Tubal Ligation and Reversal Tips

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What should I consider when thinking about a tubal reversal?

Factors in Considering Tubal Ligation Reversal

Just as there are factors to be considered in getting a tubal ligation, there are also things you should think about when considering a tubal ligation reversal. Some of these may include:

  • tubal ligation reversal is a surgery, and has the same risks as other surgeries, including bleeding, infection, bowel injury, scarring and adverse reaction to the anesthetic
  • tubal ligation reversal is not guaranteed to make you fertile - scarring, incomplete reversal or infections can make the procedure ineffective in re-establishing your fallopian tubes
  • after making the decision to become sterile, what has changed your mind about becoming pregnant? Are there other factors which are encouraging the decision, such as a new relationship with someone who desires children?
  • if health factors were a consideration in your tubal, have those factors been resolved so that you will not suffer adverse outcomes if you become pregnant

Talk with your fertility specialist about tubal reversals and procedures, the risk and potential complications, and the projected outcome. This information will better prepare you to make the decision about moving forward with your tubal reversal.

What are the risks related to tubal ligation reversal?

Risks and Complications of Tubal Ligation Reversal

Just as with the tubal ligation, there are certain risks with a tubal ligation reversal. This is a type of surgery, and every surgery carries risks, regardless of the length or type of the procedure.

Tubal ligation reversal risks are related to opening the lower abdomen to perform the procedure. Use of general anesthesia is normally required, due to the length of the procedure. A urinary catheter may be placed, as well. Some potential risks and complications of tubal reversal include:

  • bleeding
  • surgery incision infection
  • anesthetic reaction
  • injury to the bowel or other pelvic organs
  • adhesions or scarring of the tubes or other organs
  • incomplete reversal or spontaneous ligation from scarring within the tubes
  • urinary tract infection
Ideally, the decision to have a tubal ligation should involve considerations about possible future life changes and should not be made lightly. However, it is impossible to predict life events, and the availability of tubal reversal surgery can restore fertility for women who have had prior ligations, and for whom natural conception is a priority.

What is post tubal ligation syndrome?

Post Tubal Ligation Syndrome

Though the tubal ligation does not normally have negative effects on hormone production or cause lasting side effects, some women do experience symptoms that may prompt them to seek a tubal ligation reversal. These symptoms can include:

  • irregular and heavy periods, bloating, cramps
  • early onset of menopause - hot flashes, sweats, mood swings, weight gain, breast tenderness or loss of breast size
  • severe PMS symptoms - irritability, mood swings, sleep disturbance
  • loss of sex drive
  • ectopic pregnancy - this is considered a risk of the procedure
  • anxiety symptoms, feelings of dread, memory fluctuations, depression
  • loss of vaginal moisture, or vaginal itching
The cause is not completely understood, but it is believed to be related to hormonal imbalance which may be caused by damage to blood vessels or hormone receptors during the procedure. Since the body's hormone levels are in a delicate balance, small changes or fluctuations can create significant symptoms. In women with Post Tubal Ligation Syndrome, the symptoms can become overwhelming and can interfere with their normal life functioning.

For some women, a tubal reversal relieves these symptoms and allows them to feel and function better. If you have had a tubal ligation and are having new and disturbing symptoms, talk to your Gynecologist about Post Tubal Ligation Syndrome

What are the risks of having a tubal and a tubal reversal?

Risks and Complications of Tubal Ligation

As with any surgical procedure, tubal ligation or tubal ligation reversal, there are risks and potential complications.

Since most tubal ligations are now completed using laproscopic surgery - small incisions in the abdomen through which they insert a camera and surgical instruments - the risks and potential complications are similar for a tubal reversal, and can include:

  • risk for infection
  • bleeding
  • ectopic pregnancy (following the ligation)
  • anesthetic reaction
  • incomplete ligation - if using clips, rather than cautery or cutting of the tubes
  • injury to the bowel or other pelvic organs
It is important to talk to your Gynecologist before considering a tubal ligation, to ensure that the benefits of the procedure outweigh any risks associated with the surgery, and that the procedure is the best option for long-term birth control, for you.

What alteratives do I have besides tubal ligation for long-term birth control?

Alternatives to Tubal Ligation

A Tubal Ligation is considered to be permanent birth control. The procedure involves surgery to sever or cauterize your fallopian tubes, to prevent eggs from moving down the tubes and becoming fertilized, resulting in pregnancy. Because a tubal ligation is considered permanent, if you do decide to become pregnant, you may need to undergo a tubal ligation reversal, especially if you wish to have natural conception.

But tubal ligation is not the only option for reliable long-term birth control. Other options include:

  • Implanon - small hormone-releasing "sticks" are implanted in your upper arm, which release small amounts of hormones, over a period of 3 years, to prevent pregnancy. The implants are removed after 3 years, during a brief office procedure. Risks include irregular periods, acne, weight gain and headache.
  • Mirena - hormone-releasing intra-uterine implant, which lasts 5 years. Risks include post-procedure cramping, irregular periods, risk for pelvic infections. It cannot be used in women who have uterine fibroids.
  • Copper intrauterine device - copper wire releases minute amounts of copper which make the uterine environment unfriendly to sperm and eggs. Risks include pelvic infection, post-surgical cramping, and longer and heavier periods. Removed after 5 years.
If you think that there may be a chance that you will change your mind, after having a tubal ligation, it is best to discuss alternatives to tubal ligation, with your Gynecologist. Taking the time to look at alternatives, can reduce the chance that you may have to undergo a tubal ligation reversal, with its associated surgical risks.

Why might someone get pregnant after a tubal ligation?

Pregnancy after Tubal Ligation

Tubal ligation is considered a permanent form of birth control for women who choose not to have any children or future children. During the procedure, the fallopian tubes are either clipped, cut or cauterized. Sometimes a section of the tube is removed.

But for a small number of women, pregnancy does occur after tubal ligation, even without a tubal reversal. The most common causes of this include:

  1. If the tubes are clipped, the clips may not be clamped tightly enough, and sperm can swim through minute openings, to fertilize eggs within the fallopian tubes. Since the egg may be too large to pass beyond the clip, it begins to divide to become a fetus, within the fallopian tube. This is called an ectopic (pronounced "eck-top-ick") pregnancy. This can be life threatening.
  2. If the tubes are cut, but segments are not taken out to create space between the tube ends, the tubes can spontaneous reconnect in what is called recanalization.
  3. The woman had intercourse the night prior to the procedure and sperm already had swam up the fallopian tube. Following the tubal ligation, if an egg was released and then fertilized, it will develop above the ligation, resulting in an ectopic pregnancy. This chance of this is very rare.
Of course, if a woman opts to have a tubal reversal, she can become pregnant, however this is not directly related to, or immediately following, the tubal procedure

How is a tubal ligation performed?

Tubal Ligation Procedure

Tubal ligation is the process by which the fallopian tubes are cut or clipped to prevent the passage of eggs, and therefore pregnancy.

A tubal ligation is performed by a gynecological surgeon - a doctor who specializes in the treatment of women and their reproductive organs - and is completed under general or local anesthesia and is usually an outpatient procedure.

Most tubal ligations are done using laparoscopic surgery - they make small incisions in your abdomen, then insert a camera and operating tools through the incisions. Since the incisions are small, and the amount of organ manipulation is limited, the recovery time is much faster than a regular abdominal surgery, and there are fewer complications.

It is suggested that you take two to three days off of work and limit sexual activity until you feel better. Tubal does not normally affect libido - sex drive - or impair hormones, and you will still have periods, due to natural hormonal fluctuations.

Talk to your Gynecologist about tubal ligation, to see if this is right permanent birth control method for you. Remember that tubal ligation is considered a permanent birth control procedure. The only way to undo a tubal, is through tubal ligation reversal, which has greater risk for complications and do not guarantee return of fertility.

Why does someone choose tubal ligation?

Choosing Tubal Ligation

Tubal Ligation is a procedure where the fallopian tubes are severed or clipped to prevent passage of eggs. This prevents pregnancy, and is considered a permanent type of birth control. It is important to remember that if you change your mind, tubal ligation reversal is a more complex procedure with more risks factors, and it not guaranteed to restore fertility.

There are different reasons why a woman may choose tubal ligation over other forms of birth control, which can include:

  • to limit the number of pregnancies
  • to prevent future childbirth
  • to prevent pregnancy which could be injurious to health

Some women may have underlying health problems that could result in serious injury or even death, if they become pregnant. Women with severe or brittle diabetes or history of pre-eclampsia (toxemia of pregnancy) may be cautioned against pregnancy, in addition to those with kidney failure or serious heart disease.

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