Macroscopic Tuboplasty: Reversal of Female Sterilization

Between 1982-88 physicians performed tubal sterilization reversals using macrosurgical techniques on 57 women at Nehru Hospital in Chandigarh India. Some patients were lost to follow up. 59.65% had earlier undergone abdominal tubal ligation (Pomeroy method) and 38.6% laparoscopic ring sterilization. 91.2% requested sterilization reversal because they had lost at least 1 previous child especially a son and 8.77% because of remarriage. Most of the women wished to have a son. 38.6% did not have any surviving children at the time of reversal. 21 (54%) of the 39 women who could be followed for >6 months became pregnant. In fact these 21 women experienced 25 pregnancies. 61.9% of these women conceived within the 1st 6 months following reversal surgery. The pregnancy rate for women whose interval between sterilization and reversal was =or- 36 months was 55% compared with 45% for >36 months. 22 (88%) of the pregnancies resulted in term delivery. 1 was an ectopic pregnancy (4%) 1 (4%) pregnancy ended in spontaneous abortion and another pregnancy (4%) was terminated in the 2nd trimester due to an anencephalic fetus. 61.9% of the pregnant women had had a laparoscopic ring sterilization compared with 33.3% of nonpregnant women. The leading type of sterilization reversal surgery was bilateral end to end anastomosis (90.5% of pregnant women and 61.1% of nonpregnant women). The sites that resulted in the best and worst pregnancy rates were bilateral end to end isthmo-isthmic anastomosis (56.14%) and the bilateral ampullo-ampullary (31.25%). A higher percentage of nonpregnant women underwent ampullo-ampullary reanastomosis than pregnant women (39% vs. 23.8%). Overall the postoperative tubal patency rate was 90% of the 39 cases followed for >6 months. Of the 18 women who had not yet conceived at >6 months follow up 14 (77.7%) had patent tubes.