device is surgically resected. the remaining portion of each healthy fallopian tube is then reintroduced into the newly created openings. this procedure can restore the natural function of the fallopian tube and allow for natural conception. the first case of successful outpatient tubouterine implantation to reverse essure sterilization was published in 2012. surgeons who published the first case report of successful essure reversal subsequently published a larger cohort study of 70 patients who underwent outpatient tubouterine implantation to reverse essure sterilization and 36% of patients reported pregnancy through natural conception. dr. charles monteith, medical director of a personal choice tubal reversal center, has collected non-published data on the risks of outpatient essure reversal surgery. between 2009 and 2018, monteith performed 469 outpatient tubouterine implantation procedures to reverse essure sterilization. he documented intraoperative, postoperative, and pregnancy risks associated with his procedures. intraoperative risks observed were failure to complete the planned procedure (either essure removal and tubal occlusion or essure removal and bilateral tubouterine implantation) <1%, fracture of essure devices during removal (approximately 10% risk with manual traction and < 1% with en bloc dissection), transfer to hospital <1%, referral to emergency room or hospital within 24 hours of surgery <1%, bleeding requiring blood transfusion or hospitalization for operative complication 0%, anesthesia complication 0%, and death 0%. postoperative risks observed were major surgical site infection 0%, minor surgical site infection <1%, need for a second operation/procedure within 30 days <1%, and persistent symptoms requiring additional surgery < 10%. pregnancy related risks were failure to become pregnant and possible tubal closure (estimated to be <60%) and ectopic pregnancy 5%. all patients were advised to have a planned cesarean delivery before the onset of labor and the risk of uterine rupture was observed to be 4%. the majority of uterine ruptures occurred at 36/37 weeks gestation. factors associated with more difficult surgical procedures were patient obesity (bmi ≥ 30), presence of uterine leiomyomas, and uterine adhesive disease primarily from prior cesarean delivery. adiana sterilization reversal adiana sterilization was approved by the fda in 2009. adiana sterilization is a hysteroscopic tubal occlusion procedure, which is very similar to essure sterilization. the adiana procedure involves inserting a small camera (hysteroscope) through the cervix and into the uterine cavity. a smaller catheter is inserted into the tubal ostia. the catheter emits radiowaves (microwaves). the radiowaves cause injury to the tubal lining and will result in the tube gradually closing. prior to removal of the catheter a small silicone stent is left inside the isthmic portion of the tube and this promotes tubal closure by the acceleration of the tubal scarring. adiana sterilization is similar to essure sterilization and the adiana procedure causes blockage of the proximal isthmic portion. adiana sterilization can surgical reversed with tubouterine implantation. the first case of successful outpatient tubouterine implantation to reverse adiana sterilization was published in 2011. hologic corporation discontinued the procedure in march 2012, resolving ongoing litigation with conceptus concerning patent infringement claims. tubal reversal success rates tubal reversal success rates vary widely depending upon many factors. these include the women's ages, methods of tubal ligation that they had performed, experience of the surgeon and techniques for repairing the tubes, length of follow-up after reversal surgery among other factors. overall, for those who are less than 35 years of age at the time of reversal, more than 70% achieve intrauterine pregnancy, with most pregnancies occurring within 18 months after surgery. overall, for those who are 35 years of age or more, approximately 55% will achieve an intrauterine pregnancy.