Is It Possible to Reverse Tubal Ligation?

By MD (gynecologist), (embryologin), BSc, MSc (embryologist) and (invitra staff).
Last Update: 05/14/2020

When a woman decides to have her tubes tied, it is because she does not want to have any more children in the future. However, the reasons for her decision may change.

Life is full of decisions that are made according to the circumstances surrounding that moment. But those situations can change and cause us to take another direction in life.

Couples may break up, find other loves, and want to start a new family despite having their tubes tied. Or the patient who had the operation may simply change her mind and want to become a mother again.

It is estimated that 14.3% of women who have had a tubal ligation want to become mothers again before the first 14 years after surgical sterilization. Today, the possibility of having children again is viable thanks to tubal ligation reversal.

Tubal ligation reversal is a surgery to unlink and reconstruct the fallopian tubes, allowing again a natural pregnancy. Therefore, we can say that tubal ligation surgery is not always definitive.

Below you have an index with the 12 points we are going to deal with in this article.

What is tubal ligation reversal?

Tubal ligation was considered a permanent method of contraception that was only recommended for women who were already mothers and were sure they did not want any more children. However, the advance of medicine has allowed, in certain cases, the tubal recanalization, making this process reversible.

The fertilization of the egg by the sperm takes place in the fallopian tubes. When the tubes are linked, the union of both gametes (egg and sperm) cannot take place and therefore gestation is prevented. If we manage to open the passage through the tubes, pregnancy can be achieved again.

Previous indications for tubal reversal

Reversal surgery is not suitable for all women. Those who wish to undergo this procedure should be studied by their physician and meet the following requirements and indications:

  • The patient will have a better prognosis when the fimbrias are preserved after the tubal ligation operation. The fimbria is a structure located at the distal end of the fallopian tube in the form of fringes that embrace the ovary. When the ovary releases an egg, it is collected by the fimbriae and channeled into the Fallopian tube.
  • The woman must preserve at least 4 centimeters of the tube in order to restore tubal function.
  • The patient's age must be less than 40 years old, as from this age the chances of achieving a natural pregnancy are reduced.

Tests prior to tubal reversal surgery

Before having a tubal ligation reversal, the doctor should study the couple to make sure they will both be able to become parents after the surgery.

Therefore, the tests demanded by the doctor will be aimed at studying the fertility of the patient and her partner.

The hormonal analysis and an ovarian ultrasound for the woman will be the fundamental tests to know that she will be able to become pregnant in the future. In the case of the man, a seminogram will be the test that determines if his fertility is correct.

To find out how affected the fallopian tubes are that were cut in the previous operation, the doctor will require the study of the following tests, if necessary:

  • Hysterosalpingography: the doctor will be able to determine if the woman's remaining fallopian tube is in a condition to be restored or if it is completely damaged.
  • Laparoscopy: with which the doctor can explore the abdominal cavity by inserting a small camera. From this camera, the doctor will be able to examine how damaged the fallopian tubes are.

The result of all these tests will show if the patient can continue with the process of restoring her fertility.

The tubal reversal procedure

The success of this procedure depends on how the tubal ligation operation was performed in the past, as it is necessary for the patient to retain a section of the fallopian tube for a reversal to be possible.

Overall, surgical techniques that help restore fertility after tubal ligation offer an average pregnancy rate of 55%.

In the following section, we will look at the different processes of sterility reversal.

Ligation of fallopian tubes by occlusion or section

The most successful tubal ligation procedures are those that section or disable a small portion of the fallopian tube. In this case, we are talking about sterilization techniques by section and by tubal occlusion:

  • Tubal ligation by section of the tube: this surgical operation is based on the section or cutting off a part of the fallopian tube. The severed ends will be tied off. Within this group of techniques is the tubal ligation known as the Pomeroy method.
  • Tubal occlusion: is based on the placement of a device, such as a clamp, clip, or ring, that compresses the tube and prevents fertilization.

The reversal of this type of tubal ligation is simple, as it consists of removing the knotted section of the object obstructing the tube. The two ends of the tube are then sutured together to restore its permeability.

Tubal ligation by section or tubal occlusion is the easiest to reverse.

Pomeroy tubal ligation or tubal obstruction reversal achieves 70% of natural pregnancies in patients under 35 years of age in the first 18 months after reversal.

Ligation of Fallopian Tubes by Removal of Fimbriae

Ligation of the fallopian tubes by excision of the fimbrial bones has a much lower chance of reversal than the previous options.

The reversal operation is based on the reconstruction of the fimbrial bones with the rest of the woman's remaining fallopian tube.

The chances of achieving a natural pregnancy after fimbria reconstruction are below 25%.

Ligation by disabling the fallopian tubes

The fallopian tube ligation techniques that offer the most effectiveness as a contraceptive method are those that disable most of the tube. However, these techniques reduce the possibility of future reversal. These surgical methods are as follows:

  • Fallopian tube removal: if the woman is sterilized by the complete removal of the fallopian tube, the chances of reversal are not possible. In those cases where the partial removal of the tube is performed, it is necessary to have at least 4-6 cm of a healthy tube in order to reverse the ligation operation.
  • Irreversible damage to the fallopian tubes: Some sterilization systems produce irreversible damage along the fallopian tube. For example, the Essure system is a spring-loaded device that is placed inside the fallopian tube to keep sperm out. Due to numerous cases where women reported abdominal pain or allergies produced by this device, its use as a contraceptive method is in disuse. However, today you can still find women with this device inside.

Reversing sterilization in patients with this type of tubal ligation is technically impossible.

In these cases, it is recommended that women resort to in vitro fertilization treatments in order to become mothers.

Care after reversal surgery

It is important to remember that tubal ligation reversal is a much more complex surgery than the ligation itself and is much longer-lasting.

While tubal ligation surgery takes about five minutes, tubal recanalization surgery can take up to two hours. Therefore, the benefit of the operation must be carefully assessed.

The patient's recovery time will depend on the surgical method used by the surgeon. Those interventions by means of an abdominal surgery, where an intersection is made in the lower part of the belly, will need more rest and recovery time.

However, most operations to restore the function of the tubes are performed by microsurgical techniques.

In this type of operation, the operation is performed through small perforations in the abdomen through which small surgical instruments used by the surgeon to operate are introduced. This type of surgery is less invasive and the patient can recover from home.

After this procedure, most patients are able to return to their daily lives gradually. The patient usually recovers completely within 2 weeks of the operation.

Risks and complications of reversal surgery

Every surgery has its risks, and although these risks are not very common, patients should be aware that after the operation they may face the following complications:

  • Infections
  • Bleeding
  • Damage to nearby organs
  • Scarring of the fallopian tubes
  • Complications from anesthesia
  • Risk of ectopic pregnancy
  • Failure of the operation and impossibility of achieving a natural pregnancy

Successful tubal reversal procedure

As we have seen, the success rate will depend on the surgical procedure that was used to proceed with the tubal ligation.

After 3 or 4 months after the operation, the patient should go to the doctor's office to have her tubes checked and have a study made of their permeability.

Normally, new hysterosalpingography will be the indicated test to know if the fallopian tubes are open again to the passage of sperm.

In those cases where the reversal is not possible or has not been successful, the couple can resort to in vitro fertilization as an alternative to natural pregnancy.

Reversal surgery or IVF treatment?

Facing the decision to undergo tubal ligation reversal or IVF treatment is not easy.

Not only must factors such as the patient's age, the cost of each treatment, time or the presence of other potentially negative fertility problems be taken into account. The couple's long-term family planning needs to be considered as well.

If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

Therefore, when a woman wants to restore her fertility after a tubal ligation, it is necessary to ask: How many children do you want to have, what is the best option according to the woman's age, what treatment has the highest probability of pregnancy?

In the following section, we will see the data from several scientific studies, where the different pregnancy rates between tubal ligation reversal and IVF treatments were analyzed based on the ages of the patients.

In women under 35 who want to have more than one child

If a woman wants to have more than one child in the future, tubal ligation reversal will be her first choice. Surgery for recanalization will always be the best decision when a woman is young, has a good ovarian reserve, and can conceive her future babies naturally.

Tubal ligation reversal offers a pregnancy success rate of over 70% in young women. This is why more and more patients who have undergone these contraceptive procedures decide to undergo operations to reverse the process.

In women between 35 and 37 years old

In this case, the decision should be made depending on the cost and effectiveness that both techniques offer. If the woman only wishes to have one child, IVF may be the most suitable option, to avoid the risks involved in an operation.

However, if the patient wishes to have more than one child in the future, tubal ligation reversal will be of greater benefit to the couple if previous fertility studies allow it.

The chance of pregnancy with IVF in women under 37 who undergo this treatment because they have a tubal ligation done is 52.4%. However, this success rate increases to 72.2% in those women who choose to have tubal reversal surgery. Therefore, if a woman wants to have more than one child in the future and is less than 37 years old, tubal reversal surgery will be the most appropriate treatment.

Women over 37 years of age

All the research groups that have dealt with this subject agree that in women over 37 years of age the most profitable and effective treatment is IVF, as it has a 51.4% success rate compared to 36.6% of pregnancies in women who have undergone tubal reversal.

From the age of 37, a woman's fertility is reduced because the quality of the eggs and the ovarian reserve is drastically affected.

Women over 42-43 years old

In women over the age of 42, the success rates for achieving a pregnancy are very low, both in the reversal surgery procedure and in the IVF treatment. This is due to the decrease in ovarian reserve suffered by women at the end of their reproductive stage.

Women over 42 years old with tubal ligation, not only face the impossibility of not getting pregnant after the reversal operation but also have to face the low success rate in IVF processes, which is between 1 and 3%.

Success rates per cycle in IVF are better than those for a tubal reversal for all age groups in all published reports.

FAQs from users

Is tubal ligation reversal effective when it comes to getting pregnant?

By Dr. Jon Ander Agirregoikoa MD (gynecologist).

Tubal ligation consists of preventing the passage of sperm into the tubes, thus preventing fertilization.

The reversal of tubal ligation is not always satisfactory, the factors that may influence are age, time since surgery, and the technique used. In women under 34 years can reach 70% of pregnancies.

Another important factor is the length of the tube after surgery, which must be more than 4 cm.

We can consider reversing a tubal ligation in women under 34 years old and with a residual tube longer than 4 cm.

What is the best solution for getting pregnant with blocked Fallopian tubes?

By Zaira Salvador BSc, MSc (embryologist).

IVF treatment is the most appropriate treatment to achieve pregnancy when the woman does not have tubal functionality. Usually, it is the technique of choice in women who have a tubal ligation done and wish to have a child. In addition, the advantage of IVF is that it also offers guarantees of success even if the male's semen is not of good quality.

Can an Irving tubal ligation be reversed?

By Laura Parra Villar (embryologin).

It's not possible. This technique was designed to provide greater sterilization protection against other techniques that rechanneled the tube and reopened it.

Because much of the tube is damaged by this method, it is not technically possible to reverse the tubal ligation to restore fertility.

What is partial salpingectomy?

By Zaira Salvador BSc, MSc (embryologist).

As the name implies, partial salpingectomy is the cutting and removal of a segment of the fallopian tube. This method is the most commonly used to perform a tubal ligation and is known as Pomeroy.

Suggested for you

If you have a tubal ligation done and want to know more about how you can get pregnant through an in vitro fertilization treatment, we recommend you the article What Are Your Chances of Pregnancy After Tubal Ligation?

IVF treatments are the most widely used assisted reproduction techniques for people who do not have functional fallopian tubes. If you want to know more about this treatment, we invite you to read our article What Is In Vitro Fertilization (IVF)? - Process, Cost & Success Rates.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Boeckxstaens A, Devroey P, Collins J, Tournaye H. Getting pregnant after tubal sterilization: surgical reversal or IVF?. Hum Reprod. 2007 Oct;22(10):2660-4.

Gomel V. The place of reconstructive tubal surgery in the era of assisted reproductive techniques. Reprod Biomed Online. 2015 Dec;31(6):722-31.

Van Seeters JAH, Chua SJ, Mol BWJ, Koks CAM. Tubal anastomosis after previous sterilization: a systematic review. Hum Reprod Update. 2017 May 1;23(3):358-370.

Messinger LB, Alford CE, Csokmay JM, Henne MB, Mumford S5, Segars JH, Armstrong AY. Cost and efficacy comparison of in vitro fertilization and tubal anastomosis for women after tubal ligation. Fertil Steril. 2015 Jul;104(1):32-8.e4.

Berger GS, Thorp JM Jr, Weaver MA. Effectiveness of bilateral tubotubal anastomosis in a large outpatient population. Hum Reprod. 2016 May;31(5):1120-5.

Monteith CW, Berger G, Zerden ML. Pregnancy success after hysteroscopic sterilization reversal. Format: AbstractSend to
Obstet Gynecol. 2014 Dec;124(6):1183-9.

Jayakrishnan K, Baheti SN. Laparoscopic tubal sterilization reversal and fertility outcomes. J Hum Reprod Sci. 2011 Sep;4(3):125-9.

Conway S. Tubal Reversal versus IVF: Which is the best choice?

FAQs from users: 'Is tubal ligation reversal effective when it comes to getting pregnant?', 'What is the best solution for getting pregnant with blocked Fallopian tubes?', 'Can an Irving tubal ligation be reversed?' and 'What is partial salpingectomy?'.

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Authors and contributors

Dr. Jon Ander  Agirregoikoa
Dr. Jon Ander Agirregoikoa
MD
gynecologist
Graduated in medicine from the "Pays Basque" University, with a specialization in obstetrics and gynaecology. He has several years of experience in the field of assisted human reproduction and is co-director and co-founder of the ART clinics. He also combines his medical activity with teaching at the "Pays Basque" University. More information about Dr. Jon Ander Agirregoikoa
License: 014809788
 Laura Parra Villar
Laura Parra Villar
Embryologin
Graduate in Biology from the University of Valencia (UV) and embryologist with a Master's degree in Biotechnology of Human Reproduction from the University of Valencia in collaboration with the Valencian Institute of Infertility (IVI). More information about Laura Parra Villar
Licence number: 3325-CV
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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