Reversal after sterilisation: Becoming pregnant after tubal ligation

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

Introduction

Sterilisation in women is considered a very reliable and usually permanent form of contraception. Many people, however, regret the decision later: life circumstances change, a new relationship begins, or the desire for another child unexpectedly returns. Reversal — internationally commonly called tubal ligation reversal or microsurgical tubal reanastomosis — aims to restore patency of the fallopian tubes after a tubal ligation so that you may conceive naturally without needing assisted reproductive technology every cycle.

What happens with sterilisation and reversal?

Sterilisation alters the fallopian tubes so that egg and sperm can no longer meet. Typical methods include clips or rings, removal of a tube segment, or thermal coagulation. Some procedures remove the tube entirely (bilateral salpingectomy).

Reversal addresses this directly. The surgical team exposes the remaining tube stumps, releases them from scar tissue and sutures the ends together under high magnification. The goal is to recreate a continuous channel from the ovary toward the uterus.

The current statement from the American Society for Reproductive Medicine emphasises that reconstructive tubal surgery — including sterilisation reversal — still has a role alongside modern IVF techniques. Individual benefit–risk assessment remains essential.

Key decision: reversal or IVF?

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

  • Reversal with the hope of spontaneous cycles and natural pregnancies
  • IVF-based approaches, 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, type of sterilisation, semen quality and whether you want one or multiple children. Reviews in Fertility and Sterility highlight that tubal surgery is particularly attractive when overall fertility is good and multiple pregnancies are planned.Fertil Steril 2021

Who is a good candidate?

Not every sterilisation can be reasonably reversed. Specialist centres assess multiple factors together.

Typical criteria for favourable conditions 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 normal early-cycle hormones suggest a stable ovarian reserve.
  • Type of sterilisation: Clips or rings often leave more reconstructable tube tissue than extensive coagulation or complete removal.
  • Residual tube length: After reconstruction, ideally four or more centimetres of functional tube should remain.
  • Sperm quality: A normal semen analysis from the partner prevents an unrecognised male factor from reducing your chances.

If both tubes have been completely removed or there are extensive adhesions, anatomical reversal is not possible. In those cases, IVF or related techniques are the remaining options.

Why the desire for children returns

Many women report that they chose sterilisation at a very different stage of life than the one they are now in. Reasons the wish for another child may reappear include:

  • A new partnership and the wish for a child together
  • More stable circumstances with secure income and better housing
  • The desire 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 public health services explicitly note that regret after sterilisation is more common than many expect, especially when the procedure was done at a young age.NHS (UK): 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 about 50 to 80 percent after reversal in suitable candidates, with most pregnancies occurring within one to two years after surgery.Cleveland Clinic: Tubal ligation reversalVerywellHealth: Pregnancy after reversal

Simplified, the picture looks like this:

  • Under 35 years: Series report pregnancy rates of 60 to 80 percent in good cases.
  • 35 to 39 years: Often 40 to 60 percent, strongly depending on ovarian reserve and tube length.
  • From 40 years: Chances fall noticeably, both after reversal and after IVF.

Successful reversal does not automatically mean a live birth. Miscarriage, ectopic pregnancy or failed implantation remain possible. Treat statistics as orientation, not guarantee.

Preoperative investigations

Before scheduling surgery, fertility centres carefully assess whether reversal is appropriate in your situation.

Typical diagnostic steps:

  1. Early-cycle hormone profile including AMH, FSH, LH and estradiol to estimate ovarian reserve.
  2. Transvaginal ultrasound to evaluate uterus, ovaries, antral follicle count and possible cysts or fibroids.
  3. Semen analysis from the partner according to current WHO standards to detect relevant impairments.
  4. Contrast study of the tubes (HSG or HyCoSy) to assess residual patency, adhesions or hydrosalpinx.
  5. Anaesthesia consultation to evaluate individual surgical and anaesthetic risks.

On this basis, the clinic can give realistic success estimates and fairly compare reversal, IVF or other options.

Procedure of the reversal operation

Reversal is today usually performed minimally invasively by laparoscopy under general anaesthesia. You will be asleep for the whole procedure.

In simplified terms the operation proceeds as follows:

  • Camera and fine instruments are introduced through a few small incisions in the lower abdomen.
  • The tube remnants are exposed, freed from adhesions and carefully prepared.
  • Scarred, non-functional tissue is removed and usable tubal tissue is measured.
  • The tube ends are joined layer by layer with very fine sutures — usually under high magnification and sometimes with robotic assistance.
  • A dye test shows 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 low complication rates.

Recovery, everyday life and sports

After the operation you remain under observation for several hours. Many patients can leave the hospital the same day or the next day.

Typical recommendations for the first days and weeks include:

  • Rest during the first days, avoid heavy lifting
  • Pain relief as prescribed by the clinic, gradually increasing activity
  • Wound checks with the follow-up physician or 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 for everyday life after about one to two weeks. Full recovery can take longer — this is normal and not a sign of “failure” of the operation.

Risks and ectopic pregnancy

As with any operation, reversal carries risks. These include bleeding, infection, injury to neighbouring organs, anaesthetic complications and recurrent 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 materials from the NHS (UK) on ectopic pregnancy, stress that early assessment for pain, dizziness or bleeding can be life-saving.

Warning signs for which you should seek immediate medical help include, for example:

  • one-sided, increasing lower abdominal pain
  • shoulder pain, dizziness or fainting tendency
  • bleeding in early pregnancy, especially combined with pain

An ectopic pregnancy is not your “fault” but a possible complication that, when detected early, is well treatable.

Reversal vs. IVF in comparison

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

Put simply:

  • Reversal is especially suitable if your overall fertility is still good, the tubes are technically reconstructable and you can imagine having more than one child.
  • IVF is often preferable if the tubes are severely damaged or removed, multiple fertility factors are present, or you want a faster, 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 conditions for any fertility therapy — whether reversal or IVF.

  • Stop smoking; nicotine can worsen egg quality, blood flow and implantation.
  • Reduce alcohol and keep intake low during the active fertility phase.
  • Aim for a healthy body weight, since significant under- or overweight can reduce fertility.
  • Plan regular activity, for example three to four sessions of moderate aerobic exercise per week.
  • 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 change statistics overnight, but they improve your general 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 overviews often quote amounts in the range of several thousand units of local currency for a microsurgical reversal.VerywellHealth: Cost and success rates

IVF can incur similar costs per treatment cycle — if several attempts are needed, expenses add up quickly. Therefore it is worth considering not just the “price per procedure” but asking:

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

Regardless of the system, get a written cost estimate, ask about hidden additional fees and clarify in advance whether and to what extent insurance may contribute.

Finding a good centre

The team’s experience with reversals is crucial — both for the procedure itself and for honest counselling beforehand. In the first consultation, questions that may help include:

  • How many reversals does the centre perform per 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 infer from that?
  • How fairly and transparently are reversal and IVF presented side by side in counselling?
  • How is follow-up organised, 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 “right now.”

Emotional side and communication

The decision for or against reversal is rarely purely medical. Feelings of guilt, fear of disappointment, pressure from others or conflicts with former partners often play a role.

Helpful measures can include:

  • Open conversations with your current partner about wishes, boundaries and possible scenarios.
  • Neutral counselling, for example through specialised fertility counselling services or psychotherapy.
  • Connecting 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 manage the next steps — whether you eventually choose reversal, IVF or a different path.

Summary

Reversal after sterilisation is not a magic solution, but it can offer selected women a realistic chance of natural pregnancy, especially younger patients with good ovarian reserve, technically reconstructable tubes and normal partner semen. At the same time, the operation is one option among several: modern IVF techniques may be faster, more predictable or safer in some situations. The best decision arises when you review numbers, risks and alternatives with an experienced fertility centre and then choose the path that is medically, financially and emotionally right for you.

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 partially reversed with microsurgical reversal, especially when clips or rings were used and sufficient tube tissue remains; when tubes have been completely removed, anatomical reconstruction is no longer possible.

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

Yes, age is one of the most important factors: under 35 years the chances after reversal are significantly better than beyond 40, regardless of how well the surgery is performed.

After surgery your body needs weeks to heal and many centres recommend attempting conception only 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 discomfort for several days, which are usually well controlled with prescribed pain medication.

Many patients are able to resume everyday activities after about one to two weeks but should take physical rest during this time and generally avoid heavy lifting or intense sport for four to six weeks until cleared by the treating clinician.

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 promptly evaluated 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 clinician or emergency services rather than wait to see if it improves on its own.

Whether reversal or IVF is more appropriate depends on your individual situation and should be discussed in the fertility centre taking into account age, ovarian reserve, type of sterilisation, semen analysis, desired family size and financial circumstances.

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

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

In many health systems reversal is considered an elective procedure and is partially or not covered, so check with your insurer before surgery and obtain written confirmation of any coverage.

AMH gives an indication of 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 — quitting smoking, moderate alcohol intake, balanced nutrition, normal weight, exercise and stress reduction — can support general fertility but does not replace medical treatment or overcome the realistic limits of age.

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