We’ve all heard the horror stories of women who had their tubes tied and then ten years later they have a surprise pregnancy. Some of them end up on television shows because they were oblivious to the fact that they were pregnant while assuming it was impossible. It’s not. Women get their tubes tied pretty routinely in this country and many of them end up pregnant afterward.In some cases, the pregnancy won’t be viable. In other cases, women are likely not prepared for the pregnancy that they are blessed with. Regardless, it’s a situation anyone with a uterus can find themselves in — sterilized or not.
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Tales of a Tubal
Tubal ligation can be performed in a variety of ways nowadays. The most traditional method involves cutting the tubes and tying them in knots. In some cases, doctors will now use a cauterizing tool to burn the snipped ends so that they cannot easily fuse back together. Tubal ligation can typically be performed on an outpatient basis, but general anesthesia is still required. The process might be done via the cervix with a long tool fitted with a camera on the end; this is known as a hysteroscopic tubal ligation. Other doctors may prefer to complete the tubal ligation laparoscopically via small incisions made in the wall of the abdomen.
Rates of Efficacy
The effectiveness of a tubal ligation is actually better the more time passes. Some people think it should be the other way around, but it starts out poorer and increases as time goes by since the likelihood that the tubes will fuse back together and overall fertility both decrease with age. In the first ten years following the surgery, the efficacy of a tubal ligation is estimated by the University of Pittsburgh Medical Center as being roughly 95 percent in women under 28 years old, 98 percent in women aged 28 to 33, and 99 percent in women aged 34 and older.
Pregnancy After a Tubal
Most people would wonder how a pregnancy could be possible after a tubal ligation is performed. The short answer is that the tubal manages to undo itself. Sometimes the tubes actually find one another again. The body is constantly trying to repair itself from injury and that is how it views tubal ligation — as an attack on itself. Given the opportunity, the amazing human body will attempt to fuse those tubes back together. If successful, the woman would likely never know unless she gets pregnant. It is more likely that this will happen in younger women than older.
In other circumstances, a pregnancy may occur outside of the uterus and implant itself elsewhere. The most common site for this in the case of women who have had tubal ligations is in the actual tube itself. The sperm manages to make its way to fertilize the egg and it resides inside a fallopian tube. These pregnancies are known as ectopic pregnancies. They are never viable since a baby cannot possibly grow and develop inside a fallopian tube.
Ectopic pregnancies are very risky to the health of the mother, too; they can be fatal in some cases. The end result could also cost the woman her tube. While this isn’t a major concern to most women who have already had a tubal ligation and decided they don’t want any (more) children, the situation is further complicated should they ever change their mind on that. Tubal reversals actually have pretty impressive efficacy rates. However, women who have lost a tube will have impaired fertility.
Losing a Tube
Ectopic pregnancies must be surgically removed. Sometimes the tube must be removed with the ectopic pregnancy if the pregnancy has progressed too much. Even if fertility isn’t a concern, women who lose a tube due to ectopic pregnancy after a tubal ligation will see some side effects from it. They may have irregular periods following the loss. This is because the ovaries take turns releasing eggs month after month. Most people think they switch on and off equally taking turns, but this isn’t quite true. Nonetheless, if a tube is lost, then eggs may not make it out each month. This means periods will no longer happen every month.
This may sound like a dream to most women, but the period has a purpose and it involves more than fertility. That regular bleeding cycle is necessary for women to maintain optimal health. The decline of hormones is actually the same time in a woman’s life that her overall health starts to decline, too. Skipping periods means the uterus has to wait longer between cycles to shed its lining. As estrogen causes it to keep thickening each cycle before shedding, women may find that their periods are heavier after the loss of a tube. In addition, they may develop PMS symptoms that they didn’t have before, like cramps and backaches. Some women may even develop Premenstrual Dysphoric Disorder as a result of the hormonal upset the loss of a tube can cause.
Some women develop Post Tubal Ligation Syndrome after having the surgery performed. Those who lose a tube due to ectopic pregnancy are also at risk of developing PTLS. Symptoms of it include:
- Irritable mood
- Night sweats
- Hot flashes
- Menstrual cramps
- Mood lability
Pregnancy on Purpose
Women who are actually hoping to get pregnant after they’ve had a tubal ligation have a few options. Since the likelihood of the tubes fusing together on their own is so small, it isn’t recommended that women hold out hope for natural conception. However, reversal procedures are in place that can help women to conceive again after having their tubes tied. The reversal process involves a surgical procedure — once again under general anesthesia — that stitches the fallopian tubes back together. Reversal is more difficult if the tubes were burned, but it can still be accomplished by first snipping off the burnt ends before stitching them back together. Factors that complicate this procedure can include infection and the formation of scar tissue that could cause the fallopian tube to become blocked. If conception isn’t achieved within the first year of restoring the fallopian tubes intact, an HSG screening may be warranted to rule out any blockages or clear them out. The success of tubal ligation reversals is roughly 70 to 80 percent in the first year for women under 35 years old and around 30 percent for those over that age, per Attain Fertility. The cost of this procedure is approximately $7,900, according to Tubal Reversal.
Some women may choose to bypass tubal ligation reversals altogether and opt for more extreme fertility measures. In vitro fertilization involves combining a woman’s eggs with a man’s sperm in test tube form and waiting for fertilization to occur. Monitoring this process in a laboratory environment allows for only fertilized embryos to be transferred into a woman’s uterus to attempt implantation. The success rate is roughly 20 to 40 percent per cycle, according to Resolve, but it comes at a much steeper price than tubal reversal does. The cost of just one round of IVF can be as much as $15,000, per Infertility Resource. Which path a woman chooses to become pregnant following a tubal ligation is an individual choice. She should weigh the pros and cons of both options with her partner and her doctor.