Reproductive Outcomes After Tubal Reanastomosis in the Era of Assisted Reproduction

To evaluate reproductive outcomes after tubal reanastomosis during long-term follow-up, with emphasis on clinical pregnancy, live birth, ectopic pregnancy, and time to pregnancy.

This retrospective single-center study included 59 women who underwent tubal reanastomosis for fertility restoration after tubal ligation between January 2010 and December 2025 at a tertiary university hospital. Patients with complete medical records and postoperative follow-up data were analyzed. The primary outcome was postoperative clinical pregnancy. Secondary outcomes included live birth, ectopic pregnancy, miscarriage, time to pregnancy. Kaplan-Meier analysis was used to assess time to pregnancy.

Postoperative clinical pregnancy was achieved in 29 of 59 women (49.2%). In the overall cohort, live birth occurred in 15 women (25.4%), ectopic pregnancy in 8 (13.6%), and miscarriage in 6 (10.2%). Women who conceived were significantly younger than those who did not (33.4 ± 3.9 vs. 38.6 ± 4.2 years, p < 0.001). Likewise, women who achieved live birth were significantly younger than those who did not (32.3 ± 4.0 vs. 37.3 ± 4.4 years, p < 0.001). Median time to pregnancy was 9 months (95% CI: 7-12). Women younger than 35 years had a significantly higher cumulative probability of pregnancy than those aged 35 years or older (p < 0.001).

Tubal reanastomosis remains an important fertility-restoring option, particularly in younger women. Age was the most consistently associated with postoperative reproductive success, influencing both the likelihood and timing of conception. Success after tubal reanastomosis should be assessed beyond pregnancy alone and include live birth, ectopic pregnancy, and time to pregnancy.