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 tubes.

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.

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