Fertility outcome following sterilization reversal by laparotomy was evaluated. We studied all sterilization reversals performed between January 1978 and December 1991; a total of 226 women were treated. Tubal anastomosis was performed according to the rules for microsurgery. The microsurgical technique comprised two main phases: preparation of the healthy tube segments and the anastomosis carried out on two layers. It was possible to study the subsequent fertility of 206 patients in all, as 20 patients were lost to follow-up (8.8%). Cumulative pregnancy rates were evaluated by life-table analysis. The overall intrauterine pregnancy rate, including births and miscarriages, was 69.9% (144 patients) after 2 years. The cumulative intrauterine pregnancy rate was 62% at 18 months. Analysis of the fertility results demonstrated that age was the most significant predictive factor. The cumulative intrauterine pregnancy rate at 2 years was 83.5% (61 cases) for patients < or = 33 years, 70% (35 cases) for patients aged 34-36 years, 62.5% (30 cases) for patients aged 37-39 years, and 51.4% (18 cases) for patients aged > or = 40 years. Even for patients aged approximately 40 years, microsurgical repermeabilization can be retained as the first choice rather than in-vitro fertilization.
PIP: At Cochin-Port Royal Hospital in Paris, France, gynecologic surgeons used laparotomy to perform microsurgical sterilization reversal on 226 patients aged 6-41 during January 1978-December 1991. 20 women were lost to follow-up. The researchers used life-table analysis to examine cumulative pregnancy rates. The mean interval between sterilization and sterilization reversal was 6.15 years. The surgeons first prepared the healthy tube segments and then performed anastomosis on two layers. At 18 months and 2 years post-reversal, the overall intrauterine pregnancy rates (births and miscarriages) stood at 62% and 69.9%, respectively. The average time between sterilization reversal and intrauterine pregnancy was 9.6 months. At 2 years, there were 4 ectopic pregnancies (2%). Even though women who had undergone bilateral sterilization reversal were more likely to become pregnant and to become pregnant more quickly than those who had undergone unilateral sterilization (73% vs. 56.4% and 8.8 vs. 12.2 months), the differences were insignificant. The type of anastomosis (e.g., isthmic-isthmic or isthmic-ampullary) had no bearing on fertility, as long as the tubes were at least 3 cm in length. The intrauterine pregnancy rates decreased with age (p = 0.01) (at 2 years post-reversal: 83.5% for age 33 or younger; 70% for age 34-36; 62.5% for age 37-39; and 51.4% for age 40 or older). Age was the most significant predictive factor of return to fertility. The findings show that microsurgical repermeabilization can remain the first choice rather than in-vitro fertilization for sterilized women wishing to bear a child, even women around age 40.