Charles W Monteith1, Gary S Berger, Matthew L Zerden. 1. Chapel Hill Tubal Reversal Center, Raleigh, and the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Abstract
OBJECTIVE: To evaluate the effectiveness of hysteroscopic sterilization reversal by assessing pregnancy rates and identifying surgical complications. METHODS: All patients at a single center undergoing elective reversal of hysteroscopic sterilization for fertility were followed from January 2009 to May 2014. Eligible patients met prespecified criteria for outpatient surgery. Patients underwent outpatient reversal using a transverse suprapubic abdominal incision with tubouterine implantation performed with either bilateral cornual or single transverse posterior-fundal uterine incisions. Patients were evaluated on postoperative day 1, called the following day, and e-mailed at 2 weeks and 12 months. Pregnancy outcomes were assessed through a 12-month questionnaire and self-reporting using an Internet-based patient portal. Univariate analysis of patient and operative characteristics was performed. RESULTS: Seventy patients underwent bilateral tubouterine implantation and completed at least 12 months of follow-up. All surgeries were outpatient without any immediate operative complications. Four patients had complications between 2 and 30 days, none requiring extended hospitalization. Women who became pregnant were younger (mean age 34 years) than those who did not become pregnant (mean age 38 years). Twenty-five patients (36%, 95% confidence interval [CI] 25-47%) reported a total of 31 naturally conceived pregnancies. Twenty-seven percent (19/70, 95% CI 17-37%) of those undergoing surgery subsequently reported live births. A single pregnancy complication of postpartum hemorrhage after cesarean delivery requiring transfusion was reported; no ectopic pregnancies were reported. CONCLUSION: Hysteroscopic sterilization can be reversed using tubouterine implantation and both pregnancy and live birth rates are promising.
OBJECTIVE: To evaluate the effectiveness of hysteroscopic sterilization reversal by assessing pregnancy rates and identifying surgical complications. METHODS: All patients at a single center undergoing elective reversal of hysteroscopic sterilization for fertility were followed from January 2009 to May 2014. Eligible patients met prespecified criteria for outpatient surgery. Patients underwent outpatient reversal using a transverse suprapubic abdominal incision with tubouterine implantation performed with either bilateral cornual or single transverse posterior-fundal uterine incisions. Patients were evaluated on postoperative day 1, called the following day, and e-mailed at 2 weeks and 12 months. Pregnancy outcomes were assessed through a 12-month questionnaire and self-reporting using an Internet-based patient portal. Univariate analysis of patient and operative characteristics was performed. RESULTS: Seventy patients underwent bilateral tubouterine implantation and completed at least 12 months of follow-up. All surgeries were outpatient without any immediate operative complications. Four patients had complications between 2 and 30 days, none requiring extended hospitalization. Women who became pregnant were younger (mean age 34 years) than those who did not become pregnant (mean age 38 years). Twenty-five patients (36%, 95% confidence interval [CI] 25-47%) reported a total of 31 naturally conceived pregnancies. Twenty-seven percent (19/70, 95% CI 17-37%) of those undergoing surgery subsequently reported live births. A single pregnancy complication of postpartum hemorrhage after cesarean delivery requiring transfusion was reported; no ectopic pregnancies were reported. CONCLUSION: Hysteroscopic sterilization can be reversed using tubouterine implantation and both pregnancy and live birth rates are promising.