Tubal Ligation Reversal Surgery: How to Prepare and What to Expect

What is tubal ligation reversal surgery?

Tubal ligation surgery is surgery that reverses the tubal ligation process. It’s intended to restore fertility to people who have had blocks or cuts in their uterine tubes. Tubal ligation prevents eggs released by the ovaries from reaching the uterus. It’s a permanent form of birth control, and it’s 99 percent successful at preventing pregnancy. It’s considered to be one of the best contraception options for people who have had high-risk pregnancies in the past or who are unable to take hormonal birth control and don’t want any future pregnancies.

Can you get your tubes untied? Possibly, although the procedure is considered major abdominal surgery. Here’s an overview of the process.

To reverse a tubal ligation, either the blocks and scar tissue are removed, or the two severed pieces of each tube are reconnected. If the procedure is successful, it creates complete uterine tubes that connect the ovaries and the uterus. This may allow sperm to reach eggs in the uterine tubes and a fertilized egg to move through the tube into the uterus for implantation.

Ovulation still occurs after tubal ligation, so an ovary will typically release an egg each cycle. However, after tubal ligation, the egg reaches the blocked end of the uterine tube and is reabsorbed into the body. Tubal ligation also doesn’t stop menstruation from occurring, as it doesn’t affect the hormones that regulate the menstrual cycle.

Who can undergo tubal ligation reversal?

Not everyone who’s had a tubal ligation is a good candidate for the reversal surgery. For example, in extreme cases where future pregnancies could be dangerous, the entire uterine tubes may have been removed in surgery. In these cases, there isn’t any tube left to reconnect, and artificial uterine tubes aren’t currently available.

For everyone else, your doctor may consider several factors for a successful reverse tubal ligation. Age is an important factor — people over 35 may not be approved for surgery. Body Mass Index, or BMI, is another factor. A BMI in the obese range (30 and over) typically has other adverse effects on fertility and healthy pregnancy, and even people who are overweight (BMI of 25-30) may not be ideal candidates for surgery. If you are fairly young, however, your doctor may advise weight loss and a reevaluation.

Further examination, including ultrasounds, may be necessary in order to determine the extent of damage to the uterine tubes and the length of the remaining tubes. The type of tubal ligation you received may also be a factor. Typically, it’s easier to remove blocks than to undergo a procedure that reattaches each piece of the uterine tube back to its other half.

Your overall fertility and the quality of your eggs may also be part of your evaluation. If you’re trying to conceive with a male partner, they may have to undergo an examination for sperm count and viability. If neither your eggs nor his sperm are determined to be viable, then your doctor may not approve the reverse tubal ligation surgery, because it is a major and invasive procedure.

Pregnancy success rate after ligation reversal surgery

If reverse tubal ligation is successful, pregnancy rates range from 50–80 percent.

If you’re a candidate for reverse tubal ligation surgery, there’s no guarantee you’ll become pregnant after the procedure, which is why approval for the operation is usually limited to people who are fertile. People under 35 with a BMI of 18–25 usually have a higher success rate for conception. The more healthy uterine tube pieces you have, the greater the chance that the surgery will be successful and create a path for the egg to travel to the uterus.

Success rates largely are determined by your age and the type of tubal ligation you had initially. People under 35 have a greater chance of healing fully from the procedure, and people who had their tubes tied using clips or rings generally have a greater success rate than people who had sections of their tubes removed or cauterized. Other types of female sterilization, such as Essure, generally aren’t considered reversible.

How tubal ligation reversal surgery is performed

This procedure may be performed either laparoscopically or through a small incision in the abdomen. The method used will be determined by the findings of your initial exam and the type of tubal ligation you had.

For laparoscopic or robotic procedures, the surgeon will make tiny incisions in the abdomen through which small tubes will be inserted. Using tiny cameras and the tools attached to these tubes, the surgeon will reattach the uterine tubes and remove any clamps or rings (if used).

If the damage is more extensive or it’s been a while since the tubal ligation, then open surgery may be necessary. This requires a small incision in the lower abdomen to expose the uterus, ovaries, and uterine tubes.

During surgery, the surgeon will first remove any fragments that block each end of the tubes. Then, the tubes will be repaired with tiny, absorbable stitches. However, depending on the condition of the uterine tubes, both tubes may not be successfully repaired.

Ovulation typically alternates between ovaries, so if only one uterine tube was successfully reattached, your fertility window will alternate each cycle. Your body may not be consistent about alternating between ovaries, and it’s not always possible to tell which side ovulates (it causes some people a little pain and soreness), so it’s best to try for pregnancy midway through each cycle if only one tube was restored.

Preparing for tubal ligation reversal

You’ll receive personalized pre-surgery instructions from your obstetrician or general surgeon before the procedure. However, you may wish to speak with a reproductive therapist as well. The procedure may not be successful even if you’re an excellent candidate. In addition, even if the uterine tubes were reattached successfully, bear in mind that 20–50 percent of people successfully become pregnant afterwards. Your doctor will explain the condition of your uterine tubes and their predicted chance of success, but bear in mind that these predictions may change during or after surgery.

You may also receive information about becoming pregnant through different methods, such as IVF fertilization and implantation. Many people who have damaged uterine tubes may still have plenty of healthy eggs and a uterus that’s capable of supporting implantation and a subsequent healthy pregnancy.

There are risk factors associated with tubal ligation reversal, which your physician will discuss with you. Most commonly, numbness in the lower abdomen, infection, and bleeding are side effects of the surgery. You may also have scarring of the uterine tubes, which can affect your ability to become pregnant. This scarring may lead to adhesions over time, which are connective tissue that attaches your reproductive organs to the bowels or abdominal wall.

There may also be an injury to the nearby organs or anesthesia complications. After the procedure, your likelihood of ectopic pregnancy, when a fertilized egg develops outside the uterus, can increase. If there is scarring of the uterine tubes that prevents a fertilized egg from reaching the uterus, an ectopic pregnancy is even riskier.

Recovery after tubal ligation reversal

Rest and refraining from overexertion are important, as are proper nutrition and staying hydrated. Other factors that can improve your recovery rate and ensure you return to full health include abstaining from alcohol, smoking (and vaping), and drugs, with the exception of any medications prescribed by your doctor.

After surgery, it’s advisable to slowly return to normal activities under the guidance of a doctor. People who work out regularly should speak with their doctor or surgeon to determine what frequency and intensity of exercise is appropriate. It may be necessary to scale back, especially with strenuous core exercise and endurance sports. It usually takes one or two weeks after surgery to resume normal life. 

The stitches used to repair the uterine tubes are designed to naturally dissolve and won’t require removal. However, removal of incision sutures or staples may be necessary, depending on how the operation was performed. Most patients schedule a follow-up appointment a couple of weeks after the procedure. This appointment is a good time to discuss attempting conception. Before the initial follow-up appointment, it’s important to refrain from sex and inserting anything into the vagina.

Tubal ligation reversal cost

Tubal ligation reversal cost is an important factor to think about when considering the procedure. Tubal ligation reversal is considered elective surgery, so it isn’t covered by most insurance plans. The out-of-pocket costs for a reverse tubal ligation can average about $10,000. For people who have a more complicated procedure, the costs can be higher. Government insurance programs such as Medicaid or military insurance also don’t cover this procedure.

The takeaway

A reverse tubal ligation is a major medical procedure that can have serious complications. Before making an appointment to have this procedure, it’s important to research your options and have a serious conversation with your doctor about the success rate of the procedure and your feelings about it.