Fallopian tube ligation is one of the most commonly used definitive family planning methods.
There are several techniques to perform it: cutting the tubes, tying them with a plastic ring or suture material and sealing them with the use of energy. All of them seek to generate an obstruction of the fallopian tubes, which prevents the eggs and sperm from coming together to give rise to the formation of an embryo and finally a pregnancy.
Although tubal ligation is considered a “definitive” method, a large number of women and/or couples change their minds and decide to seek a new pregnancy after having undergone this procedure. Fortunately, there are good options to overcome this obstacle and reach pregnancy: tubal reconstruction (tubal reanastomosis) and in vitro fertilization.
Reconstruction of the fallopian tubes by surgery is an effective method. This can be achieved by open surgery, with an incision similar to that used to perform a cesarean section, or by laparoscopic surgery, which is performed through small 5 mm incisions in the abdomen for the introduction of surgical forceps and a lens, which is connected to a video screen. allowing you to see and manipulate the organs inside the pelvis. In the hands of specialized and well-trained personnel, the chance of the tubes becoming permeable and functional again is approximately 50 to 60%. If this is achieved, the chance of getting pregnant spontaneously is very good.
Sometimes the tubes do not regain good functionality and/or remain obstructed despite the attempt at reconstruction. This usually happens when they are very deteriorated as a result of the technique used for ligation, in which a large portion of the tube has been resected or cauterized. It should be noted that after tubal reconstruction, there is an increased risk of having an ectopic pregnancy (pregnancy outside the cavity of the uterus) in the tube, because there may be narrowing in the duct or alterations that affect the proper transport of the embryo in its normal journey through the fallopian tube. as a result of the healing process.
The second option to obtain a pregnancy in the presence of previously ligated tubes is in vitro fertilization. This technique was developed in the 70s specifically for women with infertility caused by obstruction of their fallopian tubes. Under normal conditions, after the ovary releases the egg (ovulation), the fallopian tube captures it and the sperm, deposited in the vagina, enters the uterus, then the tube and swims to the end of it, where it meets the egg, which fertilizes to form the embryo.
The latter, once formed, is transported by the tube until it is carried to the uterus. In in vitro fertilization, eggs are removed from the ovary by means of a needle that enters through the vagina, through its wall to reach the ovary directly. They are then surrounded by sperm in the laboratory to allow fertilization and the formation of the embryos, which are then deposited in the uterine cavity, entering vaginally, again. In this way, permeable or functional tubes are not required at any time. Usually, each attempt at in vitro fertilization can give a chance of pregnancy of about 45%.
In vitro fertilization is considered a better option in women with tubal ligation, who are 35 years old or older, in whom there is not much time to reach pregnancy, since their fertile potential is already beginning to be compromised by a decrease in the number and quality of their eggs. It may also be a better option in cases where a very destructive technique has been used for tubal ligation or in couples with other associated causes of infertility. Conversely, surgical tubal reconstruction may be a better option in women under 35 without any other reproductive disorders.
In conclusion, there is a lot to offer women with tubal ligation who have changed their minds and want a new pregnancy. They definitely have a good chance of being mothers again.
Grupo inSer
Article for the blog of El Colombiano Hablemos de Fertilidad
