It is not uncommon for a woman to want to have another baby after having had a tubal ligation. There are many reasons women seek a reversal of their sterilization procedure. In some situations patients have undergone the sterilization procedure and later become divorced. When she finds another partner, she may want to have a baby with him, even if he has fathered babies in a previous relationship. Occasionally, women may simply regret having had a sterilization procedure and want to undo it.

At ovulation, an egg is released from the ovary and is picked up by the fimbriated end of the fallopian tube (the portion of the tube nearest the ovary). The egg remains in that area until it is fertilized by a sperm. If fertilization does not occur, the egg is resorbed by the fallopian tube. A tubal ligation is performed to ensure that the tube is blocked so that the sperm is prevented from traveling to the fimbriated portion of the tube. Therefore, the egg does not become fertilized.

Patients talk of “untying” their fallopian tubes. Actually, the tubes are not simply tied, but rather a portion of the fallopian tube has been surgically destroyed so that it becomes obstructed. To reverse a tubal ligation, the damaged area of the fallopian tubes needs to be surgically removed and the remaining tubal segments need to be repaired (sewn back together). This surgical procedure can be performed with a very small incision just above the pubic bone or through a laparoscope. It is a tedious procedure and usually takes a couple of hours to complete the reconstruction.

The success rate of the procedure is determined by several factors. Most importantly, the surgery should be performed by someone well trained and experienced in doing the procedure. The highest success rate of reversing a tubal ligation is when the fallopian tube has been clipped or a very small portion of the tube has been removed. If the sterilization procedure was performed by cauterizing (burning with an electrical current) or a very large portion of the tube has been removed, the success rate for reversal is much lower. In this situation, it is far better for the woman to undergo in vitro fertilization (IVF). IVF has a very high success rate for most young women desiring to have a baby after a sterilization procedure. And, IVF has a very low ectopic (tubal) pregnancy risk and does not require surgery. Also, if the new male partner has a very low sperm count, the more successful procedure for the couple is to undergo IVF.

Women desiring to become pregnant following sterilization should consult a reproductive endocrinologist who is skilled in fallopian tube reanastomosis (tubal reversal) and IVF. A thorough review of the type of sterilization procedure and a semen analysis will provide the necessary information to make the better decision as to whether the patient should have a reconstructive surgical procedure or undergo IVF.