Can I still have a baby after tying off?
Dear Dr Mitchell,
I’m 32 and I had my tubes tied a year ago. I want another baby though, and I heard that they could either be untied or I could have IVF, where there would be no need for tubes at all. Is this true? Do they bypass the tubes in IVF and just inject whatever they inject straight to the uterus?
Tubal ligation is considered a permanent form of contraception. Patients are usually counselled extensively and encouraged to use alternative forms of contraception such as the condom (male and female), oral contraceptive pills, injection (Depo Provera or Mesigyna), subdermal implant (Norplant) or the intrauterine contraceptive device (IUCD). Some patients are adamant that they have discussed this with their consort and that they are sure that this is what they want so the doctor is left with no choice but to go ahead and tie the fallopian tubes.
Unfortunately circumstances change, and the desire for further fertility now becomes a challenge. Reversal of tubal ligation is a major operation and usually requires general or regional anaesthesia (spinal or epidural). It is much easier to tie the tubes than to reverse tubal ligation. In some instances the fimbrial of the tubes is removed and reversal of tubal ligation is not possible. Sometimes the portion of fallopian tubes left back is too short and there is not enough functional length of tube to join together.
Having successfully reversed tubal ligation there is also a significant risk of scarring at the site where the tubes are joined together and this results in an ectopic pregnancy. An ectopic pregnancy is a situation in which the embryo lodges in a site outside of the cavity of the uterus. The most common site is the fallopian tubes. The chance of this happening is increased when the tube is damaged or scarred and reversal of tubal ligation is a definite risk factor for an ectopic pregnancy.
In vitro fertilisation (IVF) is a good option for you. The procedure involves stimulating your ovaries to produce eggs in a controlled cycle by the use of special hormones. The eggs are then fertilised by sperm collected from your partner by masturbation. The embryos (usually two) are then inserted into the uterine cavity a few days later, thus bypassing the fallopian tubes. The outcome from IVF is usually very good in young patients under 35 years, so you should have a good outcome with this procedure. The other advantage of IVF is that the extra embryos are usually frozen and kept in storage for use at a later stage if conception does not occur after one attempt. The subsequent attempt is usually less expensive since the embryo is already available for implantation.
IVF is not inexpensive so you need to start saving for this procedure. The good news is that IVF is available in Jamaica at the Fertility Management Unit at the University Hospital. The success rate is comparable to that in First World countries and the cost is significantly less, thus making the procedure accessible to less fortunate couples who have a desire for childbearing.
A diagnostic laparoscopy will help to evaluate the fallopian tubes to determine the status of the tubes and help you to determine if there is enough length available for reanastomosis and to assess the status of the fimbrial end of the tube. The fimbrial end is the portion of the tube that is absolutely necessary to pick up the egg after ovulation. If this is absent then tubal reanastomosis is not feasible.
Consult your gynaecologist who will advise you further and make the appropriate referral to a fertility specialist.
Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions and comments via e-mail to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.
