Reverse Tubal Ligation
Pregnancy after Reverse Tubaligation
Gary S. Berger, M.D.
Tubaligation in the US
Tubaligation, or tubal ligation, is one of the most popular forms of contraception in the United States. Tubaligation is considered a permanent method of female sterilization and women are usually told when having their tubes tied that it is irreversible. Although most women understand this, several studies have reported that approximately 10% of women who have undergone tubaligation procedures subsequently regret their decision and about 1% want to restore their fertility. Their treatment options are either reverse tubal surgery or in vitro fertilization (IVF).
Women younger than 30 years old at the time of tubal sterilization are twice as likely as older women to seek information about reverse tubal than older women. Women who divorce and remarry after sterilization surgery are 3 times more likely to seek such information.
Chapel Hill Tubal Reversal Center Study
An early study from Chapel Hill Tubal Reversal Center followed 189 women for 12 to 18 months after reverse tubal surgery. The women in this study group ranged from 25 to 46 years of age and the average age was 34 years. The average time from sterilization to reverse tubal surgery was 8 years (range 1-24 years). The most common reasons stated for requesting reversal were a change in marital status and the desire to have a child with a new partner or husband, a desire for more children with the current partner or husband, death of a child, symptoms related to post tubal syndrome, and other psychological or religious reasons.
All of the women in this study had had at least 1 year of follow-up after their reverse tubal surgery. Of the 189 women, 122 (65%) had had one or more pregnancies. Term deliveries and ongoing intrauterine pregnancies occurred in 66 (35%) of the patients; miscarriage in 40 (21%), and ectopic pregnancy in 16 (9%) of the patients. 67 (35%) of the study patients who had not yet become pregnant at the time of their follow-up telephone interview.
Time from tubaligation to reverse tubal surgery
The time period from tubaligation to reverse tubal surgery was known for 187 patients (99%). The pregnancy rate was 74% for the group with a time interval of 5 years or less; 63% for the group with a time period of 6-10 years, and 62% for the group with a time period of 11 years or more between sterilization and reversal. These differences were not statistically significant.
Implications for older women
Tubaligation is a common form of contraception among married women and formerly married women in the U.S. Although intended to be a permanent form of contraception, regret is always possible after a sterilization procedure. In contrast to previously published studies, the interval from tubaligation to reverse tubal surgery had little bearing on the pregnancy rate or outcome of pregnancies.
Many women age 40 or older wonder about their chances of having another pregnancy. Often they have been told that their chances of conceiving again are small or non-existent. There were 25 women in this study who were 40 years of age and older. 13 (52%) of the women in this age group had one or more pregnancies after reverse tubaligation. Based on these data, it seems unwarranted to exclude women requesting reverse tubal surgery based on a specific but arbitrary age limit. Reverse tubal surgery is more likely to result in pregnancy and birth than the alternative treatment of IVF for older women unless donor eggs from women in their 20s are used during IVF. Read more about tubalreversal vs IVF for a comparison of pregnancy and birth rates for the two treatment options (reverse tubal sterilization and IVF) for women of similar age groups.