If you are considering a tubal ligation reversal because you have decided you would like another child, there are several factors to consider. You will need to discuss the procedure with your physician and weigh the option of a tubal ligation reversal against your potential to have a successful in vitro fertilization. The best candidate for a tubal ligation reversal will be a woman whose tubes are at least 3-4″ long following reversal of the tubal ligation.
Reversing a Tubal Ligation When the Tubes Have Been Cut or Tied
While cutting or tying the tubes then cauterizing, or burning them, is considered a form of lasting sterilization, it can still be reversible. During this type of procedure the tubes are cut or tied, then heat is applied to a section of the tube midway, leaving the bulk of the fallopian tubes relatively unharmed. Cauterization is also known as coagulation, and is commonly done to prevent the tube from bleeding and to accelerate the tube healing. A normal, healthy fallopian tube can be as long as 7 inches therefore there is generally some of the healthy tube remaining following cauterization.
Reversing a Tubal Ligation When the Tubes Were Clamped
Called the occlusive method of tubal ligation, either a Falope ring or a Hulka clip are used to block the fallopian tubes. The clamp is placed across a small segment of the fallopian tubes; this method probably has the highest success rate for future reversal and pregnancy, therefore doctors who perform a tubal ligation on young women will typically use this method. The clips or ring will simply be removed during this relatively minor procedure; for women in their twenties who have undergone this procedure the pregnancy rate is 87%. For women in their thirties, the success rate is 73% and for women age 40 or older, the pregnancy rate following the reversal of a tubal ligation using clamps is about 47%.
Reversing a Tubal Ligation Following the Use of Essure
If a woman opts to use Essure as a form of sterilization, the physician will place a tiny insert into each of the fallopian tubes, which, once in place, will cause tissue to grow around them, effectively blocking the tubes and preventing sperm from entering. Essure is not immediately effective, and you must have an x-ray three months following the insertion to make sure the tubes are blocked. Essure has only been available since 2002, and the reversal method involves clipping the device out of the uterine muscle, and placing the remaining fallopian tube piece into the uterine cavity through a new uterus opening. The success rate of reversing Essure sterilization is somewhere between 25% and 50%.
Other Factors in Tubal Ligation Reversal
There is a much higher success rate when a tubal reversal is performed if the woman is under the age of 40. Nevertheless there are women over 40 who have ovaries which still maintain strong functioning, and a successful pregnancy can be achieved following a tubal reversal. A woman’s weight–or more precisely her body mass index–can impact the level of difficulty the surgeon will encounter when performing a tubal reversal as being obese can prolong your time in the operating room which increases complication risks. If the tubal reversal procedure is successful, then most couples will be able to conceive within three to seven months. If this has not happened, an HSG test may need to be performed (antiseptic dye is inserted through the cervix while an x-ray tracks the dye to establish whether or not the fallopian tubes are clear.
Most women can return to work fairly quickly following a tubal reversal, as the incision is typically about two and a half inches long, pain following the procedure is minimal, and recovery is rapid. The average time for returning to work is around a week. Approximately 6-7% percent of women who have undergone a tubal reversal will experience an ectopic pregnancy, so while this is a concern, it is not considered a large safety risk.
