Tubal ligation reversal after sterilisation: becoming pregnant after tubal ligation

Author photo
Zappelphilipp Marx•
Gynaecologist performing a microsurgical tubal ligation reversal on a patient's fallopian tubes

Introduction

Female sterilisation is considered a very reliable, usually permanent form of contraception. Many people later regret the decision: life circumstances change, a new relationship forms or the wish for another child suddenly returns. Refertilisierung – internationally usually called tubal ligation reversal or microsurgical tubal reanastomosis – aims to restore patency of the fallopian tubes after tubal ligation so that you can conceive naturally and do not have to rely on assisted reproduction for every cycle.

What happens during sterilisation and tubal ligation reversal?

During sterilisation the fallopian tubes are altered so that egg and sperm can no longer meet. Typical methods include clips or rings, partial removal of a tube segment or coagulation with thermal energy. Some procedures remove the tube entirely (bilateral salpingectomy).

Tubal ligation reversal targets exactly this. The surgical team exposes the remaining tube segments, removes scar tissue and sutures the ends together again under high magnification. The aim is to re-establish a continuous channel from the ovary towards the uterus.

The current opinion of the American Society for Reproductive Medicine emphasises that reparative tubal surgery – including sterilisation reversal – still has a place alongside modern IVF techniques. Individual benefit–risk assessment is always important.

Key decision: reversal or IVF?

If the desire for children returns after sterilisation there are essentially two medical routes:

  • Reversal with the hope of spontaneous cycles and natural conception
  • IVF-based treatments, where eggs are retrieved, fertilised in the laboratory and embryos transferred to the uterus

Which strategy suits you depends mainly on your age, ovarian reserve, the type of sterilisation, sperm quality and whether you want one or more children. Articles in Fertility and Sterility highlight that tubal surgery is especially attractive when overall fertility is good and multiple pregnancies are planned.Fertil Steril 2021

Who is a suitable candidate?

Not every sterilisation can be reversed sensibly. Specialist centres consider several factors together.

Typical favourable criteria include:

  • Age: Best chances usually under 35 years, often acceptable until the late 30s; success rates decline with increasing age.
  • Ovarian reserve: A sufficient AMH level and unremarkable early‑cycle hormones indicate a stable ovarian reserve.
  • Type of sterilisation: Clips or rings often leave more reconstructible tube tissue than extensive coagulation or complete removal of the tubes.
  • Remaining tube length: After reconstruction there should ideally be four or more centimetres of functional tube.
  • Sperm quality: A normal semen analysis from your partner prevents an undiagnosed male factor from reducing your chances.

If both tubes have been completely removed or there are extensive adhesions, anatomical reversal is no longer possible. In such cases IVF or related techniques remain the option.

Why the desire for children returns

Many women report that they had the sterilisation in a very different phase of life than they are in now. Reasons the wish for another child can reappear include:

  • a new partnership and the desire for a child together
  • more stable life circumstances with secure income and better housing
  • wanting to give an existing child a sibling
  • loss of a child or other life‑changing events
  • changed religious or cultural views on family and parenthood

Large health services explicitly point out that regret after sterilisation is more common than many expect, especially if the procedure was performed at a young age.NHS: complications of sterilisation

Success rates: how well does reversal actually work?

The central question is almost always: 'What is my chance of becoming pregnant after reversal?'

Large centres and reviews report pregnancy rates of around 50 to 80 percent after reversal in suitable candidates, with most pregnancies occurring within one to two years after the operation.Cleveland Clinic: Tubal ligation reversalVerywellHealth: Pregnancy after reversal

Put simply:

  • Under 35 years: Some series report pregnancy rates of 60 to 80 percent.
  • 35 to 39 years: Often 40 to 60 percent, strongly dependent on ovarian reserve and tube length.
  • From 40 years: Chances fall markedly, both after reversal and with IVF.

Successful reversal does not automatically mean a live birth. Miscarriage, ectopic pregnancy or failed implantation remain possible. Numbers are therefore guidance, not a guarantee.

Pre‑operative investigations

Before an operation date is considered, fertility centres carefully assess whether reversal is sensible in your situation.

Typical diagnostic pathway:

  1. Early‑cycle hormone profile including AMH, FSH, LH and oestradiol to assess ovarian reserve.
  2. Transvaginal ultrasound to evaluate the uterus, ovaries, antral follicle count and any cysts or fibroids.
  3. Semen analysis from your partner according to current WHO standards to identify relevant impairments.
  4. Contrast imaging of the tubes (HSG or HyCoSy) to check residual patency, adhesions or hydrosalpinx.
  5. Pre‑anaesthetic assessment to evaluate individual surgical and anaesthetic risks.

On this basis the clinic can give realistic chances of success and fairly compare reversal, IVF or another route.

Procedure of the reversal operation

Reversal is nowadays most often performed minimally invasively by laparoscopy under general anaesthesia. You will therefore be asleep for the entire procedure.

The operation typically proceeds as follows:

  • Through a few small incisions in the lower abdomen a camera and fine instruments are inserted.
  • The residual tube segments are exposed, freed from adhesions and carefully prepared.
  • Scarred, non‑functional tissue is removed and usable tubal tissue measured.
  • The tube ends are re‑connected layer by layer with very fine sutures – usually under high magnification, sometimes with robot‑assisted systems.
  • A dye test demonstrates whether the reconstructed tube is patent from the uterus to the fimbrial end.

Systematic reviews and Cochrane reviews on tubal surgery emphasise that the team's experience is a key success factor for both pregnancy rates and a low complication rate.

Recovery, everyday life and sports

After the operation you remain under observation for a few hours. Many patients can leave the clinic the same or the next day.

Common recommendations for the first days and weeks include:

  • Rest for the first few days, avoid heavy lifting
  • Pain relief as prescribed by the clinic, gradually increasing activity
  • Wound check during follow‑up with your clinician or at the centre
  • Light activity (walks) possible after a few days
  • Intense sport and heavy training only after clearance, often after four to six weeks

Many women feel relatively fit again after about one to two weeks. Full recovery can still take longer – this is normal and not a sign that the operation has 'failed'.

Risks and ectopic pregnancy

As with any operation, reversal carries risks. These include bleeding, infection, injury to neighbouring organs, anaesthetic complications and renewed adhesions in the abdominal cavity.

Of particular importance is the issue of ectopic pregnancy. After sterilisation and reversal the risk is increased that a fertilised egg implants in the tube rather than the uterus. Major guidelines and patient information, such as those from the NHS on ectopic pregnancy, stress that early assessment for pain, dizziness or bleeding can be life‑saving.

Warning signs that require immediate medical attention include, for example:

  • one‑sided, increasing lower abdominal pain
  • shoulder pain, dizziness or feeling faint
  • bleeding in early pregnancy, especially if combined with pain

An ectopic pregnancy is not your 'fault' but a possible complication that, if detected early, can usually be treated effectively.

Reversal vs IVF compared

Reversal and IVF are two different routes to the same goal. Both have strengths and limitations.

In simplified terms:

  • Reversal is particularly suitable when your overall fertility is still good, the tubes are technically reconstructible and you can imagine having more than one child.
  • IVF is often more appropriate when the tubes are severely damaged or removed, multiple fertility factors are present or you prefer a quicker, more predictable treatment.

A Cochrane review comparing tubal surgery and IVF shows there is no simple 'one size fits all' answer. The best strategy matches your age, history, finances and personal priorities.

What you can do yourself

A healthy lifestyle does not replace medical treatment but improves the chances for any fertility therapy – whether reversal or IVF.

  • Stop smoking: nicotine can impair egg quality, blood flow and implantation.
  • Reduce alcohol and keep intake low during active attempts to conceive.
  • Aim for a healthy body weight, as both underweight and overweight can reduce fertility.
  • Plan regular exercise, for example three to four sessions per week of moderate aerobic activity.
  • Take stress seriously and use strategies such as relaxation exercises, sleep hygiene or counselling.
  • Discuss with your treating clinician whether folic acid and other supplements are appropriate.

These measures will not instantly change statistics, but they improve overall health – which is always beneficial when trying to conceive.

Costs and financial planning

The cost of reversal varies widely between countries, clinics and surgical techniques. International reviews often cite figures in the range of several thousand units of the local currency for a microsurgical sterilisation reversal.VerywellHealth: Cost and success rates

IVF can cost similar amounts per treatment cycle – and costs add up if several attempts are needed. It is therefore sensible to consider not only the 'price per procedure' but also:

  • How realistic are one or more children after reversal at your age?
  • How many IVF cycles might you need in the worst case?
  • Which services are covered by your health insurance or public programmes, and which are not?

In any system: ask for a written cost estimate, query possible additional charges and clarify in advance whether and to what extent an insurer will contribute.

Finding a good centre

The team's experience with reversals is crucial – both for the operation itself and for honest counselling beforehand. In a first consultation questions that may help include:

  • How many reversals does the centre perform each year?
  • What are the pregnancy and live birth rates after sterilisation reversal in my age group?
  • What is the ectopic pregnancy rate after the operation?
  • Which sterilisation method was used on me, and what chances do you derive from that?
  • How fairly and transparently are reversal and IVF presented alongside each other in counselling?
  • What does follow‑up care look like, and what happens if there are problems or pain after the operation?

Reputable clinics give you time to consider, invite follow‑up questions and document risks and chances clearly – without pressure to 'decide now'.

Emotional aspects and communication

The decision for or against reversal is rarely purely medical. Guilt, fear of renewed disappointment, pressure from others or conflicts with previous partners often play a part.

Helpful measures can include:

  • Open conversations with your current partner about wishes, boundaries and possible scenarios.
  • Neutral counselling, for example from a specialised fertility counsellor or psychotherapist.
  • Sharing experiences with others affected, for example in moderated online communities or support groups.

A clear medical plan combined with emotional support reduces pressure and helps you carry the next steps – whether you ultimately choose reversal, IVF or a different path.

Summary

Tubal ligation reversal after sterilisation is not a miracle cure but can offer selected women a real chance of natural conception, especially younger patients with good ovarian reserve, technically reconstructible tubes and a partner with unremarkable semen analysis. At the same time the operation is only one option among several: modern IVF techniques may be quicker, more predictable or safer in some situations. The best decision comes from an experienced fertility centre presenting numbers, risks and alternatives clearly so you can choose what fits medically, financially and emotionally with your life.

Disclaimer: Content on RattleStork is provided for general informational and educational purposes only. It does not constitute medical, legal, or other professional advice; no specific outcome is guaranteed. Use of this information is at your own risk. See our full Disclaimer.

Frequently asked questions (FAQ)

Many sterilisation methods can be at least partly reversed with microsurgical tubal ligation reversal, especially when clips or rings were used and sufficient tubal tissue remains; if the tubes were removed completely, anatomical reconstruction is not possible.

In suitable candidates studies report pregnancy rates roughly between 50 and 80 percent over one to two years, but an individual’s chance depends strongly on age, ovarian reserve, tube length and sperm quality.

Yes, age is one of the most important factors: under 35 the chances of pregnancy after reversal are significantly better than beyond 40, regardless of the technical success of the operation.

Your body needs some weeks to heal and many centres recommend trying to conceive after two to three cycles, so most pregnancies occur between six and twenty‑four months after reversal.

Reversal is performed under general anaesthesia so you feel nothing during the procedure; afterwards you may have wound pain and abdominal tension for several days which can usually be managed well with prescribed pain relief.

Many patients are fit for everyday activities after about one to two weeks but should take physical rest seriously and usually wait four to six weeks before heavy lifting or intensive sport, until their clinician gives the go‑ahead.

After sterilisation and reversal the risk of ectopic pregnancy is increased, so lower abdominal pain, dizziness, shoulder pain or bleeding in early pregnancy should always be assessed promptly to detect complications early.

Warning signs such as increasing pain, heavy bleeding, fever, redness or discharge at the wounds, or circulatory problems indicate you should contact your doctor, clinician or emergency services rather than waiting to see if it gets better.

Whether reversal or IVF is more appropriate depends on your individual situation and should be discussed in a fertility centre considering age, ovarian reserve, type of sterilisation, semen analysis, desired number of children and financial constraints.

If only one child is planned and other factors limit fertility, IVF may be strategically more suitable, whereas reversal is often more appropriate with a favourable baseline situation and the possibility of multiple spontaneous pregnancies.

Costs vary by country, clinic and technique and are in the range of several thousand units of the local currency; obtain a written estimate and a clear list of potential additional costs before deciding.

In many health systems reversal is considered an elective procedure and is only partially or not covered, so you should check with your insurer beforehand and obtain any possible cost contribution in writing.

AMH provides information about ovarian reserve and helps clinicians estimate whether you are more likely to benefit from reversal with natural cycles or from IVF with stimulated cycles, but it is only one component of the overall assessment.

A healthy lifestyle with smoking cessation, moderate alcohol intake, balanced nutrition, normal weight, exercise and stress reduction can support your overall fertility but does not replace medical treatment or the realistic limits of your age.

If the tubes remain patent and your overall fertility is sufficient, multiple pregnancies are possible in principle, but there is no guarantee, since cycles without conception or miscarriages can still occur after a successful operation.