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Possibilities for Pregnancy After Tubal Ligation or Tubal Damage
The decision for tubal ligation or having your tubes tied should be
considered a permanent decision. Still, it is possible to conceive
after this procedure.
A recent study showed that an alarming percentage of women who
had had the procedure conceived accidentally. This problem has
been remedied by cutting, tying and burning the ends of the
fallopian tubes.
If you want to actively reverse this there are two options. The first is
to have surgery to rejoin the tubes. This does not have a very high
success rate. At best, it is up to 60%. If there are any other
problems, such as short remaining tubes, or other damage to
them, the rates are quite low. The rate of success is decreased for
women whose tubes have been burned, due to more extensive
tubal damage. There is also a much greater risk of ectopic
pregnancy with rejoined tubes. This is because there is often
scarring and narrowing of the tubes where they are rejoined. The
ovum may be too large to pass through the constricted portion, yet
it can still be fertilized. Success has also been found to depend on
the age of the woman, the technique of ligation, tubal length after
rejoining, and if one or both tubes are rejoined.
The second option is in vitro fertilization. This also has a low
success rate. It can vary with the clinic involved, but generally it is
between 10-25%. It also carries the possibility of an increased risk
of ovarian cancer. The woman must be given doses of female
hormones to stimulate the production of several eggs in one cycle.
This large dose of hormones is thought to be the cause of cancer
in some women twenty or thirty years after the procedure. The
studies are not yet clear on this issue, because we haven't been
doing this procedure on enough people to know for certain.
In any case, when the hormones are given, the woman usually
produces several eggs, which are removed, from her body via a
needle inserted through the vaginal wall. The eggs are fertilized
outside the body and implanted in the womb. There is a higher rate
of spontaneous termination with in vitro fertilization. When the
procedure is successful, there is a higher rate of multiple births.
Multiple birth pregnancies, especially if more than three, pose
additional health risks to the mother. The likelihood of children born
with complications is much higher.
If you decide to explore one of these options further, ask lots and
lots of questions of the potential health providers. Check out their
credentials; ask for references of couples who were not able to
have a child. Check and see if they have any lawsuits filed against
them and why (in a high risk field, such as this, do not be alarmed if
there are a couple). Check out your state medical board to see if
there are any complaints filed against them. Ask them for their
success rates. This should reflect the percentages of infant births,
not merely fertilizations or conceptions. Find out about the rate of
complications in infants. If you are doing in vitro fertilization, find
out what the clinic does with your extra fertilized eggs, if you have a
successful pregnancy early on. (One clinic owner has faced
charges of selling extra fertilized eggs to women who could not
produce eggs, without the original woman's knowledge or
consent.)
If a woman chooses to do this, she should know the risks. I don't
mean to be too cynical, but sometimes the people who do these
procedures emphasize the positive and brush over the negative.
Damaged Tubes Preventing Pregnancy
If a woman has problems in her tubes that have not been brought
on by ligation, the likelihood of pregnancy depends on the nature
and severity of the underlying problem. Things that are associated
with lower success rates are: a personal history of previous failed
attempts to repair the tubes, a single tube with problems in more
than one section, severe pelvic adhesions, if the remaining tube
will be less than 4 cm with the problem area removed, and
hydrosalpinx (fluid filled tube) with severe dilation and thickening.
IVF has success rates averaging 25% per embryo transfer
procedure. But again, the rates vary tremendously from center to
center.
A woman may want to find out more about her doctor's estimate
based on her particular tubal problem and this doctor's center's
rate of IVF success. Post-tubal surgery pregnancy has a higher
rate of ectopic pregnancies because the fertilized egg can get
caught at the point of repair, which may be smaller due to scarring.
She may also want to make sure that she is getting up to date
rates from the particular clinic or center, not national averages.
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