Tubal ligation is a medical sterilization (birth control) procedure for women. However, pregnancy after tubal ligation may occur under extremely rare circumstances. If you are curious to know more about it, keep reading.
Tubal ligation is a permanent contraceptive technique for women. It is a combination of two words where ‘tubal’ means the ‘fallopian tubes’ consisting of the eggs and ‘ligation’ refers to ‘binding up.’ Thus, this procedure involves tying up the fallopian tubes so that the eggs cannot enter the uterus for fertilization (1).
What Are The Chances Of Pregnancy After Tubal Ligation?
During the surgical procedure, the fallopian tube is cut and then tied off, which leaves very little chance for a future pregnancy. However, like any other birth control method, tubal ligation is not 100% effective. Pregnancy after tubal ligation is possible if (2):
- The tubes regrow together, making way for the eggs into the uterus, where they get fertilized by the sperm if any.
- The surgery was done improperly.
- The woman is pregnant at the time of the surgery.
To lower the chances of pregnancy, women usually get a tubal ligation done immediately after the delivery or the first menstrual cycle. If all fails and you still get pregnant, you will experience symptoms similar to that of a healthy pregnancy.
Signs And Symptoms Of Pregnancy After Tubal Ligation
If you had a tubal ligation, then check for the following signs and symptoms associated with pregnancy.
- Missed period
- Breast tenderness
- Pain in the lower abdomen
The chances of pregnancy after tubal ligation are minimal. However, it may happen if the procedure fails in any way.
How Common Is Pregnancy After Tubal Ligation?
According to the University of Pittsburgh Medical Center, about 5 in 1000 women get pregnant after one year and 13 in 1000 after five years following this surgical procedure (2). The failure rate of tubal ligation was estimated to be 1.85% in 10 years.
It was also found about one-third of the pregnancies resulted in ectopic (pregnancy taking place inside the fallopian tube instead of the uterus) following a tubal ligation (3). It is believed that pregnancy will generally occur in the first two years post tubal sterilization (4).
Not that the chances of the pregnancy being ectopic are higher after the procedure. Keep reading to know about that and other risks of pregnancy after tubal ligation.
Risks Of Pregnancy After Tubal Ligation
Ectopic pregnancy is one of the risks associated with tubal ligation, even though the chances of pregnancy itself are rare. Ectopic pregnancy is one of the major causes of mortality and morbidity occurring in early pregnancy.
Therefore, if you have had a tubal ligation, get checked for ectopic pregnancy if you experience amenorrhoea or lower abdominal pain (4). A study including 10,658 women found that the risk of ectopic pregnancy was about 7.3 per 1000 sterilization procedures done within ten years.
If an ectopic pregnancy is diagnosed, you need to see the doctor as it could be life-threatening. Whether to manage medically or surgically will be decided by your clinician depending upon the size, presence of cardiac activity, chances of rupture and your condition at presentation. (5).
What Are The Symptoms Of Ectopic Pregnancy?
Other symptoms include (7):
- Lower back pain
- Mild pain in the pelvis or abdomen
- Abnormal cramps with vaginal bleeding
- Mild cramping to one side of the pelvis
- Low blood pressure
If you experience abnormal bleeding and severe pelvic pain, consult an obstetrician-gynecologist immediately. As the ectopic pregnancy progresses, the risk of fallopian tube rupture increases. You may also experience more severe symptoms including:
- Sudden and severe pain in the pelvis or abdomen
- Fainting, dizziness, and weakness
- Shoulder pain
Fallopian tube rupture is associated with severe internal bleeding, which could be life-threatening. So if you experience any of the symptoms mentioned above, visit your doctor immediately.
Usually, women with certain conditions are more susceptible to ectopic pregnancy.
Who Is At The Risk Of Ectopic Pregnancy?
Ectopic pregnancy can occur in women who (6):
- Have had an ectopic pregnancy previously
- Had a Fallopian tube surgery
- Had a previous pelvic or abdominal surgery
- Have STI (Sexually Transmitted Infection)
- Having endometriosis
- With PID (Pelvic inflammatory disease)
- Have any infertility problems
- Are taking ovulation-stimulating medications
Some other factors include (7):
- Age above 35 years
- Cigarette smoking
- History of infertility
- Use of IVF (in vitro fertilization) or any other assisted reproductive technology
Tubal ligation has a good rate of success, but it has failed to prevent pregnancy in some cases.
What Are The Reasons For Tubal Ligation Failure?
Reasons for the failure of tubal ligation (8):
- Improper surgical procedure
- Recanalization of the fallopian tube
- Tuboperitoneal fistula
- Minilaparotomy (minilap)
Sterilization-failure rates after tubal ligation:
|Years||% of failure|
Pregnancy after a tubal ligation needn’t just be an accident. You can also choose to get pregnant by going for the tubal ligation reversal procedure.
What Are The Options For Pregnancy Post Tubal Ligation?
Getting pregnant post tubal ligation is possible through either tubal recanalization or ART (assisted reproductive technique). The tubal recanalization is a surgical procedure that involves re-attaching the cut or blocked ends of the fallopian tube. However, the success rate of the reversal procedure solely depends on the following (9):
- The method used for tubal ligation. Reversal is more likely in procedures using clips and rings rather than the Electrocautery method.
- If the time span between the tubal ligation and the reversal surgery is less, then the success rate for the reversal procedure is more.
- If the tubes are less damaged, then the reversal surgery is more likely to be successful.
The success rate for tubal ligation reversal is 70-80% based on the method used for the sterilization and the extent of damage to the fallopian tube. Also, women who had undergone this procedure have a moderate risk of getting the egg implanted in the fallopian tube (ectopic pregnancy).
The pregnancy rate with successful tubal ligation reversal method is around 75% over a time period of two years, with half of the pregnancies occurring in the first six months post tubal ligation (10).
Here is a story on tubal ligation reversal (11)
In 2016, Donna Fiorenza (40 yrs) from Harvey, Australia gave birth to a baby girl (named Ella), after getting the tubal ligation reversed. She had her tubes tied for 12 years and got pregnant eight months after the reversal procedure. Ella is now a healthy and happy child.
Next, we address a few commonly asked questions about pregnancy after tubal ligation.
Frequently Asked Questions
1. How can you get pregnant without reversing tubal ligation?
Lately, the surgical reversal procedure has been replaced by the IVF method owing to its increasing success rates. So, women who wish to get pregnant are counseled for getting IVF done instead of the reversal surgery (12).
2. What are the complications of tubal ligation?
Like any surgery, tubal ligation is also associated with complications such as bleeding, reaction to anesthesia, infection, injury to organs like bladder, uterus, ovaries, and blood vessels (13).
3. Will tubal ligation decrease the sexual desire in women?
No. As there will no longer be any fear of getting pregnant, a woman can have an active sexual life.
Tubal ligation can help prevent pregnancy in most cases. However, this surgical birth control method isn’t 100 percent effective. Tubes regrowing together and improper surgery are scenarios when pregnancy after tubal ligation can be possible. If at all you get pregnant after tubal ligation, you will experience the same symptoms as a healthy pregnancy. However, it could raise the risk of ectopic pregnancy. So, if you don’t want babies, you can consider discussing tubal ligation with your doctor before deciding. Later in life, if you wish to expand your family, you can speak to your healthcare provider about the reversal of tubal ligation.
2. Tubal ligation and tubal implants; UPMC (2019)
3. Chances of Pregnancy After Tubal Ligation; Sutter Health (2018)
4. Akaba GO, et al.; Ruptured Ectopic Pregnancy after Bilateral Tubal Ligation: A Case Report; Journal of Women’s Health Care (2013)
5. Treatment; NHS
6. Ectopic Pregnancy; KidsHealth
7. Ectopic Pregnancy; American College of Obstetricians and Gynecologists (2018)
8. Shilpa Vishwas Date, et al.; Female sterilization failure: Review over a decade and its clinicopathological correlation; International Journal of Applied and Basic Medical Research (2014)
9. Tubal Ligation Reversal; American College of Cardiology
10. Tubal Ligation Reversal; UAB Medicine (2019)
11. Claire Hannum; This Woman Had A Baby After Having Her Tubes Tied For 12 Years; SELF
12. Tubal ligation reversal; NIH
13. Public Education Pamphlets; The Society of Obstetricians and Gynaecologists of Canada (SOGC)
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Dr. Asmita Kaundal(MD)
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