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Sterilization Reversal

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Sterilization Reversal

Most men and women who have chosen voluntary sterilization as a permanent method of family planning remain happy with the choice. However, a few of the people who have had sterilizations change their minds. Some do because of major changes in their lives; they want to be able to have children again because they have remarried after divorce or the death of a partner or because one or more of their children have died. Others have trouble adjusting to no longer being able to have children. These people often seek to have their sterilizations reversed.

What is sterilization reversal?
How successful is it?
How do I know if I'm a good candidate for reversal?
How will I be screened?
How does the sterilization method used affect success of reversal?
Does the reversal technique used affect success?
How long will I have to stay in the hospital?
What are the risks of reversal surgery?
How much does reversal surgery cost?
I've had a sterilization and am thinking about reversal. What should I do?
I haven't had a sterilization but am planning one and am interested in reversal. What should I do?

What is sterilization reversal?

Sterilization reversal is the surgical attempt to restore an individual's ability to have children by reconnecting the tubes that have been blocked by sterilization. These tubes are the vasa deferentia in men and the fallopian tubes in women. Reversal surgery is a major operation.

How successful is it?

New techniques have made reversal surgery more successful than ever, but success reports have to be weighed carefully.

Most people think about reversal because they want another child. Thus, the only way to judge success is whether a couple has a baby after the reversal operation has been performed. Unfortunately, not all reports use this definition of success.

Also, success reports do not count those men and women who have asked for reversal but have been screened out because it is unlikely that their reversal surgery will be successful. For example, one report claims that, when everything seems right for reversal, 60% of women and 50% of men who have reversal surgery will be able to have another child. However, these success rates do not include those who were rejected for the operation.

How do I know if I'm a good candidate for reversal?

You may be a good candidate for reversal if:
  • You are in your late thirties or younger (if you are a woman).
  • You are in your forties or younger (if you are a man).
  • You are in good health.
  • Your partner is fertile (and, if you are a woman, you ovulate regularly).
  • Fewer than 10 years have passed since your sterilization operation.
  • Only small sections of your tubes were damaged by sterilization.

How will I be screened?

The screening process will probably consist of:
  • A physical examination
  • A medical history
  • A series of laboratory tests
  • A review of the medical reports of your sterilization
  • An evaluation of your partner's fertility
Women will usually undergo a diagnostic laparoscopy, a surgical procedure that is done to examine the condition of their tubes. Some physicians will require a special test be performed after the couple resumes sexual relations.

How does the sterilization method used affect success of reversal?

How does the sterilization method used to block the fallopian tubes affect the success of reversal?

The success of reversal surgery depends upon the damage done to the tubes by the sterilization operation. Some sterilization methods destroy more tissue than others. Clips do the least damage, followed by rings and tying methods. Electrocoagulation does the most damage and is the least reversible.

Although sterilization methods that destroy the most tissue are the least reversible, they are believed to be the most effective means of sterilization. This is why electrocoagulation has been widely used in the United States as a method of blocking the tubes.

What factors in the original vasectomy will influence the reversal success?

Successful reversal of vasectomy also depends upon the amount of undamaged tube left after sterilization. Ligation damages less tissue than electrocoagulation. In addition, the chance of reversal success is greater if the vasectomy was done on the straight sections of the vas, and if the pieces to be joined are of equal size. Unfortunately, the surgeon can judge whether the conditions are good for successful male reversal only at the time of the reversal surgery.

Does the reversal technique used affect success?

The use of an operating microscope or surgical loupe to magnify the surgical area during the operation is important. It is even more important in male reversal procedures than in female procedures, since the thin vas deferens is more difficult to reconnect than the larger fallopian tube.

The reports of greater success using microsurgical techniques may also be due to the increased training and experience of most microsurgeons. The skill and experience of the surgeon strongly influence the outcome of reversal surgery.

How long will I have to stay in the hospital?

A reversal operation is major surgery and is usually performed under general anesthesia which puts you to sleep.

Female reversal surgery requires three to six hours of surgery, up to one week in the hospital, and two to three weeks of recovery at home. Most male reversal surgery takes one to two hours in the operating room, several days in the hospital, and several days of recovery at home. Some physicians and clinics do male reversal surgery on an outpatient basis.

What are the risks of reversal surgery?

For women, reversal surgery carries with it the risks usually associated with major surgery of the abdomen or pelvis and the risks associated with anesthesia. In addition, after a reversal that leads to a pregnancy, there is increased likelihood of ectopic (tubal) pregnancy. In an ectopic pregnancy, the fertilized egg attaches outside the uterus, usually in the fallopian tube. Ectopic pregnancy is dangerous and requires immediate medical attention. This risk may be greater if a more destructive method, like electrocoagulation, was used for the sterilization.

For men, hematoma (a collection of blood under the skin) and infection are more common after reversal surgery than after vasectomy. There are also risks associated with anesthesia.

How much does reversal surgery cost?

As with most medical procedures, costs vary according to the doctor and part of the country, but reversal surgery is expensive. First, you will be charged for the screening tests that will help the surgeon decide whether you are a good candidate for reversal. If you go ahead with the operation, the surgeon's fee for female reversal can be $5,000 or more; male procedures are very close to that figure. Added to this are the costs of the operating room, the assistant surgeon, the anesthesiologist, and the hospital stay.

You will want to ask your surgeon for an estimate of the total cost of the procedure before you decide to go ahead with it.

Will my medical insurance pay for a sterilization reversal?

At the present time, most insurance plans do not cover reversal surgery. Assistance from Medicaid is available in some states. You should check with your source of medical insurance to find out just how much financial help you will have.

I've had a sterilization and am thinking about reversal. What should I do?

First, you might want to explore your reasons for thinking about reversal with a family planning counselor. Many people have had sterilizations because they have not been satisfied with other kinds of birth control. If you are one of these people, you should think about what form of family planning you will use if the reversal operation is successful.

Then, if you decide you are still interested, contact a surgeon who specializes in reversals to discuss your chances for success. You should be able to get the name of such a physician from your urologist or gynecologist, your family doctor, a family planning clinic, or the nearest large medical center. You will want to know about the physician's experience, success rate (in terms of babies born), and surgical techniques.

I haven't had a sterilization but am planning one and am interested in reversal. What should I do?

Because the success of reversal cannot be guaranteed, sterilization should be considered permanent. If you are considering a sterilization and are also thinking about reversal, perhaps sterilization is not for you. Think about the step carefully. Discuss it with your partner and with your doctor or family planning counselor. Explore temporary methods of birth control, which may better suit your needs at this time. No one should have a sterilization as a temporary measure. It is intended to be permanent. If you have further questions or want additional information, please send us e-mail at info@avsc.org or write or call:

AVSC International
440 Ninth Avenue, New York, NY 10001
(212) 561-8000

Note: AVSC does not make referrals to individual physicians.

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