Robotically Assisted Microsurgery Could Reverse Tubal Ligation

A new study reports that robotically assisted laparoscopic surgery allows successful tubal reanastomosis and satisfactory birth rates in women aged 40 years or less.

Researchers at University Hospital Saint-Pierre (Brussels, Belgium) conducted a retrospective cohort study to evaluate the pregnancy and delivery outcome of robot-assisted tubal reanastomosis in 97 patients with available follow-up who underwent the reversal of tubal ligation, with a median age of 37 years (range, 24-47 years).

The researchers found that 66 women became pregnant at least once, and 58 gave birth at least once, and 8 women gave birth twice. Overall, 39% achieved a first pregnancy within 3 months, 51% within 6 months, 62% within 12 months, 66% within 24 months, and 70% within 48 months. The outcomes differed when stratified by age, however. For every 5-year increase in age, the probability of becoming pregnant fell by 38%; in addition, the likelihood of pregnancy decreased by 21% for each 3-year increment in time since ligation. The median time to first conception was 3 months in women 35 years or younger, and 6 months in women aged 36 to 39 years; but among women 40 years and older, the pregnancy rate remained below 50%. On multivariate analysis, age was the only independent prognostic factor for conception. The study was published early online on December 10, 2009, in Fertility and Sterility.

"Our results show that before the age of 36 years, the chances of pregnancy and delivery are high, between 36 and 40 years they remain acceptable, and between 40 and 43 years they are much lower,” concluded lead author Martin Caillet, M.D., and colleagues. "After 43 years old, the chances of becoming pregnant are extremely low, as is common in the general population. The question of whether surgery should be performed remains a question for debate.”

Tubal ligation is a permanent form of female sterilization. There are four main occlusion methods for tubal ligation, typically carried out on the isthmic portion of the fallopian tube: Partial salpingectomy, clips, silicone rings, and electrocoagulation. Another form of permanent birth control is the nonsurgical Essure procedure, in which micro-inserts the size of a grain of rice are placed inside the tube, resulting in eventual occlusion of the fallopian tubes due to the in-growth of tissue.

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