title: Effectiveness of bilateral tubotubal anastomosis in a large outpatient population.
abstract: OBJECTIVE
  Is bilateral tubotubal anastomosis a successful treatment in an outpatient patient population?
  
  
  CONCLUSIONS
  For women wanting children after tubal sterilization, bilateral tubotubal anastomosis is an effective outpatient treatment.
  
  
  BACKGROUND
  With the current emphasis in reproductive medicine on high technology procedures, the effectiveness of female surgical sterilization reversal is often overlooked. Previous clinical studies of tubal sterilization reversal have been mostly retrospective analyses of small patient populations.
  
  
  METHODS
  A cohort of women who underwent outpatient bilateral tubotubal anastomosis from January 2000 to June 2013 was followed prospectively until December 2014 to determine the proportions of women undergoing the procedure who became pregnant and who had live births. Data were collected at the time of pregnancy. Differences in pregnancy rates and live birth rates associated with age, race and sterilization method were evaluated.
  
  
  METHODS
  A total of 6692 women, aged 20-51 years, underwent outpatient bilateral tubotubal anastomosis.
  
  
  RESULTS
  The crude overall pregnancy rate was 69%. The crude overall birth rate was 35%. Results varied according to age at sterilization reversal and the method of sterilization. Women under 30 years of age at reversal of ring/clip sterilizations had an 88% pregnancy rate and 62% birth rate. Pregnancy and birth rates declined as age increased at sterilization reversal. Coagulation sterilization reversals resulted in the lowest rates of pregnancies and births. Ligation/resection reversals had intermediate success rates.
  
  
  CONCLUSIONS
  Limitations of our study include probable underreporting of pregnancies based on patient-initiated reports; possible errors in the reporting of pregnancies or early miscarriages that may have been based solely on home pregnancy tests; and probable over-reporting of the diagnosis of ectopic pregnancies. We identified age and sterilization method as being associated with subsequent pregnancy, however, in order to be considered predictive, the associations would need to be validated in an independent second prospectively studied group of representative patients. Finally, we also included patients in the study population who had additional surgical procedures performed at the time of tubotubal anastomosis (e.g. uterine myomectomy, fimbrioplasty, ovarian cystectomy and adhesiolysis), factors that could result in differences in pregnancy statistics in our study versus other patient populations.
  
  
  CONCLUSIONS
  The results of this study can help inform patients and clinicians about this low technology alternative to IVF.
  
  
  BACKGROUND
  None.
  
  
  BACKGROUND
  N/A.
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, 3025 Old Clinic Building, Campus Box 7570, Chapel Hill, NC 27599, USA.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Berger
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, 3025 Old Clinic Building, Campus Box 7570, Chapel Hill, NC 27599, USA john_thorp@med.unc.edu.
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.affiliation: Departments of Medicine and Biostatistics, University of North Carolina at Chapel Hill, 258 Brinkhouse-Bullitt, Campus Box 7064, Chapel Hill, NC 27599, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Weaver
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D015331:Cohort Studies; D005187:Fallopian Tubes / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D018873:Pregnancy Rate; D013243:Sterilization Reversal / Q000379:methods*; D013245:Sterilization, Reproductive / Q000379:methods; D016896:Treatment Outcome
keywords: bilateral tubotubal anastomosis; female surgical sterilization; outpatient; pregnancy; sterilization reversal