Tubal Ligation Failure – Causes, Techniques, Repeat Surgery

Tubal ligation is a permanent contraception method. It is a surgical procedure that involves cutting or sealing off the fallopian tubes. As a result of tubal ligation, sperms and eggs fail to meet, fertilization does not occur and pregnancy is avoided.  When properly performed, tubal ligation surgery provides nearly complete protection against unwanted pregnancies.

However, in some instances, tubal ligation may not be able to prevent a pregnancy. In such cases of tubal ligation failure, the surgical procedure should be performed again if the women chooses not to have any more children. It is important to note that failure of tubal ligation is very rare.

Causes of Tubal Ligation Failure

There are many different reasons for tubal ligation failure. Many of the reasons for tubal ligation failure pertain to the shortcomings in the ligation methods that are used during the surgical procedure. However, not all of these causes are unavoidable. The following are some of the possible causes of pregnancy after a tubal ligation.

Pre-ligation conception

In some cases, a woman may discover that she has become pregnant after the ligation surgery. However, it is possible in such cases that conception may have occurred before the surgery and got detected after the ligation procedure. This is not really a failure of the ligation procedure.

Ectopic pregnancy

Ectopic pregnancy remains a possibility after tubal ligation. Women who underwent a bipolar electrocoagulation procedure for tubal ligation are at a relatively higher risk of ectopic pregnancy.

Spontaneous growth

A cut or pinched fallopian tube may spontaneously become patent in a variety of ways. For example, the clamp used to pinch the fallopian tube may become loose. The ring used for tubal ligation may fall off. The cut ends of the fallopian tube may undergo anastomosis.

A fistula may form between the cut ends of the fallopian tube. All these events could lead to a reestablishment of the continuity of the fallopian tube. Fertilization and pregnancy then become a possibility.

Improper ligation

Tubal ligation surgeries are not always done properly. For example, the device used to occlude the fallopian tube may not have been placed properly. The tube may not have been blocked or cut properly.

One may even have cases where the round ligaments get tied off rather than the fallopian tubes. In such cases, the fallopian tube continues to function normally despite the surgery. Some tubal ligation surgeries are inherently difficult due to the presence of obesity or pelvic adhesions.

Slipped device

Tubal ligation failure could also occur after a successful surgery. In time, the device used to occlude the fallopian tube may slip and fall off.

Choice of  Technique

The rate of failure in tubal ligation surgery also depends on the type of technique that is used to close the fallopian tubes. Techniques that cause minimal damage to the fallopian tubes (such as using clamps or clips to shut off the passage through the fallopian tube) have a relatively higher failure rate than techniques that involve electrocoagulation damage or removal of large parts of the fallopian tube.

Incomplete tubal ligation

Tubal ligation failure may also be caused by an incomplete tubal ligation surgery. Such cases may be attributed to equipment failures or poor surgical skills.

Use of hysteroscopic techniques

Sterilization methods like Adiana or Essure that utilize hysteroscopic techniques require the use of other contraceptive methods till the sterilization is complete. These methods rely on occlusion of the fallopian tube by scar tissue. This takes some time. Therefore, other contraceptive methods need to be used for about three months after the procedure. Failure to do so may result in pregnancy.

Prevent Tubal Ligation Failure

The failure of tubal ligation could occur due to many causes. Some of these causes may be preventable. But others are not. However, taking certain precautions can help in reducing the chances of an unexpected pregnancy. Some of these preventive measures are described next.

Test for pregnancy before tubal ligation

In order to prevent a situation in which one may undergo tubal ligation surgery while being pregnant, one should get a pregnancy test done before opting for tubal ligation. An ELISA-based pregnancy test can be done on the day of the operation to rule out an existing pregnancy before commencing the tubal ligation surgery.

Continue using other contraception

Some tubal ligation procedures may take time to become completely effective. Therefore, it is advisable to take other contraceptive measures after a tubal ligation procedure till the next period or for three months. One may begin taking other contraceptive measures before the tubal ligation procedure is opted for.

For example, if a woman has been using an IUD for contraception, it can be kept intact till the time of the next period after the tubal ligation procedure. This would significantly lower the chances of any unwanted pregnancy. Use of additional contraceptive measures is especially important for women who are undergoing a hysteroscopic method such as Adiana or Essure.

This procedure relies on the growth of a scar tissue that ultimately blocks the fallopian tubes. The process of scar formation takes time and a woman needs to have additional contraceptive protection during this period.

Timing of tubal ligation

Timing the tubal ligation procedure with the menstruation period can reduce the chances of failure. The tubal ligation procedure could also be timed to occur during the postpartum period in order to eliminate the chances of getting pregnant.

Points to Consider

Tubal ligation is offered as a permanent contraceptive solution to women who do not intend to conceive again in their life. Therefore, it is usually a big shock when a woman gets pregnant despite having undergone a tubal ligation or sterilization procedure. To avoid such an alarming outcome, the following facts need to be kept in mind before undergoing a tubal ligation surgery.

  • Tubal ligation can fail for a variety of reasons. The failure of tubal ligation can occur at any time after the surgery. Some failures may occur a short while after the surgery. Others may occur many years after the procedure.
  • It has been found that the failure rates tend to go up after a decade of undergoing the tubal ligation surgery.
  • The chances of tubal ligation failure are higher in younger women than in older women who have undergone the procedure. There is a natural decline in fertility as a woman ages.
  • If a pregnancy ensues anytime after a tubal ligation procedure, one must check for the presence of an ectopic pregnancy.

More Related Topics