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Tubal Ligation Procedures
Tubal ligation is the general term for any surgical procedure that blocks the fallopian tubes to prevent pregnancy. Sperm enter the fallopian tube through the uterus, and eggs enter from the ovarian or fimbriated end of the tube. When the fallopian tubes are blocked, sperm and eggs are kept apart and conception is prevented. Ligation means “to tie”, and tubal ligation is often called "tying" the tubes. Many people picture tying a fallopian tube like tying a shoe lace or a bow, and wonder why the tube can't simply be untied to restore fertility.
Fallopian Tube Anatomy
The fallopian tube is a narrow muscular organ arising from the uterus and ending just next to the ovary. It is about the diameter of a pencil. The inner tubal lining is rich in cilia, the microscopic hair-like projections that beat in waves and move the egg to the uterus. The normal fallopian tube is about 10 cm (4 inches) long and consists of several segments. Starting from the uterus and proceeding toward the ovary, these are the:
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Interstitial segment -- passes through the uterine muscle
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Isthmic segment -- narrow muscular segment by the uterus
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Ampullary segment -- wider middle segment
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Infundibular segment -- funnel shaped segment near the ovary
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Fimbrial segment -- ciliary lining facing the ovary
Tubal Ligation Procedures
Different doctors use different methods for tubal ligation. The particular method of ligation used by your physician will be specified in the tubal ligation operative report that your operating physician will have in his or her records. Several of the most popular methods of tubal ligation procedures are:
- Pomeroy Technique
- Tubal Rings and Clips
- Monopolar and Bipolar Tubal Coagulation
- Parkland and Irving Procedures
- Fimbriectomy
Your Chances of Becoming Pregnant Again
The chances of becoming pregnant after a tubal reversal procedure depends on the specific tubal ligation procedure, the age of the wife and the fertility of the husband. Please see Is Tubal Reversal Right for Me? for more information on making the decision about whether to proceed forward with tubal reversal surgery.
The specific tubal ligation procedure your surgeon used is an important factor in whether you will have a successful tubal reversal surgery. Each of the ligation methods above use different methods to prevent an egg from travelling down the fallopian tube to where it could potentially meet up with sperm. Unfortunately, these procedures do not simply "tie" your fallopian tubes and therefore cannot be simply "untied." Some methods cut off a segment of the tubes, others use a clip to pinch the tube closed, while others stitch the tube closed. Your chances of becoming pregnant again depend on the method used and how well the tube can be restored back to its original condition. Methods in which too much fallopian tube were cut away make pregnancy more difficult.
| Type of Tubal Ligation |
Average pregnancy rate % after reversal |
Recommended Procedure |
| Clips or Rings | 70-80% | Either TR or IVF |
| Pomeroy or Parkland | 60-70% | Either TR or IVF |
| Bipolar Coagulation | 50-60% | Either TR or IVF |
| Irving | <30% | IVF |
| Fimbriectomy | <1% | IVF |
* TR - Tubal reversal surgery IVF - In vitro fertilization
Your chances of becoming pregnant again after tubal reversal surgery are also influenced by the age of the wife. As women age, the quality of their eggs decline and the chances of pregnancy also decline. Even though your tubal reversal surgery may successfully put your tubes back together, your egg quality may prevent a future pregnancy.
| Age of wife | % Chance of pregnancy after trying for 1 year |
| < 25 years old | 85% |
| 25-30 years old | 75% |
| 31-35 years old | 60-70% |
| 36-39 years old | 50-60% |
| >40 years old | 40% |
Additionally, the husband can also affect your chances of becoming pregnant after tubal reversal surgery if your husband's sperm count is low. It is highly recommended that your husband get a sperm count test prior to tubal reversal surgery.
| Sperm Count | % Chance of pregnancy after trying for 1 year |
| < 10 million/ml | <10% |
| 10-20 Million/ml | 10-20% |
| >20 Million/ml | 85% |
Please see Is Tubal Reversal Right for Me? for more information on making the decision about whether to proceed forward with tubal reversal surgery.