Tubal Ligation Reversal Fertility Treatment

Tubal ligation, also known as “having your tubes tied,” is where your fallopian tubes are cut or blocked. Fertilization, where sperm and egg fuse, happens in the fallopian tube. If the tubes are blocked, sperm and egg can’t meet, making pregnancy impossible.

Approximately 1 percent of women who have had tubal ligation choose to have it reversed. A tubal ligation reversal reconnects the blocked or cut segments of the fallopian tube. This allows a woman who previously had her tubes tied to become pregnant naturally. This procedure is also known as a tubal reanastomosis (reuniting) procedure, tubal reversal, or tubal sterilization reversal.

With tubal ligation reversal, surgeons repair or reconnect the fallopian tubes. The procedure allows a person’s eggs to once again move through the tubes and into the uterus for fertilization.

First, your doctor reviews your history. Not everyone is a good candidate for reversal. If you are much older, it’s been a long time since the tubal ligation, if the tubes are damaged, or you have genetic risk, your fertility specialist may recommend IVF as a potentially better option.

In surgery, the physician typically starts by looking at your fallopian tubes using a laparoscopic camera. This is a small camera put into your abdomen through a tiny incision (cut). If your doctor sees that you have enough fallopian tube left to reverse your tubal ligation, and everything else looks healthy, they’ll perform the surgery. However, sometimes the surgery has to be canceled (or should be) because the tubes are in such poor shape that pregnancy is unlikely with reversal.

Most tubal ligation reversals are done with laparoscopic surgery. This means the surgeon will make several small incisions in your abdomen (the largest being approximately ½-inch long), then put in a camera and small instruments to do the surgery. They’ll control these from outside your abdomen. This takes approximately two to three hours, and you’ll need general anesthesia, where you’ll be asleep.

Your doctor will remove the most damaged sections of your fallopian tubes and remaining devices from the tubal ligation, such as clips or rings. They’ll then use very small stitches to reattach the undamaged ends of your fallopian tubes. (These stitches are often 1/3 the diameter of a human hair, so they are incredibly delicate.)

Once the tubes are reconnected, the surgeon will inject a dye through the uterus into the tubes. If the dye spills out the far end of the tube, that means the tubes have been reattached successfully.

A common question is whether a robot should be used with tubal reversal. Robotic assisted laparoscopic tubal reversal is increasingly common, as the robot is better at stabilizing needles and performing the very precise movements necessary for tubal reversal. However, robotic assistance can add cost. Moreover, some studies don’t show a clear benefit to using a robot.

According to this published report from NIH, Laparoscopic tubal reanastomosis is the best approach for women <40 years of age due to pregnancy outcomes that are comparable to other methods, cost effectiveness, and favorable safety profile of minimally invasive surgery.

Mini-laparotomy is when the surgeon makes a small incision in your abdomen, usually about 6-8 inches. They’ll then take the ends of the fallopian tube out of your abdomen through this opening. The surgeon will remove damaged parts of the fallopian tube and reconnect the healthy sections while the tubes are outside your body. Minilaparotomy also usually takes about 2 to 3 hours.

Your doctor will consider several things before you decide that the tubal ligation reversal is right for you:

• Age
• Type of sterilization procedure they underwent
• When sterilization occurred
• Quality and quantity of a woman’s eggs
• Your overall health and the health of your ovaries, uterus, and remaining fallopian tubes, especially their length
• When your tubes were tied
• If your pregnancies were healthy
• If there are other gynecologic conditions, such as endometriosis and fibroids
• If there have been previous events that may have damaged the tubes such as previous gonorrhea, chlamydia, pelvic inflammatory disease (PID), ectopic pregnancies, and ruptured appendicitis

In general, tubal reversal could be right for you if you had only small parts of your fallopian tubes removed, or if your tubes were closed with rings or clips.

• Some surgeons say the best candidates for tubal reversal are women younger than 35 who had their tubes tied right after childbirth, a procedure called postpartum tubal ligation.

Not every person who would like a tubal ligation reversal is suitable for the procedure .

• The type of tubal sterilization. Some types of tubal sterilization are not reversible.
• How much of the fallopian tube is left undamaged . Reversal surgery is more successful when there’s a lot of healthy fallopian tube left.
• Whether the tube was burnt. If the tube was burnt, much more of the tube has to be removed to find healthy tissue before the tubes can be reconnected. This puts more tension on the stitches, making them more likely to fall apart.
• Age. Reversal is more successful in younger women.
• Body mass index. Reversal may be less successful for women who are obese or overweight. This also can make it harder to get pregnant, even if the tubes were not tied.
• Other health conditions. Other health conditions, such as autoimmune diseases, can affect pregnancy. If you have one of these conditions, your doctor might take that into account when deciding if a tubal ligation reversal is right for you.
• General fertility. Having general fertility problems makes tubal ligation reversal less successful. Prior to surgery, your doctor will probably test both you and your partner to learn more about your sperm, egg, and uterine health.

Recovery time depends on the surgical method your doctor used. Tubal reversal is major abdominal surgery that is much more difficult and takes longer to do than the original ligation.

Women who have laparoscopic or robotic methods usually go home the same day, typically within 2 to 4 hours after the surgery is complete. Though some women undergoing mini-laparotomy go home the same day, some are also observed overnight, particularly if the procedure was started later in the day.

Most women are usually sore for a week with laparoscopy (and typically a few weeks for mini-laparotomy, though it depends on the size of the incision), most women are back to their old selves quickly. Of note, however, it may take a few months before one should do lifting over 10 pounds or abdominal straining. The stitches for a reversal are delicate and excessive pressure could cause the tubal reversal to fall apart.

There is debate as to when one should try to conceive after tubal reversal. Some argue for one month for healing, while others encourage trying to conceive right away.

In general, though 50 to 80 percent of women after tubal ligation reversal become pregnant, usually half of these won’t be successful pregnancies. Roughly a quarter of pregnancies after reversal miscarry, and another quarter are ectopic (tubal) pregnancies. This is important because if 50 to 80 percent of women under age 35 become pregnant, often only 25 to 40 percent bring home a baby.

Factors that can further lower the success include:

• Your partner’s sperm count and quality. Pregnancy is more likely to be successful if neither you nor your partner have any fertility issues.
• The amount of healthy fallopian tube left. If less damage was done to your fallopian tubes when you had tubal ligation, you’re more likely to get pregnant.
• Presence of pelvic scar tissue. Scar tissue from previous pelvic surgeries may affect your chances of getting pregnant.
• Type of sterilization. Women who had ring/clip sterilization are more likely to get pregnant after reversal.
• Age. Pregnancy rates after tubal reversal is most likely in women under 35 and least likely in women over 40. The pregnancy rate for women under 35 is 50 to 80 percent, while the rate for women over 40 is 30 to 40 percent, with live birth rates often being half or less for these numbers.

• Adoption. There are many ways to build a family. Though the child wouldn’t share the DNA from either parent, there are so many other factors that shape who a child becomes.
• Child- free living. Though this is not the advice most are looking for, some need to hear that it is OK also to be at peace for where they are on the family building journey.
• In vitro fertilization (IVF). At Positive Steps Fertility patients with a tubal ligation often have the highest success rates through IVF. It is often double the live birth rate that a patient would see with reversal. It is important to realize that many clinicians who perform tubal reversal overestimate the efficacy of reversal and underestimate the efficacy of IVF. They do this in a few ways:
  • They estimate pregnancy rates rather than live birth rates.
  • They include total pregnancies after reversal rather than per woman (i.e. one woman having two children and one having none is different statistics than both having one).
  • They use old IVF statistics (IVF is a lot more effective these days than a decade ago.)
  • They use statistics for IVF programs with low success rates.

There are some important additional genetic options with IVF that also can’t be done with tubal reversal. These include testing for potential miscarriage risks for genetically inherited conditions (such as Down syndrome), and for family balancing. IVF can also allow for egg vitrification, so if a patient only wants one child, that often can be achieved.

Mini-IVF. There are multiple ways to perform a mini-IVF which makes many of the published statistics misleading. Success is usually dependent on the number of eggs obtained. The highest success rates with “mini-IVF” are often achieved by using the exact same medications as full IVF, but with slightly lower doses.

True mini-IVF typically uses oral medication and is roughly half the cost of full IVF, but typically yields only one embryo instead of five or six. For women under 30 with good ovarian reserve and normal sperm to work with, this can still often result in 40-50% chances of a live birth, similar to tubal reversal (or arguably slightly better) for similar cost.

When it comes to reversing a tubal ligation, there is never a perfect answer—only the one that is right for you. These decisions shouldn’t be made through a web page or an internet chat group, as medicine should be personal and account for your realities.

What applies to one person online may not apply to another, so meeting with a clinician to understand your body and needs is critical. After all, the greatest risks are not in what you know, but what you don’t.

An expert can better find these missing factors and help you on your journey. If there is any way we can help you, please call us at Positive Steps Fertility. We are here to help you have the family of your dreams in the right way at the right time!