Factors affecting the reproductive outcome after microsurgical tubal ligation reversal

Abstract

Objective: The factors that affect the pregnancy rate after tubal ligation reversal have an impact on the patient’s decision to have surgery. The objective of this study was to evaluate these factors. Design: A review was done of the charts of all patients having microsurgical tubal reanastomosis performed by a single surgeon at a tertiary care center between January 1995 and May 2001. Patients with a minimum follow up of 6 months were included in a retrospective clinical study. Materials/Methods: Comparative pregnancy rates were analyzed according to the following factors: age, body mass index (BMI), concurrent hysteroscopy for menorrhagia, concurrent myomectomy, tubal ligation method, and post-tubal reversal hysterosalpingogram (HSG) result. Odds Ratios, logistic regression, chi squared tests, and Fisher’s exact tests were used to assess statistical significance of these factors. Results: The overall pregnancy rate was 76.2% in the 63 patients with sufficient follow up, and the intrauterine pregnancy (IUP) rate was 74.6%. Five patients had an ectopic pregnancy after their surgery, and 4 of these also had an IUP. Of 23 patients who had an HSG, 15 (65.2%) showed bilateral patency, and 8 (34.8%) showed unilateral patency. Nine patients (60.0%) with bilateral patency had an IUP, and 4 patients (50.0%) with unilateral patency had an IUP. Sixteen patients had no IUP; 10 of these had an HSG showing tubal patency on one or both sides. This number, combined with the 47 cases of IUP, yields a total of 57 patients (90.5%) who had anatomically successful tubal reversal surgery on at least one side. The remaining six cases had no IUP, but elected not to have an HSG to assess tubal patency. The IUP rate was 91.2% for the 34 patients at or below the median age of 32, and 55.2% for the 29 patients over 32 years of age. The patients at or below the median BMI of 25 had an IUP rate of 83.9% (26/31), while those above the median BMI had an IUP rate of 65.6% (21/32). The IUP rate in patients without concurrent myomectomy was 78.6% (33/42) versus 66.7% (14/21) in patients with myomectomy. Twenty-seven of 35 patients (77.1%), who did not have concurrent hysteroscopy, had an IUP; the IUP rate was 71.4% (20/28) for those with concurrent hysteroscopy. The IUP rates by method of tubal ligation were 73.0% (27/37) for Pomeroy, 72.7% (8/11) for rings/clips, and 90.0% (9/10) for cautery. Conclusions: (1) There was a very strong association between age and IUP, and a moderate association between BMI and IUP. Further consideration of these factors may be warranted in order to better inform the patient of her chances for a successful pregnancy after tubal reversal. (2) The IUP rate was only slightly higher in patients with bilateral versus unilateral tubal patency. (3) There was little or no evidence of an association between IUP rate and myomectomy, hysteroscopy, or method of tubal ligation. Supported by: N/A.