Untying the Tubes

Reversal of Tubal Ligation after Divorce

If you have had your tubes tied (tubal ligation) and are now divorced or remarried, you may have changed your mind and want to have more kids.

Reversal of female sterilization can be quite successful and it is estimated that 10-20% of women regret tubal ligation and wish to have it reversed.

The Biology of Pregnancy

For a pregnancy to occur naturally, sperm must enter the fallopian tube through the uterus by way of the vagina and cervix (opening to the uterus or womb). The oocyte (egg) is released from the ovary and is picked up from the other end of the tube (ovarian or fimbrial end). When the fallopian tubes are blocked, sperm and eggs are kept apart and fertilization is prevented.

The fallopian tube is a narrow muscular tube arising from the upper corners of the uterus and ending just next to the ovary. The inner tubal lining is rich in cilia, microscopic hair-like projections that beat in waves that move a fertilized egg (embryo) towards the uterus. The fallopian tube is normally about 10-12 cm (4–5 inches) long.

Factors in Successful Reversal

In general, at least 5 cm or greater in tubal length is needed for the best chance at success after tubal reversal. There are a variety of ways that the original ligation could be done. Reversal has an even better chance of success if the tubal ligation was performed with clips or rings. The surgery is less successful if the tubes were cut (burned) using an electrocautery instrument or if other pelvic disease such as scaring or endometriosis is present.

Tubal reversal works best for women in good health, in their late thirties or younger, who have a fertile partner. The results are best from this surgery if it has been 10 years or less since the original tubal surgery, and only small sections of the tubes have been damaged by the previous surgery.

Surgery to Reverse Tubal Ligation

Reversal of tubal ligation is performed by laparotomy (major surgery) using magnification and microsurgical techniques and should only be performed by surgeon with extensive experience in this procedure. The actual tubal ligation reversal is a lengthy and exacting procedure requiring a microscope and very fine suture material. Dye is injected to confirm that the fallopian tube passageway is open. Patients are generally discharged from the hospital the next day, but full recovery and return to work will take several weeks.

Risks of Reversed Tubal Ligation

The main risks associated with tubal ligation reversal are a blockage rate of approximately 5% and an ectopic pregnancy rate of 8% to 12%. When a positive pregnancy test is detected following tubal ligation reversal, an early ultrasound and blood work should be done to identify a possible ectopic pregnancy.

The other risk relates to the woman’s age. The older the woman, the higher the risk of birth defects. The most common is Down syndrome. At age 20, that risk is 1 in 1,667; at age 45, the risk is 1 in 30. At age 52, it is about 1 in 8. For women over 45, the risk of miscarriage also is well over 50 percent.

Other Options to Reversal of Tubal Ligation

Besides reversing tubal ligation, you can choose other options such as assisted reproduction, for example in vitro fertilization or adoption. The choice between a tubal reversal, or in vitro fertilization, depends on the woman’s age, method of tubal ligation, finances, and the patients desires. Information about the type of tubal ligation done will be needed before a decision can be made. Many health insurance companies do not cover reversal of tubal ligation so check with your health insurance company.

Disclaimer: No information or materials posted here are intended to constitute medical advice, nor can we guarantee the accuracy of posted information, especially as to each individual situation. For medical advice, please contact your doctor or hospital.