According to a study done at Columbia-Presbyterian Medical Center, approximately 700,000 women undergo surgical sterilization each year in the U.S. And it’s estimated that more than 1 percent of these women will eventually opt for reversal, deciding they'd like to become pregnant after all.
For some of these women, in vitro fertilization (IVF) is the answer, as even after surgical sterilization a woman can continue ovulation, and her eggs can be retrieved from her ovaries. Then fertilization takes place in vitro (in a lab petri dish) rather than in vivo (in the body). But many women prefer to try and have their surgical procedures reversed so they can become pregnant the old-fashioned way.
Getting Pregnant Again
“Tubal ligation is meant to be a permanent method of birth control. This is what doctors who perform the procedure and counsel women about it are taught,” says Gary S. Berger, M.D., reproductive surgeon and medical director of the Chapel Hill Tubal Reversal Center in Chapel Hill, North Carolina. “However, in most cases, tubal ligation can be reversed, and under the right circumstances a healthy pregnancy will be achieved.” The procedure to reverse a tubal ligation is called tubal anastomosis, or tubal reanastomosis.
The success of the reversal--and a woman's chance of getting pregnant afterwards-- depends in part on what type of surgery was originally performed. The most commonly used method of tubal ligation is called the Pomeroy Procedure (also called “ligation re-section technique”). In this method, part of the fallopian tube is lifted to create a loop or knuckle. A ligature is tied around the base of the elevated portion, and the segment is removed. Within a few days, the tissue grows to cover the cut ends of the segments, which separate as the ligature dissolves. Surgeons like this procedure because it is simple, effective, and it leaves two healthy segments of fallopian tube that can be rejoined through reversal surgery later, if desired, once again creating a path for the egg to follow from the ovaries to the womb after ovulation.
Another method, done with a tubal ring or clip to block the fallopian tube, is even more ideal for reversal because it damages only a small length of the tubes.
There are a few circumstances in which women’s surgical sterilization cannot be reversed, and obviously in these cases women will not be able to get pregnant naturally, although they may still become pregnant with IVF. Women with severe endometriosis, pelvic adhesive disease and poor egg quality are not good candidates for tubal ligation reversal.
Women who’ve had a new method of surgical sterilization, called Essure, should consider their sterilization permanent. In this method, doctors use a hysteroscope (a lighted tube inserted into the uterus), to place a synthetic material into the fallopian tubes to create a blockage. Over the three months following the surgery, the insert spurs the body to produce tissue and create a permanent barrier.
The big advantage of this method is that it is non-surgical; women undergoing the procedure have no incisions, cuts or stitches to deal with afterward. The disadvantage is that—at least for the present—it is considered irreversible and permanent.
Tubal ligation reversal surgery is performed as an outpatient procedure, although full recovery takes from one to two weeks. It is a microsurgical procedure usually performed under general anesthesia. Besides the specific technique used for the original surgery, the success of reversal also depends on the woman’s age at the time of the reversal, and the length of healthy fallopian tube remaining to be joined. Women can attempt pregnancy after their first menstrual period following surgery.
“Most couples would rather conceive naturally than undergo assisted reproductive treatment,” says Dr. Berger. “Our follow-up statistics show that tubal reversal has a higher pregnancy rate, higher birth rate and lower adverse pregnancy rate than in vitro fertilization.” The pregnancy rate for women under 35 who reversed their tubal ligation was 69 percent, and the live birth rate was 44 percent, according to a study conducted at Chapel Hill.
What You Need to Know…
For tubal ligation reversal candidates, the doctors best qualified to perform the surgery are gynecologists who are members of the Society of Reproductive Surgeons. Their web site at www.reprodsurgery.org provides information about this organization and the doctors who are members.
A version of this article was originally published in the Spring 2005 issue of Conceive Magazine.
Related Topics: Boost Your Fertility; Fertility Health; Fertility Tips
