Pregnancy After Tubal Ligation

Tubal ligation reversal facts

• Tubal ligation reversal surgery undoes the permanent sterilization method of tying off or blocking the fallopian tubes, which prevents sperm from reaching an egg for fertilization.
• The procedure is not appropriate for everyone who has had their “tubes tied.”
• Considerations include the person’s age, whether they can ovulate, the type of surgical procedure that tied/blocked/clipped the fallopian tubes, and overall reproductive health including the length of the remaining fallopian tubes.
• For those who have had their tubes tied and are not good candidates for a reversal, in vitro fertilization (IVF) is an optional treatment to achieve pregnancy.
• Dallas IVF no longer performs tubal reversals.

 What is tubal ligation reversal?

It reverses a tubal ligation, which is a sterilization surgery commonly known as having one’s “tubes tied” that ties, clips, burns or otherwise blocks the fallopian tubes. This is a popular form of permanent sterilization, chosen by about 1 in 4 married couples as birth control. Reverting the process – called tubal ligation reversal or tubal reanastomisis – is an option for some women (or transgender men) that allows them to become pregnant.

It is not uncommon that people who have had this sterilization may want to become pregnant afterward. They may change their minds due to life changes, such as having had the tubal ligation after a bad pregnancy experience, due to pressure from a partner or just wanting to now get pregnant.

What are tubal ligation reversal success rates?

Tubal ligation reversal success depends on various factors (below) and can range from 30% to 80%. Pregnancy usually occurs one to two years after the reversal procedure.

Factors affecting success of the procedure include:

• The patient’s age, reproductive history and overall health.
• The skill and experience of the surgeon.
• Whether ovulation is possible, either naturally or with stimulation.
• The way in which the fallopian tubes were surgically blocked or tied.
• Length of the fallopian tube that is to be rejoined.
• Presence of scar tissue in the area.

The fertility specialist will review with the tubal reversal candidate the above factors and other individual considerations in determining whether the patient is a good candidate for the procedure.

The American Society for Reproductive Medicine advises that tubal ligation reversal is not an option:

• When the length of the tube to be retied is less than 4 centimeters (about 1.5 inches).
• In the presence of adhesive disease (when scar tissue binds organs together).
• If the patient has endometriosis.
• When any infertility issue exists that is more significant than mild male factor infertility.

It is important to evaluate the patient for infertility before deciding reversal is an option. This is true even if the person was able to conceive previously.

The success rates are best for patients under age 35 and worse for those over age 40.

How reversal surgery on the fallopian tubes is performed

Once the decision has been made to have the tubal reversal surgery, it is recommend that the patients, both partners if possible, have a physical exam that may include blood tests to make sure there are no other reasons that would prevent pregnancy following the surgery. The surgical procedure will typically be performed by a fertility specialist in a hospital.

The surgeon will perform a mini-laparotomy with an operative microscope, which is a common method of tubal ligation reversal. An incision of about two to four inches is made just above the pubic line and results in no visible scar above the bikini line. The patient will remain in the hospital overnight. Full recovery time is about two weeks, with return to work usually possible in one week.

Since the fallopian tube has been closed at the ends where it has been separated, it needs to be reopened and the two ends rejoined. The surgeon will remove clips or ties that have closed off the sections of the fallopian tube as well as any damaged portions of the tube. Then the surgeon will open the end portion of the tube still attached to the uterus (the proximal end) and run dye through it to make sure it is open.

Next, the other end of the tube that accepts an egg from the ovaries (the distal end) is opened. These two sides of the tube are then sewn together. Finally, the surgeon will run dye through this rejoined tube to make sure it is open.

Risks of reversing tied tubes

Risks from this procedure are the same as for any surgery, including pain, infection, bleeding and potential injury to nearby organs and other tissues. These risks are rare in tubal ligation reversal.

After the procedure, scarring may occur that can re-block the fallopian tube.

The surgeon will discuss all risks and concerns thoroughly with each patient before undergoing the procedure.