Microsurgical tubal anastomosis for sterilization reversal

Trends in contraception and sterilization in Australia

Life-history data collected in a national survey of women in 1986 are used to derive the first national estimates of trends in contraception and sterilization in Australia over the last 30 years. The pill rapidly became the method of choice after its release in 1961. The intrauterine device, the other truly modern method, has never attained the same popularity. The move toward sterilization dates from the early 1970s and has been so complete that women of 35 or older are now more likely to be protected by a ligation or laparoscopic sterilization than by the pill or, indeed, by all other methods combined. Unmarried women are now indistinguishable from married women on the basis of their use of contraception, and childless married women are now more likely to be using a reversible method than married women with children.

Tubal anastomoses by means of modified microsurgical technique

Twenty tubal anastomoses using a modified microsurgical procedure have been performed on 18 women who requested reversal of sterilization. Follow-up exceeded one year in 10 patients and was less than a year in five patients; three patients have deferred attempting pregnancy. Intrauterine pregnancy has been achieved in eight of the 10 patients who were followed up longer than one year; there have been five term deliveries, five abortions, one ectopic pregnancy and one patient was pregnant at the time of writing. The only pregnancies of three patients have terminated in abortions. Anastomotic dehiscence occurred in one patient, and tubal patency after a reanastomosis has been achieved, but she has failed to become pregnant as has one other patient with confirmed tubal patency. Tubal patency has been demonstrated in the three patients who have deferred pregnancy, and there has been one failure in the five patients who were followed up for less than a year. A second successful reanastomosis was performed in another patient in whom pelvic inflammatory disease followed an abortion which was performed in a country centre. Despite tubal patency, she also remains infertile. The possible reasons for failure and the abortions are discussed.

Tubal microsurgery--a review

Microsurgery is being applied with considerable advantage to tubal reconstruction, particularly in relation to improved pregnancy rates. These results justify the additional costs in equipment and time which are required.