Knowing one’s chance of pregnancy before reversal is a must, and that depends on many factors.
Fewer women, only about 1 in 4 married women, choose tubal ligation as their permanent form of birth control. More women are choosing reversible contraceptive options, such as IUD or birth control pills, because many people change their minds about wanting more children. Women who have gotten their tubes tied can decide to have their tubes untied in a tubal ligation reversal surgery in order to possibly get pregnant.
Possibly, and that’s the key. According to the National Institutes of Health, more than half of women who have tubal ligation reversals are able to get pregnant. And it’s usually in the first year after the reversal that those women do get pregnant.
Here are the first two questions a doctor considers before doing the tubal reversal: Are you a good candidate for this surgery? (it’s a more complex operation than the original ligation) and Will you have a good chance of pregnancy afterward if it is successful?
A surgeon should exam you for the first item and a fertility specialist for the second. The surgeon will give you a physical examination to see if you are a good candidate for the reversal surgery and get your operative report on the tubal ligation. How that surgery was performed partly determines if a reversal is possible and also your prospects for pregnancy afterward.
Factors determining your chances of pregnancy
Across the board chances range from about 87 to 30 percent. There are several variables, but they primarily come down to age and the condition of the fallopian tubes as a result of the original tubal ligation. Factors for pregnancy success after reversal surgery include:
- Your age
- The skill and experience of your surgeon
- The area of the fallopian tubes where they were tied
- The method of tying or clamping the tube
- Your ovulation function, egg quality and egg quantity
- Pelvic issues such as fibroids or endometriosis
- Your partner’s sperm quality
- Your health and lifestyle.
When doctors evaluate all these factors, they’ll arrive at a good idea of your individual chances of pregnancy after the tubal ligation reversal surgery. The best chance is 87 percent for women younger than 30 who had ligation using a clip or a ring method. Women older than 40 who had ligation by removing an end of the fallopian tube have the lowest chances of achieving pregnancy after reversal surgery, at about 30 percent.
Another factor that may affect pregnancy success after tubal reversal surgery is the length of the remaining fallopian tube. Prior to ligation, most fallopian tubes are 10-12 cm long. After tubal ligation surgery, women with at least 7.6 cm of fallopian tube have about an 80 percent chance of achieving pregnancy.
Where the tube was tied has a large bearing on pregnancy success. If it was tied near the juncture of the uterus, chances for pregnancy are less than if they were tied or closed at the middle. The amount of scar tissue accumulated can also affect chance of pregnancy.
When to begin trying to get pregnant
The tubal ligation reversal surgery with the daVinci robotic surgical system is a minimally invasive surgery with minimal risk for complications. Patients usually go home the same day and are able to return to everyday activity in a few weeks.
I recommend waiting until your second period after the operation to begin trying to get pregnant. Some women can start trying after their first period.
You’ll want to monitor your ovulation so you have sex at the optimal time around ovulation. Sometimes, ovulation-stimulating drugs such as clomiphene citrate or letrozole may be a good idea.
In order to have the best chances of pregnancy, an intrauterine insemination (IUI) may be recommended to help the sperm reach the egg.
Women who get pregnant after the reversal surgery have a higher chance of developing an ectopic pregnancy, which occurs when an embryo implants outside the uterus, often in a fallopian tube. Ectopic pregnancy can be a life-threatening condition and the pregnancy typically ends in a miscarriage.
For this reason, if you’ve had a tubal ligation reversal surgery and you get pregnant, it’s a good idea to see your physician to be evaluated for an ectopic pregnancy.