What patients have the highest success rates?  Healthy women under 30 with at least 5 cm (about 2 inches) of tube and who have children with their current husband, have a 90% or better chance of having another child after tubal reversal.

What factors affect the success?  The success of this surgery depends on factors such as the length of tube, sperm counts and other fertility factors.  Although pregnancy rates are around 90%, live birth rates can be much lower depending on various factors.  When all else is healthy, the live birth rate are greater than 80% with tubes of 5 cm (about 2 inches) but are less than 5% with tubes shorter than 3 cm (about 1 inch) of tube. Short tubes have a low live birth rates because the egg moves though the tube too rapidly and pregnancies miscarry. With short tubes, in-vitro fertilization (IVF) or adoption is a better answer than tubal surgery for fertility.  The success rate is also related your age, weight gain since your last pregnancy, your health, your husband's health and any other medical factors.
 

What women should consider IVF?  Women with a history of more than 3.5 cm of tube removed, with short tubes of 3 cm (about 1 inches) remaining at surgery, with excess weight gain, or with a husband with a low sperm count should consider IVF.

At age 35, are my eggs still good?  Although age 40 to 44 is the common time of worry, some women have early changes in egg quality.  Hormonal testing (FSH, estradiol) is available if we are concerned about early menopausal changes.  These tests start changing 5 to 10 years before menopause.
 

What women should consider donor eggs?  Women over age 43 especially with high basal FSH blood levels can get pregnant, but they often miscarry.  If pregnant, they may have a 10% chance of a baby and a 90% chance of miscarriage.  Hormonal treatment may lower the miscarriage rate to 50%.  These women can have a better chance of a baby with donor eggs.
 

Summary of Success Rates:
90% in healthy couples with:
    - Age less than 30
    - Tubes 5 cm or more in length
    - Previous children together
70% overall with good length tubes if husband has previous children.
60% overall with good length tubes if husband has no children but has a good sperm count.
50% decrease after age 40 and decrease can be worse if FSH testing is abnormal.
Pregnancies are uncommon after age 43.
IVF, egg donors or adoption may be better with:
    - Low sperm count
    - Short tubes
    - Excess weight gain since your last pregnancy
    - Age greater than 43
 

How do I know the length of my tubes?  Dr. Martin can review your tubal sterilization note and pathology report and estimate the length of the tubes and the success rate.  There is no charge for this review.

If your tubes were cut and tied after a delivery (Pomeroy or Parkland tubal ligation), look at the length of the specimens removed. If it is less than 2.5 cm, the chances of a successful reversal are 80% or better if other factors are healthy. At 3.5 cm, the chances are about 60%. If more than 3.5 cm is removed, there is concern that the tubes may be too short and rapid passage will result in miscarriage.  With more than 3.5 cm removed, IVF may be a better option.

If your tubes were burned, then the number and spacing of burns are important. One, two and sometimes three burns close together are reasonable for repair. Two or three burns spread apart can leave short tubes and the possibility or the egg moving through so fast that the pregnancy miscarries.

If the operative note is not available or if the information is inadequate, a diagnostic laparotomy (open surgery) can be used to determine the length.  If the diagnostic part of the laparotomy shows adequate tube or tubes, one or both tubes would be repaired at that time.  There is a refund if only one tube or if neither tube is opened.  That is listed at Costs.

Laparoscopy (belly button surgery) is another way to check the tubal length.  Laparoscopy is reasonable when there are other reasons for surgery, such as pain, and when there is insurance coverage.  You heal more quickly from a laparoscopy than a laparotomy.  But laparoscopy can add $4,000 to $8,000 to the overall costs.  Laparotomy is less expensive than laparoscopy when there are no additional reasons for surgery and no insurance for a laparoscopy.
 

Is information available as PDF files?   Click to see list of PDF downloads

Is an anastomosis used for tubes blocked by infection?  Sometimes it is.  More often a cuff salpingostomy is used for a hydrosalpinx.
 

How long has Dr. Martin performed anastomosis?  Dr. Martin has performed tubal anastomosis since 1974.  He changed to microsurgical techniques in 1977 and began use of out-patient procedures in 1987.  He has performed about 870 reversals during this time and currently does about 60 a year.  Click here for more information on Dr. Martin.
 

What type physicians perform tubal repair?  Tubal repairs are usually performed by reproductive surgeons, reproductive endocrinologists and/or gynecologists.  Dr. Martin was trained in all three of these areas (reproductive surgery, reproductive endocrinology and gynecology) at the Johns Hopkins Hospital in Baltimore 1972-1977.  He has also trained other physicians at the University of California, Irving and American Association of Gynecologic Laparoscopists workshops.

Can my physician do preoperative lab testing?  Yes, you need a Pap smear, a blood count, a cervical chlamydia and a cervical culture & sensitivity done in the past year.  Your husband needs a sperm count.  This is at Testing.

Can I have a reversal in one visit to Memphis?  Yes, please read the section at Out of Town.
 

Where is the office?  Use "7945 Wolf River Boulevard, Germantown, TN 38138"  for my office at http://www.google.com/maphp?hl=en&tab=wl&q=7945 Wolf River Boulevard Germantown TN
http://www.google.com/maphp?hl=en&tab=wl&q=7945%20Wolf%20River%20Germantown%20TN
or use My Maps.
Driving instructions are at: Driving Instruction.
 

How do I get to the office from I-240?  Use I-240 Expressway Exit 13 and go East.  Turn Right on Humphreys Boulevard just past Wendy's.  Go past the Baptist Memorial Hospital Campus.   Humphrey’s Boulevard curves left and extends to Wolf River Boulevard.  Dr. Martin’s office is at the UT Medical Group, Inc. Germantown Office Building at 7945 Wolf River Boulevard is about 3.1 miles from the Baptist campus.
 

Where is the surgery center?  Use "80 Humphreys Center, Memphis, TN 38120" for the surgery center map at http://www.google.com/maphp?hl=en&tab=wl&q=or use my maps.
 

Where is the closest motel?  The Hampton Inn Memphis-Walnut Grove/Baptist Hospital East is at 33 Humphrey Center Drive, Memphis, TN 38120 is near the surgical center.  Their phone is (901) 747-3700.  The Fax is (901)-747-3800.  Use I-240 Expressway Exit 13 and go East. 

Will scar tissue make it hard for the egg to pass through?  This would appear to be the least common problem.  Short tubes are more common.
 

Could the tube scar over and close?  Yes, the chance appears to be around 2% for one tube and less than 0.5% for both tubes. If repeat reversal is needed, Dr. Martin does not charge a surgical fee.  This happened once about 20 years ago.   That was repeated, with no additional charge by Dr. Martin, and she had a baby.
 

Is the egg a lot smaller than the diameter of the tube? Yes.
 

What type incision is used?  Surgery is performed through an open incision near the hairline.
 

How long does the surgery take? This usually takes less than 2  hours.  However, when there are other problems such as cysts, this can take as long as 3 to 4 hours.
 

How long will I be at the surgery center?  You will generally be at the surgery center 5 to 10 hours.  This includes 1 to 2 hours before surgery, 2 hours for surgery and 2 to 6 hours for recovery after surgery. Although most women do well as outpatients, there is a 1 in 50 chance of significant discomfort or nausea requiring 1 to 3 days in the hospital.
 

How much healing time do I need before I can try again to become pregnant? You can try in 10 to 14 days.  However, you may not feel like trying for 6 to 8 weeks. In addition, there may be energy loss and weakness for 1 to 3 months.
 

How long does it take to get pregnant?  The average time to pregnancy depends on the length of tube. My patients have been pregnant as soon as one month and as late as 5 years.
 

Will I be put to sleep all the way? Yes.
 

Will the fallopian tubes still have the ability to have muscular contractions to help the the fertilized egg reach the uterus? This should happen.
 

Should I give blood before surgery?  Blood transfusion is rare after this type surgery.  However, self-blood donation is still an option.
 

Can allergic reactions happen during or after surgery?  Allergic reactions can occur with any medication.  However, these are rare at surgery.

What do I ask my insurance company to see if tubal reversal is covered?  Questions for insurance companies are listed at Steps.  Coverage can change, so be sure your information is up to date.

Do you have to remove any tube when you do the surgery?  Yes, but this is not commonly a major problem.  On occasion, endometriosis or scar tissue can require the removal of more tube.  This is one of the reasons that we cannot be sure of the success rate until the surgery is over.
 

Is it true that with the latest microsurgical techniques that chances for tubal pregnancy (ectopic) is reduced?  Yes, but there is still a 5% chance of tubal pregnancy.  This is higher than the general population who has less than a 1% chance.    If you do not live near Memphis, please discuss this possibility with your personal physician who will see you early in pregnancy.  Close monitoring is needed in the first 4 weeks of pregnancy for prompt diagnosis and treatment.  This includes two or more blood pregnancy tests at 2 to 3 weeks and one or more sonograms at 3 to 3.5 weeks
 

What are the other complications? Complications are uncommon.  These have included:
Bladder infection
Bleeding
Allergic reactions
Damage to bladder (twice in 30 years) and bowel (once) with up to two day hospitalization
Decreased sexuality
Possible surgical complications that have not happened here can include: blood transfusion, hysterectomy, paralysis, colostomy, coma or death.
 

Is there any damage to my ovaries from a lack of blood supply due to the tubal ligation?  In theory, this may be so.  However, there are no comparative or prospective data to confirm this. Although this may effect hormonal situations such as premenstrual syndrome, there is no evidence that this changes success rates.
 

Are the fimbriated ends (fingers) of the tubes close enough or still attached to the ovary for transfer of the egg into the tube?  There is no reason to suspect that this is a problem.  This should be the same as when you had your last children.
 

Is the other end still attached to the uterus?  This should be the same as it was when you had your children.
 

Should I be taking vitamins?  Multi-vitamins with folic acid (400 mcg per day) appear to be helpful in decreasing birth defects.
 

Are PDF downloads available?  Click to see list of PDF downloads