I had my tubes tied almost six years ago. I was wondering what my chances are of becoming pregnant again? I have not been feeling well for the past couple of weeks, my breasts are very sore, and my periods have been very irregular for the past couple of months. If this isn't pregnancy, what could it be?

--Ann

According to the CREST (Collaborative Review of Sterilization) study, the failure rate for tubal ligation is about 1.4 percent overall. Six years after a tubal, the cumulative failure rate (meaning the sum total of all failures up to that point in time) is about 1.7 percent. So, your chances of being pregnant are not very high, but they are not zero either.

The symptoms you describe (breast tenderness, irregular cycles, not feeling well) could be anything. Some possibilities are PMS, thyroid disease or the approach of menopause. Stress can also cause irregular cycles as well as a general feeling of unease or not being quite right. Too much caffeine may contribute to breast tenderness.

If you have skipped a period, then do a home pregnancy test. If it is positive, see your doctor immediately, as women who have had a tubal ligation and subsequently get pregnant are at increased risk for an ectopic pregnancy. If you are not pregnant and these symptoms persist, make an appointment with your doctor for a general physical to rule out other problems.