Refertilization in Women

Refertilization in women is the restoration of fertility (fertility) after sterilization. In addition, refertilization is performed in cases of damage to the tubes (fallopian tubes) due to, for example, adnexitis (inflammation of the fallopian tubes) or adhesions (adhesions), for example, after abdominal surgery. Female sterilization is usually performed as a so-called tubal sterilization. In this procedure, the tubes (fallopian tubes) are electrocoagulated (cooked by heating) during a laparoscopic procedure. Since the tubes have to be reanastomosed (joined together) during the refertilization, the sterilization procedure is nowadays performed with foresight. This means that the cutting should be done in the area of the tubal isthmus (constriction in the middle third of the fallopian tube) and the so-called fimbrial funnel (end of the fallopian tube, which is located at the ovary and catches the egg after ovulation) should be preserved. In addition, the remaining tube length should be more than four centimeters. The procedure competes with in vitro fertilization (IVF, insertion of a fertilized egg into the woman’s uterus). However, refertilization surgery is preferred because the success rate for tubal infertility (infertility due to the fallopian tubes) is higher than for in vitro fertilization. Pregnancy rates of 50-75% are observed with the microsurgical refertilization described here – also by laparoscopic surgery. The birth rate is 51-54 %. However, the birth rate in the first five years after surgical tubal reconstruction is highly dependent on the age of the patients:

  • Women between the ages of 20 and 39 have a 51% chance.
  • Over 40-year-old women have only a 26% chance.

Possible reasons for refertilization are:

  • Change of partner
  • Psychological reasons
  • Death of the children
  • Improvement of economic conditions

Indications (areas of application)

Before surgery

Before the operation, a spermiogram of the partner is performed. Furthermore, the patient should be informed in detail. In order not to jeopardize wound healing, cigarette consumption and anticoagulant medications (e.g. acetylsalicylic acid/ASS) should be avoided for seven to ten days prior to surgery.

The surgical procedure

The following is a brief overview of the refertilization procedure and possible postoperative complications. The procedure is usually a microsurgical procedure. This can be done abdominally (via abdominal incision), but more commonly a laparoscopy (laparoscopy) is performed. The procedure is performed under general anesthesia. A small incision is made on the abdominal wall through which the surgeon inserts the laparoscope or surgical instruments. First, the severed tubes (fallopian tubes) are visited and detached from the surrounding tissue, and scar tissue is also removed. Then the tubes are sutured layer by layer (mucosa, muscularis, serosa; one suture per organ tissue layer). If adhesions (adhesions) are present in the area of the fibrin funnel, fimbriolysis (dissolution of adhesions at the fibrin funnel) is performed. The success of the operation depends on the condition of the tubes before the operation. If there are inflammatory changes and adhesions, the chances of success are lower.

After surgery

The external skin sutures usually heal in about 7-10 days, and complete healing of the reconnected fallopian tubes takes about 3 weeks. In addition, physically stressful activities should be avoided during this time. Sports activities should not be performed for a total of 4 weeks.

Possible complications

  • Extrauterine pregnancy – The risk of implantation of an egg outside the uterus – for example, as tubargravidity/tubaria (tubal pregnancy), ovariangravidity (pregnancy in the ovary), peritonealgravidity, or abdominalgravidity (abdominal pregnancy) – is increased.
  • Bleeding
  • Inflammations
  • Post-bleeding
  • Scarring lumen obstruction of the fallopian tube – narrowing of the fallopian tube by scar tissue.