The greatest percentage of success in pregnancy outcome has occurred with microsurgical tubal reversal. This success depends partially on the presence or absence of associated diseases such as endometriosis, pelvic infection or the formation of adhesions. All tubal sterilizations cannot be reversed; however, success of the procedure depends on how the original tubal sterilization was performed and the location and amount of tube removed. Access to previous medical records, therefor, is essential since patients are usually unaware of the details regarding the previous sterilization. The original operative report should be obtained if possible.

Why should someone want to reverse a sterilization procedure? Many of these women have remarried and wish to start a family. They are usually females in the 25-to-37 year age group who have had two or three children and had a tubal sterilization while still married. They are now divorced and are either remarried or contemplating remarrying. They express a strong desire to have a child with this husband.

These patients are carefully evaluated prior to surgery. An X-ray of the uterus and fallopian tubes gives evidence of the status of the uterus and tubes before reaching the point of blockage if one exists. A laparoscopy is essential for the complete evaluation of the woman's pelvis prior to any microsurgical repair. This "telescope-type" of examination allows the surgeon to examine the patient's internal female organs. it helps him determine the amount of tube present after the block. (The length of tube needs to be at least 2.5 cm and optimally 5 cm.) In addition, the extent of scar tissue and any other associated disease may be seen.

Today, modern facilities allow video taping of the female internal organs through the laparoscopic procedure. The attending physician and the patient can then view the pelvis, see the problems that need to be managed and determine the treatment accordingly. If the patient, however, should decide to have a procedure performed at a later date or at another institution, she may take the videotaped information as part of the record. In this way, the need for a repeat laparoscopy is eliminated.

The current success rates for pregnancy following microsurgery are 60 to 80 percent. Many factors, however, must be taken into consideration before the procedure is done. These include such risks as tubular pregnancy, the age of the patient, the emotional needs of the patient and the family and the presence of associated disease. If all factors are properly satisfied, there is then an alternative to infertility through microsurgery. This procedure offers the patient hope for improved success which was previously unavailable.