| Many women have had their tubes tied because they did not plan to have children in the future. For some, circumstances can lead them to change their mind. For those women there may be hope that they can achieve a healthy birth through either in vitro fertilization (IVF) or tubal reversal.
Surgical reversal of a previous tubal ligation (also known as "untying the tubes") is one of the most effective tubal reconstructive surgeries available. In these cases the tubes remain open after surgery 70 to 80 percent of the time, with pregnancy rates slightly lower, in range of 50 to 75 percent. As with any type of tubal surgery, the reversal of a tubal ligation increases a woman's risk of a tubal pregnancy. The surgery is less successful if the tubes were cut with a cautery or if other pelvic disease such as scarring or endometriosis is present. Reversal of tubal ligation is performed by laparotomy (major surgery) using magnification techniques and should only be performed by surgeons with expertise in this procedure.
Technique/Procedure
The actual tubal ligation reversal is a lengthy and exacting procedure, requiring magnification and very fine suture material. The surgery is performed under general or regional anesthesia. The average operating time is approximately 3 hours. Most women are able to return to their normal activities or work within four to six weeks. If a woman is considering this surgery, her physician may review the operative and pathology notes from the initial tubal ligation. Further information may also be gained from an HSG (tubal dye test). Finally, if any doubt exists that the procedure would have a good chance of success, the physician may perform a diagnostic laparoscopy before deciding if there is a good chance that the tubal ligation can be successfully reversed.
Factors determining candidacy
- Woman's Age
- Day 2 or 3 FSH and Estradiol
- Semen Analysis
- Tubal Ligation Method
Possible risks involved in surgery*
- Bleeding
- Infection
- Anesthesia
- Injury to other structures
*Although based on extensive experience these are very rare.
Possible risks following surgery
- Procedure may be unsuccessful
- Ectopic (tubal) pregnancy
Conclusion
For women who have had a tubal ligation, microscopic tubal reversal frequently results in acceptable pregnancy rates. For women with a tubal ligation whose prognosis for a successful reversal is not good, in vitro fertilization may offer a good chance of achieving pregnancy. |
