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For more information on tubal ligation and tubal reversal, contact the Center for Assisted Reproduction by filling out the form below.
There are several methods of tubal ligation, a surgical procedure performed on women to prevent pregnancy. More commonly referred to as "getting one's tubes tied," tubal ligation involves interrupting the passage of ova from the ovaries to the uterus. This can be achieved using several different methods, all of which involve altering the fallopian tubes. The tubal ligation method chosen can affect the chances of success in a subsequent tubal reversal procedure. The most common methods of tubal ligation include the following:
The Pomeroy technique of tubal ligation and resection is the most commonly used method. Named after Dr. Ralph Pomeroy, who described this procedure a century ago, the Pomeroy method involves creating and tying off a loop of the fallopian tube. The tied off section is then surgically removed. The ligatures are designed to dissolve, eventually leaving two sealed ends. There are variations of the Pomeroy technique, and successful tubal reversal depends on the length of fallopian tube segments remaining that can be repaired. About two-thirds of the women who undergo tubal reversal following Pomeroy tubal ligation become pregnant.
Of the methods listed, application of a ring or clip to the tube offers the best outcome following tubal reversal as it involves the least amount of tubal damage. Tubal ring ligation is similar to the Pomeroy technique; the main difference is that an elastic ring is used to bind the loop in the fallopian tube. The constriction of the ring cuts off the blood supply to the tissue in the loop, and scar tissue forms in its place. The segments of the fallopian tube eventually separate. Tubal ligation with clips is similar to using rings, except only the tissue compressed by the clips is damaged. Tubal reversal studies show about two-thirds of patients become pregnant following this microsurgery procedure.
The tubal ligation and resection method involves the removal of a portion of the fallopian tube. This form of tubal ligation is most commonly utilized immediately following delivery (post partum). Ligatures are used to tie off a section of the fallopian tube, then the section in between is removed. Typically only one to two centimeters of fallopian tube are taken from the middle of the tube. This type of tubal ligation is generally amenable to reversal but is dependent on the length of fallopian tube removed. An estimate of the length of tube that was removed can be obtained from the pathology report, which is generated at the time of tubal ligation. The pregnancy rates for tubal reversals of this procedure range from 60 to 70 percent.
Tubal coagulation is primarily used for laparoscopic tubal ligation procedures. A pair of forceps that can conduct electricity is used to grasp the fallopian tube at the appropriate point. An electrical current passes through the forceps and coagulates the blood vessels in adjoining tissue. There are two main variations on this procedure: bipolar and monopolar coagulation. Pregnancy rates following tubal reversal of bipolar coagulation are around 60 percent. Monopolar coagulation tends to damage a larger section of the fallopian tubes, and the tubal reversal pregnancy rates hover near 40 to 50 percent.
Infrequently, a partial salpingectomy or the removal of the fimbriated end of the fallopian tube may be used as a method of sterilization. The fimbriae are finger-like projections of the fallopian tube that move over the surface of the ovary and are critical in picking up the egg at the time of ovulation. The fimbriae are typically tied, cut, and removed. While some believe this form of tubal ligation cannot be reversed, new openings can be made in the ends of the tubes. Pregnancy rates for tubal reversal of fimbriectomy are approximately 30 to 40 percent.