Laparoscopic tubal anastomosis: fertility outcome in 202 cases

Objective: To evaluate the fertility outcome after laparoscopic tubal anastomosis for reversal of sterilization. Design: Retrospective clinical study. Setting: A private practice affiliated with a university medical school. Patient(s): Two hundred two women who desired reversal of tubal sterilization. Intervention(s): Laparoscopic tubal anastomosis. Main Outcome Measure(s): The cumulative pregnancy rate (PR) and factors that influenced the fertility outcome. Result(s): The cumulative PR in the 186 patients for whom follow-up data were available was 60.3%, 79.4%, and 83.3% at 6, 12, and 18 months after operation, respectively. Five patients (3.2%) had ectopic pregnancies; one of these patients subsequently conceived normally. There were no statistically significant differences in the PR according to the sterilization method used, the site of the tubal anastomosis, or the length of the fallopian tube after surgery. The intrauterine PR was 87.1% (149/171) with bilateral anastomosis and 60% (9/15) with unilateral anastomosis. The PR decreased with increasing patient age (mean [+/-SD], 35 +/- 3.6 years) but was still 70.6% (12/17) in patients aged 40-45 years. Conclusion(s): Our findings suggest that laparoscopic tubal anastomosis is a highly successful procedure. This less invasive approach could be considered the procedure of choice in patients who desire reversal of tubal sterilization. (Fertil Steril(R) 1999;72:1121-6. (C) 1999 by American Society for Reproductive Medicine).