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Getting Pregnant After Tubal Reversal Surgery at NCCRM

Pregnancy after tubal reversal: How long before I will be ready to try to conceive?

Click here for discharge instructions after Adiana, Essure and tubal reversal surgery.
Unless your reversal is particularly difficult, you may try as soon as you like. We have patients who have successfully conceived in the same cycle as their tubal reversal surgery.  We will tell you after your reversal if you need to wait before trying and you will be given detailed instructions before you go home.

What do I do if I think I’m pregnant?

Three things need to be done the minute you miss a menstrual period. You need to get one of the urine stick tests. If that is positive, you need to get a quantitative blood pregnancy test [called an HCG test]. The third thing is a vaginal ultrasound to make sure the baby is in the womb.

A primary concern is the risk of ectopic [tubular] pregnancy – it is greater after tubal ligation reversal than if your tubes had never been tied. Ectopic pregnancies can be dangerous, even rarely fatal, but that is not why we are so concerned. If you catch an ectopic pregnancy early, it can be treated with medicine and the tube is saved.

Early detection of an ectopic pregnancy means that it almost always can be treated without surgery. The tests need to be completed in the first week or two after you miss your period. Sometimes our tubal reversal patients forget these things that we tell them about early pregnancy detection and I tell them to call us if that happens.

Getting Pregnant After My Tubal Reversal Surgery

Natural Cycle is exactly what it implies. It uses one’s own cycle in conjunction with timed intercourse, intrauterine insemination or therapeutic donor insemination. One may have intercourse every other day starting on cycle day 11 or choose to use an ovulation detection kit to determine the LH (leutinizing hormone surge) and have intercourse 12 hours after the surge and again in 24 hours after the surge. Ovulation usually occurs 24 to 32 hours after the LH surge.

The first step is to determine when you’re ovulating. Ovulation detection is accomplished with the use of an LH predictor kit. An LH predictor kit detects the increase of luteinizing hormone (LH) in the urine. You can purchase ovulation detection kits at any drug store. Normally 1 – 2 days before the middle of a menstrual cycle, this hormone will have a sudden peak (this is called the LH surge). Usually an egg is then released from the ovary within 24-32 hours after the surge (ovulation). Ovulation predictor kits should be started cycle day 11, testing twice daily approximately 12 hours apart. When an LH surge is detected, intercourse or insemination should occur within 12 to 24 hours after the surge.

If you are not pregnant within a specific amount of time Dr. Toma or Dr. Mulvaney tells you in your consultation, you can then start using Clomid (Clomiphene citrate) or Femera.  These are fertility drugs taken orally for the purpose of inducing ovulation (the release of one or more eggs). It is often a first line of treatment in young women (less than 40 years of age) who fail to ovulate (anovulatory), ovulate irregularly (oligo-ovulatory), and women who ovulate abnormally with associated hormone imbalance (dysovulatory). These medications have never been associated with the development of birth defects in humans.

Clomiphene and Femera are administered for five days during the early menstrual cycle. Some clinicians prescribe the drug from the 5th through the 9th day of the cycle. However, we prefer that the drugs be taken from cycle day 1 through 5 because there is some evidence that the earlier the drug is administered, the more likely it is to promote the development of the optimal number of follicles (fluid-filled spaces in the ovaries that contain the maturing eggs and produce the hormone estrogen) without affecting the lining of the uterus.

Clomiphene acts by blocking the ability of cells in the hypothalamus (a specialized area of the brain which orchestrates the body’s hormonal changes), to detect the amount of estrogen (a hormone produced by the ovarian follicles) in the blood. When the hypothalamus senses a deficiency of estrogen, it responds by releasing messages to the pituitary gland (a small structure suspended by a stalk from the base of the brain, located above the roof of the mouth). The pituitary gland in turn releases superphysiological amounts of FSH. FSH initiates the growth of ovarian follicles.. Estrogen prepares the uterine lining to receive the embryo(s) about six days after ovulation. As soon as estrogen levels rise sufficiently, either in response to clomiphene or in natural cycles, it will initiate a sudden release of luteinizing hormone (LH – also produced by the pituitary gland). LH triggers the ovulation process while at the same time causing maturation of the eggs to be released. When clomiphene is administered, a spontaneous LH surge will usually take place. However, in order to ensure that ovulation actually occurs, we sometimes recommend the administration of human Chorionic Gonadotropin (hCG, a hormone produced during pregnancy which is similar to LH in structure and effect), at the time the follicle(s) have attained optimal growth as indicated by ultrasound examination. Patients who receive clomiphene from cycle day 2 through 6 can expect the peak response around cycle day 12 of treatment. Therefore ultrasound examinations are performed at about this time and the follicles are expected to be 20 to 24 mm. In mean diameter. HCG has an action similar to that of LH. Accordingly its administration on the 12th day of the stimulated clomiphene cycle is an effort to assure that ovulation occurs even if the pituitary gland does not initiate its own LH surge.

Although clomiphene is only administered for five days, its effect is maximal in the period following discontinuation of its administration. At the time of ovulation, blood levels of clomiphene are very low. Because clomiphene alters the ability of cells to respond to estrogen, it is necessary for the ovaries to produce increased amounts of estrogen to promote the development of an endometrial lining (endometrium) which is thick enough to allow proper implantation to occur. In natural cycles, 150-200pg/ml of estrogen will produce a good lining. Because of the anti-estrogenic effect of clomiphene, it is necessary for the ovaries to produce two or three time this amount (a plasma estradiol concentration of 400-600 pg/ml) in clomiphene cycles. This requires the development of three or more follicles. Older women (more than 40 years of age), often do not have the capability of producing that many follicles and accordingly are poor responders to clomiphene. Indeed, some women, especially women with polycystic ovary syndrome, have no response to clomiphene, and it is necessary to proceed to injectable drugs.

If your are not successful in conceiving after using Clomid or Femera for three cycles, you may consider Intrauterine Insemination (IUI)Click here to read more about artificial insemination at NCCRM after tubal reversal surgery.

 

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