Tubal resection and anastomosis I. Sterilization-reversal

Seventy-seven women (median age 30 years, range 21 to 43) underwent microsurgical tubal resections and anastomoses for sterilization-reversal. All patients had a laparoscopy between 8 and 21 days postoperatively to allow early diagnosis and treatment of adherences that had formed between tube and ovary or between adnexa and uterus or bowel. Follow-up ranged from 1 to 21 months and outcome was assessed with life-table methods. The cumulative probability of pregnancy was 63% at 6 months from surgery, 80% at 12 months and 87% at 18 months. Empirically, average fecundability, or monthly probability of pregnancy, was 13.6%; of 70 women followed-up and not on contraception, 59 (84.3%) have in fact conceived. The data indicate that: tube-length, at least above 4 cm, has no discernible effect on Fallopian tube function when fimbrial access to the ovary is not compromised; elapsed time between sterilization and reversal is irrelevant to subsequent likelihood of pregnancy; deleterious effects of endometriosis on fertility can be overcome surgically, provided precautions are taken to prevent adnexal adhesions forming; and reversals of bilateral partial salpingectomies are less likely to be followed by pregnancy than are other methods of tubal interruption.