Reestablishing fertility after tubal sterilization -: Success rates of microsurgical tubal anastomosis when compared to in-vitro fertilization (IVF)

Purpose: A significant number of previously sterilized women desire the restoration of their fertility for various reasons, although the primary motive is a desire to conceive additional children in a new relationship. Microsurgical tubal anastomosis is one of the most promising techniques for reestablishing fertility. This paper evaluates the Success rates of this procedure. Material: From 1990 to 2000, 110 women underwent microsurgical tubal anastomosis by mini-laparotomy. Data subsequently gathered from 76 of these patients was included in this retrospective analysis. The remaining 34 patients could no longer be contacted. Results: This study focused on the first pregnancy after the surgical procedure. 75% (57/76) of women became pregnant, including 5.3% ectopic pregnancies (4/76) and 15.8% miscarriages (11/75). The median age of these women was 34.44 years (26-42). 53.9% of the patients delivered healthy babies (41/76). 19 out of 76 patients (age 37.68 [31-42]) did not conceive (25%). In comparison, the pregnancy rate and birth rate of a single IVF-procedure in Germany 2001 (performed for tubal pathology) was reported as 26.65 and 15.98% respectively. Conclusion: The pregnancy rate of 75% and the birth rate of 53.9% after microsurgical tubal anastomosis are significantly higher compared to a single IVF procedure. However, using multiple in-vitro fertilizations can lead to higher success rates. The advantages of reestablishing fertility when compared with IVF are the permanent reestablishment of the ability to conceive with a single therapeutic intervention, generally higher rates of postoperative pregnancies and live births, the possibility of additional pregnancies without renewed therapy and generally overall lower costs. Microsurgical refertilization through mini-laparotomy should be recommended to women, including older women at the ages of 42 or 43, who have been previously sterilized and who desire renewed fertility after excluding serious ovarian or andrological diseases.