Dear doctor,
When I had my last baby in 2010, I had both of my tubes tied. Am now in a new relationship and would wish to have a baby. Is the procedure reversible?
The tying of fallopian tubes is commonly referred to as Bilateral Tubal Ligation (BTL). It is a permanent method of contraception, and should always be taken as such. Once the procedure has been done correctly, the chance of spontaneous conception is almost nil. A problem arises when a change of mind occurs and future childbearing becomes desirable.
There are many opportunities to get tubal ligation done. This can be shortly after birth and before discharge from the hospital. It can also be done at the time of delivery via a Caeserean Section. Or one can get it done at any other time in the absence of pregnancy.
Various methods are employed to ensure interruption of tubal function. The tubes can be tied, partial or whole portions can be removed, permanent clips can be applied, or separation can be achieved with the use of various energy sources. Once effectively done, the eggs and sperms will not be able to meet, thereby negating subsequent conception.
You need to be as sure as you can be that you are done with pregnancies before having a BTL. Some may have medical conditions warranting permanent contraception. The younger you are below mid-thirties, the more the likelihood of future regret.
Before accepting BTL, you must consider alternatives that are reversible, and have comparable effectiveness to permanent contraception. Vasectomy for your partner is an alternative. It’s a much simpler procedure, and much less expensive.
Yes, reversal can be considered once you change your mind after a previous BTL. But the chances of a successful reversal and eventual spontaneous pregnancy are very low.
The various factors that come into play are how the BTL was done, and the skill of the surgeon attempting the reversal. Even if reversal succeeds, you may not achieve a pregnancy, or may end up with an ectopic pregnancy.
Your current age matters as well. The older you are above mid-thirties, the more the decline in ovarian function and consequential lower potential for spontaneous pregnancy.
Get a thorough review by your gynaecologist. It’s best to come up with a quantified figure of the predicted potential to succeed. Once a decision is made, the surgery is best done is a specialised unit and by a specialised team, with a proven track record of successes.
Your everyday gynaecologist, in a general gynaecological set-up, is unlikely to get you the results you desire. If reversal is deemed unlikely, your best bet becomes assisted conception (IVF). In the grand scheme of outcomes, this may be the best choice from the outset.
- Dr Alfred Murage is a consultant obstetritian and gynaecologist