Reversal of previous tubal ligation procedures for the restoration of fertility has become an increasingly frequent request. Microsurgical techniques are believed to offer a postoperative pregnancy rate superior to that obtained with macroscopic procedures. Of 63 women who requested reversal, microsurgical reanastomosis was performed in 40. With at least 6 months' follow-up, 22 women have become pregnant (55%), and there has been 1 ectopic pregnancy (2.5%). Comparison with previous studies using standard macroscopic techniques indicates that the use of meticulous surgical methods with precise reapproximation of the fallopian tubes results in a significant (P less than .005) improvement in pregnancy rates.