, the better the chances of success. Thus, patients who have had a tubal ligation done through the laparoscope, using Falope rings (silastic bands) or clips, have an excellent chance of achieving a pregnancy after microsurgical reversal of the ligation, because these methods cause minimal tubal damage.
After reviewing the operative notes, a laparoscopy may be advised so that the exact state of the fallopian tubes can be assessed. If the patient has enough normal tube, tubal microsurgery may be attempted and pregnancy rates can be as high as 75% in favorable cases. If, unfortunately, the patient has had both tubes completely removed or if the tubes are very badly damaged, then the only chance of success will be with IVF.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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