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Reversing female sterilisation


Robotically assisted laparoscopic microsurgery allows successful tubal re-anastomosis, investigators from Belgium reported in an online publication of the journal Fertility and Sterility on December 29, 2009.

Changing mind after sterilisation

As many as 5% of women who undergo tubal ligation for sterilisation will ask that the procedure be reversed, the authors explain, but laparoscopic tubal re-anastomosis (re-joining the divided tubes)  is "a technically difficult procedure that only a few experts can perform optimally."

Lead author Dr. Martin Caillet, with his colleagues from University Hospital Saint-Pierre, Free University Brussels, evaluated times to conception, as well as crude pregnancy and birth rates, in 97 women after robot-assisted laparoscopic tubal re-anastomosis.

The women ranged in age from 24 to 47 years (median, 37 years).

Sixty-six women became pregnant at least once and 58 gave birth at least once. 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.

Outcomes differed 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 tubal ligation (tubal occlusion).

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% and so no median could be reported.

Age and probability of success of reversal of sterilisation

On multivariate analysis, age was the only independent prognostic factor for conception.

Overall, 58 women each gave birth to at least one infant after the surgery; only 8 of these women were above the age of 39 and only 1 was older than 42. Eight women each gave birth twice.

"Our results show that before the age of 36 years, the chances of pregnancy and delivery are high (91% and 88%, respectively), between 36 and 40 years they remain acceptable (75% and 66%), and between 40 and 43 years they are much lower (50% and 44%)," the researchers conclude.

"After 43 years old," they add, "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."

Reversal of female sterilisation in the UK

Regardless of the factors considered here, women in the UK who wish to have reversal of sterilisation will have to explore the private route. This treatment is no longer available on the national Health Service (NHS) except in quite exceptional circumstances.

Alternatives to sterilisation

It is possible that many women who request and actually undergo sterilisation are not aware or have inadequate information about alternatives. That there are long acting reversible contraceptive methods is a crucial piece of information that every woman considering sterilisation should have. Many will be surprised to learn that some of these methods are in fact more reliable than sterilisation in preventing an unwanted pregnancy. This subject is discussed in more detail here: