diagnosis guide
If you’ve just received a medical diagnosis, or you’re concerned that something in your present or past health history might be jeopardizing your fertility, check here for quick info on common medical conditions and how they can affect conception and pregnancy.
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Tubal Ligation (and Reversal)
What It Is
A surgical procedure to render a woman incapable of conceiving a child. Tubal ligation involves separation of the fallopian tubes into two segments using a ring, clip, stitch, or electric current. This prevents the egg from moving through the tube and keeps the sperm from reaching the egg. Most methods of female sterilization work right away; the failure rate is less than 1 percent.
Who Gets It
Women who don’t want to be pregnant. According to a study done at Columbia-Presbyterian Medical Center, approximately 700,000 women undergo surgical sterilization each year in the U.S. 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.
Treatment (reversal)
Some women who change their mind after sterilization and decide they want to become pregnant opt for in vitro fertilization (IVF). Even after surgical sterilization a woman can continue to ovulate, so her eggs can be retrieved from her ovaries. Fertilization then 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 sterilization procedure reversed so they can become pregnant the old fashioned way. While tubal ligation is meant to be a permanent sterilization, it can be reversed in most cases, 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.
Statistics show that tubal reversal has a higher pregnancy rate, higher birth rate and lower adverse pregnancy rate than IVF. 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 Chapel Hill study. For tubal ligation reversals, the doctors best qualified to perform the surgery are gynecologists who are members of the Society of Reproductive Surgeons.
Pregnancy Prognosis
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.
There are, however, a few circumstances in which women’s surgical sterilization cannot be reversed, although those women 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.
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