Tubal Ligation Reversal

What is tubal ligation reversal?

Tubal ligation is a prevalent surgical procedure in the United States that patients commonly refer to as getting their “tubes tied.” This method is a permanent, though reversible, contraceptive option that clamps, cuts, blocks or seals a woman’s fallopian tubes.

This ends the woman’s fertility and removes the chance of pregnancy by preventing sperm from fertilizing the egg in the fallopian tubes, where fertilization occurs. It also blocks a possible fertilized egg’s path to the uterus to implant for pregnancy.

A tubal ligation reversal is a procedure that unblocks the fallopian tubes to restore a woman’s fertility.

Another option that allows a woman who has a tubal ligation to have a child is in vitro fertilization (IVF). In most cases, IVF is a better choice because it gives patients the maximum chance of pregnancy in the shortest amount of time, plus it prevents them from undergoing the significant surgical procedure of tubal ligation reversal.

Reasons to have tied tubes reversed or IVF treatment

When a woman decides that she does want to become pregnant, due to changed circumstances or for any reason, she may undergo a tubal ligation reversal procedure. A tubal ligation reversal may be desired for several reasons including:

• Change of marital status.
• The initial procedure was implemented as an adolescent.
• Tubal ligation was completed within less than a year of giving birth.
• The woman didn’t receive enough information about tubal ligation or other birth control methods.
• Pressure from spouse/partner to undergo the reversal procedure.
• Regretted having the tubes tied.

Factors affecting reversal success

A tubal ligation reversal aims to remove the closed portion of the fallopian tube and reconnect the remaining segments to restore normal reproductive function of the fallopian tubes and fertility. The reversal surgery enables the sperm to reach the egg in the fallopian tube for fertilization and also enables a fertilized egg, or embryo, to progress to the uterus and implant for pregnancy.

Tubal ligation reversal is usually more successful when a sizable portion of the fallopian tubes has been left intact after the original ligation procedure. Previous tubal ligations that cause minimum damage to the fallopian tubes are most likely to be successfully reversed.

Similarly, a successful tubal ligation reversal also depends on the amount of tube left after the restoration (the longer the better) and where the repair is performed. Repairs performed on the segment of tube closest to the uterus carry the highest success rate.

Tubal ligation reversal can be all that is needed for a woman to achieve pregnancy. In other instances, a woman may require other assisted reproductive procedures, such as IVF or intrauterine insemination (IUI).

Other considerations of reversal surgery

There are several other factors to consider in determining if a tubal ligation reversal is an appropriate procedure to effectively treat infertility. These include:

• Age.
• Overall health.
• Weight and body mass index (BMI); calculate BMI.
• Type of tubal ligation procedure performed previously.
• Quality of the fallopian tube ends near the ovaries.
• Other fertility factors.

IVF as an alternative to tubal ligation reversal

If a woman chooses not to have a reversal or is not a good candidate, there are many benefits to selecting IVF instead. A major reason is that it means the patient can avoid tubal reversal surgery altogether. Another is a quicker time to pregnancy.

After a tubal ligation reversal surgery, it takes about three months to show that the surgery was a success. Once tests are done to confirm the tubes are cleared, the average amount of time from start to pregnancy is two years.

The time to pregnancy with IVF is much shorter, ranging within one year. As a woman ages, it can be harder to get pregnant due to the amount and quality of the eggs. With IVF, the process can begin sooner.

The cost of a single IVF cycle in most cases is comparable to the cost of tubal ligation reversal. In addition, if the damage to a woman’s fallopian tubes is significant and the reversal is unsuccessful, an IVF cycle will still be required. This would almost double the cost of just going with IVF in the first place.

The reversal surgical procedure

During the procedure a woman is put under general anesthesia to ensure the surgeon can reattach, unclamp or implant an extension in the fallopian tubes to make them functional. For sufficient healing, a hospital stay of at least one night and up to five is required, with full recovery taking four to six weeks.

With new advances in technology and microsurgery, tubal reversals can be performed with less invasive techniques, shortening surgery time to less than an hour using local anesthesia and making it an outpatient procedure (not requiring a hospital stay). This technique decreases risk of complications or injury and allows the patient to recover within five to 10 days. Robotic surgery, a type of minimally invasive or laparoscopic surgery, can usually be used and allows for much faster recovery for the patient.

Side effects and risks of tubal ligation reversal

Rare side effects of tubal ligation reversal surgery include:

• Bleeding.
• Infections.
• Anesthetic complications.
• Damage to the surrounding organs.
• Negative reaction to anesthesia.
• Wound infection.
• Damage to the abdomen, including the bowel, bladder or major blood vessels.
• If pregnancy is achieved, there is a 4% to 7% possibility of an ectopic pregnancy, which is a life-threatening situation when the fertilized egg implants outside of the uterus, and the pregnancy must be terminated.