This is a treatment for a cause of infertility, which in many cases is more successful than IVF. The major improvement in tubal surgery was the use of the microscope and very fine instruments. Unfortunately, microsurgery requires particular specialist skill from the surgeon and few doctors are trained in it. Successful microsurgical repair of the tubes allows a patient to become pregnant after natural intercourse.

The main microsurgical procedures are:

• Division or removal of tubal adhesions. Known as an adhesiolysis when it is used to remove adhesions around the ovaries or uterus, and as a salpingolysis when the fallopian tubes are involved. There is 40 to 60 percent chance of successful pregnancy afterwards.
• Opening the ovarian end of the tubes Blockage of the fallopian tubes near the ovary causes the tube swells up with fluid causing a hydrosalpinx. The operation to open this end of the tube is called ‘salpingostomy’. A large or scarred hydrosalpinx is unlikely to respond to surgery so best to proceed straight to IVF. Successful salpingostomy can result in up to 35 percent of patients conceiving naturally.
• Blocked tubes near the uterus Microsurgery can be used to remove the blocked or damaged area where the fallopian tube joins the uterus (cornu), then stitch the healthy tube together (cornual anastomosis). Between 45 and 65 percent of the women who have this operation can have a live baby afterwards.
• Reversal of sterilisation Women who have been sterilised can usually have their tubes repaired by microsurgery. The chance of a live birth afterwards is between 65 and 95 percent, depending on how the original sterilisation was done.

Microsurgery can be done with so little tissue damage that patients often recover very quickly. They are normally in the hospital for three to four days. The worst discomfort is usually in the first two days caused by the swelling of the abdomen with wind. After seven days, stitches can be removed. It usually takes at least five or six weeks to recover completely. There is no harm in having sex as soon as both partners feel up to it, but for the first two weeks avoid heavy lifting or vigorous exercise. Although the tubes themselves cannot be damaged, over-exertion will delay the healing of the wound.

Regular attendance at the clinic is essential at least every three months until a pregnancy or a decision to try alternative treatments. As soon as a woman thinks she is pregnant, she should let her specialist know as any previous tubal damage slightly increases the chance of ectopic pregnancy.

In some cases, it is worth assessing the fallopian tubes laparoscopically six months to one year after the surgery to ensure they are still open and that there are no adhesions. Women who decide on tubal surgery must understand that often it is not an instant solution. It is as well to remember that following any fertility surgery the chance of conception each month is never more than ten percent, compared to the normal chance of 15 to 20 percent in those who never had any tubal damage or pelvic scar tissue. Nearly all women who have had tubal damage of any kind have some ovarian damage. Those who have considerable tubal damage, even after microsurgery, will have a reduced chance of a pregnancy.

Professor Winston discusses various treatments for infertility treatment, including tubal microsurgery, in the video below.

Despite countless breakthroughs in medical science, we still do not understand why some pregnancies will end in tragedy. For most of us, having a child of our own is the most fulfilling experience of our lives. All of us can imagine the desperation and sadness of parents who lose a baby, and the life-shattering impact that a disabled or seriously ill child has on a family.

Professor Robert Winston’s Genesis Research Trust raises money for the largest UK-based collection of scientists and clinicians who are researching the causes and cures for conditions that affect the health of women and babies.

Essential Parent is proud to support their wonderful work. You can learn more about them here.