Mr Clive Pickles has undertaken many successful reversal of sterilisation procedures privately at The BMI Park Hospital, Nottingham. Here, he discusses the process and procedures. It is estimated that approximately 10,000 female sterilisation operations are performed every year by the NHS, with many more being performed privately. While the numbers are steadily falling since the advent of LARC (long acting reversible contraceptives), this still represents a large number of women who have decided to rely on sterilisation as their chosen method of longterm contraception. While the vast majority of women remain happy with their decision to be sterilised, a proportion will regret it. It is thought that about 13-25% of women regret their decision over time with the following being the main risk categories: change of marital status; young age at the time of the sterilisation (less than 30); marital problems at the time of the procedure; stress due to recent pregnancy complications; being sterilised at the time of caesarean section or immediately after delivery. However, only 0.2% of women decide to go ahead with a reversal procedure. This very small number is often due to non availability on the NHS, lack of information about tubal reversal, perceived cost of the procedure, absence of insurance coverage, advice that their only treatment option is In Vitro Fertilisation (IVF) or even that the tubal ligation operation cannot be reversed.
The procedure Carried out under a general anaesthetic, reversal of sterilisation can take up to an hour and a half to perform. A small bikini-line incision is made and the tubes are opened, then brought together over a nylon splint. This is joined by very fine stitches (pictured, right). It is a delicate procedure performed under magnification and is best done by a surgeon who has much experience and has undertaken many successful procedures. No operation is without risk, but these are few and infrequent and will be discussed prior to the reversal procedure being performed.
The results The success of this procedure is dependent upon many factors: percentage of patients who achieve open tubes, percentage of patients who get pregnant or most importantly the percentage of patients who have a live birth. Surgeons who perform reversal procedures should accumulate their results so that audited figures can be published (www.femalesterilizationreversal.co.uk/mr-pickles-female-reversal-of-sterilisation-success-rates). The main factors which determine potential success are: age at the time of the reversal (younger the better), type of sterilisation (clips most successful), remaining length of tube after the reversal (longer the better) and previous gynaecological history. Mr Clive Pickles MB ChB, consultant gynaecologist, BMI Park Hospital, Sherwood Lodge Drive, Burnt Stump Country Park, Arnold, Nottinghamshire NG5 8RX. Appointments by arrangement via his secretary (Mandy Banbury) on 0115 906 3079 or email firstname.lastname@example.org. Further information is available at www.femalesterilizationreversal.co.uk
Published Summer 2013