| Summary: | Objective: Between 20% and 30% of women who have undergone tubal ligation regret their decision. The
alternative to regain fertility for these women is either in vitro fertilization or tubal re-anastomosis. This article
presents a systematic review with meta-analysis to assess the current evidence on the efficacy of tubal recanalization surgery in patients who have previously undergone tubal ligation.
Study design: The search was conducted in the World of Science (WOS) database, The Cochrane Library and
ClinicalTrials.gov record using the keywords “tubal reversal”, “tubal reanastomosis” and “tubal anastomosis”.
The review was carried out by two of the authors. Data from 22 studies were evaluated, comprising over 14,113
patients who underwent the studied surgery, following strict inclusion criteria: articles published between
January 2012 and June 2022, in English and with a sample size bigger than 10 patients were included. A
random-effects meta-analysis was performed.
Results: The overall pregnancy rate after anastomosis was found to be 65.3 % (95 % CI: 61.0–69.6). The percentage of women who had at least one live birth, known as the birth rate, was 42.6 % (95 % CI: 34.9–51.4).
Adverse outcomes after surgery were also examined: the observed abortion rate among women who underwent
surgery was 9.4 % (95 % CI: 7.0–11.7), and the overall ectopic pregnancy rate was 6.8 % (95 % CI: 4.6–9.0). No
differences were found between the outcomes when differentiating surgical approaches: laparotomy, laparoscopy, or robotic-assisted surgery. The patient’s age was identified as the most significant determining factor for
fertility restoration. Finally, when comparing the results of tubal reversal with in vitro fertilization, reversal
procedures appear more favorable for patients over 35 years old, while the results are similar for patients under
35 years old, but more data is needed to evaluate this finding.
Conclusion: Therefore, the available literature review demonstrates that surgical anastomosis following tubal
ligation is a reproducible technique with relevant success rates, performed by multiple expert groups worldwide.
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