Tubal ligation reversal not always successful

Dr. K. Javeed Nayeem, MBBS, MD

I am a twenty-eight-year-old lady who has undergone tubectomy five years ago after having two children. What are the chances of successful conception if I go in for reversal of tubal ligation and what are the other options I have to conceive and have a child?

The first thing that one should understand is that there are many widely differing tubal ligation procedures and not all these are amenable to successful reversal. In fact, some kinds of procedures can never be reversed. So, before considering the possibility of success, the feasibility of attempting a reversal procedure has to be considered first. The doctor you approach for recanalization, will only after ascertaining what kind of procedure you have undergone, be able to tell you whether you are the right candidate for attempting a successful reversal or not. Even in the most ideal setting the success rate of a reversal procedure can vary greatly depending on the experience and competence of the operating surgeon and also the amount of scarring that invariably occurs after any kind of surgical procedure, however trivial. For the same reason, people who undergo tubal ligation reversal procedures have a significantly higher incidence of tubal or extra-uterine pregnancies. Here the ovum or egg after fertilization by the sperm, fails to reach the cavity of the uterus through the fallopian tube and gets attached at an abnormal location and begins to grow into a baby there, leading to some complications which may even require termination of the pregnancy itself.

The other option for having a child after tubal ligation is to go in for In Vitro Fertilization or IVF. In this procedure the ovaries are usually stimulated by drugs to produce eggs which are then harvested through a minimally invasive and relatively simple procedure and fertilized outside the body, under controlled conditions in a laboratory. Once successful fertilization takes place, the egg is replaced directly into the uterine cavity which is the natural site of pregnancy and allowed to grow there till its full term. Of late, due to advancements in the art, the success rates for a pregnancy to occur through IVF have begun to overtake the success rates after tubal recanalization. But success rates, irrespective of the procedure one chooses, depend on many factors like the age of the patient, her general health, the quality of sperm and egg and the competence of the center where it is done. One must understand that irrespective of the kind of procedure chosen, the success rate is inversely proportional to the age of the candidate. So, an early decision is likely to be met with greater success. Secondly, it has been observed that younger women do better with tubal recanalization while the older ones do better with IVF. Lastly, if the woman desires to have more than one child, tubal recanalization seems to be a better choice because it does not require periodic multiple procedures, while for those who want just one child IVF would be a better option.

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