If you’ve ever thought about getting your tubes tied (otherwise known as a tubal ligation) because you’re done giving birth to children or because you know you never want to give birth, you might have thought of it as being a permanent situation. Despite that misconception, you can, in fact, get your tubes untied, but in terms of getting pregnant after a reverse tubal ligation, it’s not so straightforward.
In a tubal ligation, your fallopian tubes are either cut or blocked (Essure, an insert that gets placed into your fallopian tubes, prompts the formation of scar tissue so sperm can’t make it into fertilize eggs, is one manner of tubal ligation, although reversing this is more complicated). A tubal ligation can be done as an outpatient procedure, or you can have it done after vaginal birth or C-section. (There is some evidence to suggest this might be an easier situation to reverse.) There is a very small likelihood of pregnancy after getting your tubes tied. Plus, just because you can’t get pregnant doesn’t mean you can’t get STIs, so tubal ligation shouldn’t be an excuse to abandon barrier methods, like condoms.
In a reverse tubal ligation, your fallopian tubes are reconnected, but this is only possible if enough of the tube remains (if the tubal ligation you had was done via tying or clipping, as opposed to cauterizing, which isn’t reversible). It’s not possible to evaluate how much of the tube you have left without undergoing a hysterosalpingogram or an X-ray that discerns what’s happening with your fallopian tubes. (An HSG is a regular part of a full fertility assessment.)
Another consideration in successfully reversing a tubal ligation is the state of the fimbriae, which are the structures at the end of the fallopian tube that scoop up the egg when it’s released during ovulation. If those are damaged, there’s a lower possibility of pregnancy after the tubes are reattached.
However, even if you do have enough tube left and your fimbriae are great, it’s not just a matter of getting them untied and being on your way. There’s an increased chance of ectopic pregnancy after reversal. While a tubal ligation is an outpatient procedure, reversing it will mean a hospital stay of three days and a ceasing of normal activities, like work, for up to three weeks. And although 75 percent of those who undergo reverse tubal ligation will get pregnant in a year, that’s only if the tubes are long enough to be reattached and they’re not damaged.
Dr. Rebecca Chilvers is a reproductive endocrinologist with Fertility Specialists of Texas. She is trained in reversing tubal ligation (not all doctors are) and performs them, but also urges her patients to consider IVF as opposed to having their tubes untied since there are many variables at play. Successful pregnancy after reverse tubal ligation is more likely if you have enough eggs (ovarian reserve) and they’re of sound quality, your male partner’s sperm is in good shape, you’ve had no or minimal abdominal surgery (for endometriosis, fibroids, pelvic inflammatory disease, etc.), you’re young in terms of reproductive age (under 35) and your overall health is sturdy. Chilvers recommends waiting three months after surgery to start trying to conceive, and if the reversal has been successful, pregnancy should occur in between six to 12 months.
IVF is a much less invasive procedure than reverse tubal ligation, and rates of pregnancy with IVF are much higher than they once were (if you’re under 35, the likelihood of a live birth is around 40 to 50 percent). And while IVF is expensive, reverse tubal ligation isn’t exactly cheap and is rarely covered by insurance companies, although tubal ligation is.
Why, then, might one opt for untying one’s tubes? Chilvers says her patients choose it for religious reasons (some faiths consider intercourse the only appropriate way of conceiving a baby) and out of a desire to achieve pregnancy “naturally,” without the interventions involved in IVF. In addition to avoiding the possibility of an ectopic pregnancy, Chilvers points out that IVF, unlike reverse tubal ligation, has the ability to prolong one’s fertility since you can produce and freeze more than one embryo.
If you have had your tubes tied and you’re interested in getting pregnant, this is obviously a personal decision, and you should discuss it with your doctor, but ultimately, only you can decide which route is right for you.