Tubal Ligation Reversal

Overview  

Tubal ligation, commonly referred to as “having your tubes tied,” is a surgical procedure that prevents pregnancy by blocking the fallopian tubes. This can be done by tying, cutting, or burning the tubes, effectively stopping eggs from meeting sperm, and thus preventing fertilization. 

If someone who has undergone a tubal ligation later decides they want to become pregnant, there are two primary options: tubal ligation reversal surgery or in vitro fertilization (IVF). With IVF, fallopian tubes are not needed because fertilization occurs outside the body. Both options have advantages and disadvantages, depending on individual circumstances. 

Tubal ligation reversal, also known as tubal reversal or tubal reanastomosis, is a surgical procedure that restores the function of the fallopian tubes. This operation reconnects or reopens the tubes, allowing eggs and sperm to meet naturally and making conception possible once again.

Reasons for undergoing the procedure  

A good candidate for tubal ligation reversal is someone who has a strong likelihood of becoming pregnant after the procedure. The success rate is influenced by several factors, including: 

• Age: As age increases, the natural chances of pregnancy decrease. Younger individuals typically experience higher pregnancy rates and face lower risks of miscarriage or congenital disorders in the baby. 
• Partner’s sexual health: The health of the partner’s sperm plays a key role in determining the success of the surgery. 
• Tubal ligation procedure: The method used for tubal ligation affects the potential success of reversal. Procedures involving clips or rings to tie the fallopian tubes are generally easier to reverse compared to those using electrocautery, where the tubes are burned. 
• Other infertility causes: Conditions such as irregular periods, uterine fibroids, pelvic scarring, or endometriosis (where the tissue lining the uterus is also present outside the uterus) may lower the likelihood of success following a tubal ligation reversal. 
• Fallopian tube length: An adequate length of healthy fallopian tube segments is essential for a successful reconnection during surgery. 

Risks

Reversing a tubal ligation has relatively little risk. But like with any surgery, there is a chance of problems, such as:  

• Infection.  
• Blood clots or bleeding.  
• Reaction to anesthetic that is allergic.  
• Damage resulting from surgery on other organs.

Although there is a chance of an ectopic pregnancy after a tubal ligation reversal, it is still extremely minimal. After a tubal reversal, 2% to 7% of pregnancies result in ectopic pregnancies. An ectopic pregnancy occurs when an embryo (fertilized egg) implants in your fallopian tube rather than your uterus. An ectopic pregnancy is a medical emergency that has to be attended to by your doctor.  

Before the procedure  

Your doctor will go over the procedure’s details and associated dangers with you. To make sure you’re a good candidate for surgery, they’ll do the following procedures:  

• Health history. Your medical history will be carefully examined by your doctor. Your history of pregnancies, tubal ligation procedures, and any other pelvic surgeries will be questioned about.  
• Analysis of semen. After a tubal ligation reversal, your doctor will evaluate the quantity and quality of your partner’s sperm to estimate your chances of becoming pregnant.  
• Extra examinations. Based on your medical history and test findings, your doctor might prescribe imaging studies, blood tests, or both.  

Preparation  

On your initial visit with your fertility specialist, it would be beneficial if you could bring a copy of the report from your tubal ligation procedure. Additionally, bring the pathology report if your tubes were removed.

To increase the likelihood that your pregnancy will be healthy:  

• Ascertain that any ongoing medical issues are adequately managed.  
• Give up smoking.  
• Cut back on caffeine and alcohol.  
• Consume a folic acid-containing prenatal vitamin or multivitamin.  

During the procedure  

In a hospital, tubal ligation reversal procedure takes two to three hours to complete. On the day of your procedure, you’ll be allowed to return home.

The process your surgeon employs will dictate the course of the surgery. A mini-laparotomy involves your doctor making a single, 2-inch side-to-side incision slightly below your bikini line. Using an operating microscope, the procedure is then carried out via the incision. In a robotic-assisted laparoscopy, your surgeon makes multiple tiny abdominal incisions and uses a console to control robotic arms to do surgery.

When doing surgery, your doctor will:  

• Give you a general anesthetic dose so that the surgery puts you to sleep.  
• During surgery, a tiny tube known as a catheter will be inserted into your bladder to collect urine.  
• To reach your fallopian tubes, make one large incision or multiple smaller ones.  
• Determine if it is possible to reconstruct your tubes. Should tubal reversal be a viable option, your surgeon will do the procedure right away. They will rejoin the segments of your fallopian tubes and unblock the blocked ends of your tubes.  
• Use an intrauterine dye injection to determine whether your fallopian tubes are open.  
• Apply a bandage to the surgical site and use dissolvable sutures to close your wounds beneath your skin.  

After the procedure  

After surgery, you’ll probably need to spend another two hours in the hospital. Your doctor will keep an eye on you throughout that period to make sure it’s safe for you to return home. Your doctor will administer pain, nausea, and vomiting medication as needed before you leave the hospital. They’ll also provide you advice on how to look after yourself while you’re healing.

As the anesthesia wears off after surgery, you could feel drowsy or disoriented for a few hours. You need a friend or family member to drive you home so you can be safe. 

Outcome 

After a tubal ligation reversal, the pregnancy rate typically ranges from 50% to 80%. Several factors influence your candidacy for the surgery and its outcome, including your age and the remaining length of your fallopian tubes post-ligation. The skill and experience of your surgeon also play a significant role in the success of the procedure.

Most individuals can return to their normal activities within one to two weeks, but it’s advisable to confirm this with your fertility doctor. Most pregnancies following a tubal reversal occur within the first one to two years. You may need to wait two menstrual cycles before actively trying to conceive.