Reproductive Outcomes After Tubal Reanastomosis in the Era of Assisted Reproduction

Aim To evaluate reproductive outcomes after tubal reanastomosis during long‐term follow‐up, with emphasis on clinical pregnancy, live birth, ectopic pregnancy, and time to pregnancy.

This retrospective single‐center study included 59 women who underwent tubal reanastomosis for fertility restoration after tubal ligation between January 2010 and December 2025 at a tertiary university hospital. Patients with complete medical records and postoperative follow‐up data were analyzed. The primary outcome was postoperative clinical pregnancy. Secondary outcomes included live birth, ectopic pregnancy, miscarriage, time to pregnancy. Kaplan–Meier analysis was used to assess time to pregnancy.

Postoperative clinical pregnancy was achieved in 29 of 59 women (49.2%). In the overall cohort, live birth occurred in 15 women (25.4%), ectopic pregnancy in 8 (13.6%), and miscarriage in 6 (10.2%). Women who conceived were significantly younger than those who did not (33.4 ± 3.9 vs. 38.6 ± 4.2 years, p < 0.001). Likewise, women who achieved live birth were significantly younger than those who did not (32.3 ± 4.0 vs. 37.3 ± 4.4 years, p < 0.001). Median time to pregnancy was 9 months (95% CI: 7–12). Women younger than 35 years had a significantly higher cumulative probability of pregnancy than those aged 35 years or older (p < 0.001).

Tubal reanastomosis remains an important fertility‐restoring option, particularly in younger women. Age was the most consistently associated with postoperative reproductive success, influencing both the likelihood and timing of conception. Success after tubal reanastomosis should be assessed beyond pregnancy alone and include live birth, ectopic pregnancy, and time to pregnancy.

fertility restoration, laparoscopy, minimally invasive surgery, reproductive outcomes, tubal reanastomosis 1. Introduction Female tubal sterilization remains one of the most widely used methods of permanent contraception worldwide [1]. Globally, an estimated 200 million women of reproductive age rely on tubal occlusion for pregnancy prevention, underscoring its major role in reproductive health care [2, 3]. Because of its high contraceptive efficacy, the procedure is generally presented as a definitive method of family planning [4]. Nevertheless, despite its intended permanence, a proportion of women later experience sterilization regret and seek restoration of fertility [2, 3]. Changes in reproductive intentions may arise from altered life circumstances, including a new partnership, the loss of a child, or a renewed desire for childbearing [3]. As a result, requests for fertility‐restoring interventions after sterilization continue to represent an important and clinically relevant issue in gynecologic practice [3]. For women seeking to restore fertility after tubal sterilization, the two principal treatment options are in vitro fertilization (IVF) and surgical tubal reanastomosis [5, 6]. With improving success rates and broad availability, IVF has become a commonly used approach in this setting [3, 7]. Nevertheless, tubal reanastomosis remains an important alternative in appropriately selected patients [8]. Unlike IVF, which requires intervention with each treatment cycle, successful tubal reversal may restore natural tubal continuity and allow repeated spontaneous conceptions without further assisted reproduction [2, 9]. In addition, several studies have suggested that surgical reversal may be more cost‐effective than IVF in selected populations, particularly in younger women [2, 10]. However, reported reproductive outcomes after tubal reanastomosis vary considerably across studies, highlighting the importance of identifying the clinical and operative factors that influence postoperative success [2, 4]. The reproductive success of tubal reanastomosis is influenced by several factors, among which maternal age at the time of surgery is one of the most consistently recognized predictors [11, 12]. In general, younger women tend to have higher conception rates, whereas overall fertility potential declines with advancing age [5, 11]. Beyond age, however, the literature remains heterogeneous, and reported associations with other potential determinants are not fully consistent across studies [2, 5]. Previous comparative data have also suggested comparable pregnancy outcomes among laparotomic, laparoscopic, and robotic reanastomosis approaches [13]. These discrepancies may reflect differences in sample size, patient selection, and follow‐up protocols, underscoring the need for additional real‐world clinical data [2, 5]. Moreover, because conception does not necessarily translate into a successful delivery, clinical evaluation of tubal reanastomosis should extend beyond pregnancy rates alone and include broader reproductive outcomes such as live birth and ectopic pregnancy [1, 5]. Traditionally, the success of tubal reanastomosis has been assessed primarily by clinical pregnancy rates [5, 11]. However, conception alone is an incomplete measure of postoperative efficacy, as it does not necessarily result in a successful delivery [1]. A more comprehensive evaluation should therefore include broader reproductive outcomes, particularly live birth, as well as adverse outcomes such as miscarriage and ectopic pregnancy [5]. Ectopic pregnancy is of particular clinical importance because it represents a significant postoperative complication with implications for maternal morbidity and future fertility [7, 11]. In addition, time to pregnancy provides further insight into reproductive performance after surgery, especially in women with a limited reproductive window [6, 7]. Taken together, these considerations support a broader and more clinically meaningful assessment of reproductive success after tubal reanastomosis. This retrospective single‐center study aimed to assess the reproductive success of tubal reanastomosis during long‐term follow‐up by examining pregnancy, live birth, ectopic pregnancy, and time to pregnancy in women treated with different surgical approaches. 2. Methods 2.1. Study Design and Participants In this retrospective single‐center study, 59 women who underwent tubal reanastomosis for fertility restoration after prior tubal ligation at a tertiary university hospital between January 2010 and December 2025 were included. Only patients with complete medical records and available postoperative follow‐up data were eligible for analysis. Patients with missing data were excluded. Because of the retrospective design of the study, routine preoperative semen analysis was not available for all male partners. However, semen evaluation was not considered mandatory in couples with proven prior fertility, defined as having previously conceived a child together. Preoperative pelvic ultrasonography showed no additional uterine pathology, such as endometrial polyps or uterine myomas, in the included patients. The patient selection process is summarized in Figure 1. The study protocol was approved by the Ege University Medical Research Ethics Committee (approval no. 26‐4.1T/7). 2.2. Surgical Technique All procedures, including laparoscopic, robotic, and laparotomic tubal reanastomosis, were performed by experienced surgeons in the same tertiary referral center using standardized institutional surgical principles. The previously ligated segments of both fallopian tubes were identified, and the occluded portions were excised with scissors to expose the tubal lumens. After the excision of the scarred and occluded tubal segments, proximal and distal tubal catheterization was performed with a 3‐Fr double‐J catheter to guide luminal alignment during anastomosis. A single‐layer interrupted suture repair was completed using 6‐0 polydioxanone (PDS) sutures, with care taken to achieve accurate mucosal and seromuscular approximation without excessive tension or luminal narrowing. Mesosalpinx reconstruction was performed to restore tubal alignment and reduce tension on the anastomosis. Tubal patency was assessed intraoperatively with methylene blue dye (chromopertubation). The anastomotic site was determined intraoperatively according to the remaining proximal and distal tubal segments after excision of the occluded portion; however, detailed anatomical categorization of the anastomotic site, such as isthmic–isthmic, isthmic–ampullary, or ampullary–ampullary anastomosis, had not been systematically recorded in the operative notes and therefore could not be analyzed. 2.3. Data Collection and Variables Data were obtained from hospital records and subsequent telephone interviews. The following variables were recorded: age at surgery, gravidity, parity, laterality of anastomosis (bilateral or unilateral), and surgical approach (laparoscopy, robotic surgery, or laparotomy). Information on the original sterilization technique was not systematically available in the retrospective records and therefore could not be included in the analysis. Postoperative reproductive data included clinical pregnancy, live birth, ectopic pregnancy, miscarriage, time to pregnancy, and total follow‐up duration. 2.4. Outcomes The primary outcome was postoperative clinical pregnancy after tubal reanastomosis. Secondary outcomes included live birth, ectopic pregnancy, miscarriage, and time to pregnancy. Clinical pregnancy was defined by postoperative serum beta‐human chorionic gonadotropin (β‐hCG) positivity together with ultrasonographic visualization of an intrauterine or extrauterine gestational sac, or by definitive clinical and/or histopathological evidence of pregnancy. Time to pregnancy was defined as the interval between surgery and the first documented postoperative pregnancy. For women who did not conceive, follow‐up duration was defined as the interval between surgery and the last available follow‐up. Ectopic pregnancy was diagnosed according to standard clinical, laboratory, and imaging criteria. 2.5. Statistical Analysis Statistical analyses were performed using jamovi version 2.6.45.0. Continuous variables were assessed for normality using the Shapiro–Wilk test. Normally distributed variables were presented as mean ± standard deviation and compared using the independent samples t‐test. Non‐normally distributed variables were expressed as median (interquartile range) and compared using the Mann–Whitney U test. Categorical variables were summarized as number (percentage) and compared using Fisher's exact test, as appropriate. Patients were compared according to postoperative pregnancy status and live birth outcome. Time to pregnancy was analyzed using Kaplan–Meier methodology. Women who conceived were coded as events, whereas women who did not conceive were censored at the time of last available follow‐up. Women were dichotomized into < 35 and ≥ 35 years age groups for Kaplan–Meier analysis. The 35‐year cutoff was chosen as a clinically interpretable reproductive‐age threshold and to allow a simple comparison of cumulative pregnancy probability in this relatively small cohort. Differences in cumulative pregnancy probability between women aged < 35 and ≥ 35 years were evaluated using the log‐rank test. A two‐sided p value < 0.05 was considered statistically significant. 3. Results A total of 59 women who underwent tubal reanastomosis were included in the study. The mean age at surgery was 36.0 ± 4.8 years. The median gravidity and parity were 2 (IQR: 1) and 2 (IQR: 1), respectively. Bilateral anastomosis was performed in 52 patients (88.1%). Regarding the surgical approach, laparoscopy was the most commonly used method (76.3%), followed by robotic surgery (18.6%), and laparotomy (5.1%) (Table 1). TABLE 1. | Variable | Overall cohort (n = 59) | |---|---| | Age, years | 36.0 ± 4.8 | | Gravidity (IQR) | 2 (1) | | Parity (IQR) | 2 (1) | | Bilateral anastomosis, n (%) | 52 (88.1) | | Operation approach, n (%) | | | Laparoscopy | 45 (76.3) | | Robotic | 11 (18.6) | | Laparotomy | 3 (5.1) | | Clinical pregnancy, n (%) | 29 (49.2) | | Live birth, n (%) | 15 (25.4) | | Ectopic pregnancy, n (%) | 8 (13.6) | | Miscarriage, n (%) | 6 (10.2) | | Time to pregnancy, months (IQR) a | 9 (6) | | Total follow‐up duration, months (IQR) a | 121 (65) | Note: Data are presented as mean ± standard deviation, median (interquartile range), or number (percentage), as appropriate. Time to pregnancy was calculated among women who conceived (n = 29), whereas total follow‐up duration was reported for women who did not conceive (n = 30). Postoperative clinical pregnancy was achieved in 29 of 59 women (49.2%). In the overall cohort, live birth occurred in 15 women (25.4%), ectopic pregnancy in 8 (13.6%), and miscarriage in 6 (10.2%) (Table 1). The median time to pregnancy among women who conceived was 9 months (IQR: 6 months). Among women who conceived, live birth occurred in 51.7%, ectopic pregnancy in 27.6%, and miscarriage in 20.7%. Women who achieved postoperative pregnancy were significantly younger than those who did not conceive (33.4 ± 3.9 vs. 38.6 ± 4.2 years, p < 0.001). No significant differences were observed between the groups with respect to gravidity (p = 0.742), parity (p = 0.867), bilateral anastomosis status (p = 0.424), or surgical approach (p = 0.374) (Table 2). TABLE 2. | Variable | Pregnancy (n = 29) | No pregnancy (n = 30) | p | |---|---|---|---| | Age, years | 33.4 ± 3.9 | 38.6 ± 4.2 | < 0.001 | | Gravidity (median) | 2.0 | 2.5 | 0.742 | | Parity (median) | 2.0 | 2.0 | 0.867 | | Bilateral anastomosis, n (%) | 27 (93.1) | 25 (83.3) | 0.424 | | Operation approach, n (%) | 0.374 | || | Laparoscopy | 23 (79.3) | 22 (73.3) | | | Robotic | 6 (20.7) | 5 (16.7) | | | Laparotomy | 0 (0.0) | 3 (10.0) | Note: Data are presented as mean ± standard deviation, median, or number (percentage), as appropriate. Age was compared using the independent samples t‐test; gravidity and parity were compared using the Mann–Whitney U test; categorical variables were compared using Fisher's exact test. Kaplan–Meier analysis demonstrated that the median time to pregnancy after tubal reanastomosis was 9 months (95% CI: 7–12 months). Women younger than 35 years had a significantly higher cumulative probability of pregnancy than those aged 35 years or older (log‐rank χ 2 = 11.9, p < 0.001; Figure 2). In the < 35‐year group, the median time to pregnancy was 11 months (95% CI: 8–85 months), whereas the median was not reached in the ≥ 35‐year group, indicating that less than 50% of women in this group achieved pregnancy during follow‐up. When patients were stratified according to live birth outcome, women who achieved live birth were significantly younger than those who did not (32.3 ± 4.0 vs. 37.3 ± 4.4 years, p < 0.001). Gravidity and parity were similar between the groups (p = 0.228 and p = 0.487, respectively). Likewise, bilateral anastomosis status and surgical approach were not significantly associated with live birth (p = 0.666 and p = 0.536, respectively). 4. Discussion Our study suggests that tubal reanastomosis remains a clinically relevant fertility‐restoring option in appropriately selected women. Postoperative pregnancy was achieved in a substantial proportion of the cohort, and age emerged as the most important determinant of this outcome. Among women who conceived, a considerable proportion ultimately achieved live birth, although ectopic pregnancy also represented a clinically relevant outcome that should not be overlooked. Most conceptions occurred within the first postoperative year, while women who remained nonpregnant were followed for a sufficiently long period. Notably, age was also significantly associated with live birth, whereas surgical approach and bilaterality were not associated with either pregnancy achievement or live birth in this cohort. In our cohort, maternal age at the time of surgery was the factor most consistently associated with postoperative reproductive outcomes. Women younger than 35 years showed better reproductive performance after tubal reanastomosis than older women, a finding that is consistent with previous studies identifying age as one of the strongest predictors of success after sterilization reversal [5, 9]. This is biologically plausible, as restoration of tubal patency cannot fully compensate for the age‐related decline in overall fertility potential, particularly the progressive reduction in oocyte quantity and quality [2, 8]. Accordingly, even technically successful surgery may yield different reproductive outcomes depending on the patient's age at the time of treatment. These observations highlight the importance of age‐based patient selection and careful preoperative counseling when considering tubal reanastomosis [8]. In our cohort, neither surgical approach nor bilaterality showed a significant association with postoperative pregnancy or live birth. This observation is consistent with previous comparative data showing no significant difference in pregnancy outcomes among different surgical approaches [13]. These findings may reflect the limited sample size, unequal subgroup distribution, and reduced statistical power of the study rather than true clinical equivalence between groups. As reported in previous studies, patient‐related biological factors (most notably maternal age) may have had a greater influence on reproductive outcomes than operative variables in this series [1, 5, 9]. Therefore, the absence of statistical significance for these surgical parameters should be interpreted cautiously and not as evidence that operative factors are irrelevant to fertility restoration. Although pregnancy rates are commonly used to evaluate the success of tubal reanastomosis, conception alone provides an incomplete measure of postoperative outcome [1, 5]. Live birth more accurately reflects meaningful reproductive achievement and is ultimately the endpoint most relevant to patients seeking fertility restoration [5, 14]. At the same time, adverse outcomes must also be considered, particularly ectopic pregnancy, which remains a clinically important complication after tubal reconstructive surgery and should be addressed during preoperative counseling [7, 9, 12]. In addition, time to pregnancy offers practical clinical value, as earlier conception may be especially important for women with a limited reproductive window [1, 12]. Taken together, these considerations support a multidimensional assessment of success after tubal reanastomosis rather than reliance on pregnancy rates alone [7, 11, 12]. In our study, the postoperative clinical pregnancy and live birth rates were broadly consistent with the existing literature on tubal reanastomosis [2, 6]. Although clinical conception is frequently reported as a primary measure of success, achieving a live birth represents a more definitive and clinically meaningful reproductive endpoint [5, 14]. In addition, ectopic pregnancy remains a clinically relevant adverse outcome after tubal reconstructive surgery and should be addressed during preoperative counseling and postoperative surveillance [2, 6]. Ultimately, direct comparisons between our findings and those of other studies remain difficult because of substantial methodological heterogeneity in patient age, patient selection, surgical technique, and follow‐up duration [2, 5, 15]. The ectopic pregnancy rate observed in the present cohort was higher than that reported in several previous series. Systematic review data have generally reported ectopic pregnancy rates in the range of 4%–8% after tubal anastomosis, while large long‐term and comparative surgical series have reported lower overall rates [2, 5, 11]. This difference may be partly explained by the relatively small number of pregnancies in our cohort and by unmeasured surgical factors, particularly the original sterilization method, residual tubal length, and detailed anastomotic site, which were not systematically available in the retrospective records. Therefore, this finding should be interpreted cautiously, but it highlights the importance of early pregnancy localization and close postoperative surveillance after tubal reanastomosis. For women desiring conception after previous tubal ligation, IVF and tubal reanastomosis represent the primary fertility‐restoring options [2]. Although they are not directly interchangeable (as surgery restores natural tubal anatomy whereas IVF bypasses it) they are frequently considered alternative clinical strategies [2]. Previous literature has suggested that tubal reversal may be cost‐effective compared with IVF in selected patients, particularly younger women [2, 16]. Our finding that maternal age, especially the 35‐year threshold, was the dominant determinant of surgical success is consistent with these economic models. Because most conceptions in our cohort occurred within the first postoperative year, younger patients may have a sufficient reproductive window to benefit from the restored potential for repeated natural conception [2]. In our local setting, this distinction may be even more relevant, as public reimbursement for IVF is subject to specific eligibility criteria, including the absence of a child within the current marriage, whereas tubal reanastomosis may remain accessible as a surgical option within the public hospital system. Although direct comparisons are methodologically limited, the overall clinical pregnancy rate of 49.2% and live birth rate of 25.4% observed in our cohort provide a restorative efficacy that is roughly comparable to the general outcomes of IVF performed specifically for tubal factor infertility, where reported success rates typically range from 31% to 55% depending on maternal age [5, 17]. Ultimately, treatment choice should be individualized according to age, reproductive goals, local access, and cost considerations [2]. These considerations should also be interpreted within the health‐care context in which treatment is provided. The relative economic appeal of tubal reanastomosis versus IVF is unlikely to be uniform across settings, because reimbursement rules, public funding for assisted reproduction, treatment availability, and local procedural costs differ substantially. This is particularly relevant when comparing a one‐time reconstructive surgical procedure with cycle‐based assisted reproduction, for which patient‐borne costs and access may vary widely. Therefore, cost‐related arguments should be regarded as context‐specific and supportive rather than as generalizable evidence favoring one strategy over the other. While most of the published literature on tubal reversal has focused primarily on overall pregnancy rates, fewer studies have provided clinically meaningful information on time to conception [12]. In our cohort, most pregnancies occurred within the first postoperative year. This finding is consistent with previous clinical series showing that, when spontaneous conception occurs after surgical recanalization, it most often takes place within the first 6 to 12 months [11, 18]. Several retrospective studies have similarly reported relatively short intervals to pregnancy, with most successful conceptions occurring during the first postoperative year [11, 18]. Understanding this temporal pattern is highly relevant in clinical practice, particularly for women with a limited reproductive window related to advancing age [11]. In such patients, prolonged but unsuccessful attempts at natural conception may delay timely transition to assisted reproductive technologies [7]. These considerations highlight the clinical value of incorporating time‐to‐pregnancy analysis into studies of tubal reanastomosis. The present cohort represents a highly specific patient population: women who previously underwent tubal ligation and later sought fertility restoration. Therefore, the reproducibility of similar cohorts may be limited, and the findings should be interpreted within this specific clinical context. Importantly, the reproductive outcomes reported here apply specifically to post‐sterilization tubal reanastomosis and should not be extrapolated to women with tubal factor infertility caused by pelvic inflammatory disease, chlamydial infection, hydrosalpinx, endometriosis, or other inflammatory tubal pathologies, which involve different patterns of tubal damage and different reproductive prognoses. This study has several limitations. First, its retrospective single‐center design introduces the possibility of selection and information bias and may limit generalizability. Generalizability is also limited by the specific nature of the cohort, which consisted exclusively of women undergoing fertility restoration after prior tubal ligation rather than women with tubal infertility due to inflammatory or infectious tubal disease. In addition, because postoperative reproductive outcomes were partly obtained through telephone follow‐up, recall bias cannot be excluded, particularly for the timing of pregnancy and early pregnancy losses. Second, the sample size was relatively small, and several subgroup analyses (particularly those according to surgical approach, bilaterality, live birth, and ectopic pregnancy) were based on limited event numbers and unequal group distributions, reducing statistical power. Third, a major limitation of the present study is the lack of systematically recorded information regarding the original sterilization technique. Because many patients underwent sterilization at outside institutions and the study covered a long retrospective period, details such as whether sterilization had been performed by the Pomeroy technique, clips, rings, or electrocautery were not consistently available. Similarly, residual tubal length and detailed anatomical categorization of the anastomotic site were not systematically documented. These missing surgical variables may have influenced postoperative pregnancy rates, ectopic pregnancy risk, and the technical feasibility of reconstruction, and therefore limit the interpretability and generalizability of our findings. In addition, routine preoperative semen analysis was not available for all male partners, and unrecognized male factor infertility cannot be fully excluded. Finally, because the study did not include a direct IVF comparison group, conclusions regarding comparative effectiveness or cost considerations remain indirect and literature‐based. Despite these limitations, the study has notable strengths, including long‐term follow‐up, a single‐center cohort managed within a relatively consistent clinical setting, standardized surgical principles across approaches, and the inclusion of clinically meaningful endpoints beyond pregnancy alone, particularly live birth, ectopic pregnancy, and time to pregnancy. Another strength is that most procedures were performed using contemporary minimally invasive approaches, mainly laparoscopy and robotic‐assisted surgery, which enhance the clinical relevance of the findings in current reproductive surgical practice. In the era of assisted reproductive technologies, tubal reanastomosis is performed less frequently in many centers, raising concern that experience with this reconstructive procedure may progressively decline [10, 16]. Our cohort nevertheless suggests that maintaining expertise in tubal reanastomosis remains clinically relevant, particularly as most procedures in this series were performed using laparoscopic or robotic approaches. Preserving this surgical capability may help ensure that appropriately selected patients continue to have access to a fertility‐restoring option that allows natural conception and may be advantageous in selected clinical and economic settings. In conclusion, tubal reanastomosis remains an important fertility‐restoring strategy, but its success is not uniform across patients. Age emerged as the dominant determinant of outcome in our cohort, underscoring the importance of careful patient selection and age‐based counseling. A clinically meaningful evaluation of success after tubal reanastomosis should extend beyond pregnancy alone to include live birth, ectopic pregnancy, and time to pregnancy. Author Contributions Murat Ulukus: validation, visualization, data curation, writing – review and editing. Fatih Sendag: conceptualization, methodology, writing – review and editing, supervision. Cihan Mutu: conceptualization, methodology, writing – review and editing, project administration, data curation, investigation. Ali Akdemir: supervision, writing – review and editing, investigation, methodology, software, formal analysis. Arif Onur Atay: conceptualization, methodology, validation, writing – original draft, investigation, data curation, formal analysis, project administration. Funding The authors have nothing to report. Disclosure An earlier version of this article was presented in abstract form at the 11th National Gynecological Endoscopy Congress, which was held in Izmir, Turkey, on April 10–13, 2025. Compared with the conference abstract, the current manuscript includes an expanded study population, additional follow‐up data, and more comprehensive statistical analyses. An updated ethics approval was obtained for the expanded version of the study. Ethics Statement The study protocol was approved by the Ege University Medical Research Ethics Committee (approval no. 26‐4.1T/7). Consent Because of the retrospective design of the study, the requirement for informed consent was waived by the Ethics Committee. Conflicts of Interest The authors declare no conflicts of interest. Acknowledgments The authors thank all staff involved in the surgical treatment and follow‐up of the patients included in this study. Data Availability Statement The data underlying this study are not publicly deposited in a repository because they consist of individual‐level clinical and reproductive outcome data obtained from hospital records and postoperative telephone follow‐up. The dataset includes sensitive information related to prior sterilization, fertility‐restoring surgery, pregnancy outcomes, ectopic pregnancy, miscarriage, live birth, and follow‐up timing. Because this is a relatively small single‐center cohort involving a specific clinical population over a long study period, public sharing of individual‐level data, even in de‐identified form, may create a risk of patient re‐identification. In addition, the ethics approval for this retrospective study did not include permission for unrestricted public deposition of patient‐level data. Therefore, public data sharing is restricted by ethical considerations, patient privacy, and institutional data protection requirements. De‐identified data may be made available to qualified researchers upon reasonable request to the corresponding author, subject to approval by the relevant institutional authority and/or ethics committee and completion of an appropriate data use agreement.

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Data Availability Statement The data underlying this study are not publicly deposited in a repository because they consist of individual‐level clinical and reproductive outcome data obtained from hospital records and postoperative telephone follow‐up. The dataset includes sensitive information related to prior sterilization, fertility‐restoring surgery, pregnancy outcomes, ectopic pregnancy, miscarriage, live birth, and follow‐up timing. Because this is a relatively small single‐center cohort involving a specific clinical population over a long study period, public sharing of individual‐level data, even in de‐identified form, may create a risk of patient re‐identification. In addition, the ethics approval for this retrospective study did not include permission for unrestricted public deposition of patient‐level data. Therefore, public data sharing is restricted by ethical considerations, patient privacy, and institutional data protection requirements. De‐identified data may be made available to qualified researchers upon reasonable request to the corresponding author, subject to approval by the relevant institutional authority and/or ethics committee and completion of an appropriate data use agreement.