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Laparoscopic tubal reanastomosis: 10-year pregnancy results of a single tertiary center
Eralp Bulutlar1, Gizem Berfin Uluutku Bulutlar2, Resul Karakuş1, Sultan Seren Karakuş1, Gizem Boz İzceyhan11Department of Obstetrics and Gynecology, University of Health Sciences, Turkey. Istanbul Zeynep Kamil Maternity and Children’s Diseases Health Training and Research Center, Istanbul, Turkey2Department of Obstetrics and Gynecology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
INTRODUCTION: This study aims to investigate whether tubal reanastomosis can be considered a superior or alternative method to in vitro fertilization (IVF) for women who have previously undergone tubal ligation but wish to conceive again. The focus is on assessing tubal reanastomosis as an option for patients seeking natural conception after changing their minds for various personal reasons. The study specifically evaluates this method in relation to IVF, particularly in cases where factors such as age, ovarian reserve, and partner spermiogram values are considered.
METHODS: This clinical trial and case series study screened women who had previously undergone tubal ligation and later applied to the Gynecology and Obstetrics Service at Zeynep Kamil Hospital between 2012 and 2022. From this group, 86 women were deemed suitable for surgery and underwent tubal reanastomosis. Postoperative pregnancy rates and outcomes, including abortion, ectopic pregnancy, and term delivery rates, were analyzed to assess the effectiveness of tubal reanastomosis.
RESULTS: The pregnancy rate following tubal reanastomosis was 33% within the studied group. Among these pregnancies, 8% ended in abortion, 3% resulted in ectopic pregnancies, and 89% reached full term. Tubal reanastomosis was shown to be a cost-effective method compared to IVF, avoiding complications associated with IVF, such as multiple pregnancies and ovarian hyperstimulation syndrome (OHSS). The method also demonstrated high patient compliance and success rates. Additionally, it allowed for simultaneous surgical intervention for co-existing conditions, such as endometrial polyps, ovarian cysts, fibroids, and adhesions.
DISCUSSION AND CONCLUSION: Tubal reanastomosis presents as an effective alternative treatment op-tion to IVF for select patient groups, with favorable pregnancy rates and fewer associated complications. It is particularly suited for patients who are younger, have adequate tube length after ligation, a favorable hormone profile, and a supportive partner spermiogram. This method is less costly, has fewer risks, and offers a viable path to conception for those seeking natural pregnancy after tubal ligation.
Manuscript Language: English
