Mira chose to have their fallopian tubes “tied” after being absolutely sure that she and her husband wouldn’t want to have further children after the birth of their only child. She unfortunately lost both her husband and her child to an accident and after years of solitude is ready to have another relationship. She consulted me to discuss the possibility of having children as that would be something that should be addressed before she committed herself to another relationship.
Today, there are many women faced with the dilemma of having had their tubes tied too early and wanting to have further children at a later stage in their lives. There are two procedures to assist them. As a fertility expert, I am fortunate to have at my disposal 2 accepted techniques - Tubal Reversal Surgery or In Vitro Fertilization (IVF) to help women who regret their tubal ligation. Each process has its own benefit, success rate and risks.
If a woman approaches me to have her tubes tied especially if she is less than 30years of age, I would ask her to reconsider her decision especially if she doesn’t have 2 children atleast. I would offer alternative long term contraceptive options such as Copper –T (loop) or Mirena (hormone-containing loop) that work for 5 to 10 years. This would reduce the chances of approaching a fertility doctor lamenting her previous decision.
Tubal Reversal Surgery or In Vitro Fertilization(IVF)
To offer solution to women like Mira, recent evidence from medical studies has shown that in almost all situations it is probably best to undergo tubal reversal, otherwise known as tubal re-anastomosis or tuboplasty. If proper microscopic technique is used, the overall statistics are that a woman will have 75% chance of eventually having a baby. Many women also reach that 75% success within 3 attempts of IVF, it may three attempts to reach that statistic, making tubal reversal a better financial choice.
The first thing we consider before proceeding forward with the reversal surgery is to know the method by which tubes were originally tied. Sometimes the tubes have just been destroyed beyond repair. As a general rule, if your tubes were tied roundabout the time of childbirth, either at caesarean section or shortly after vaginal delivery, then the reversal should go well and give a good result. If the tubes were “tied” with electrocautery at laparoscopy then often, but not always, we just don’t have enough tube left and the couple are left with only IVF to give them any hopes of pregnancy. Moreover, before offering surgery for reversal of sterilization, it is important to check that the man’s sperm count is normal as this would have an impact on natural fertility.
Another factor is female age as fertility declines with increasing age of a woman. If women have low ovarian reserve, IVF would offer better chances of success than tuboplasty. Couple should adequately be counselled regarding the success rates and costs and treatment is individualised.
Women can help themselves by following a healthy lifestyle and organising a health check so that they optimize their chances of pregnancy with whatever method is chosen.