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.

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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.

At Positive Steps Fertility, Dr. Parry previously performed tubal reversal surgery. However, with the advancements and success rates of IVF (in vitro fertilization), he now exclusively recommends IVF. Many women achieve higher take-home baby rates with mini-stim IVF compared to tubal reversal at a comparable cost or significantly higher success rates with full IVF.

Mini-stim IVF, or Minimal Stimulation IVF, is an alternative approach to traditional in vitro fertilization that uses lower doses of fertility medications to stimulate the ovaries. Instead of aiming for a high quantity of eggs, this method focuses on producing fewer but higher-quality eggs, aligning more closely with a woman’s natural cycle. According to the American Society for Reproductive Medicine (ASRM), mini-stim IVF often involves oral medications like clomiphene citrate (Clomid) or letrozole, combined with low doses of injectable gonadotropins. This approach can be less physically taxing, reduces the risk of ovarian hyperstimulation syndrome (OHSS), and lowers medication costs. While mini-stim IVF typically results in fewer eggs retrieved compared to conventional IVF, studies suggest that it can be particularly beneficial for women with diminished ovarian reserve or for those seeking a more natural and cost-effective treatment option.

The advantages of IVF, including mini-stim IVF, include the following:

1. Completely Bypassing Fallopian Tubes:
   With IVF, the condition of the fallopian tubes is irrelevant to success. Even if the tubes are tied, removed, or damaged, IVF remains effective. In some cases, IVF is even possible after a hysterectomy, provided the ovaries are intact and another person carries the pregnancy. This is particularly beneficial for women with additional risks of tubal damage due to conditions like chlamydia, pelvic inflammatory disease (PID), endometriosis, fibroids, or prior abdominal surgeries. While these issues can reduce the success of reversal, they have minimal impact on IVF outcomes.
2. Lowering the Risk of Miscarriage and Ectopic Pregnancy:
   Approximately 25% of pregnancies after tubal reversal result in miscarriage, and another 25% are ectopic (tubal) pregnancies, significantly lowering take-home baby rates compared to initial pregnancy rates. IVF reduces the ectopic pregnancy rate to about 1-2%. Additionally, with advanced genetic testing such as PGT-A, IVF can identify embryos with chromosomal abnormalities (e.g., Down syndrome) before transfer, potentially reducing the likelihood of miscarriage. Such testing isn’t available with tubal reversal, where one must wait until the first or second trimester for similar information.
3. Maximizing Success Rates:
   When tubal reversal fails, it often takes months or years to confirm, and repeat surgeries rarely succeed, leaving IVF as the next step. In contrast, modern IVF offers success rates of 80% or more for women aged 25-30 with a tubal ligation. If an embryo transfer doesn’t work or results in miscarriage, or if a woman becomes pregnant, delivers, and wants another child, additional cycles of IVF are usually unnecessary. Instead, previously frozen embryos can be thawed and transferred.

By comparison, tubal reversal involves surgical risks, requires a longer recovery period, and offers uncertain outcomes, as success depends on factors like the extent of damage to the fallopian tubes and the time elapsed since the ligation.

If you are interested in exploring your personal success rates with each approach, our team is here to help. Factors like your age, the timing and type of your tubal ligation (e.g., clips, extent of tube removal, or whether the tubes were burned) all influence your chances of success. For instance, before considering a tubal reversal, it’s essential for your partner to get a semen analysis—an affordable $75 test. It’s surprisingly common for couples to discover after a reversal that the male partner has a fertility issue, such as low sperm count.

To learn more about your options, 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!