Tubal Reversal Study 2007 Report

Pregnancy Rates After Tubal Reversal At Chapel Hill Tubal Reversal Center

Notice of Study Update

The following is Dr. Berger's report from 2007. The corresponding page of an updated report can be seen in 2 expanded pages in the Tubal Reversal Pregnancy Study 2009 – Pregnancy Rates by Age and Tubal Ligation Method and Pregnancy Rates by Tubal Length

Pregnancy Rates By Age

As expected, younger women had higher pregnancy rates than older women. The pregnancy rate after surgery ranged from 82% for women under 30 to 41% for women 40 years of age and older (Table 3).

**Table 3. Pregnancy Rates by Age**
Age	Total Cases	Pregnant (No.)	Pregnant (%)
<30	558	460	82%
30-34	1496	1130	76%
35-39	1465	978	67%
40+	506	207	41%
Total	4025	2775	69%

Pregnancy Rates By Tubal Ligation Method

Reversal of tubal ring or clip procedures had the highest pregnancy rate (76%), followed by ligation/resection (69%) and coagulation (68%). Patients with fimbriectomy or unknown methods of tubal ligation had the lowest pregnancy rate (56%).

**Table 4. Pregnancy Rates by Tubal Ligation Method**
Method	Total Cases	Pregnant (No.)	Pregnant (%)
Ring/clip	921	697	76%
Ligation/resection	1604	1098	69%
Coagulation	1188	805	68%
Fimbriectomy/unknown	312	175	56%
Total	4025	2775	69%

Pregnancy Rates By Age And Method

Pregnancy rates taking into account both age and tubal ligation method are shown in Table 5. The highest pregnancy rate (87%) was reported by women age 29 or less who underwent reversal of a previous ring or clip method of sterilization. The lowest pregnancy rate (31%) was for women age 40 and older with either a fimbriectomy or unknown method of tubal ligation. Of the two variables, age is more predictive than tubal ligation method of the likelihood of becoming pregnant after reversal surgery.

**Table 5. Pregnancy Rates by Age and Tubal Ligation Method**
Age	Ring/clip	Ligation/resection	Coagulation	Fimbriectomy/unknown
<30	139/160 (87%)	159/201 (79%)	142/168 (85%)	20/29 (69%)
30-34	265/318 (83%)	456/614 (74%)	357/482 (74%)	52/82 (63%)
35-39	238/327 (73%)	399/599 (67%)	260/408 (64%)	81/131 (62%)
40+	55/116 (47%)	84/190 (44%)	46/130 (35%)	22/70 (31%)

Pregnancy Rates By Fallopian Tube Length

The fallopian tube lengths remaining after a tubal ligation procedure are important determinants of the success of tubal reversal surgery. (Normal fallopian tube length before a tubal ligation is approximately 10 cm or 4 inches.)

Tubal segment lengths were measured by Dr. Berger during surgery. The average length of the two fallopian tubes after repair was correlated with the likelihood of becoming pregnant (Table 6). Women with longer average tubal lengths had significantly higher pregnancy rates than women with shorter lengths following tubal reversal. Women with tubal lengths 7.5 cm or longer had a pregnancy rate of 80%. The pregnancy rate declined as tubal length decreased, but even women with the shortest tubes (less than 2.5 cm) became pregnant (38%). Although previously unreported in the medical literature, it became apparent during this study that a repaired fallopian tube of any length can result in pregnancy based on reports by women with only 1 fallopian tube. Tubal lengths as short as 1 cm have resulted in normal pregnancies among the women in this study.

**Table 6. Pregnancy Rates by Tubal Length (cm)**
Length	Total Women	Pregnant (No.)	Pregnant (%)
7.5+	371	295	80%
5.0-7.4	2209	1624	74%
2.5-4.9	1308	801	61%
<2.5	101	38	38%
Total	3989	2758	69%

(Cases with missing data exluded.)

Age And Tubal Length

When age and average tubal lengths are taken into account simultaneously, both factors are important predictors of outcome in terms of pregnancy (Table 7). Pregnancy rates were over 80% for women under 40 who had tubal lengths of 7.5 cm or longer.

**Table 7. Pregnancy Rates by Age and Tubal Length**
Age	7.5+	5.0-7.4	2.5-4.9	<2.5
<30	61/71 (86%)	281/334 (84%)	114/143 (80%)	3/8 (*)
30-34	105/125 (84%)	657/809 (81%)	339/508 (67%)	23/43 (54%)
35-39	112/135 (83%)	568/802 (71%)	285/475 (60%)	8/37 (22%)
40+	17/40 (43%)	118/264 (45%)	63/182 (35%)	4/13 (31%)