Definition & Overview
A tubal ligation is a permanent form of birth control. Also called female sterilization, it is a surgical procedure wherein the fallopian tubes are closed or blocked to prevent the eggs released by the ovaries from entering the uterus so they will not be fertilized by sperm during sexual intercourse. In cases wherein a woman decides to get pregnant following the procedure, tubal ligation reversal can be performed, which essentially reopens or unties the fallopian tubes.
Who Should Undergo and Expected Results
A tubal ligation reversal is recommended for women who have previously undergone female sterilization but for some reasons, wish their ability to conceive restored.
Studies show that women who undergo a tubal ligation at a young age, specifically in their 30s, are more likely to regret their decision. Many patients also change their minds due to some changes in their circumstances. These are likely in cases wherein the patient was pressured to undergo the procedure or those who underwent tubal ligation due to marital issues.
A tubal ligation reversal can restore a woman’s ability to conceive. However, not all patients make good candidates for the procedure and the success rates tend to vary greatly depending on the type and techniques used during the initial tubal ligation surgery. Factors that are being considered when assessing patients' eligibility for a tubal ligation reversal include:
- The patient’s age – The success rate of the procedure is higher in women who are 40 years old and younger.
- The length of the fallopian tubes – This is usually significant if some parts of the tubes were cut during the ligation procedure.
- The technique used in previous tubal ligation procedure - Some types of sterilization procedures have irreversible effects.
- The general health of the patient’s reproductive structures – To qualify for the procedure, the patient’s ovaries, uterus, and fallopian tubes must be in good condition.
- When the tubal ligation was performed – Women who have undergone the procedure right after childbirth have a better chance of achieving successful outcomes.
- Previous surgical procedures – Surgical procedures for the treatment of gynecological disorders, such as endometriosis or pelvic inflammatory disease can lead to the development of scar tissue, which may hinder the success of the reversal procedure.
In cases where a reversal procedure is no longer possible or was not successful, patients may consider assisted reproductive technology, such as in-vitro fertilization, as their alternative option.
How is the Procedure Performed?
A tubal ligation reversal is a major abdominal procedure that takes about two to three hours and is considered more complex than the original tubal ligation surgery. It can be performed in the traditional manner or with the use of microsurgical techniques. While the former requires up to three days of hospital stay, the latter is an outpatient procedure that allows patients to go home as early as two to four hours after the surgery.
Prior to the procedure, patients undergo routine testing such as blood and imaging tests as well as hysterosalpingogram (HSG), which is performed using either X-ray and dye or ultrasound and saline, to check the overall condition of the ovaries and the length of the fallopian tubes.
If the patient is undergoing the procedure with the intention of achieving pregnancy with a partner, her partner will also have to undergo certain tests prior to the procedure to ensure that he does not have any infertility problem that may hinder them from conceiving despite having undergone the tubal ligation reversal. These tests include a semen analysis and sperm count.
During the surgery itself, the patient is placed under general anesthesia, which means she will be asleep during the entire surgery. The surgeon begins the procedure by making a small incision along the pubic line to gain access to the fallopian tubes. If the tubes were cut, the surgeon will remove the cut fragments before reconnecting the tubes using absorbable stitches. If the tubes were sealed or blocked, the clips or rings are removed.
If modern microsurgical techniques are used, the entire procedure is performed using a laparoscope, a small thin tube with a light source attached to its end. Other microsurgical tools and instruments are simply attached to the end of the scope. Thus, instead of a large open incision, the procedure is performed through a tiny surgical cut, which significantly minimizes bleeding and scarring.
During the recovery period, patients are advised to avoid any strenuous activities as well as sexual intercourse for the first two weeks after the procedure. They should also return to their normal activities at a gradual pace.
Possible Risks and Complications
A tubal ligation reversal carries some risks, including:
- Post-operative pain
- Allergic reactions to the anesthesia
- Damage to nearby organs
- Scar tissue formation – In rare cases, a scar tissue may form as a result of the procedure, which can block the fallopian tubes again.
Studies show that patients who undergo ligation reversal are more likely to experience an ectopic pregnancy, a serious complication that can put the patient’s life at risk and thus requires immediate medical attention.
Jayakrishnan K., Baheti S. (2011). “Laparoscopic tubal sterilization reversal and fertility outcomes.” J Hum Reprod Sci. 2011 Sep-Dec; 4(3): 125-129. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276946/
Bartz D., Greenberg J. (2008). “Sterilization in the United States.” Rev Obstet Gynecol. 2008 Winter; 1(1):23-32. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2492586/