What Are Your Chances of Pregnancy After Tubal Ligation?

By BSc, MSc (embryologist), MD (gynecologist), BSc, MSc (embryologist) and (invitra staff).
Last Update: 05/11/2020

Tubal ligation in women is considered a permanent contraceptive method, as the possibility of a natural pregnancy after this surgery is practically zero.

However, a woman who has her tubes tied can become pregnant again these days thanks to these two options:

What is tubal ligation?

The fallopian tubes are the muscular tubes that connect the ovaries and the uterus. This is where fertilization takes place, that is, the union between the egg and the sperm to give rise to the embryo, which will later descend into the uterus to implant in the endometrium and give rise to pregnancy.

Tubal ligation, also known worldwide as Pomeroy, consists of surgery to block this transport of the egg and sperm and therefore prevents fertilization and subsequent gestation.

During the surgical procedure, the tube can be sectioned, cut, ligated, or cauterized, to ensure that the ends of the tube are not rejoined.

The Pomeroy is the most commonly used technique to do a tubal ligation. It consists of cutting about 3 or 4 cm of the fallopian tube in its middle part. Generally, the Pomeroy allows for posterior tubal reconstruction.

Due to the high efficacy of this contraceptive method, it is recommended to do it in women who have been mothers and decide with total certainty not to have more children.

However, for various reasons in the lives of these women, it is possible to change their mind and want a pregnancy again, which can be attempted through assisted reproduction or by reversing tubal ligation.

Pregnancy by IVF

As we have said, tubal ligation prevents the encounter between the egg and the sperm and, as a consequence, fertilization. However, this does not imply a blockage of ovulation, that is, the woman would still release an egg from the ovary in each menstrual cycle.

Tubal ligation does not imply menopause, therefore, women sterilized with this method continue with their regular menstrual cycle, producing both ovulation and menstruation.

This opens up the possibility for these women to access assisted reproduction if they wish to become mothers again. Specifically, pregnancy is possible with a treatment of in vitro fertilization.

Tubal ligation does not affect either the ovaries nor the uterus. It is, therefore, possible to administer drugs to the patient to perform an ovarian stimulation and then extract the eggs from the ovary to fertilize them in the laboratory.

The embryos are developed in culture for a few days and then transferred to the mother's uterus, where they will remain waiting to be implanted and lead to a pregnancy.

Tubal ligation reversal

This is the alternative method to IVF for achieving pregnancy in women with cut tubes. Tubal ligation reversal is a surgical procedure in which the ends of the tubes that were cut are joined back together.

Reconstruction of the fallopian tubes is technically possible but less effective than IVF because the tubes must regain both permeability and motility after the operation.

Thus, it should be kept in mind that rechannelling of the tubes does not imply 100% recovery of fertility since it is possible that tubal functionality may not be recovered.

Tubal ligation reversal is advised for young women, under 38, who want more than one pregnancy in the future.

Before doing the reversal surgery, it is necessary to perform some diagnostic tests on the patient:

Laparoscopy
exploration of the abdominal cavity to see if the tubes can be recanalized since the ends of the tubes must measure more than 6 cm for this purpose.
Partner fertility testing
the goal is to rule out other pathologies that would prevent natural pregnancy. It would not make sense to reverse the tubes if there is another cause of infertility in both men and women.

The success of tubal ligation reversal is usually 70%, although it will depend on the type of ligation performed previously.

It should be noted that surgeries related to the fallopian tubes, including tubal recanalization, increase the risk of extra-uterine pregnancy. For this reason, in addition to the complexity of the operation, most experts recommend considering IVF as the first option for achieving pregnancy after tubal ligation.

Costs

Both techniques cost approximately up to $6,000 depending on the center where they are performed. However, as already mentioned, tubal reversal is not a 100% effective technique and does not ensure that pregnancy can be achieved. For this reason, most women prefer to resort to IVF rather than spend the money on something they don't know will work.

As far as IVF is concerned, it should be noted that medication is usually not included in the initial treatment budget. About 2500 and 3000 dollars are charged extra for the stimulation treatment.

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.

If it is necessary to resort to egg donation to achieve pregnancy with eggs from an anonymous donor, the price of IVF rises to $25,000.

There is a cheaper option which is embryo adoption. These come from the donation of a couple who have had surplus embryos in their IVF treatment. The cost is usually around $3000.

In any case, it is advisable to go to a fertility clinic where specialists can advise on the best alternative to have children depending on the possibilities of the woman or the couple.

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.

Is it possible to do artificial insemination after tubal ligation?

By Zaira Salvador BSc, MSc (embryologist).

No. In order to perform artificial insemination, it is essential that the fallopian tubes are permeable to allow the passage of sperm to the egg and then the transport of the embryo to the uterus. The assisted reproduction technique that allows pregnancy with the tubes tied is IVF.

Is natural pregnancy possible with a tubal ligation?

By Zaira Salvador BSc, MSc (embryologist).

Yes. Although this method of contraception is highly effective, there is a 1% chance that recanalization will occur and that the tubes will be rejoined. This chance increases over the years, and there is also an increased risk of ectopic pregnancy with tubal ligation.

For more information on this pregnancy complication, we recommend reading the following article: ectopic pregnancy.

What are the symptoms of tubal ligation pregnancy?

By Zaira Salvador BSc, MSc (embryologist).

If pregnancy occurs with the Pomeroy or another tubal ligation method, the signs and symptoms that would be noticed would be the same as in women without tied tubes because female hormones influence pregnancy in the same way. Therefore, during the first months of pregnancy, the woman will feel nausea, tiredness, absence of periods, breast discomfort, etc.

It is important to pay special attention to the symptoms that could occur in ectopic pregnancy: abnormal bleeding, very strong abdominal pain on one side, weakness, low back pain, low blood pressure, etc.

Lectura recomendada

In vitro fertilization is the appropriate assisted reproduction technique to achieve pregnancy if the woman has a tubal ligation. If you need more information about this treatment, you can continue reading on the following link: What is in vitro fertilization (IVF)?

In case you are looking for an effective contraceptive method, we encourage you to consider other options like the ones you can find in the following post: Which contraceptives work?

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

Authors and contributors

 Clara Miret Lucio
Clara Miret Lucio
BSc, MSc
Embryologist
Bachelor's Degree in Pharmacy from the University of Valencia (UV). Master's Degree in Biotechnology of Human Assisted Reproduction from the UV. Experience as a pharmacist and embryologist specialized in Reproductive Medicine at Valencian Infertility Institute (IVI), and currently at Equipo Juana Crespo (Valencia, Spain). More information about Clara Miret Lucio
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
 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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