Tubal Ligation Reversal - A Chance to Get Pregnant Again

Tubal ligation is a commonly performed means of birth control in which the fallopian tubes are cut so that eggs from the ovaries cannot be fertilized by sperm. For many years tubal ligation was considered a permanent means of birth control; however, tubal reversal surgery is offering woman a chance to get pregnant again after tubal ligation surgery.

A tubal reversal is a surgery to undo a tubal ligation-the fallopian tubes are reconnected. Once these tubes are reconnected, an egg that is released from the ovary during ovulation can make its way to the uterus. Also, a tubal reversal procedure allows sperm to reach the egg since a connection is once again made between the uterus and the ovary.

Tubal reversal surgery is performed under general anesthesia and can be done as an open procedure (laparotomy) or laparoscopically. The cut and tied fallopian tubes are visualized by the surgeon and these ends are once again cut. The cut ends of the fallopian tubes are sutured together; much like two pipes would be joined. Obviously suturing two cut ends of the fallopian tubes requires a high degree of manual dexterity and sufficient magnification of the area with a surgical microscope or magnifying laparoscope. While tubal reversal procedures are fairly common, they are technically challenging.

Tubal reversal recovery involves pelvic rest for as long as a month after surgery. This means that nothing is placed in the vagina during this time. Three months into tubal reversal recovery, a specific test should be performed to see if the tubal reversal was a success. This test is called a hysterosalpingogram and involves the injection of a dye into the fallopian tubes. An X-ray is taken to see if the dye reaches the entire way to the ovary of both sides. If the fallopian tubes were not successfully connected during the tubal reversal surgery, IVF (in vitro fertilization) should be the next step rather than a repeat tubal reversal.

If the tubal reversal surgery is successful, women can expect to become pregnant about one year after the procedure. The special imaging (hysterosalpingogram) can provide some clues as to whether the tubal reversal will be successful. Fallopian tubes of a good diameter without kinks, bends, or narrowing have the most promise for successful pregnancy.

In terms of reproduction, the fallopian tubes are more than simple tubes. The inside of the fallopian tube is coated with small, hair-like cells that help move the egg from the ovary to the uterus. One complication of tubal reversal surgery is that the hair-like cells in this area may not function properly because of the surgical manipulation. In its least severe form, this complication simply means that it is harder to achieve a pregnancy. However in a worst case scenario, an egg can become fertilized and grow within the fallopian tube at the section that was reconnected. If this occurs, it is an ectopic pregnancy and is a medical emergency.

Alternatives to tubal reversal surgery should be discussed with an OB/GYN prior to surgery. In many cases, IVF and other fertility treatments are preferable to tubal reversal in terms of greater overall success and fewer (less serious) complications.