About a third of female infertility is caused by tubal factors and endometriosis. In some cases the tubal problem is caused by pelvic inflammatory disease, previous ectopic pregnancy, obliterative fibrosis, tubal polyps, fibroids, salpingitis isthmica nodosa , fimbrial agglutination or adhesions and hydrosalpinx. However the most common reason for tubal infertility is previous tubal ligation for sterilization. This could be at the proximal (close to the uterus), midsegment (mid-portion) or distal ( the last third) of the tubes.
Tubal reversal is accomplished by tuboplasty. Tuboplasty with the use of operating microscope, loupes results in improved and precise reapproximation and reanastomosis of the tubal portions that are undamaged. Microsurgical reanastomosis has been successful in most cases with resulting restoration of fertility in our experience.
In cases where the tubal occlusion is at the tubocornual segment (the portion of the tube closest to the uterus), microsurgical tubocornual reanastomosis is done. At the midportion tubal isthmic-isthmic reanastomosis is done with the greatest success rate. Tubal isthmic-ampullary reanastomosis, neosalpingostomy and fimbrioplasty are performed for more distant tubal occlusion or obstruction cases.