Pregnancy after tubal ligation — risks and possibilities

All Woman

WE have all made a decision that we wish that we could go back on. For some women, this is opting to have their tubes tied because they did not plan on future pregnancies, and then deciding otherwise and wanting to turn back the hands of time. Unfortunately, obstetrician-gynaecologist (ob-gyn) Dr Robyn Khemlani said that the procedure, which involves cutting and tying off the Fallopian tubes to prevent the ovum and sperm from uniting, cannot easily be reversed, and even if it's possible, does not guarantee a pregnancy.

“Tubal ligation is considered a permanent form of birth control and is one of the most effective ways to prevent pregnancy with a less than two per cent failure rate. A reversal procedure can be done with the goal being to remove abnormal tissue and reapproximate the healthy tubal segments; however, not everyone will be a candidate for this procedure,” Dr Khemlani told All Woman.

She pointed out that if a woman is considering a reversal, then she needs to receive counselling on factors that will likely influence how successful the surgery is. The doctor will then further help to guide her to see if she is a good candidate for reversal or not.

“The reversal process is very complicated and does not guarantee the possibility of getting pregnant. Data shows that when a tubal sterilisation is reversed, many women still are not able to get pregnant,” Dr Khemlani shared.

The ob-gyn notes that several factors may influence the success rate of tubal reanastomosis including the age of the patient – with lower success rates with increasing age – time from sterilisation, the extent of damage to the Fallopian tubes, the sterilisation technique, and tubal length. She explained that shorter residual tubal lengths make the surgery more likely to be unsuccessful. However, if the residual tube length is longer after the sterilisation, then the surgery will be more successful.

“If the doctor decides to go through with the reversal it is important to know that there are some risks that are associated with the procedure such as infections, bleeding, scarring of the Fallopian tubes, injury to nearby organs, anaesthesia complications, and ectopic pregnancies,” Dr Khemlani outlined.

An ectopic pregnancy means that the fertilised egg implants outside the uterus, usually in the remnants of the Fallopian tube that was rejoined. When this happens, the ob-gyn said that immediate medical treatment is required because it has life-threatening complications for the mother such as internal bleeding, and the pregnancy, because of its location, cannot continue to birth.

If your doctor determines that you are not a good candidate for a reversal, then Dr Khemlani said that he/she will talk to you regarding in vitro fertilisation (IVF).

“IVF is a procedure which is used to assist with conception. What is done is that the woman's eggs are placed in a laboratory dish along with sperm. When fertilisation takes place, then the embryo/s are directly inserted into the uterus through the cervix, with the hope that the embryo attaches to the lining of the uterus,” Dr Khemlani explained.

As for women considering tubal ligation, she said they should avoid making the choice during times of stress, because of pressure from a partner or others. She recommends that you speak to a doctor about trying other lasting, reversible alternatives so you don't run the risk of living with regrets.

“There are several long-acting reversible contraceptive methods that you can consider such as the intrauterine device or implant which lasts for several years. They are about as effective at preventing pregnancy as sterilisation. They can be removed at any time if you want to become pregnant,” Dr Khemlani advised.

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