Although in most cases ovarian cysts are nothing to be concerned about, occasionally they can cause pain, and in rare instances they can be cancerous.  Non cancerous cysts occur as a result of normal process or a minor abnormality that can clear up on its own.  In those circumstances Dr. Morice may recommend that you follow up in a month or two to see if the cyst has resolved on its own.  In certain circumstances Dr. Morice might recommend further imaging, medications,  or even surgery to better understand what is causing the cyst.

Because there are many different types of cysts, Dr. Morice may want to get a better understanding of what is causing yours, particularly if you are undergoing a tubal ligation reversal.  Identification can be done with an ultrasound before the tubal reversal is performed just to make sure that there isn’t anything more concerning occurring prior to your surgery.

The 5 most common types of ovarian cysts are:

-          Functional cysts

-          Endometrial cysts

-          Cystadenomas

-          Dermoid cysts

-          Polycystic ovaries

Functional cysts are the most common among young women who are cycling normally, regardless of wether they have had a tubal ligation reversal. These cysts are a normal process of menstruation and usually clear up on their own without you or Dr. Morice ever even knowing about them. There are 2 types of functional ovarian cysts. The first comes from the Graafian follicle (or sac) where the egg develops every month. It is the most common and occurs if the sac fails to break open and release its egg.  The second type of functional cyst is a simple fluid filled cyst.  Both types typically resolve on their own in one to three months.

Another remnant from the monthly cycle is a corpus luteum cyst. After the egg is released, this portion of the ovary usually disintegrates. However, if the woman becomes pregnant, for example after a tubal ligation reversal, sometimes this cyst can form if the sac seals off. This ‘sealing’ of the cyst wall results in a buildup of fluid.  Again these cysts normally resolve in a few weeks with most women remaining unaware that they’re even there. The likelihood of getting an ovarian cyst is not increased at all by a tubal reversal.

Occasionally the cysts can become enlarged and rupture. This may cause a little bit of bleeding and pain. Sometimes the blood will collect inside of the cyst itself, and this is called a hemorrhagic cyst. Although a hemorrhagic cyst can be quite painful, it is also a benign condition that can be safely watched without intervention and without concern for an underlying cancer.  As always, if you have concerns about pelvic pain or your risk for ovarian cancer you should discuss these concerns with Dr. Morice.

These tests are needed to assess the preoperative condition of the patient.  These blood analysis are compulsory prior to your tubal ligation reversal.  They can be prearranged by your regular gyneclogist, or can be done at your local laboratory facility (DR. MORICE WILL FAX AN ORDER TO YOUR LOCAL FACILITY):

1. Complete blood count (CBC)
2. Urinalysis
3. Possibly hormonal studies
4. Possibly a semen analysis

Preoperative lab results must be done within 7 days of the surgery date. In the case of abnormal test results, possibly indicative of some medical problems, the surgery will be postponed.

Additional preoperative tests may be needed according to an individual’s prior medical history, such as:

1.       Cycle day 3 FSH – done for women 40 and older. This will assess ovarian function and quality of reserve of eggs.  The “egg quality testing” for patients will ensure their chances if are still good for conceiving after the tubal reversal.

1. Semen analysis for male partner is sometimes ordered.  A semen analysis should be performed prior to your tubal ligation reversal. Although artificial insemination is inexpensive and effortless, you need to know if it will be necessary before you undergo tubal reversal surgery.
2. Urinalysis.
3. Testing of the uterus to ensure there are no problems which would hamper with pregnancy as fibroids or other uterine abnormalities.
4. A baseline mammogram – pregnancy after a tubal ligation reversal complicates treatment for breast cancer and visa versa.
5. AIDS testing if having likelihood.

If egg quality is impaired, then IVF may be the best option rather than tubal reversal.

Which method is better for regaining fertility?

Whether or not IVF or tubal reversal is better must be based on individual factors and workup.

IVF is a nonconventional method and involves the daily administration of fertility injections.  The patient’s response is checked over a 2-4 week period, together with frequent visits for further management.  At the appropriate time, the eggs are harvested from the woman by placing a needle through the vagina and into the ovary.  This procedure drains follicular fluid from the ovaries.  On the day of egg salvage, the husband’s sperm is combined with the patient’s eggs and the embryos are produced.  The succession of the fertilized eggs (now an embryo) is monitored over a phase of several days.  The embryos are transferred back into the patient’s uterine cavity by insertion of a small tube through the cervix and into the uterus.

Some reasons making IVF a less desirable choice than Tubal Reversal include:

• In general, one to four embryos are transferred, depending on the patient’s age.  The success rate of pregnancy is quite variable and may lead to multiple attempts. When couples are unproductive, they must want the process again, which is costly
• IVF has a much greater risk for multiple gestations than Tubal Reversal
• Some couples may not have the time nor wish to make multiple visits to the clinic, which are obligatory for IVF, and nt for Tubal Reversal
• Many of the steps for IVF are uncomfortable. Many people must convince themselves that the procedure may work ‘this time,’ unlike Tubal Reversal which involves just one procedure
• Risks of over-stimulating the ovaries are much greater than for Tubal Reversal, and can be very serious (Ovarian Hyperstimulation Syndrome – OHSS).

Tubal reversal is preferable for people who want to conceive naturally with a conventional procedure.

What are the disadvantages of having a Tubal Reversal rather than IVF?

• Tubal Reversal allows the possibility to conceive more pregnancies. This is a disadvantage for those who just want to have single child . This requires future contraception.
• Any pregnancy after Tubal Reversal needs to be monitored early due to an increased risk for ectopic pregnancy

Success rate comparison between IVF and Tubal Reversal:

• It is found 20-35% success rate via IVF.
• It is found 66% pregnancy rate over time via tubal reversal.

IVF is the best option for patients for whom tubal reversal is not possible, or in patients who are poor candidates for a tubal reversal. Many patients will have additional infertility factors presence, such as diminished ovarian reserve (can be evidenced by a rising follicle stimulating hormone (FSH) value), blocked fallopian tubes, advanced age, other medical conditions, or severe sperm abnormalities that make tubal reversal a less optimal procedure that IVF. Additionally, some tubal ligations remove too much of the fallopian tube to reanastomosis, and therefore a tubal reversal is less likely to be successful.

When does the ectopic rate after tubal reversal enter in critical risk zone?

There is no set age limit for the risk of an ectopic pregnancy after tubal reversal, but some empirical data suggests that women above 40 have a higher risk in general with tubal reversal, and likewise with ectopic pregnancy after a reanastomosis. The risk of an ectopic pregnancy among the general population is about 1 in 100 and this risk increases to about 5 in 100 after undergoing a tubal reversal.

There is some optimistic analysis of the fertility results observed as well. Although it was demonstrated that age is the most significant predictive factor, for women who had undergone a microsurgical tubal anastomosis procedure (tubal reversal) at age 40 years or older, the reproductive outcomes of the microsurgical tubal anastomosis patients demonstrated a tubal reversal was a justifiable alternative to IVF, even when considering an ectopic pregnancy rate of 2.4 percent.

Managing ectopic pregnancy after tubal reversal

It is important that women are aware about the risk of ectopic pregnancy prior the tubal reversal.  Early diagnosis is needed once a positive pregnancy test is obtained.  If the blood pregnancy test (HCG level) is 1,500 or greater, the contents of the uterus should be seen with a vaginal ultrasound exam. Early diagnosis at this stage is important.  If it is diagnosed that you have an ectopic pregnancy, one or two doses of a prescribed medicine will absorb the ectopic.  Note that time is most important thing, and there are limits to the use of medicine in treating ectopic pregnancy. If the ectopic pregnancy is too far along, the only option may be surgery, and in this case it is extremely important to have a skilled minimally invasive surgeon such as Dr. Morice perform the procedure so that when removing the ectopic pregnancy the fallopian tube suffers minimal damage.

Patients need to be more aware of the fertile possibilities of tubal reversal before going for a tubal reversal.  The factors that go into whether a tubal reversal is right for you are:

1. Age:  Better if you are less than 40.  Analysis of the fertility results demonstrated that age was the most significant predictive factor.  This directly links to ovulation. Decide about a tubal reversal at the right time.  There is a sharp turn down in fertility that starts to occur approximately at the age of 36 in women.  Even so, the chances of pregnancy stay good until women reaches 40.  If a woman is beyond the age of 43, the chances of producing eggs in good health can be much lower.

1. Type of ligation: As there are many types and methods of performing bilateral tubal ligation (ie by rings, clips, fulguration, Parkland, Pomeroy, Falope ring, coagulation, and Irving), the damage to the tubes may differ from one patient to another. If the tubal ligation is performed without excessive damage to the tubes, nearly all types of tubal ligations can be reversed with a tubal reversal procedure. To ensure patency, after tubal reversal a colored dye is used to examine the patency of the fallopian tubes.

1. Blockage site on the tube.  HysteroSalpigoGram (HSG) is the test that allows Dr. Morice to better evaluate the blockage site on the tubes in the prospective patient for tubal reversal, and to get a better idea of how much proximal tubal length is available for a tubal reversal or reanastomosis.   If the ligation method caused excessive scar tissue on the blockage site, this could minimize the potential of fertility later.  The amount of healthy tube remaining is extremely important when considering a tubal reversal to regain fertility.

1. Hormone levels:  Checking the hormone levels is an excellent indicator of fertility and must be considered for all patients over the age of 30 before a tubal reversal.  This includes a day 2-4 FSH level and estradiol level.

1. Normal uterus: All patients undergoing a tubal reversal should have an ultrasound report prior to the procedure. Dr. Morice performs this as part of the routine work-up and this is included in the price of the tubal reversal procedure.

1. Some other factors:  There are other factors that provide good predictive value for success with tubal reversal. These include your general health, obstetrical history, partner’s health, social habits such as smoking and drinking, and frequency of intercourse.

After tubal reversal surgery, you will become very eager to start planning your pregnancy. You will dream of holding your cute new baby in your arms. You will start planning to welcome the new member of the family. This is very natural.

After tubal reversal, there are some points to keep in mind. When women get the good news that they are pregnant, they must take good care of themselves, and even some extra care as compared to the normal pregnancy. They must also track their cycle carefully as the chance of a tubal pregnancy or a miscarriage can occur. An early appointment with their physician is very important for tubal reversal patients.

After tubal reversal, if pregnancy is not achieved after a few months, don’t get too upset or worried. In the practical study of patients, pregnancy can occur on average from 6 months to a year. These results are related to the fertility of both parents.

After tubal reversal, some patients are interested in making sure that the reversal has not healed incorrectly and that their tubes are still open. A HysteroSalpingoGram (HSG) is a good method of evaluating the success of a tubal reversal. HSG should be done by an experienced doctor.

Dr. Morice and his team provide the excellent surgical care that maximizes the chances of a successful tubal reversal. Dr. Morice is an experienced expert in performing tubal reversal surgery with Microsurgical Tubal Reanastomosis (MTR) techniques.

After tubal reversal, patients are discharged home within the same day of surgery. Tubal reversal surgery is an outpatient procedure. After tubal reversal, patients may experience some bleeding from the vagina due to the tubal reversal procedure. Patients may also have minor abdominal swelling and feel shoulder pain, backache, or muscular pain. Patients can take showers after 24 hours after tubal reversal, and baths one week after tubal reversal.

Most patients are also able to return to work one week after tubal reversal surgery. Patients can have intercourse two weeks after tubal reversal surgery, and then return to all other activities.

Doctors also advise patients to take pre-natal vitamins, engage in as exercise regimen, and to stop smoking before tubal reversal surgery. This not only prepares patient and her partner physically, but also emotionally. Having tubal reversal surgery and a new pregnancy and baby is both very demanding and challenging.

Tubal Reversal is a process for those women who would like to restore their fertility in order to have more babies. This surgery, also known as tubal ligation reversal, microsurgical tubal reanastomosis, and sterilization reversal, is done by opening the previously blocked fallopian tube so that the egg can be fertilized by the sperm. It is a very safe procedure.

For tubal reversal surgery, different techniques are used in comparison to conventional surgery. Microsurgical reanastomosis (tubal reversal) involves the use of very delicate suturing and high magnification. All of these methods are used just to open the fallopian tube between the uterus and ovary.

Tubal reversal has been successful for over 30 years, and continues to be the best way to achieve pregnancy after tubal ligation. The whole tubal reversal procedure takes less than 2 hours. After a tubal reversal, pregnancy is possible simply by having sex, and does not require in vitro fertilization (IVF).