How difficult will it be to become pregnant again if I have my tubal sterilization reversed? #914/13

Hi, I was wondering if I can get some advice. In 2005 I had a tubal sterilization after giving birth to twins.  Now I am 29 years old and my kids are 8 years old.  I want to know if it is possible that I can become pregnant without having to reverse this procedure. Does my age have an impact on the surgery success? And are there any chances of becoming pregnant before the age of 35? Do I really need to go and reverse it as I am now looking to have another child?

 

By the way, my first pregnancy was in 2000 and gave birth naturally then the twins by C- section. So, I already have 3 kids.



Good morning, my suggestions:

 

Reversal of a tubal sterilization operation is a major decision.  It is expensive and it is not necessarily effective.  No more than 50% effective in the best of hands.

 Below is some additional information on the reversal of tubal sterilization:

 

It is sometimes possible to reverse a tubal sterilization operation.

Try to find a physician who has extensive experience reversing tubal sterilization and how often he or she has been successful and the reversal procedures have led to a delivery. This would give you part of the answer to your question. Experience always improves the results of a surgical procedure.


I suggest that you contact your local or state Planned Parenthood people and find out about the local scene.  If you lived in the Atlanta area, I would recommend that you go to the Atlanta Feminine Health Center (FWHC).

Early in the process you might want to check with your insurance folks. 

The operations vary so much in price. They cost lots.

Any chance you could discuss this with the clinician who did the procedure?

I am not an expert in the subject about which you are seeking information.  But here are some data from the book Contraceptive Technology and from the organization, ENGENDERHEALTH that does come from experts:

 Desire for Pregnancy Following Tubal Sterilization

Sterilization should be considered permanent, but even with careful counseling; some women will have a change in personal circumstance In vitro fertilization or microsurgical tubal reversal can be considered to attempt pregnancy following trans-abdominal sterilization. Success is not guaranteed with either approach.

 

The Essure device is, by design, placed in the uterine cornua, and therefore patients are not candidates for traditional microsurgical reversal. In addition, a 6 to 10 mm portion of the coil remains protruding into the uterine cavity after the device is placed, which could be detrimental both to the success of the in vitro fertilization (IVF) procedure and to the pregnancy, if achieved. FORTUNATELY, YOUR PROCEDURE WAS NOT AN ESSURE PROCEDURE. Pregnancy outcome data on IVF with the Essure device in place is not currently available. At this time, Essure should be considered an irreversible method of female sterilization.[i][i][i]

 

The choice between IVF and tubal surgery to achieve pregnancy following tubal sterilization is dependent on multiple factors, including the age of the woman at the time of treatment, severity of the tubal damage and remaining tubal length, as well as other fertility factors. With careful case selection and meticulous surgical technique, reasonable pregnancy rates can be achieved following microsurgical reversal of tubal sterilization.[ii][ii][ii]

 

Surgery, especially major abdominal surgery, carries operative risks as well as risks due to anesthesia. Ectopic pregnancy is more common among pregnancies occurring after surgical reversal of female sterilization. Ectopic pregnancy rates range from 1 % to 7%—higher rates can be observed in specific anatomical situations. Nonetheless, sterilization reversal may be appealing for younger women, couples who desire more than a single additional pregnancy, or those who are not comfortable with IVF. Both IVF and reversal surgery are costly and are often not covered by health insurance. Finally, those couples utilizing tubal reversal surgery may have the need for future contraception. A large Canadian study showed that 23% of women obtaining tubal reversal following sterilization went on to obtain a subsequent sterilization.[iii][iii][iii]

 

 

According to Engenderhealth: A review of many studies reveals the chance of successful pregnancy to be roughly 50%.  In actual practice they point out that this percentage is probably much lower.

Certainly I hope you will be advised by a clinician with extensive experience doing tubal recanastamosis operations.  I am sure that you and your partner are considering whether you have any inclination to consider adoption.  What are your partner’s thoughts about adoption?  Are you ovulating fairly regularly?

 

Does all the above information help or is it just too much information (TMI)?

 

Good luck!

 

To learn more about the advantages and disadvantages of sterilization, go to www.managingcontraception.com and click on Choices.  You can also order this wonderful new educational book from our website or by calling 404-875-5001.  Do you have your copy yet?



Key Words:  tubal sterilization, twins, pregnant, surgery, reversal, procedure, success, C-section, extensive experience, Planned Parenthood, expensive, Contraceptive Technology, ENGENDERHEALTH, counseling,  Essure procedure, risks      

           

References:

[i][i][i] Ledger W. Implications of an irreversible procedure. Letter to the editor: Fert Steril 004.08.005

[ii][ii][ii] Lee D, Patton P. Tubal surgery and treatment of infertility. GO 04 Vol 5/ Chap 106 Reproductive Endocrinology, Infertility, Genetics.

[iii][iii][iii] Trussell J, Guilbert E, Hedley A. Sterilization failure, sterilization reversal, and pregnancy after sterilization reversal in Quebec. ObstetGynecol 2003;101:677-84.

Posted 10-7-2013, Updated 10-11-2013

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Posted on

October 11, 2013