Female sterilization is a prevalent method of birth control worldwide. However , couples do regret their decision and request reversal of the procedure. It is estimated that 2-13% of women develop post-sterilization   regret and 1-3% seek tubal reanastomosis. The treatment options available to these couples are either reversal procedures or assisted reproduction techniques (ART). These patients are usually otherwise fertile and have better success with both procedures. Reversal of tubal ligation is achieved by opening the occluded ends of proximal and distal segments and anastomosing them with fine sutures using magnification and microsurgical techniques. Traditionally, tubal anastomosis has been done by open microsurgical techniques. A review on tubal anastomosis has shown that laparoscopic tubal anastomosis is equally effective as microsurgical procedures by laparotomy.  Laparoscopic microsurgery is technically demanding and requires training and experience. The use of one stitch technique , titanium clips, and fibrin glue have been tried recently to circumvent the difficult laparoscopic suturing but the results were not optimal. The goal of laparoscopic surgery should be to duplicate standard microsurgical techniques. Robotic assistance have been evaluated to facilitate laparoscopic tubal anastomosis. Increased cost and operative time are the disadvantages. Author is using 3D laparoscopy for more precise  tubal reanastomosis.

Laparoscopic tubal anastomosis gives an intrauterine pregnancy rate of 60-80% and very low ectopic pregnancy rate of 1-6% . Success rate mainly depends on women’s age, the type of sterilization; Falope rings and clips give a higher success rate than Pomeroy’s and other techniques. Two other prognostic factors associated with success of the procedure were tubal length and type of anastomosis. It is difficult to compare ART with tubal surgery since the probability of an IVF pregnancy is limited by the number of cycles performed. ART is a “palliative” technique whereas tubal surgery is curative. It allows women to conceive naturally, and is therefore an option for couples with ethical and religious concerns. More than one pregnancy is also possible with tubal surgery. ART is much costlier than tubal surgery and many patients cannot afford this treatment.  Risks of tubal surgery are very low. Although ART is an outpatient procedure , there is a risk of ovarian hyperstimulation and multiple pregnancy. ART is  psychologically very stressful treatment and many discontinue after first attempt. Health of children conceived after ART is another major concern now. Tubal anastomosis should not be considered when final tubal length  is less than 4 cm,there are significant tubo-ovarian adhesions or stage 3-4 endometriosis, and /or more than mild male factor.

 To conclude, Tubal anastomosis for reversal of sterilization  has significantly higher cumulative pregnancy rate than ART, and it is more cost efficient, even in women 40 years of age or older.