Have you had your tubes tied, but now you realize that you'd like to become a mother? This situation isn't uncommon in women who've had a change of heart or entered a new relationship. In fact, as many as 25 percent of women change their minds later in life about having more children, according to the Cleveland Clinic.
Of course, there's good news and bad news when it comes to conceiving after tubal ligation. The good news is that many women are able to become pregnant. The down side? Some will face much lower success rates than those who haven't had their tubes tied. "Patients need to remember that the original surgery was deemed 'permanent and irreversible,'" says Monica McHenry Svets, MD, an ob-gyn at the Cleveland Clinic. "Tubal reversals are elective procedures that an infertility specialist must perform."
There are currently two methods for getting pregnant if you had a tubal ligation: Get your tubes untied or try to conceive with in vitro fertilization (IVF). Here's what you need to know.
What Happens When You Get Your Tubes Untied
Tubal ligation is a surgery that can be reversed for some women. During this procedure, the fallopian tubes are reconnected, re-establishing the pathway from the ovaries to the uterus and allowing for two-way traffic. The egg can enter the uterus and the sperm can enter the fallopian tubes to reach the egg, according to the Mayo Clinic.
If the remaining, healthy fallopian tubes are not long enough, they may not be able to be reconnected. Similarly, if the tubes are scarred or otherwise damaged, this could partially block egg and sperm from meeting. Additional procedures — like those that try to remove scar tissue — may be necessary, according to the Mayo Clinic.
What Influences Success of a Reversal?
Tubal reversal is more successful if the original tubal ligation was performed using clips or rings, rather than by burning segments of the fallopian tubes to close them. "Other factors that may influence the success rate of this procedure include the age of the patient, the time that's elapsed from sterilization and the initial method of sterilization," says Dr. Svets. If there's evidence or a history of gynecologic disease — such as endometriosis or pelvic adhesive disease — this procedure could prove difficult and may be ruled out.
"There are also risks that accompany the reversal surgery, such as bleeding, infection, damage to surrounding organs (uterus, ovaries, tubes, bowel, bladder, blood vessels) and risks related anesthesia," reports Dr. Svets. The success rate for conception after tubal reversal can be up to 80 percent for pregnancy and delivery within the first 6 months, she adds.
When Should You Consider IVF?
If your tubal ligation reversal can't be completed or you don't want to undergo that surgery, you can attempt IVF. During this series of procedures, your eggs (or a donor's eggs) are harvested and fertilized with your partner's or donor's sperm in a laboratory. The fertilized embryos are then inserted into the uterus, bypassing the need for working fallopian tubes, according to the Centers for Disease Control and Prevention (CDC).
Dr. Svets explains that a woman's age may make a physician counsel her away from tubal reversal and tip the scales in favor of IVF. This is because IVF may provide more "bang for the buck" in those of advanced maternal age or in women with risk factors for infertility, such as endometriosis and gynecologic disease.
The success rate for UVF is between 41 to 43 percent for women under 35, but then it drops to 13 to 18 percent for those over 40, per the American Pregnancy Association. The expensive procedure is also often not covered by insurance. Still, many couples have found success with this procedure, and according to December 2015 research published in the Journal of the American Medical Association, the treatment becomes more effective the more you have it.