"Permanent" sterilization by tubal ligation is the most common form of contraception in women age 30 and older. In women the tubal ligation involves obstructing the mid-portion of the fallopian tube (the duct through which the egg must travel to reach the uterus). Once the tube is obstructed, the sperm cannot reach the egg to fertilize it. Various methods have been used to ligate (tie-off) tubes, such as elastic blands, small metal clips, suturing, and burning with electrocautery.

Fortunately this form of contraception can often be reversed by a procedure called Tubal Reversal. Another option for these women is In-Vitro Fertilization (IVF). Each of these two options has its advantages and disadvantages. It is up to the individual couple to decide which option best fits their lifestyle once they understand the medical pros and cons. 

Sterilization reversal surgery for women is highly successful if a sufficient length of tube remains on both ends of the ligation. Often the operative report from the tubal ligation procedure is useful in identifying candidates who do not have a good chance for successful reversal. However, in approximately 5% of cases, the tubal reversal surgery cannot be performed due to unexpected findings in the pelvis at the time of the intended reversal surgery. These findings include scarring of the fimbriated end of the tubes or absence of the fimbria. The fimbria are the tiny finger-like structures that sweep the egg into the tube from the ovary. The tubal reversal surgery is performed through a 3 to 4 inch "bikini cut" incision. The patient leaves the hospital or surgical center 23 hours later in most cases. Two to 3 weeks are needed to return to normal function. If the patient's job involves heavy lifting she may need to take 4-6 weeks off work. In the situations where the scarring or length of the remaining tube prevents the reversal, the patient avoids the full incision with its resultant cost and recovery time. This is because we perform a laparoscopic assessment of the tubes immediately prior to the tubal reversal while the patient is under general anesthesia (completely asleep). The tubal  reversal surgery requires a certain amount of expertise; therefore, you should choose a reproductive surgeon who has undergone a fellowship in infertility and preferably is board certified in Reproductive Endocrinology. An operating microscope is used to reconnect the two ends of the tubes using very fine suture material to reduce the chance of scar formation.

If we perform your surgery, the chance that you will have a normal pregnancy within one year of the surgery is 70% assuming that you are under the age of 40. Women between the ages of 40 and 44 who demonstrate on a blood test that they have adequate ovarian reserve, have a pregnancy rate that is half of that. An advantage of the surgical approach is that if you successfully conceive a pregnancy, you can usually go on to have more pregnancies if your desire.  Of course this could also be a disadvantage if you want to have only one more child and don't want to have to worry about subsequent contraception. Another disadvantage is that there is a 5% incidence of tubal pregnancy following a surgical reversal. If your medical insurance doesn’t cover the tubal reversal procedure, the total cost to you is approximately $15,000. This covers the charges for our surgeon fees of $4000 and hospital/anesthesia costs.

For a comparison of tubal reversal versus IVF, see the table below.

Note - If a pregnancy has been established by 1 year after tubal reversal, with adequate attempts at conception, IVF would be recommended.

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