Tubal Ligation: The Facts
What is it?
Tubal ligation is used as a form of birth control. It involves the
physical disruption of the fallopian tubes. The fallopian tubes are
the pathway for the egg from the ovary to the uterus. If the egg is
fertilized, it can implant in the uterus and cause pregnancy. Tubal
ligations prevent pregnancy by preventing contact between the egg
and sperm. The egg is simply reabsorbed by the body.
How is it done?
There are many methods for tubal ligations. They are classified by
how they are done. The most common method is called the
Pomeroy. The Pomeroy involves the creation of a loop in the
fallopian tube, which is tied off. The loop is cut out. The tie is made
of a material typically used in internal surgeries that the body can
break down and absorb. When this happens, the two ends of the
tube fall apart. The danger is that they will re-attach, or the egg or
sperm can cross the gap, resulting in a regular or more likely an
ectopic pregnancy. This is why two other procedures, the Irving
and the Uchida, move the ends of the tubes away from each other.
There are also devices that block the tubes. The Hulka clip and the
silastic falope ring are used to clamp the tube.
Tubal ligation typically involves an incision in the abdomen, usually
under the belly button. A small incision of about a half an inch or
simply a few circular areas the size of a pencil eraser. In the not
too distant future, expect to see office procedures that will go in
through the vagina and cervix and plug or otherwise disrupt the
Reversal of a Tubal Ligation
The chances of conceiving after a tubal ligation are slim but not
non-existent. In order to decrease the risk of accidental
conception, tubal ligations normally involve the burning, tying or
cutting of the fallopian tubes. For this reason, reversing the
procedure can be difficult. There are two options for reversing a
tubal ligation, namely, rejoining her tubes and in vitro fertilization.
Before considering either of these options she should see her
doctor and evaluate the extent of damage to her tubes, her general
health, and her overall chances of getting pregnant in order to
avoid any unnecessary surgery.
Rejoining a woman's fallopian tubes after a tubal ligation under
optimal conditions has a success rate of 70-80%. If there are any
problems, such as short remaining tubes, or damage to the tubes,
the rates are much lower. The rate of success is decreased for
women whose tubes have been burned, due to more extensive
tubal damage. There is also a much greater risk of ectopic
pregnancy with rejoined tubes. This is because there is often
scarring and narrowing of the tubes where they are rejoined. The
ovum may be too large to pass through the constricted portion, yet
it can still be fertilized. Success has also been found to depend on
the age of the woman, the technique of ligation, tubal length after
rejoining, and if one or both tubes are rejoined.
The second option is in vitro fertilization. Varying with the clinic
involved, the success rate is about 10-30%. The success rate is
towards the higher end of this range for women under 35 and
toward the lower end of the range for women over 40. It is
important to consider that this procedure carries the possibility of
an increased risk of ovarian cancer. The woman must be given
doses of female hormones to stimulate the production of several
eggs in one cycle. This large dose of hormones is thought to be
the cause of cancer in some women twenty or thirty years after the
procedure. The studies are not yet clear on this issue, because the
procedure has not been performed on enough people for a long
enough time to know for certain.
In any case, when the hormones are given, the woman usually
produces several eggs, which are removed from her body via a
needle inserted through the vaginal wall. The eggs are fertilized
outside the body and then implanted in the womb, simply skipping
over the fallopian tubes entirely. If fertilization is successful, it is
important to remember that there is a higher rate of spontaneous
termination with in vitro fertilization. There is also a higher rate of
multiple births. Multiple birth pregnancies, especially if more than
three, pose additional health risks to the mother. In addition, the
likelihood of children born with complications is much higher.
If a woman decides to explore one of these options further, she
should ask many questions of the potential health providers.
Reversal procedures are expensive (about $8000) and not
typically covered by insurance, so the financial aspect of this
should also be considered. Check out the doctor's credentials, ask
for references of couples who were not able to have a child, ask for
statistics on success rates, and see if any lawsuits have been
brought against the clinic you are considering using.