Tubal ligation1 is a permanent contraceptive method. Many women undergo this method in the heat of the moment, or because they already have many children, or because they have gone through somewhat traumatic experiences. However, tubal ligation can also lead to regret later on. Some women have it done too early, while still young and with one or two children. After some time, they may separate and start a new life, and wish to have children in their new relationship; or even if they don’t separate, they may long for a baby in their arms again. Then comes the regret of having had a tubal ligation so early, but that doesn’t mean a woman can never have children again—did you know there is a possibility of tubal ligation reversal?
There’s little talk about tubal ligation reversal, but yes, it can happen. For it to be possible, certain requirements must be met in that particular case and it must be considered by the doctor. Tubal ligation reversal is only possible in cases where the fallopian tubes were tied; if the tubes were removed, it is unfeasible and impossible because there is no way to reimplant them2.
The fallopian tubes are more than necessary channels for a new natural pregnancy, because it is in the tube that the sperm meets the egg. After sexual intercourse, the sperm swims as fast as it can up the uterus to meet the egg, and that’s where the magic happens, in the tube. After fertilization in the tube, the baby is carried along by tiny internal arms of the tube until it drops into the uterus to implant, and then the pregnancy truly begins, with the implantation of the zygote in the endometrium!
Tubal ligation reversal is only possible on tubes that have been clipped or surgically tied, and it can be performed by videolaparoscopy (two or three small incisions in the abdomen) or even through a vaginal approach. Some doctors perform tubal ligation during childbirth, but most doctors prefer to do it six months after the birth of the last child to make sure the patient is certain about undergoing such a complex procedure that would change her life, as she will become infertile! Unfortunately, there are cases where the baby may not survive, and also cases of regret from the woman.
How Does Pregnancy Happen After Tubal Ligation?
Tubal ligation reversal is done by removing the clips or untying the section that was keeping pregnancy from happening. Most tubal ligation reversal procedures are carried out in the same way as the original procedure, through laparoscopy. However, not every reversal guarantees that pregnancy will occur… There are cases where these procedures can harm, damage or even render the tube unviable for a new fertilization. The post-operative recovery is generally good and quick—48 hours in the hospital and a month of “rest” before trying for pregnancy again.
The viability of the tube is tested at the time of the procedure—a dye is injected to see if the tube is open and functional. Pregnancy after tubal ligation is possible if the reversal procedure is reasonably successful; a good professional and the woman’s good health make all the difference. The success rate ranges from 8 to 40% in healthy couples without any previous fertility issues before the ligation. The healthier and younger the woman, the greater her chances of natural pregnancy after tubal ligation reversal.
Reversal procedures can be done through the public health system (SUS) or with private insurance, but there may be extra costs for the patient. Some materials are not fully covered and may generate additional expenses as it’s a highly detailed procedure involving micro-sutures. Pregnancy after tubal ligation can also happen without reversal, as some couples opt for in vitro fertilization. Though expensive, it is an excellent solution3. There are agencies that provide it free of charge for couples who had tubal ligation and regret it, but the waiting list is long! In São Paulo’s public system (SUS), hospitals like Pérola Byington and Hospital das Clínicas have waiting lists for IVF or ICSI that can reach up to three years. For many couples, this is the only option since it’s a relatively expensive treatment.
Women with tied or clipped tubes can still get pregnant if the tube becomes detached from the “tie.” That’s why we sometimes see or hear about pregnancies even after tubal ligation is done. Such cases are rare, but they still happen. The possibility of a tubal ligation reversal should be discussed with your doctor, to assess its viability and check for contraindications like more than three cesarean deliveries due to the risk of uterine rupture, blood pressure problems, or any other issue that could affect the chances of a healthy pregnancy after tubal ligation.
Interested in a tubal ligation reversal? Talk to your doctor about a full set of tests for the couple and, if possible, go ahead. Irreversible cases of tubal ligation should seek out assisted reproduction centers, either private or public (SUS). In São Paulo, check Pérola for more information (www.hospitalperola.com.br/).
See you next time!
Also see: What is Varicocele, What Are Its Grades and How to Treat?
Photo: Hey Paul Studios
