REVERSAL OF TUBAL LIGATION (RECANALIZATION) AND PRE-CONCEPTION COUNSELING
Recanalization of the Fallopian Tubes:
It is necessary to perform a gynecological examination before undergoing this procedure.
This procedure is called tubal recanalization, which takes its name from its purpose of re-channeling or reconnecting the internal surface of the uterine tubes to allow the sperm to reach the egg after a sexual intercourse, since fertilization occurs in any of the two Fallopian tubes, and is then implanted in the inner part of the uterus.
If recanalization is the option, women must undergo a specialized gynecological examination. A pap smear and a transvaginal ultrasound are performed to make sure that there are no diseases that could lower pregnancy feasibility, for example, the presence of fibroids.
However, if she has a new partner, a spermiogram may be requested to rule out her partner’s infertility, since it would not make sense subjecting her to an invasive surgery if her partner has no fertilization potential.
WHAT IS THE REVERSAL OF TUBAL LIGATION AND HOW IS IT DONE?
Ligation of the Fallopian tubes is not permanent.
The ligation or cutting of the Fallopian tubes is considered to be a permanent method of birth control and many women think that this is an irreversible method, but in many cases the ligation or cutting of the Fallopian tubes is reversible.
Once the tubal ligation is reversed, conception can occur naturally, without resorting to assisted reproduction, as it happened before.
This procedure is now being increasingly requested, Many couples who undergo a surgery to avoid having more children change their mind after 4 or 5 years and they wish to have another baby.
These demands have encouraged us to refine the surgical techniques and these procedures are currently performed with a high level of success. This is a minimally invasive procedure, recovery is fast and it has shown a high rate of success.
HOW IS IT PERFORMED?
Patients receive treatment from the physician specialist. An evaluation of the patient's general health is done, a transvaginal pelvic ultrasound is performed to examine the uterus, ovaries and the pelvis condition. It is then supplemented with pre-operative laboratory tests, the surgery is then scheduled and the patient is examined by the anesthesiologist.
WHO ARE ELIGIBLE FEMALE PATIENTS AND UP TO WHAT AGE ARE THEY ELIGIBLE?
Many women regret their decision tubal ligation for various reasons , usually for new ratio ( Remarriage ) or simply by the desire of a new baby at home made.
The first thing you should do is evaluate the couple goes with a complete medical history.
HOW LONG DOES THE RECOVERY TAKE?
The procedure is PAINLESS.
Precise indications about the necessary medications are given to the patient at discharge.
There is no need for stitches removal since an invisible suture is done with absorbable suture.
Recovery is very fast and patients can return to their normal activities in a period of 3 to 7 days.
CHANCES OF SUCCESS
The success rate is determined in terms of cumulative success rates after a year of attempting to achieve pregnancy following to the tubal ligation reversal. Approximately 60% of patients become pregnant after the first 12 months of trying to achieve pregnancy, while the pregnancy cumulative rates often exceed 70% after two-year attempts. Although it is difficult to predict how soon pregnancy will occur after the tubal ligation reversal, most pregnancies usually happen during the first six months after the procedure.
The risks of this surgery are minimal; the percentage of post-operative complications is lower than 0.1%. The range for the tubes to be reconnected is higher than 85%. Therefore, two out of three patients achieve pregnancy during the first 12 months after surgery.
WHAT IS THE PURPOSE OF THE PRE-CONCEPTION VISIT?
The main purpose of the pre-conception visit is to promote women and their descendants' health. If the family is planning to have a baby, there is a special predisposition to make healthy behavior changes. This will result from the study of the best source of information, a thorough medical history which includes the assessment of the demographic traits (environment where the couple lives), previous gestational history, and family history, history of chronic diseases and infections and medication used for their treatment, as well as psycho-social factors and life styles.
WHY IS IMPORTANT TO UNDERGO A PHYSICAL EXAMINATIO BEFORE ACHIEVING PREGNANCY?
This examination allows ensuring that the couple is as healthy as possible before conceiving a baby. The doctor may identify, and often treat, health disorders which could pose a risk during pregnancy, such as diabetes, asthma, inflammatory bowel disease, depression, rheumatoid arthritis, heart, kidney, thyroid diseases or thromboembolic phenomena, high blood pressure, hepatitis B virus infection, HIV/AIDS infection, among others.
HOW IS THE PHYSICAL EXAMINATION DURING THE PRECONCEPTION VISIT DONE?
The physical examination done during this visit evaluates the blood pressure, weight, height, pulse, thyroid examination, heart examination, examination of the respiratory tract, breast examination, pelvic and spine examination to detect leg-length differences and scoliosis that might affect gestation and the delivery process. Both the physical examination and lab tests will lead to actions based on the results: rubella vaccine prior to gestation, hepatitis vaccine if under risk factors, habits change if there is negative toxoplasma, etc.
WHAT INSTRUCTIONS DOES THE DOCTOR USUALLY GIVE DURING THIS VISIT?
The doctor may provide information about factors related to life style, such as the diet and the need to reach a healthy weight, avoid smoking or drinking alcohol, and about occupational conditions that might pose a risk for pregnancy. Likewise, the doctor may ensure that the woman's vaccinations are up-to-date and that medications she is currently taking are safe during pregnancy.
HOW SOON SHOULD I START TAKING FOLIC ACID?
Acid folic is a vitamin found in some fortified foods. If the woman has enough folic acid in her body before becoming pregnant, this vitamin can prevent birth defects in the baby's brain and spine. The spina bifida, a birth defect of the spine, can cause paralysis in the lower part of the body, lack of bowel and bladder control, and learning difficulties. Folic acid can prevent up to 70% of some severe birth defects. However to be effective, women need to take folic acid for at least one month before they become pregnant and during the first weeks when the baby is developing. The doctor will prescribe this vitamin during the pre-conception visit.
INFORMATION ABOUT HEALTHY HABITS PRIOR TO PREGNANCY
There are several educational and health promoting actions carried out during the pre-conception visits, in order to provide useful information to pregnant women about the pros and cons of some habits and situations that will help them to reach better results during pregnancy and to avoid potential risks. In this sense, family doctors and gynecologists' work is very important at the time of providing information about healthy habits prior to pregnancy.
For instance, it is striking to observe, even in the Internet age when having access to information is so simple and fast, how many women are still not aware of the risks of becoming pregnant at a late age. Women are informed during these pre-conception visits that delayed motherhood beyond the 35 years of age may be associated to infertility problems and gestational diseases such as impaired fetal growth, gestational diabetes or preeclampsia.
It is also the physician's obligation to advice future mothers for smoking cessation or at least to reduce its consumption as much as possible, since tobacco is clearly associated with the risk for miscarriage, prematurity and low weight at birth.
The same happens with alcohol, as problems caused by its consumption range from growth retardation to the severe fetal alcohol syndrome. There are studies which observe that more than half of all women of childbearing age and who do not use a contraceptive method (thus at risk of pregnancy) drink alcohol.
Obesity is another problem that is increasing with each year. It would be ideal for a woman to have a proper BMI at gestation since obesity is associated with subfertility, gestational diabetes and increase of operative and cesarean delivery. Therefore, a balanced diet and regular exercising must be promoted.
In terms of drinking caffeine, it has been associated with some adverse effect during pregnancy, but studies are not very conclusive and results are not clear, what is wise to recommend is to limit its intake to a maximum of 200 mg. per day.
Hygienic-dietary habits to be followed are some of the most concerning issues for women who wish to become pregnant and, of course, for those who are already pregnant. For this reason, it is one of the most frequently asked issues during the pre-conception, general medicine and gynecological visits. In this sense, toxoplasmosis, a zoonotic disease that results from toxoplasma gondii and that can cause serious complications if infected during pregnancy. Although the infection is extremely rare during gestation, it is one of the biggest headaches of pregnant women.
During this visit, the patient is explained about how to prevent toxoplasmosis: avoiding contact with cats, bearing in mind that if the cat is negative for toxoplasma there is no risk for the disease to be transmitted. In general, these are the cats that never go out, since they do not hunt any bird or rodents or they do not enter into contact with meat or infected stool. For this reason, in case of domestic cats, there is no need to take any further action. If in doubt, a blood test can be done by your veterinarian. Also, you must thoroughly wash vegetables, eat well-cooked meat, wash your hands thoroughly after handling food or wear gloves when gardening.
Although fairly rare, listeriosis is another infection that could affect pregnancy, sometimes seriously. It can be avoided by eating cured cheese and use pasteurized milk for foods with milk content.
VACCINATIONS BEFORE PREGNANCY
It is important to determine that the patient has been vaccinated against rubella. Although most women are currently vaccinated against it, and in case rubella is detected negative, the vaccination is undoubtedly prescribed. The patient must be informed during the visit about avoiding pregnancy during the three months following the vaccination.
Pregnant women are also a risk group in case of getting the flu, since due to the characteristics of immunity, during pregnancy the flu may be more severe and for this reason the vaccination is recommended.
Vaccination against hepatitis B is another recommendation given to women who want to become pregnant.
In terms of vaccinations, if you are planning to become pregnant try to avoid travelling to zones with endemic illnesses like malaria or cholera. Otherwise, you should be properly vaccinated prior to travelling to these zones.