Tubal Reversal

Have you had your tubes tied (tubal ligation) after a previous pregnancy and now seek to be pregnant again? If the answer is yes, then having a tubal reversal may be the best way to achieve that.

For a pregnancy to occur naturally, sperm must enter the fallopian tube through the uterus by way of the vagina and cervix (opening to the uterus or womb). The oocyte (egg) is released from the ovary and is picked up from the other end of the tube (ovarian or fimbrial end). When the fallopian tubes are blocked, sperm and eggs are kept apart and fertilization is prevented.

The fallopian tube is a narrow muscular tube arising from the upper corners of the uterus and ending just next to the ovary. The inner tubal lining is rich in cilia, microscopic hair-like projections that beat in waves that move a fertilized egg (embryo) towards the uterus. The fallopian tube is normally about 10-12 cm (4-5 inches) long.

Tubal ligation is the general term for any surgical procedure that blocks the fallopian tubes to prevent pregnancy and is usually intended as a form of permanent sterilization or contraception. Ligation means to apply a ligature or tie. Tubal ligation is often called “tying” the tubes. Frequently, there is a misconception that the fallopian tube has been tied (like a knot) or with a suture or string and that simply removing or “untying” of the knot or suture will open back up the tubes. However, there are many surgical methods used to ligate the tubes which can affect the ability and success of doing a tubal reversal.

After your tubal reversal surgery, you ideally want to end up with as much length of tube as possible. The fallopian tube is not only a channel for egg and sperm to meet, it is also where the fertilized egg has to mature and develop for preparation of implantation into the lining or wall of the uterus. If the fallopian tube is too short, the embryo does not have enough time to mature and pregnancy is less likely to happen. In general, at least 5 cm or greater in tubal length is needed for the best chance for tubal reversal success.

It is very important that we be able to obtain your Tubal Ligation Operative Note dictated by the doctor who performed your procedure. It allows us to see what type of tubal ligation method was performed and the amount of fallopian tube that was removed or damaged. In addition, there may have be other important findings noted such as adhesions (scar tissue), prior tubal damage or other problems that could affect the success rate or even the possibility of doing a tubal reversal.

If the operative note is not available, a diagnostic laparoscopy (placing a small telescope into your abdomen through your belly-button) can be performed to evaluate the amount of fallopian tube that is available. If you are not a good candidate for tubal reversal or if there are other infertility factors involved, In Vitro Fertilization (IVF) may be the preferred method for achieving pregnancy.