Endometrial Ablation and Tubal Ligation Reversal: Advice
Posted On: Monday, December 21st, 2009
Endometrial ablation and tubal ligation are common surgical procedures usually performed at the same time.
Many women will regret their decision to have these procedures and will inquire about the possibility of tubal reversal and pregnancy after ablation. We have created a series of informative articles to provide readers more information on pregnancy after endometrial ablation.
This fourth article in the series provides advice to readers who want to become pregnant after an endometrial ablation and who wonder if they are candidates for tubal ligation reversal after uterine ablation procedures.
Readers should familiarize themselves with our previous publications:
Pregnancy After Endometrial Ablation And Tubal Reversal
Effects on Endometrial Ablation on Pregnancy
Pregnancy After Endometrial Ablation: Menstrual Period?
Tubal ligation reversal and pregnancy can be possible for women after an endometrial ablation if they are having normal menstrual periods. The possibility of pregnancy and tubal reversal after ablation depends in large part on the regularity and quality of the menstrual period.
Endometrial ablation is effective in reducing the amount of bleeding with a menstrual period.
Endometrial ablation is not very effective in totally eliminating menstrual bleeding and many patients will have resumption in menstrual periods within five years of an ablation procedure.
Tubal Reversal and Uterine Ablation: No Period
If menstrual periods have ceased after endometrial ablation, then this indicates that most of the endometrial lining has been removed during the endometrial ablation procedure. In this situation, the uterus will not be able to sustain a normal pregnancy. Pregnancy is unlikely after either tubal ligation reversal or with in vitro fertilization (IVF).
No Menstrual Period: Advice
Medical evaluation may indicate other causes of the absence of menstrual periods (amenorrhea). Women should consider having their follicle stimulating (FSH), prolactin, and thyroid hormone levels checked to make sure they are not menopausal or have abnormal prolactin or thyroid hormone levels as the cause for absent menstrual periods.
If a woman is menopausal then natural pregnancy is not a feasible option. If thyroid or prolactin tests are abnormal, then these could be treatable medical conditions and after treatment menstrual periods could return.
Women should be aware the absence of menstrual periods after an ablation is very likely due to the ablation procedure; however, one can never know with certainty, which is why the above testing should be considered.
Uterine Lining After Endometrial Ablation
Women should also have an ultrasound to evaluate the uterus, uterine cavity, and the endometrium. During the ultrasound exam, the thickness of the endometrial lining is measured- this is termed the uterine, or endometrial, stripe.
Normal endometrial thickness ranges from 4-10 millimeters, depending on where a woman is in her cycle. If the ablation was effective then the endometrium (and the endometrial stripe) will be absent or minimal (less than 4mm).
There is also a possibility the endometrial lining is normal and the menstrual periods have remained inside since the ablation. This condition is called a hematometria and can be a complication of endometrial ablation. This condition is usually associated with monthly, crampy pain when the menstrual period should be occurring.
Hematometria can occur when the ablation causes the inside of the cervix to scar closed and menstrual periods will not be released.
With this complication, the endometrial lining is functioning, but menstrual periods cannot escape. This can occur without symptoms but most women will have severe cramps during the time when they should be having their period.
Tubal reversal and pregnancy after endometrial ablation could be possible if women are not having periods after the ablation – but only if the reason for the decreased periods is due to a hormonal imbalance or to cervical obstruction. Realistically, women should be aware before they request this testing that the most likely reason for absent periods is because of a successful ablation procedure.
Tubal Reversal After Ablation: Advice
We will continue our advice in the next article. The next article, Tubal Reversal After Ablation: Pregnancy Advice, will focus on patients who have light or normal menstrual periods after endometrial ablation.
More Information About Tubal Reversal
More information about tubal reversal can be found on the website of Chapel Hill Tubal Reversal Center. For personal stories about women who have had tubal reversal and pregnancy, readers are advised to visit the Tubal Reversal Message Board and Tubal Reversal Blog.
December 21st, 2009 at 11:55 am
The cartoon is excellent. How fortunate we are to have the doctor in and relating this valuable information regarding tubal reversal and uterine ablation.
December 21st, 2009 at 12:31 pm
I don’t think that most women are aware of the implications of uterine and endometrial ablation. Thanks for a clear explanation of what to expect after this procedure.
December 21st, 2009 at 8:46 pm
Thank you, Dr. Monteith, for this informative article on uterine and endometrial ablation and the varying affects it can have on whether a pregnancy occurs.
December 22nd, 2009 at 12:20 pm
[...] the advice for women who have had ablation and want to become pregnant.The previous article, Endometrial Ablation and Tubal Ligation Reversal: Advice, offers medical advice for women who are not having menstrual periods after ablation.This article [...]
January 12th, 2010 at 9:00 pm
[...] After Reversal And Uterine Ablation: Our Advice. The next article in our series is Endometrial Ablation and Tubal Ligation Reversal: Advice. We will offer advice on pregnancy and tubal reversal after uterine ablation. We will provide [...]
January 18th, 2010 at 2:23 pm
Social comments and analytics for this post…
This post was mentioned on Digg by edjohnson38: Wonderful and informative article Dr. Monteith. Loads of great information….
August 6th, 2010 at 3:41 pm
I so hope and pray that even though I had my tubal ligation performed back in 1997 and my uterine ablation 4 1/2 yrs ago, I will be able to become pregnant…i am still only 35 yrs old and my husband & I would love to have a baby
August 6th, 2010 at 4:04 pm
Alicia
It is very unlikely to get pregnant after an endometrial ablation and tubal ligation unless you have had a tubal ligation reversal.
August 31st, 2010 at 11:07 pm
I am 48, had an endometrial ablation 7 years ago, still had regular periods after (although lighter), and was thought to be in menopause as I have only had 1 period in the last 3 years. I do, however have regular cramping, migraines, “PMS” symptoms when I should have a period just no bleeding. Recently I underwent treatment for thyroid deficiency and adrenal fatigue. Three weeks ago we had unprotected sex…now I have many pregnancy symptoms. Is it possible at my age after an ablation and what seemed like menopause????
September 1st, 2010 at 6:28 am
Wanda
Pregnancy is always a possibility if you are premenopausal but also very, very unlikely at your age. You should take a pregnancy test and if it positive see your doctor.
September 16th, 2010 at 9:50 pm
I am 46 years old and had an endometrial ablation almost 3 years ago. I have regular periods although they are very light and with horrible cramping. Recently I began taking natural progesterone. For the first time in my life I am 8 days late for my period. I was considered sterile before the ablation because of not having gotten pregnant after 12 years of trying (no infertility testing was done other than my husband IS able to impregnate). Therefore, I still do not use contraceptives to prevent pregnancy. Could I be pregnant?
September 17th, 2010 at 6:47 am
Anonymous – It is very unlikely that you are pregnant. Most likely the progesterone is related to your delayed period. Of course, you can also perform a home pregnancy test to confirm whether or not you are pregnant.
December 20th, 2010 at 8:32 pm
Each month I have a cycle (endometrial ablation in 2009). Menses is lighter than before my procedure however (extreme heaviness pre procedure), but I still do have a cycle like clockwork each month with more than spotting.
I have an appointment with my obgyn in a couple of weeks. Can I ask for an ultrasound to determine the thickness of the lining? And if I do find that the lining is between 4 and 10 mm’s would that make for a greater change of a viable pregnancy? I assume there would always be risks, but Im wondering if the risks can decrease depending on the thickness of ones lining.
Thank you!
December 20th, 2010 at 9:18 pm
Heather – You certainly can ask your ob/gyn to perform an ultrasound examination to measure the thickness of your endometrial lining. The exam should be performed from the time of ovulation until 1 week after in order to get the most accurate measurement. Ideally, the endometrium will measure 6 mm or more. It is likely that the risks associated with pregnancy after endometrial ablation are inversely associated with the endometrial thickness.
December 28th, 2010 at 6:45 pm
If I have some endometrium after ablation, can I use estrogen to make it proliferate more and give me a better chance of getting/staying pregnant? I am 45, and will need IVF with donor eggs.
December 29th, 2010 at 10:27 am
It should not hurt, may help, but it is experimental and the answer to your question is unknown at this time.
January 6th, 2011 at 9:26 am
Thank you for your reply, Dr. Monteith!
January 31st, 2011 at 7:07 pm
I too, share with the ablation crew (September,2007), I am now wishing that I had opted out of the ablation decision. My last ultrasound showed a 6mm lining thickness and I have regular periods every month. My tubes are tied and cauterized. I am 30 and wonder what chances I take….
January 31st, 2011 at 8:24 pm
Ariana – With normal periods and an endometrial lining of 6 mm, you should be able to carry a pregnancy even after the endometrial ablation. At age 30, the pregnancy rate after reversal of cauterized tubes is approximately 75%.
February 1st, 2011 at 8:00 pm
Thank you for your prompt reply. I will be obtaining more information regarding your facility..as my fiance and I are eager to learn more.
February 1st, 2011 at 9:12 pm
One more thing-my doctor would like me to begin birth control…is this something that I should do? He prescribes it to me every time I visit;but I have yet in two years to get it filled. I just had a visit yesterday and he feels that since all is going well, I should take it to regulate hormones and then I am able to skips periods by not taking the blanks. If pregnancy is my goal in the next years…do I take them?
February 1st, 2011 at 9:44 pm
Ariana – I don’t see what the point is in taking birth control pills. Why do you need to regulate your hormones??
February 2nd, 2011 at 4:30 pm
Thank you…I do not see the point either. He wants to detour any endometeriosis from growing. I have been great,so I have informed him once again that I will not be taking it. I never understood why he kept pushing the contraceptive?
April 17th, 2011 at 1:45 am
I’m 26 … And I’ve had my tubes tied and novasure done over 5 years ago ! The tubal they done was where they cut and removed a small piece my dr told me it was able to be rev. But the problem is the novasure I was 20 years old when I done this I now feel like I’ve made the biggest mistake ever I have baby blues so bad !! There’s not a doctor in Alabama that will touch me ! Oh and I only spot during my periods I had wondered if ivf is possible ? But I just want my tubal rev. I think it should be my choose ! And the cost is a big factor ! So depressed I can’t believe I’ve done this to myself what was I thinking
April 17th, 2011 at 1:54 am
But I have faith that I’ll find the help I need !! I’m just so tired of being told theres no chance ! I’ve not had any test done . When I tell a dr what I’ve had done they say theres no chance !!! I’ve read on the Internet where women have had it done ! So I know there’s a chance I just haven’t found the one person willing to help … I pray every night that a miracle will happen …
June 13th, 2011 at 1:17 am
After reading the articles of EA and pregnancy, I am terrified of continuing my pregnancy. I am now 7 weeks pregnant and had minor spotting and cramping. My OB placed me on bed rest and prenatal vitamins and a hormone. Other than the spotting, I feel completely normal. I am 40 years old, have had 2 prior, normal pregnancies, my children are 15 and 12. The initial ultrasound showed a thickening of the endometrial lining and the small sack….at the time i was only 5 weeks so they could not see a heartbeat. I am due for another ultrasound on Wednesday this week. From what I am reading, however, the complications come along much further into the pregnancy. I am truly unsure of what to do or think. Am I considered “high risk” immediately due to the EA? In all other respects I am healthy according to a complete check up less than a year ago. Please advise as to what questions to ask my current OB and do I need to find a specialized doctor for my pregnancy?
June 13th, 2011 at 5:51 am
Cyndi – Any pregnancy after endometrial ablation should be considered high risk. You might discuss with your ob/gyn whether to have a consultation or be followed by an ob/gyn who specializes in high risk obstetrics, sometimes called a Maternal and Fetal Medicine specialist.
July 18th, 2011 at 5:26 pm
Are there any clinical trials for women wanting to become pregnant after a tubal and ablation? Having an ablation was the worst decision I’ve ever made. I let my doctor talk me into it out of fear, b/c I had aready had 4 miscarriages. I was afraid to have another pregnancy end in heartache. I have two healthy children and am very grateful to have them. However, I do want another child.
July 18th, 2011 at 7:15 pm
Kristin
There are no clinical trials looking at pregnancy after endometrial ablation. There are only case reports of pregnancies. If you do not miscarry then most pregnancies do well but are considered high risk.
October 7th, 2011 at 12:21 pm
Is an endometrial thickness of 12mm something to be concerned over? I am 23. Is there any way to tell if an endometrial ablation has been performed from an ultrasound or hysterocopy?
October 7th, 2011 at 4:06 pm
Kay – Endometrial thickness of 12 mm in normal. Hysteroscopy can tell if an endometrial ablation has resulted in permanent damage to the endometrial lining.
October 24th, 2011 at 5:11 pm
I had a tubal ligation twelve years ago and an ablation last year and im considering a reversal at your office. I still have regular menstrual cycles and im 33 years old. Would you consider me being very high risk and how likely is the possibility of a successful pregnancy.
October 24th, 2011 at 5:21 pm
Yvette – If you are having regular menstrual cycles then it is possible to have a successful pregnancy after endometrial ablation and tubal reversal. Because endometrial ablation is associated with increased risks of miscarriage, premature delivery, and other complications of pregnancy, before having your tubes repaired you should check the internal lining of the uterus through hysteroscopy to see if there is scar tissue in the uterus and/or missing areas of the endometrial lining. In addition, an ultrasound exam should be performed after ovulation but before your next menstrual period to measure the thickness of the endometrial lining. If both of these tests are normal, then you should not be at high risk during a pregnancy.
November 7th, 2011 at 10:05 pm
I decided to have an EA Sept 2010 because of heavy cycles. I have not had a cycle since the procedure but I do experience pain & pressure monthly. I do not feel normal. I was not properly informed & now regret having the EA because I wish to have anoher child. Is there anything that I can do to regrow my lining to resume my cycle?
November 8th, 2011 at 7:01 am
Mickey – It is likely that you have scarring in the uterine cavity. Removing the scarring my improve the chance that the endometrial lining can regrow.
November 12th, 2011 at 5:50 pm
I had a tubal ligation over 10 yrs ago AND an ablation about 8yrs ago. I am now 41yrs old and seeing a fertility doctor because I remarried and would like to have a child with my husband. We are in the process of doing the IVF, since I just had an egg retrieval procedure done today. I am to return in 2 weeks so that we can look at my lining. I have a period monthly, but it is light. In your expert opinion, do my chances for a normal pregnancy seem possible? Aside from the thickness of the lining (6mm+), are there any other questions I should ask my doctor? If my lining is not viable, we do have someone willing to be a surrogate, but I honestly would much prefer to hold the baby myself. Please advise………
November 12th, 2011 at 10:20 pm
Pregnancy is possible if you have a uterine lining.
November 12th, 2011 at 11:45 pm
Thanks for your response… but my question is am I taking a big risk if I carry my child? I read alot of the information on this site and it seems that when a woman has had an ablation procedure, the pregnancy could be at high risk…and maybe miscarry…. Also, are there any other questions that I should be asking my doctor aside from the thickness of the lining? Thanks again for your guidance!!!
November 13th, 2011 at 2:20 pm
Donna L – An issue to ask you doctor aside from the thickness of the endometrial lining is whether you have scarring inside the uterine cavity and whether there are areas inside the uterus where the lining is missing. This can only be determined by hysteroscopy. If either of these conditions exist, the risk of miscarriage, ectopic pregnancy, premature delivery, and placenta accreta (placenta growing into the uterine muscle) are all increased.
November 14th, 2011 at 8:11 pm
Thank you so much for all this information. I will most definitely speak to my doctor. You guys are wonderful & provide a great service! God bless!
December 17th, 2011 at 12:05 am
I had my tubes tied 10 years ago and EA just over 2 years ago..as life has it things have changed and I would love to be able to give my new husband a child. I did have normal/lighter periods for 4-5 months after the EA but they have since stopped I do get the cramping and fluid retention so I can tell when I should have my period. Occasionally I will have a day or two of spotting. I talked to my GYN and she sent me to a fertility clinic however they do not have any cases of pregnancy after EA so they are reluctant to help me. They did agree to 14 days of estrace and an ultra sound which showed two large folicles on each ovary however my endometrial stipe was only 1.3mm ….This completely crushed me I was hoping for at least 4-6mm I’m wondering if there is any hope that I may still be able to carry a child?
December 17th, 2011 at 8:02 am
Trish
If you are not having periods and your stripe was only 1.3mm then pregnancy would be very unlikely with either IVF or tubal reversal.