Laparoscopic tubal anastomosis and reversal of sterilization.
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Fallopian tube interruption is a common form of contraception worldwide. For a variety of reasons (e.g. change in marital status, wish for additional children, psychological factors), many of these women seek restoration of fertility. Laparoscopic tubal anastomosis is one of the newest of these procedures by which this can be achieved. Sixteen women underwent laparoscopic microsurgical anastomosis. We used a three-stitches technique with tubal cannulation adapted from methods described in the literature. Five pregnancies occurred, giving an overall pregnancy rate of 31.2%. Surgical outcome depends on the patient's age, the method of tube interruption and the length of Fallopian tube segments being anastomosed. In this study, the feasibility of laparoscopic tubal sterilization reversal is confirmed, as well as the benefits offered by laparoscopic procedures in terms of quality of life. Further improvement of surgical outcome will be achieved not only through better laparoscopic techniques but also through careful screening for surgical indications. (+info)
Reproductive outcome after sterilization reversal in women of advanced reproductive age.
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OBJECTIVE: Our objective was to assess the clinical outcome of tubal reversal in women of advanced reproductive age. METHODS: A multicenter retrospective chart review of 153 patients who underwent a tubal ligation reversal was carried out. Patients were evaluated according to age. All patients had documented ovulation and a partner with a normal semen analysis by WHO criteria. Outcome measures included rates of clinical pregnancy, ectopic pregnancy, spontaneous abortion, and live birth, and the time to conception. RESULTS: Clinical pregnancy rates were significantly lower in women > or = 40 compared to younger groups. The time to conception was significantly shorter for women < 30 compared to women > or = 35. No pregnancies occurred in women > or = 42. CONCLUSIONS: Our data support the judicious use of sterilization reversal for infertile women with no male factor through their early forties. Women > or = 42 years should be especially counseled as to the very low success rates. (+info)
Non-invasive reversal of intraluminal vas deferens polymer injection-induced azoospermia--technology.
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AIM: The rationale and technique underlying a novel concept of non-invasive removal of an intravasal vas deferens polymeric contraceptive drug to reverse drug injection-induced azoospermia are explained. Thus the conventional methods of surgical exploration to remove vas deferens plugs and intravasal injection of solvents to flush out contraceptive drugs are to be replaced by steps which will be readily accepted by subjects. METHODS: The approach is based upon the non-invasive application of specific forces to various segments of the vas deferens so that non-sclerosing and non-tissue-adherent compounds, in particular styrene maleic anhydride (SMA) can be expelled. Forces are generated by palpation; percutaneous electrical stimulation; vibration application; and percussion. The forces help to propel the intravasal polymer towards the ejaculatory duct for expulsion during ejaculation. All aspects of the total technique are clinically acceptable, simple, atraumatic, unlikely to cause pain and discomfort even without tranquilizers, local or general anaesthetics. The procedure may be repeated several times in different sittings spaced apart by about one week to achieve adequate plug expulsion. RESULTS: Model experiments demonstrated the feasibility of the concept. The polymer was nonadherent and could be moved within the vas deferens by the application of specific forces. Sufficient removal was possible to enable spermatic fluid to be transported along a region previously occupied by the polymer. A corroborating subhuman primate study by an independent investigator has shown that the semen profile becomes normal following the reversal. CONCLUSION: Adoption of the new technique may provide a means of non surgical restoration of normal semen profile after a period of fertility control obtained by intravasal drug injection. (+info)
IVF following impossible or failed surgical reversal of tubal sterilization.
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Microsurgical re-anastomosis or IVF offer ways of reversing previous tubal sterilization. This retrospective study analysed 56 attempts of IVF in 37 couples after impossible or failed surgical sterilization reversal. Efficacy of IVF in this group (TL) was compared with that of a tubal pathology control group (TP) at all stages of IVF (stimulation, fertilization and implantation). Depending on patient age, significantly fewer oocytes were produced after ovarian stimulation in the TL group than in the control (TP) group (P = 0.023 for all TL patients; P = 0.02 when patients aged >38 years were excluded). The total number of embryos available for transfer was significantly lower in the TL group (P = 0.0042), but this was age-related, since when women aged >38 years were excluded there was no significant difference between the two groups. The ongoing pregnancy rate was similar in both groups, the probability of ongoing pregnancy appearing to depend on patient age rather than on previous fertility. (+info)
Profile of Indian women requesting reversal of sterilisation.
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This is a prospective clinical study carried out on 96 tubectomised women referred for microsurgical reversal to the Pandit BDS Postgraduate Institute of Medical Sciences, Rohtak and LHMC and SSKH, New Delhi. It was concluded that in developing countries high perinatal and child mortality rates are responsible for increased demands for reversal of sterilisation. Proper pre-operative counselling, age of the women, assessment of marital stability, family size and age of children are important before advocating sterilisation as a method of contraception. (+info)
Experience of reversal of sterilisation at Glasgow Royal Infirmary.
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OBJECTIVE: To review experience at the Glasgow Royal Infirmary with regard to women who underwent reversal of sterilisation, to obtain a profile of these women and to evaluate the procedure itself in terms of safety and restoration of fertility. DESIGN: A retrospective study based on case records from the Glasgow Royal Infirmary and from the Glasgow Royal Maternity Hospital, both of which share the same catchment area. PARTICIPANTS: Eighty-five women underwent reversal of sterilisation between 1 January 1994 and 31 December 1998 at the Glasgow Royal Infirmary. Follow-up at the Glasgow Royal Maternity identified 43/85 women. METHODS: Patients were identified from relevant theatre log books and from records at the maternity hospital until December 2000 and their case notes reviewed. RESULTS: Having a new partner was responsible for 90% of requests. Median age at request for reversal was 34 years and most had been sterilised before the age of 30 years. There were few postoperative complications. Pregnancy occurred in at least 43% of women. CONCLUSION: Reversal of sterilisation is a safe and effective method of restoring fertility. The actual incidence of pregnancy after reversal is likely to be higher than the 43.5% recorded due to difficulties in achieving 100% follow-up. (+info)
Different intervals between vasectomy and sperm retrieval interfere in the reproductive capacity from vasectomized men.
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PURPOSE: To evaluate the relationship between the postvasectomy period and sperm reproductive capacity after ICSI. METHODS: Seventy-seven ICSI cycles with percutaneous epididymal sperm aspiration (PESA) were reviewed. Patients were divided into 4 groups according to the interval after vasectomy: 0 - 5 years (G1); 6 - 8 years (G2); 9 - 14 years (G3), and > 15 years (G4). RESULTS: Clinical and ongoing pregnancy rates did not correlate significantly with the time period of vasectomy until 14 years. Although the higher implantation rate observed in G1, no significant differences were noted among Groups 1-3. The miscarriage rates increased from G1 to G4, reaching a statistical significance among G1, G2, and G3 compared with G4. When groups were also divided according to the maternal age, the same results were obtained. CONCLUSIONS: The interval between the vasectomy and the sperm retrieval procedure has no effect on the outcome until the interval of 14 years. (+info)
Female sterilisation: is it what women really want?
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OBJECTIVE: To audit the effectiveness of a female sterilisation counselling clinic. DESIGN: A prospective, observational study of a female sterilisation counselling clinic over a 6-month period to determine the proportions of attenders keeping their appointment, proceeding to sterilisation, and attending for surgery. SETTING: A hospital-based, city centre family planning clinic run by permanent, family planning-trained staff. RESULTS: A total of 226 women had appointments for female sterilisation counselling and most confirmed attendance. Only 153 (68%) women attended; of those 101 (66%) chose to be sterilised, the remainder choosing reversible contraception. Ninety-three (92%) women went ahead with the sterilisation procedure. Thus only 61% of the original attenders were sterilised; this was only 41% of those referred. CONCLUSIONS: The study suggests that many women referred for sterilisation counselling fail to attend. This finding needs to be further explored. For those women who do attend, accurate information and informed counselling is important. Many women are still unaware of highly effective long-term reversible contraception, and following discussion decide against female sterilisation. Services offering counselling for female sterilisation should also be able to provide easy access to a full range of contraceptive methods. (+info)