The Fallopian tubes are muscular tubes which connect the ovaries with the uterus; women have two, one for each ovary. Their length ranges from 10 to 14 centimeters, with a diameter of 3 millimeters. The tube creates a funnel-shaped structure around the ovary, therefore facilitating egg reception during ovulation.
It is in the Fallopian tubes where the sperm meets the egg to create a new embryo, which then begins a rapid descent towards the uterus in order to implant into the uterine wall.
During this intervention, the tube can be sliced, cut, tied off or cauterized. The idea is to ensure, using surgical stitches, that the tubes are not merged together again once both sides have been sliced. This increases the contraceptive effectiveness of the intervention.
This contraceptive method turns out to be ideal for women who are already on motherhood and no longer want to have children. However, life may bring a series of unexpected circumstances, such as the loss of a child, the loss of your husband, a new marriage, etc., which may change their mind and make them want to become pregnant again. To do this, women may request a tubal ligation reversal procedure or turn to assisted reproductive technology.
On the one hand, tubal ligation hinders sperm to reach the egg; on the other hand, it also prevents the egg from getting to the uterus. This means the passage is blocked on both directions, i.e. from the uterus to the ovary, and from the ovary to the uterus.
The fact that the egg cannot be fertilized because of being unable to find its way to meet the sperm does not mean ovulation or egg release is stopped, too. In other words, women who undergo tubal ligation continue to have their menstrual cycle as usual, that is, ovulation and menstruation, including the menopause.
Tubal ligation reversal
Even though tubal repair is technically possible, it should be taken into account, however, the existence of a large number of disadvantages. Both permeability and motility must be recovered. Young women under 38 are recommended to undergo this intervention, especially those who wish to become pregnant in the future.
Previous to the reversal process, which is carried out by means of microsurgery, a laparoscopic surgery is performed in order to determine whether recanalization is possible or not, since it is necessary that both sides of the tubes measure more than 6 centimetres after tubal ligation.
This surgery is more complicated than tubal ligation, since it is carried out using tubal reversal microsurgery, a.k.a. microsurgical tubotubal anastomosis, and it takes longer given that it is more sophisticated and difficult. While tubal lugation procedure takes about five minutes, tubal recanalization could last up to two hours.
The success of the reversal surgery is generally 70 per cent, doing better after mechanical occlusion than after electrocoagulation, since the latter damages a greater part of the tube.
Studies show that, with modern microsurgery techniques, pregnancy occurs in 75% of cases, in contrast with 32% that result in ectopic pregnancy. The rate of ectopic pregnancies may become greater if a bipolar cauterization technique has been used, since it favors fistula formation.
Pregnancy after tubal ligation
Bearing in mind that neither ovulation nor menstrual cycles stop after tubal ligation, regardless of whether or not surgery has been successful, pregnancy chances do exist, either in a natural way or by means of ART.
Before taking any decisive step, the first thing every couple should do is a fertility test. This analysis is simplified if women are already on motherhood.
This test involves, among others:
- In women, a series of ultrasound scans and blood tests so that FSH, LH and estradiol are checked. It allows dismissing hormone imbalance and figuring out the capacity of the ovaries to provide eggs as well as whether natural ovulation occurs or not.
- Among males, a seminogram should be performed. There is no point in the woman being fertile if her partner’s values are unsatisfactory. Men with no children are highly recommended to undergo this test.
Depending on the results obtained, experts may recommend the most appropriate treatment to the patient. Nonetheless, women are able to get pregnant thanks to assisted reproductive techniques, especially in cases where even after reversal, chances for natural pregnancy are still non-existent.
In cases of women whose ability to produce eggs is damaged, men with low sperm quality or poor quality, or if there is some kind of disease, IVF is advisable.