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A tubal reversal is a procedure to undo a tubal ligation, which is the surgical sterilization of a woman. Also known as tubal reanastomosis, the procedure is usually performed when circumstances have changed and a woman wishes to have a child.

In women of childbearing age, one egg (ova) from an ovary moves into the fallopian tube each month. There, the egg can be fertilized by a man’s sperm produced in ejaculation during sexual intercourse. Once the egg has been fertilized, it travels down into the uterus (the hollow, muscular cavity in a woman’s pelvis) and implants in the uterine wall, where it develops into a fetus. In a tubal ligation, the fallopian tubes are separated or sealed shut to prevent the sperm from reaching and fertilizing the egg.

Each year, about 17 percent of U.S. women aged 15 to 44 years have a tubal ligation, according to the Centers for Disease Control and Prevention (CDC). In some cases, a woman may change her mind and decide to have the procedure reversed. Common reasons for seeking a tubal reversal include change in marital status, death of an offspring or husband, or young age at the time of the procedure (e.g., younger than age 30). In the past, tubal reversal usually meant major surgery. However, advances in surgical techniques now make outpatient surgery an option for many women.

In a number of cases, surgery to reverse a tubal ligation can be successful. Estimates vary, but depending on circumstances, health experts estimate the success rates to be anywhere from 25 to 75 percent. Factors that influence the likelihood of reopening the fallopian tubes include:

• Technique used during tubal ligation. Women whose tubes were blocked off or clamped with clips or rings are more likely to have a successful reversal than women whose tubes were cauterized (closed using electric heat) or who had a large section of the tube removed. Many experts say that at least 1 inch of healthy tube must remain if tube reconnection is to be successful.
  
  
• Age. Women who are younger are more likely to experience a successful reversal of a tubal ligation. Women over 40 years of age who desire to have children may want to consider in vitro fertilization (IVF) instead of a tubal reversal. IVF involves removing mature eggs from the woman’s ovary, fertilizing them with donated sperm and then surgically implanting the eggs into the woman’s uterus. This procedure does not require fallopian tubes. However, IVF is expensive and is not guaranteed to work.
  
  
• Woman’s reproductive health. Pelvic diseases such as scarring or endometriosis may affect the success of the tubal reversal.
  
  
• The experience of the physician performing the surgery. Tubal reversal is a delicate operation requiring highly specialized skill. The more experience the physician has, the better the outcome is likely to be. Patients should ask their surgeon about pregnancy and complication rates in patients treated in the past.

A tubal reversal is the only procedure that can open the fallopian tubes. Good candidates for the procedure include women who have:

• Adequate tubal segments remaining
• A partner whose sperm analysis is normal
• No other health conditions that might prevent pregnancy

However, a successful tubal reversal does not guarantee pregnancy. In most cases, women who have a successful tubal reversal typically become pregnant within the first year after the reversal. Women who have a tubal reversal are at increased risk for ectopic pregnancy (pregnancy that develops outside the uterus). For this reason, many health experts recommend that sterilized women consider IVF as an alternative to tubal reversal.

In addition, tubal reversals are usually expensive and are not typically covered by medical insurance. The same is true for in vitro fertilization.