Contraceptive procedures can be broadly classified into temporary and permanent contraception methods. Temporary contraceptive measures are effective only till an individual takes those measures. On the other hand, permanent contraceptive measures provide a long-term solution to the problem of contraception. Tubal ligation is a type of permanent contraceptive solution for women. It is a surgical procedure that involves sealing off the passage through the fallopian tube (by severing or pinching it) to achieve permanent sterility.
Tubal Ligation Reversal
Although tubal ligation is done to achieve permanent sterility, the process can be reversed in some cases. Sometimes, women may regret their decision to undergo tubal ligation and request a reversal of the procedure in order to become fertile again. Although possible, tubal ligation reversal is an expensive and difficult procedure that involves undergoing a major surgery.
Tubal ligation can be reversed by surgically re-attaching or reopening the fallopian tubes. Besides being expensive, tubal ligation reversal requires a highly skilled surgeon. Also, there is no guarantee that the surgical reversal of tubal ligation will make the patient fertile again.
Why do women opt for tubal ligation reversal?
Women opt for tubal ligation as a permanent contraceptive solution. These women usually have children and do not want to fall pregnant again. However, under some circumstances women who have undergone tubal ligation may desire to reverse it.
The following are some of the possible scenarios in which a woman may consider tubal ligation reversal:
- Significant life changes such as passing away of spouse or child, divorce and remarriage could make a woman opt for tubal ligation reversal.
- A woman may not have considered the full implication of tubal ligation properly before taking the decision to undergo the irreversible procedure.
- A woman may not have made the decision to go for permanent contraception on her own volition. Pressure from family members may have been behind the original decision to undergo tubal ligation.
- There may be regret if a woman had opted for the tubal ligation procedure to manage some other issues such as financial problems, marital issues, physical problem, unemployment problem or mental problem.
Procedure for Tubal Ligation Reversal
Tubal ligation reversal is a difficult operation that requires good surgical skills. The surgery is typically performed under general anesthesia, and may take anywhere from one to three hours to complete. The incision required for tubal ligation reversal may be bigger than the incision that was performed for tubal ligation procedure. Post-surgical recovery is not quick and the patient may be kept in the hospital for a long duration.
New microsurgical methods have now been developed that enable tubal ligation reversal in less than a hour. These microsurgical methods can be done under local anesthesia, and do not require hospitalization. The surgical incisions are also smaller, making post-operative recovery quicker. However, such microsurgical procedures require specialized training and skills. Therefore, this option may not be available widely.
- Laparoscopy: Laparoscopic surgery involves passing a laparoscope into the abdominal cavity through a tiny incision. Microsurgical instruments are also passed through this tiny incision and the microsurgery is done with the aid of a camera in the laparoscope.
- Mini-laparotomy: Mini-laparotomy is conducted under general anesthesia. The procedure involves an abdominal incision above the pubic bone.
- Robot-assisted surgery: The surgery for tubal ligation reversal may also be conducted with the help of a robotic arm that is controlled by the surgeon using remote controls.
The ends of the cut fallopian tube are brought together in alignment by passing a stent through them. These ends are then sutured together. The stent is removed after the anastomosis or joining.
In this method, a new opening is created in the uterus and the healthy part of the fallopian tube (typically the distal end) is attached to it.
This method is used when the tubal ligation was done by removing the fimbrial part of the fallopian tube.
Risks of Tubal Ligation Reversal Surgery
As mentioned previously, tubal ligation reversal is a complicated surgery. Like in any surgery, there are risks that need to be considered before opting for the procedure. The most common risk of tubal ligation reversal surgery is an increased likelihood of having ectopic pregnancies.
Therefore, all pregnancies that occur post tubal ligation reversal must be checked for the possibility of ectopic pregnancy. Other risks involved in tubal ligation reversal surgery include complications of general anesthesia, infections, hemorrhage, and injury to abdominal organs.
Success of Tubal Ligation Reversal
Even though tubal ligation is considered to be an irreversible process, surgical reversal of tubal ligation has a good success rate. The chances of success in an individual case depends on the following factors. If a successful pregnancy does not occur even after tubal ligation reversal, a woman can opt for in vitro fertilization as the last resort.
Length of the fallopian tube
Surgical operation for tubal ligation may involve cutting of the fallopian tube. This ensures that the sperms and eggs do not meet for fertilization. For tubal ligation reversal, the cut ends of the fallopian tube are rejoined so that fertilization becomes possible. However, the chances of a successful pregnancy after tubal ligation reversal depends on the length of the rejoined fallopian tube. The shorter the length of the restored fallopian tube, the lesser the chance of getting pregnant again.
Method of tubal ligation
The chances of successful pregnancy after tubal ligation reversal also depends on the kind of method that was used to perform the tubal ligation procedure. The lesser the damage to the fallopian tube during the ligation procedure, the higher the chances of getting pregnant after tubal ligation reversal. For example, ligation procedures that involve clipping the tube to block the passage of sperms have a higher chance of successful reversal than procedures that involve cutting, burning, or removal of a significant part of the fallopian tube.
Diameter of the rejoined fallopian tube
The chances of successful pregnancy after tubal ligation reversal are good if the ends of the cut fallopian tubes are of the same diameter. This facilitates proper rejoining of the ends and decreases the chances of ectopic pregnancy.
Age of the woman
The success rate of tubal ligation reversal is higher in younger women than in older women (above 38 years of age).
Health of other organs
A successful pregnancy outcome after tubal ligation reversal also depends on the health of ovaries and other organs in the pelvis.