Life is full of unexpected twists and turns. Decisions that once seemed permanent can suddenly feel less certain as time passes.
If you have had a tubal ligation or vasectomy and are now thinking about having children, you might be wondering if a reversal is the right choice for you.
Getting “snipped, clipped or tied” has been the go-to solution for many people seeking permanent birth control (a way of not becoming pregnant). More than half a million American men have vasectomies and nearly 700,000 American women opt for sterilization (tubal ligation) each year.
While most of these procedures are permanent, a small percentage of people may change their minds. Some common motivations include a new marriage or partnership, the loss of a child and the desire to have another or a change of heart about wanting children.
Priyanka Bearelly, MD, MPH, a urologist and andrologist, and Steven Dudick, MD, an OBGYN, both with Banner – University Medicine, breaks down tubal ligation and vasectomy to understand how they work and what reversing them involves.
Understanding tubal ligation and vasectomy
Tubal ligation: Often referred to as “getting your tubes tied,” tubal ligation is a surgical procedure for women or a person assigned female at birth (AFAB). It involves cutting, tying or sealing the fallopian tubes to prevent eggs from reaching the uterus to be fertilized.
Vasectomy: A vasectomy is a procedure for men or a person assigned male at birth (AMAB). It involves cutting, tying or sealing the vas deferens (the tubes that carry sperm from the testicles to the urethra). This prevents sperm from being present in the semen that is ejaculated.
What’s involved in tubal ligation and vasectomy reversals?
Tubal ligation reversal: Also known as tubal reversal surgery, this surgical operation involves looking for healthy sections of the fallopian tubes to reconnect or reopen them. The goal is to restore fertility so that eggs can travel through the fallopian tubes to be fertilized by sperm.
The success of a tubal ligation reversal depends heavily on the type of original procedure.
“Since 2015, many sterilizations involve removing the tubes completely to reduce the risk of ovarian cancer,” Dr. Dudick said. “Repairing the tube after this procedure is impossible, as no tube remains.”
Vasectomy reversal: Vasectomy reversal is a surgical procedure to reconnect the vas deferens. The goal is to allow sperm to travel from the testicles to the urethra to be present in ejaculation.
“Success rates of vasectomy reversals are quite high, as high as 95%,” said Dr. Bearelly. “The shorter the time since the vasectomy, the higher the chance of success.”
Men who have a reversal within 10 years of the original procedure have better outcomes. Success rates also depend on how much of the vas deferens was removed or cauterized.
Are there risks involved with tubal ligation and vasectomy reversals?
As with any surgery, both procedures have risks. These can include infection, bleeding, pain or complications from anesthesia (medicine that helps you sleep and not feel pain). Factors such as age and overall health also play a role.
“For tubal ligation reversals, the main risk is an ectopic pregnancy, where the pregnancy is developing outside of the uterus,” Dr. Dudick said. “This most often happens in the repaired tube and occurs in about 8% of people who become pregnant after a tubal reversal.”
Alternative options to reversals
If you are thinking about having children but are uncertain about a reversal, there are other options you may want to consider:
In vitro fertilization (IVF)
“In vitro fertilization is the most common alternative and would be the option of choice for people who have had their tubes completely removed,” Dudick said.
For women, this process involves collecting eggs from the ovaries and fertilizing them with sperm in a lab. Then, the fertilized eggs (embryos) are placed inside the uterus. IVF has a high success rate but can be expensive and emotionally challenging.
Sperm retrieval
“For men who’ve had a vasectomy, sperm can be surgically taken from the testicles and can be used for IVF,” Dr. Bearelly said.
Sperm retrieval is less invasive than vasectomy reversal. However, it may still require multiple IVF cycles, which can be costly and stressful.
Adoption
Adoption is another option for growing your family. There are many children in need of loving homes. Adoption can be a fulfilling way to become a parent. However, the process can be lengthy and involve legal, emotional and financial considerations.
Making your decision to have a reversal
Deciding whether to have a tubal ligation or vasectomy reversal is a very personal and complicated choice. Here are some steps to help you make the best decision:
- Talk to a fertility specialist: Speak with a health care provider who specializes in fertility. They can explain your choices, risks and the chances of success based on your situation.
- Think about your health: Discuss your overall health and any medical conditions that might affect your ability to get pregnant or carry a baby.
- Check your financial and emotional readiness: Fertility treatments, including reversals and IVF, can be expensive and emotionally challenging. Make sure you are prepared for these demands.
- Have a support system: Having supportive family and friends can help you emotionally through this journey.
- Consider your timeline: Think about how soon you want to get pregnant. Younger, healthier people might have better success with reversals. However, if timing is important, IVF could be a better option.
Conclusion
Deciding to reverse a tubal ligation or vasectomy is a big choice that could bring the joy of a new child into your family. While some people have success, it’s important to think about the risks and consider all options.
Thinking carefully about your situation and talking to your health care provider or a Banner Health specialist can help you make the best decision for your future.
