Is Pregnancy Possible After Tubal Ligation?
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Medically reviewed by Monique Rainford, MD
Pregnancy after tubal ligation is rare but possible. Tubal ligation (tying your tubes, or female sterilization) is a form of permanent birth control. During a tubal ligation, the fallopian tubes are surgically blocked shut.
In very rare instances, the fallopian tubes may reconnect after a tubal ligation procedure. If this occurs, spontaneous pregnancy (pregnancy from sexual intercourse) may be possible to achieve.
If you had a tubal ligation but now wish to get pregnant, you may be considering tubal ligation reversal. This surgical procedure increases the chances of pregnancy but doesn't ensure it.
This article will discuss how pregnancy might occur after tubal ligation and the potential risk you may face for ectopic pregnancy. Tubal ligation reversal is not always possible or effective. For that reason, this article will also provide information about alternative fertility options that may be a better fit.
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Reasons Pregnancy Could Happen After Tubal Ligation
Tubal ligation is close to 100% effective, but tubal ligation failure that allows for pregnancy is possible.
In rare instances, the tubes may grow back together by forming a new passageway that sperm can swim through. This is referred to as recanalization. A study in India demonstrated that the procedure stopped working due to the formation of a tuboperitoneal fistula—an abnormally formed hollow passageway that allows sperm to pass from tube to tube.
Surgical error or inadequate healing of the tubes after surgery may also cause tubal ligation failure. This procedure has a failure rate of 1.85% within a 10-year period. This means you have less than a 2% chance of getting pregnant naturally after having a tubal ligation that is not surgically reversed.
The occurrence of pregnancy after tubal ligation is reported for up to 20 years after the procedure takes place. This does not mean, however, that tubal ligation stops working or “expires” over time. In the vast majority of cases, tying your tubes provides permanent results.
Early Pregnancy Signs
Signs of early pregnancy vary between people. The most common symptom is a missed menstrual period. Tubal ligation does not stop you from menstruating, so this is important to keep in mind.
The symptoms of early pregnancy can result from a normally progressing pregnancy or from an ectopic, non-viable gestation.
Signs and symptoms of early pregnancy include:
Light spotting or bleeding
Cramps
Swollen or tender breasts
Fatigue
Nausea or vomiting
Unusual moods or feelings
Headaches
Needing to urinate more often
Heightened sense of smell, which may include an aversion to some smells
Changes in appetite that may include cravings and aversions
Risks of Ectopic Pregnancy
An ectopic, or tubal pregnancy is caused by the implantation of a fertilized egg in a location other than the uterine lining. Ectopic pregnancies often implant in the fallopian tubes but can also implant in the cervix, ovary, or abdominal cavity.
Embryos can only grow and thrive within the uterus. Ectopic pregnancies cannot proceed normally and never result in a baby. When left untreated, ectopic pregnancies can be life-threatening because the fallopian tube or other organ may rupture and cause internal bleeding.
Tubal ligation increases your risk of having a tubal pregnancy. Around one-third of all pregnancies that occur after tubal ligation are ectopic and non-viable. Tubal ligation reversal also increases your risk of ectopic pregnancy by around 2–7%.
If you have an ectopic pregnancy, you may experience some or all of the common symptoms of early pregnancy. You may also notice additional warning signs, including:
Abdominal pain
Pelvic pain or pressure
Vaginal bleeding, which may be light or heavy
Low back pain
Shoulder pain
If you suspect that you have a tubal pregnancy, seek immediate medical attention.
How Do Fallopian Tubes Grow Back Together?
Fallopian tubes don't grow back together seamlessly. Rather, they become rejoined when a fistula forms. Fistulas in the body can result from surgery, injury, or inflammation, such as the kind caused by pelvic inflammatory disease.
Fistulas that reconnect the ends of a fallopian tube cause a passageway through which sperm can enter and possibly reach an egg. This passageway is typically too small for an egg to travel through. For this reason, the sperm and egg meet higher up in the tube than they normally would.
Transportation of the fertilized egg into the uterus is not always possible because the opening formed by the fistula is too small. The fertilized egg remains lodged in the tube, and an ectopic pregnancy occurs.
Tubal Ligation Efficacy as a Form of Birth Control
Tubal ligation is considered to be a safe, effective, and permanent form of birth control. Even though it is designed to be permanent, tubal ligation is not 100% effective. The failure rate for tubal ligation is estimated to be 0.1–0.8% during the first post-procedure year.
Deciding to Reverse Tubal Ligation
Life can be unpredictable, and it's not unusual for people to regret having tubal ligation. A 2016 study of people who had tubal ligation in the United States found that 28% regretted having done so.
People who had tubal ligation when they were 30 years old or younger were most likely to experience feelings of sadness or depression about their decision.
There are many reasons why you might wish to consider tubal ligation reversal. You may decide that you want more children than you originally planned to have. Your partner or finances may have changed, opening up new doors for you. If so, talk to your healthcare provider about your options.
Tubal ligation reversal is not always physically possible. The type of tubal ligation procedure you had, the amount of undamaged tube remaining, and your age may all play a role. Your surgeon's level of experience will also affect the operation's success.
Tubal ligation reversal is not always effective. Around 50–80% of people who undergo successful reversal will go on to have a healthy and successful pregnancy.
Fertility Options
In vitro fertilization (IVF) is a form of assisted reproductive technology that people who have had tubal ligation have undergone successfully. IVF eliminates the need to undergo a tubal ligation reversal.
During IVF, eggs are removed from the ovaries and fertilized outside the body. One or more resulting embryos are placed directly into the uterus, bypassing the blocked fallopian tubes.
Your age, egg quality, overall health, and other factors will all affect the potential effectiveness of IVF. In some instances, utilizing eggs or sperm from a donor may provide you with your best option for success.
When to See a Healthcare Provider
If you had a tubal ligation and now wish to get pregnant, talk to your healthcare provider. They will be able to guide you toward the fertility solution that makes the most sense for you.
If you had a tubal ligation or a tubal ligation reversal and think you are pregnant, let your healthcare provider know immediately. In some instances, you may be carrying a healthy, normal pregnancy. Or, you may be having an ectopic pregnancy that requires immediate treatment.
Your healthcare provider can help you determine the next steps and the appropriate course of action.
Summary
If you had a tubal ligation and now wish to get pregnant, your healthcare provider may recommend a tubal ligation reversal. Or, they may determine that IVF is a more likely option for you.
In rare instances, pregnancy after tubal ligation may occur due to recanalization—a passageway forming to reconnect the fallopian tube without tubal ligation reversal surgery.
Both tubal ligation and tubal ligation reversal increase your risk for ectopic pregnancy. Talk to your healthcare provider about your hopes and concerns for pregnancy. They can guide you toward the most viable solution.
