Some women who have had tubal ligations (had their "tubes tied") wish to have their fertility restored. They have two options that can help them achieve this: 1) tubal ligation reveral, which is a surgical procedure or 2) proceeding to in vitro fertilzation. Microsurgical Reconstruction The art of microsurgical tubal reconstruction often has been pushed aside in favor of ART, but it may be the best option for some couples. Microsurgery refers to the technique of using fine instruments, delicate tissue-handling, meticulous hemostasis (controlling the flow of blood) and surgical performance under magnification.  As fewer cases are performed, fewer physicians are being trained in proper microsurgical techniques and, subsequently do not offer it to their patients.  Additionally, the success of IVF has improved so dramatically that many physicians believe it is more cost-effective to proceed directly to IVF. Advantage of Tubal Surgery over IVF for Some Couples For some couples, however, IVF may not be an option because of religious or financial reasons.  In many cases, if tubal blockage is the principle cause of infertility, these patients can be successfully treated by surgery.  Laparoscopy and laparotomy are the two approaches for surgical repair of the fallopian tubes. If successful, tubal surgery offers these advantages: Chance for natural conception and avoiding medications used in IVF and their side effects Opportunity for more than one pregnancy without additional procedures Virtual elimination of the risk of multiple pregnancy

Laparoscopy & Laparotomy

Laparoscopy One incision is made under the belly button and a second one in the pubic hairline.  The doctor introduces a scope into the abdomen and a laser is attached to the laparoscope.  The laser can be used as a knife to cut scar tissue (adhesions) or burn endometriosis.  Using the laser, the fallopian tubes also can be opened if their occlusion is at the very end.  Tiny catheters may be passed through the tubes in an attempt to clear blockages. Laparotomy This is more extensive surgery appropriate for certain types of tubal disease that cannot be corrected by laparoscopy.  An incision is made in the abdomen (bikini cut) and a microscope is used to visualize the delicate work done on the fallopian tubes.  Sutures finer than a human hair can rejoin tubes once the blocked segment is removed.  Patients who have had their tubes ligated or tied can also have their tubes rejoined in this manner. Tubal surgery will not successfully correct every patient’s tubal factor issues.  Some fallopian tubes may be beyond surgical repair.  Microsurgery is still, however, an important tool to assist couples in becoming pregnant.  In well-trained hands, and with the properly selected patient, microsurgery offers pregnancy rates comparable to IVF.