Q&A: What are the chances of getting pregnant after a tubal ligation reversal?

Personally, I don't like tubal ligations. With all of the reversible methods available today, permanently altering yourself seems so drastic! It is amazing to me how many women casually ask for it, and then how many doctors so casually do it! It is generally requested when things are at their worst...nothing but small children in the family, during a difficult pregnancy, or during bad financial times.

Times change, but cut and tied tubes don't. And there is little comfort in the fact that you can 'just' get them 'untied'. No! First of all, that's not a simple operation. It requires exquisite surgical technique and is VERY expensive - cash up front. Insurance will not pay for a tubal reversal. Got $30,000? Second of all, even if you do get the tubes reconnected, there's scarring at the junction where they were repaired--enough of a rough spot where a fertilized egg can get hung up on its way to your uterus (womb). This means there is an increased risk of an ectopic (tubal) pregnancy and may end up being a surgical emergency leading to loss of the tube, blood loss, and even loss of life. Third of all, there's this thing called the "Post tubal syndrome," where it is theorized that in a tubal ligation the blood supply to the ovaries is damaged, leading to faulty hormonal regulation and with it, faulty ovulation. And just fixing the continuity of the tubes won't make the ovaries better. (It is important to know, though, that the Post tubal syndrome is controversial -- there are as many smart doctors believe in it as there are those who don't --and the literature has always been vague on studies.) But if it's a factor, then the best tubes in the world won't benefit from bad cycles.

With the advent of ART (Assisted Reproductive Techniques), you can by-pass all of this uncertainty of the tubes for the uncertainty of the laboratory. But at least the laboratory hasn't been cut up, tied up, and burned. I'd ask my doctor for a referral to an infertility specialist. If your tubes have been ligated and you really want a baby badly, then it's a bargain at any price. And the results are getting better and better.

Finally, here's a philosophical note. Thankfully, death of a spouse is rare, but I make sure any patient who asks me about tubal ligation hears these unpleasant words. It does happen, and sterilization can make the tragedy all the worse. And there's the very painful possibility that your children may suffer some tragedy. No one who has a tubal can predict how she will feel about losing a child and having her "bridges burned" (pun intended!). Once again, tubals are asked for too casually, and shame on us doctors for doing them too casually.