Sterilization Reversal

Reversing a sterilization operation in a woman has always been difficult and the chances of success have been small. But microsurgery may have far-reaching effects on the procedure.

American surgeons, among world leaders in the field of microsurgery, have successfully reversed sterilization operations in two women who subsequently became pregnant.

One woman has given birth to a healthy girl, born 6 weeks prematurely, and the other is due to be confined soon.

The second woman’s reversal operation was a remarkable step forward because her sterilization operation had been by diathermy – heat generated by an electric current.

The striking success of these two cases indicates that there are very real new possibilities for women who have undergone sterilization or are still thinking about it.

Indeed, it represents a major step forward in the nation’s family planning concept. It is already considered by many doctors to be the most significant development since the Pill.

In recent years, more and more women have turned away from the Pill and other methods of contraception and have undergone permanent sterilization operations.

Why should this be so? The contraceptive pill, after all, has enjoyed phenomenal popularity.

In Australia, at least 1.6 million women take this form of contraception regularly. Two and a half million are claimed to use the Pill in Britain and worldwide the figure is in countless millions.

It is according to the British medical magazine Lancet, the most widely used method of contraception, both for the prevention of pregnancy and the spacing of births. And more American women seem to use it than most other nationalities.

However, with a number of side effects from the use of the Pill being constantly reported in the medical press, many women and doctors are taking a hard second look at this method of contraception.

If a woman has had all the family she wishes by the age of 23 or 24, then she could be facing the prospect of taking the Pill continuously for the next 25 years or so. And if side effects are already present, that’s quite a worrying thought.

Side effects can include a reduced enjoyment of sex, headaches, weight increase, facial pimples, and bouts of depression. And so many married couples look for a better way of contraception.

But the “better way” is pretty limited. It inevitably means the use of one or other of a range of contraceptive devices.

This is the background to the increased popularity of the permanent sterilization operation.

In the operation, the Fallopian tube (the channel which connects the ovaries with the womb) is sealed off to prevent conception.

The male equivalent – vasectomy – is slowly gaining popularity, but is far from being generally accepted.

Attention has tended to be concentrated on methods of sterilization for women, and over the past few years, more and more American women have undergone a relative form of this – the laparoscopic technique.

Before this, the operation involved making a large incision low down in the pelvis. Under direct vision, the surgeon actually tied the tube on each side.

But then came the advent of the laparoscope. This is an instrument which consists of a hollow tube and has magnifying lenses and lights at one end. It is inserted into the pelvis through only a very small incision.

Through it, the surgeon can gain an incredibly clear “fish-eye” view. Using special forceps, introduced into the pelvis through another tiny incision, he can grasp the tube. When a special current is turned on the tube is “diathermied” or sealed off.

From that moment the patient is sterile. She is in hospital for no more than about a day, has minimum side effects, and may return to an active life within a few days. Cost is low, hospital time cut to a minimum. It is a very satisfactory procedure and more and more gynecologists are becoming experts in performing it.

But while sterilization operations become easier, the difficulty arises in attempting to reverse what was supposed to be a permanent procedure.

When many younger women choose permanent sterilization, it’s obviously because they think they will never want another child. Then, for some reason – perhaps because they remarry and want to have a child with their new husband – they want the operation reversed.

Until now, the procedures available have been fairly major operations that attempted to restore potency either by rejoining the ends of the tube (very difficult because of the accuracy needed) or by implanting the tube back into the uterus, beyond the point of occlusion.

It is a hazardous operation. In fact, in 1973 a wide survey was carried out in Britain to find out how many reversal operations were being attempted and how many were successful. The surveyors questioned 350 gynecologists and learned that only 42 women had regained potency of their tubes.

However, when it came down to how many operations had resulted in a successful pregnancy, the statistics were anything but heartening. A large number of “ectopic” pregnancies had occurred. This means that the egg from the ovaries had not reached the womb, but had fertilized in the Fallopian tube itself.

This spells potential disaster. The tube almost inevitably ruptures, perhaps causing heavy hemorrhage and a surgical emergency.

There were other pregnancies that aborted spontaneously.

The success rate was poor. Of the few women who actually regained potency, 20 percent had ectopic pregnancies, 15 percent aborted spontaneously and 65 percent had full-term pregnancies.

One large group of operations carried out by gynecologist G. F. Williams consisted of 16 cases. The women underwent tubal surgery. After 18 months he reported only four full-term pregnancies and two abortions.

Others have reported higher success rates. But many reports have shown dismally poor results. Indeed, some conservative gynecologists believe that the success rate of around 30 percent is most likely.

This is why the new microsurgical techniques are seen to be so important.

In recent years, there has been a major surge forward of microsurgery. Australia is up with the world leaders in this new field. Indeed, it is now commonplace to read of fingers, toes, hands, arms, and legs that have been severed during accidents being successfully replanted on to the patient.

Several specialist surgeons in Sydney and Melbourne have an enviable record of success. Indeed, so advanced is Australia that on several occasions local surgeons have visited other countries to lecture on current techniques. Their work is frequently reported in the overseas medical journals, including such prestigious ones as the Journal of the American Medical Association.

Inevitably, the application of micro-surgery in other fields became a possibility. And why not to reverse sterilization?

The Medical Journal of Australia put forward the idea that it was only a matter of time before microsurgeons moved into the field of obstetrics.

Their new techniques seemed ideally suited to the difficulties of repairing the Fallopian tube that had been sealed off.

It has taken another four years for the idea to become a reality, but now, successfully tested and proven in Sydney, it gives rise to a totally new concept.

Instead of relying on ordinary vision when joining the tubes, the surgeon uses special operating microscopes. This allows a vastly enlarged vision of the problem and also of each step he takes during the operation.

Special fine instruments, miniature needles, and thread must be used. All this allows very accurate placing of the stitches, and fine precautions are possible which, to the naked eye, are totally impossible.

This method more or less guarantees a much neater join of the cut ends. In turn, this should greatly reduce the risk of “ectopic” pregnancies.

The success rate must escalate. As the surgeons carry out more and more of these operations and become more dexterous, then results will similarly improve.

A steady hand is essential and a special temperament is often needed for the work is extremely delicate, time-consuming, and detailed.

However, the success of the cases treated to date is proof positive that the technique is a suitable one. Time, more experience, and continuing practice by the surgical gynecologists are the ingredients that should make a continuing success story.

Microsurgery will become more common. Applied to sterilization reversal it is another major step forward in giving women a fuller measure of control over their wishes.

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