TUBAL STERILIZATION REVERSAL: IS THERE ANY ROLE IN THIS MODERN ERA OF ART?

Sarwat Rizvi,Rubar Haider,Anum Jafri

doi:10.21649/akemu.v21i4.777

Abstract

AbstractObjectives:To determine the clinical pregnancy rate and to evaluate the factors affecting pregnancy rate following tubal recanalization.Study Design:Descriptive case series.Sampling Technique:Consecutive sampling.Setting / Duration of Study:The study was conduc-ted at Lady Willingdon Hospital Lahore, from January 2010 to March 2014.Methodology:Fifty nine women were included who underwent tubal re-anastomosis at Lady Willingdon Hospital Lahore.Inclusion Criteria:Patients undergone tubal ligation, no other female cause of infertility, normal semen ana-lysis.Surgical Procedure:Patients underwent tubal re-anastomosis through laparotomy. 4-quadrant suture technique was used.Data Analysis:Data was collected and entered into SPSS version 20. Descriptive statistics were computed and differences between groups were assessed through Chi square test where it was required. P-value < 0.05 was taken as statistically significant.Results:Out of 59 patients we could follow only 55 patients for clinical pregnancy as rest of 4 were lost for follow-up. Pregnancy rate, intrauterine ongoing pregnancy, miscarriage and ectopic pregnancy were the main outcome measures. Over all pregnancy rate was 34.5% (19/55), intrauterine pregnancy rate was 84.2% (16/19), term viable pregnancy was 68.8% (11/16). Spontaneous abortions were 31.3% (5/16) and ectopic pregnancy rate was 15.8% (3/19).Conclusions:The important prognostic factors for the success of tubal recanalization are age of the patient, sterilization/reversal interval, site of sterilization, method used for sterilization and length of the tube after reanastomosis. The technique is feasible, simple and less time consuming with good intrauterine pregnancy rate. Key Words:Tubal reanastomosis, Tubal recanalization, Pregnancy rate, Tubal sterilization.

Highlights

Tubal sterilization at present remains the most common method of birth control despite the availability of a wide variety of contraception methods.[1]
The important prognostic factors for the success of tubal recanalization are age of the patient, sterilization/reversal interval, site of sterilization, method used for sterilization and length of the tube after reanastomosis
The technique is feasible, simple and less time consuming with good intrauterine pregnancy rate

Summary

Introduction

Tubal sterilization at present remains the most common method of birth control despite the availability of a wide variety of contraception methods.[1] Every year 60 million females undergo tubal sterilization worldwide.[2] In developing nations like Pakistan, tubal ligation for sterilization is one of the commonest methods of contraception practiced by females.[3]. Around 15% of females who undergo tubal ligation regret their sterilization, only 1% of such females undergo reversal.[2] A large number of reasons compel females, who had undergone tubal sterilization earlier, to ask for subsequent reversal of the procedure in order to restore their fertility.[4]. Further reasons encompass longing for more children, death of a child, spiritual concerns and psychological factors.[5] Tubal reanastomosis is a surgical procedure that re-establishes a connection between the residual segments of the fallopian tube after sterilization.[6]

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Discussion

Conclusion