If you have had, or are considering, tubal ligation (having your tubes tied) in order to prevent pregnancy, one of your concerns may well be the possibility of conception following the operation.
Most people have heard of someone who has fallen pregnant despite having their tubes tied; so, how common is this? What are the signs? Are there any risks to falling pregnant following tubal ligation? Let’s answer these questions one by one.
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1. Is Pregnancy Possible After Tubal Ligation?
The short answer is ‘yes.’ To understand why this is, it first helps to understand what happens when you have your ‘tubes tied.’ Ligation is usually carried out as an outpatient procedure. Under general anesthetic, a surgeon will essentially ‘seal’ your fallopian tubes – he may do this by cutting, banding, sealing or tying them.
Of course, your body’s response to ‘insult’ (damage) is to heal – this means that following the operation, in some cases, your fallopian tubes will repair themselves.
Most doctors agree that the likelihood of this happening is related to age – meaning that the younger you are when you have the procedure, the more likely it is that eventually, the process will correct itself and you run the risk of falling pregnant. In some countries, the age that women are able to have tubal ligation is restricted for this reason.
As a rough guide, around one in 200 women in total will fall pregnant after the operation – however, 5% of all women having a tubal ligation before the age of 28 will eventually become pregnant. That’s actually a far worse failure rate than the contraceptive pill, which is why access to the procedure may be restricted by some medics.
This drops to just 1% after the age of 35. This is because both your body’s ability to heal and your natural fertility drop after this age.
It is very important to take your age into consideration before deciding on ligation – if you are younger than 27, and you opt for the procedure, you may want to use additional contraception if you wish to avoid pregnancy.
2. What Are the Signs of Pregnancy After Tubal Ligation?
The symptoms of pregnancy following ligation are basically the same as those if you had not had the operation.
You might experience nausea – this is usually known as morning sickness; however, many women find that they can experience it at any time of the day or night and some women find that they feel sick all the time.
Some, but not all, women experience breast tenderness – in some people, this can be extreme, bordering on painful.
Unexplained tiredness can be a symptom of early pregnancy, but is often missed due to the stresses of modern life – for many people, feeling fatigued is nothing unusual, and probably wouldn’t be an indication that changes are taking place within their body.
Another symptom that women frequently experience in the early stages of pregnancy is an increased need to urinate.
Experiencing cravings for unusual food (or feeling sick or nauseous when smelling or thinking about certain foods) can also be a symptom of pregnancy, but this is not something that every woman experiences, and can also be the symptom of other illnesses.
Of course, the most obvious sign is a missed period – however, if you have had your tubes tied, you may not pay as much attention to your reproductive schedule, and it could be some time before you realize that something is amiss. If you have tubes tied and have a missed period, you should speak to your GP or Practice Nurse straight away.
All of the above may be early signs of pregnancy following tubal ligation. If you experience more than one of these symptoms, it is advisable to take a pregnancy test, either at home or at your local clinic.
If you believe that you may be pregnant following a ligation, you should initially use a home pregnancy test kit. These can be picked up cheaply and easily in pharmacies, drug stores, and supermarkets. Through time, they have become extremely reliable, and many will now allow you to find out if you are pregnant before you have even missed a period.
If you do not wish to do this, you can also make an appointment at your family planning clinic or GP. They will be able to administer a pregnancy test and discuss the results with you, as well as any concerns that you have about the efficacy of your tubal ligation procedure.
3. Are There Any Risks Associated With Falling Pregnant After Tubal Ligation?
The main ‘risk’ associated with pregnancy after ligation is that of ectopic or tubal pregnancy.
This means that the fertilized egg implants within one of the fallopian tubes rather than in the lining of the womb.
Ectopic pregnancies are never successful, as it is not possible for the fetus to grow to term. There are also risks to the mother in tubal pregnancy as if it is not detected early enough it can lead to rupture of the fallopian tube, which can be dangerous and will almost certainly require further surgery.
If you are experiencing any of the early symptoms of pregnancy, and go on to develop acute (sudden, severe) abdominal pain, heavy vaginal bleeding, light headedness or fainting you should seek medical attention as soon as possible.
In many cases, women who experience an ectopic pregnancy will never be aware that it has taken place, as the body will miscarry the fertilized egg at such an early stage. If this happens, the only symptoms might be an unusually heavy or painful period.
Although ectopic pregnancy after tubal ligation is recognized as one of the risks, it is extremely rare. In the UK, for example, there are only around 80-90 ectopic pregnancies in total every year. When you take into account that only around 5% of women under 28 who have had ligation will fall pregnant in the first place, it makes the risk of tubal pregnancy incredibly low. Nevertheless, if you experience any of the symptoms above, or believe that you might be pregnant despite having your tubes tied, it is important that you seek medical attention as soon as possible to make sure that everything is progressing normally.
4. What Does All of This Mean in Practice?
When you look online, ‘pregnancy after tubal ligation stories’ are all over the place, and it can appear that as an operation, it is not very successful! I’ve even seen one story of a woman who became pregnant after ligation not once, but twice.
However, statistically, the chances of accidentally becoming pregnant after this type of operation are very low.
If you are considering ligation, it is important to listen to your medical professional prior to making a decision about whether to go ahead. If you are very young, it might not be the best option for you for a couple of reasons.
Firstly, although ligation can be reversed, it is not always successful. Although you may feel very certain in your twenties that you do not want children (or more children), it’s possible that you might change your mind at a later date, and so it is better to use a less permanent method of birth control until you hit your thirties.
Secondly, as discussed earlier in the article, the possibility of a failed ligation is statistically higher the younger you are – if you really want to avoid pregnancy, it may be sensible to use another form of birth control even after ligation, such as condoms. Since you cannot guarantee that you won’t conceive with this method, you really have to ask yourself if it is worth having invasive surgery that you may still need to use contraception with.
In any case, if you are in your twenties, it is crucial that you take good medical advice before making a final decision on whether to go ahead with the procedure. You may find that it is not available in your local area unless there is a direct risk to your health from becoming pregnant – in this case, you will need to explore other options, which your doctor or clinic should be able to advise you on.
If you have already had a ligation, but wish to conceive, your first port of call should be your doctor. The most obvious way to achieve pregnancy is to have the ligation surgically reversed.
This involves another outpatient procedure, where the surgeon will attempt to reconnect or unblock your fallopian tubes. You will not usually need to stay in the hospital overnight after the operation, but you should expect to allow at least two weeks for full recovery.
Your doctor or surgeon will probably want to do a full physical exam of both yourself and your partner prior to agreeing to further surgery – this is because if there are other physical issues affecting your fertility, he or she may not want to agree to further surgery that is unlikely to be successful.
Success rates for the procedure vary, and again, its effectiveness varies depending on your age. Women in their 20’s who have the process reversed have a much higher rate of conception. However, generally the success rate for conception following ligation reversal can be as high as 85%, assuming that there are no other fertility issues.
Most surgeons agree that the best results for ligation reversal surgery are females under 40 who have had their tubes clamped or tied directly following childbirth. In these women, there is an extremely good chance that pregnancy will follow reversal, and recovery periods are likely to be shorter and less stressful.
Regardless of your age, the reasons or circumstances your ligation took place in, it is important that you seek the opinion of a medical expert if you wish to conceive.
A medical expert will be able to discuss with you the potential risks and benefits of further surgery in relation to your own medical history. He will also be able to recommend or refer you for tests to see if your ligation procedure needs to be reversed – as discussed earlier, in some women the process reverses itself naturally, and it could be possible that additional surgery is not required.
He will also be able to recommend further measures to improve your general health, fertility and ability to conceive following your reversal procedure.
Although the risk of ectopic pregnancy is low, if you have other risk factors for this (such as a previous tubal pregnancy), your midwife or clinician may want you to have increased monitoring during the early stages of your pregnancy.
Again, the risk of ectopic pregnancy increases with age, so if you are in your mid to late thirties and considering post-ligation pregnancy, this is something that you will need to discuss with your clinic or doctor. It is almost certain that he or she will want to take part in an early pregnancy screening program to ensure that the pregnancy follows the expected course. While it is statistically unlikely that you will have any problems, the type of complications that can follow ligation reversal are potentially serious, and it’s not worth the risk of not monitoring the early stages of your pregnancy. Once you are past the first trimester, your baby’s gestation will very likely be exactly as expected – problems after this are statistical as they would be for a normal pregnancy.
Although this can seem alarming, most women who have a ligation reversal will go on to have regular, uncomplicated pregnancies. The likelihood of complications varies from person to person and has much to do with your previous and current medical history, which is why the involvement of your health care professional at an early stage is so important.
However, with rates of conception as high as 85%, the chances of conception are reasonably high, and you will probably find that you will only experience the usual side-effects of pregnancy during your gestation period. This is, of course, great news for women looking to reverse the procedure, particularly if they are young and in generally good health.