Annually, approximately 700,000 American women undergo tubal ligation (female sterilization) for permanent contraception, a procedure commonly known as “getting your tubes tied”. Many women, like this beauty vlogger, get their tubes tied immediately following a planned Cesarean section when their bodies are already “open” anyway. And while 90,500 people Google “tubal ligation” each month, another 17,500 people are searching “tubal ligation reversal” or “tubal reversal” in hopes of conceiving naturally after previously undergoing a sterilization procedure because they, like the vlogger, go on to regret the loss of their fertility. One scenario in which this might plausibly occur is when a woman who previously underwent sterilization gets divorced and remarried, and seeks to have a biological child with her new partner or spouse. Another possible scenario, though undoubtedly tragic, would be if one experiences the death of a child, and decides to try for more children afterwards, as this Scary Mommy writer experienced.
Health authorities caution that tubal ligation should be thought of as “permanently sterilizing”
Mainstream health websites routinely caution women considering tubal ligation against presuming that reversal will be possible. On its tubal ligation page, the Mayo Clinic warns not once, but twice, that “most tubal ligation procedures cannot be reversed. If reversal is attempted, it requires major surgery and isn’t always effective.” Furthermore, Mayo Clinic warns, one should “keep in mind that although tubal ligation reversal is possible, the reversal procedure is complicated and may not work.”
The American College of Obstetricians and Gynecologists (ACOG) emphasizes similarly, “There is also no guarantee that you will be able to get pregnant” after a reversal, and suggests women consider undergoing in vitro fertilization (IVF) as an alternative to reversal. The National Library of Medicine states bluntly “the [reversal] surgery is rarely done any more. This is because the success rates with in vitro fertilization (IVF) have risen. Women who wish to become pregnant after having tubal ligation, are most often counselled to try IVF instead of surgical reversal.”
But is it true that “most” tubal ligations are irreversible? In this case, the facts tell another story. Here we’ll address what tubal ligation reversal is, factors that make a woman more likely to have a successful reversal, the unfortunate reality of the high cost of reversals, and risks to future pregnancies after a successful reversal.
How do you reverse a tubal ligation?
According to Johns Hopkins Medicine, a tubal ligation occurs when the Fallopian tubes (where fertilization of an egg by sperm normally takes place) are “cut, tied, clamped, banded, or sealed off with an electric current.” To reverse a ligation, a surgeon reconnects the tubes in one of two ways.
In a robot-assisted procedure, any previously inserted clips or rings are removed along with any damaged sections of the tubes, and then the healthy tube tissue is stitched back together. In a mini-laparotomy, the work occurs outside the body. The Fallopian tube ends are pulled out through several small incisions made at the bikini line, and then clips, rings, and/or damaged tissue are removed. After the surgeon has stitched together the healthy tissue, it is reinserted in the body.
Tubal ligation reversal surgery lasts two to three hours on average and occurs in a hospital. If there are no complications, the woman can go home that same day with instructions about general rest, pelvic rest (no sex), and return to work. Cleveland Clinic reports that “Most patients return to normal activities within two weeks.”
Tubal ligation reversals require significant expertise
Reattaching cut tube ends requires tremendous skill, as each Fallopian tube is less than half an inch wide, and each stitch is less wide than the diameter of one hair. Unfortunately, many gynecologic surgeons simply aren’t trained or don’t have adequate experience performing reversals, as the 2015 study mentioned above noted, “in spite of the reported success rates, [tubal ligation reversal, known as tubal anastomosis] is being performed less frequently, and taught less frequently in fellowship training programs in the United States,” with just over half of primary surgical fellows reporting having ever done at least one tubal ligation reversal in one survey [1][3].
How common are tubal ligation reversals?
One 2015 study suggested that just 1 percent of tubal ligations are reversed, but this single statistic does not tell the whole story about regret and reversal, as a 2006 study found that far more women requested information about reversal than underwent it [1],[2]. Many women who regretted their tubal ligation may have experienced significant barriers to procuring reversal, with the high cost of reversal procedures likely chief among them. Of note, women who were under the age of 30 when they underwent tubal ligation were much more likely to go on to regret being sterilized than women who were over the age of 30 [2].
How successful is reversal?
An estimated 70-80% of women will go on to successfully conceive after a tubal ligation reversal. The gloom and doom stance of the Mayo Clinic, while somewhat understandable from the vantage point of wanting to be sure women undergoing tubal ligation know what they’re signing up for, is not backed up by the high success rates of tubal ligation reversal procedures.
Factors that impact reversal success include the woman’s age (reversals are more likely to be successful in younger women), how much healthy tube tissue remains after the original ligation, weight (overweight or obese women are less likely to have successful reversal), and whether she has underlying reproductive and/or other general health conditions. Furthermore, many OB/GYN practices that offer tubal ligation reversals will test the woman’s partner’s sperm count and only proceed with the procedure if his sperm count is over a certain level, since low sperm count or poor sperm motility (abnormal movement of sperm) make conception unlikely even if the reversal was successful.
Most insurance companies won’t cover reversal
While most insurance plans cover long-acting reversible contraception (LARCs) like IUDs or the arm implant Nexplanon, as well as tubal ligation sterilization procedures, very few will cover tubal ligation reversals for women who change their minds and seek to conceive naturally (this is similar to how insurers will frequently cover vasectomies, but not vasectomy reversals, which normally cost between $8,000 to $15,000 out-of-pocket). Tubal ligation reversals can be cost prohibitive as they range from $5,000-$21,000 out-of-pocket according to Healthline, with an average cost of $8,685.
At the same time that tubal ligation reversals are most often not covered by insurance, IVF costs are increasingly covered. This is disappointing for many reasons, among them the fact that for women under the age of 41, tubal ligation reversal typically makes much more financial and health sense (in terms of risks and side effects) than undergoing IVF [1].
Pregnancy risks after tubal ligation reversal
Dr. Gavin Puthoff is the founder and medical director of Veritas Fertility and Surgery in St. Louis, MO. He is trained in Natural Procreative Technology (NaPro), and he performs many tubal ligation reversals.
Dr. Puthoff’s website notes, “As with any surgical procedure, tubal reversal surgery does come with some risks, including bleeding, infection, and injury to nearby structures. In general, the risk of a complication like this is less than 1%.” The most likely pregnancy complication after tubal ligation reversal is increased chance of ectopic pregnancy, when the embryo implants outside the uterus, oftentimes in the Fallopian tube. Ectopic pregnancies have zero chance of resulting in a live birth, and can be life-threatening for the mother if the Fallopian tube ruptures as the embryo grows. Ectopic pregnancy may occur in 2% of pregnancies normally, but after tubal ligation reversal, the risk goes up to 5-7%.
To sum, while tubal ligation reversals are possible, the procedure is not without complications. It is also becoming increasingly difficult to find physicians who are adequately trained to perform reversals, and costs can be exorbitant and prohibitive. Furthermore, women and couples considering tubal ligation should not be fed false assurances that IVF–which is often costly and unsuccessful–will be an available avenue for having children should they change their minds in the future. Rather, couples who are done having children and desire a more “permanent” form of family planning would do well to consider methods of natural family planning or fertility awareness methods, which are noninvasive, side effect-free, and can be highly effective for long-term pregnancy avoidance.
References:
[1] Messinger, Laura B et al. “Cost and efficacy comparison of in vitro fertilization and tubal anastomosis for women after tubal ligation.” Fertility and Sterility, vol. 104, no. 1 (2015): pp. 15-282. http://dx.doi.org/10.1016/j.fertnstert.2015.04.019 [2] Curtis, Kathryn M. et al. “Regret following female sterilization at a young age: a systemic review.” Contraception, vol. 73, issue 2 (2006): pp. 205-10. https://doi.org/10.1016/j.contraception.2005.08.006 [3] Armstrong, Alicia et al. “The role of Fallopian tube anastomosis in training fellows: A survey of current reproductive endocrinology fellows and practitioners.” Fertility and Sterility, vol. 82, issue 2 (2004): pp. 495-97. https://doi.org/10.1016/j.fertnstert.2004.02.107Additional Reading:
The unethical push to sterilize women in the delivery room
Post-tubal ligation syndrome: When getting your tubes tied isn’t as tidy as it sounds
Is a vasectomy reversal effective enough to help you become a dad again?
The reality of vasectomy risks and side effects
A vasectomy can’t repair a broken love life—and it might cut a relationship short
