For this women’s health series, we’ve been talking about your FAQs regarding getting your “tubes tied,” or having a bilateral tubal ligation (BTL). Today, we’ll answer a very important question that you should consider before undergoing the procedure.
What are my chances of having a baby if my tubal is reversed?
Nationwide, the cost of bilateral tubal ligation (BTL) ranges from $1,500 to $6,000. The cost of a reversal can run between $3,000 (internet quote from tubal reversal clinic) to $7,000-$15,000. The cost of a cycle of in vitro fertilization (IVF) runs about the same as tubal reversal. Most insurance plans do not cover tubal reversal or IVF after voluntary tubal ligation. So before you spend your money, you may want to know what your chances for a “take home baby”are likely to be.
The results of micro-surgical reversal of BTL was studied in 1,100 Korean woman (Kim, 1997). The majority of women had been sterilized by cautery/burning of their tubes. The average time between BTL and request for reversal was 4.25 years. The estimated success in restoring more normal anatomy was 88% with a pregnancy rate of 55%. Of those that did conceive, about 72% delivered a child. Surprisingly, there was no difference in pregnancy rates between the different types of BTL, nor between women whose reversal was much later and those that tried reversal close to sterilization. The best pregnancy rates occurred in the younger women, and among those who had longer sections of healthy tube to sew together.
Women trying for a surgical reversal of their BTL were compared to women opting to use IVF instead (Boeckxstaens, 2007). After 72 months, the delivery rates were 59.5% for the reversal group and 52% for the IVF group. One again, younger women fared better as those aged less than 37 years had a delivery rate of 72.2% after reversal surgery, whilst the older women had a 36.6% delivery rate. For those women choosing IVF, delivery rates were very similar for younger and older women (52% vs 51%).
A French study (Sitko, 2001) compared women with failed reversal of BTL with women who had blocked tubes for other reasons. Both groups were trying to become pregnant using in vitro fertilization techniques. The pregnancy rates were similar between the two groups. The probability of a term pregnancy depended more upon the age of the woman than other factors (there’s that darn age thing again!).
From the scientific point of view, the few studies which have been done are flawed because numbers are small, and women have not been randomly assigned to receive either reversal surgery or IVF (Pandian, 2008). Based upon what is known, surgical reversal of a tubal ligation seems to be more successful if the woman is in her mid-30s or younger, she is healthy and has a partner with known fertility. In terms of her tubal surgery, the better reversals occur when there is less extensive damage to the tubes (e.g., clips or rings). Many GYNs also believe that total length of the tube, once the damaged part is removed, influences pregnancy rates. This would make sense given the movement of Fallopian tubes to help catch the egg as it is released.
What about wishing one hadn’t had a BTL? A group from the World Health Organization (Curtis, 2006) reviewed the studies about regret after tubal ligation. Women having BTL before age 30 were twice as likely to want a reversal, with those younger women being eight times more likely to seek a surgical reversal or IVF. Only 4% of women regretted having a tubal ligation with the Filshie clip between 5-15 years after the procedure (MacKinzie, 2009), but this was a mixed age group. For Korean women, the most common reason cited for wanting a tubal reversal was loss of existing children (Kim, 1997). Other reasons mentioned in the literature included new relationship or new partner without children.
Overall, one should consider a tubal ligation a permanent form of birth control. While expensive reversal surgeries or IVFs are possible, the success rates are not 100%. Successful pregnancy rates decline as a woman ages. If the highest rate of regrets occurs in women under age 30, perhaps one should consider a BTL done with rings or clips to improve the odds of a reversal. A BTL is a convenient form of reliable birth control, but some of the more recent hormonal methods (e.g., Implanon) are as reliable as permanent sterilization.
Like getting married, one should assume at the outset that having a tubal ligation is forever.
Read more from the series:
- Part 1: Does having a tubal bring on more menstrual or mood problems?
- Part 2: What is the failure rate for a tubal ligation?