It is not surprising when after a few years have gone by, a woman who has undergone a tubal ligation wants to get pregnant. There are many reasons (personal, family, partner…) for wanting another child because the circumstances around us change with time and a decision that earlier on had been regarded as final must now be re-examined.
The tubal ligation technique involves surgically preventing the passage of sperm to the ampullary region of the fallopian tube and thus the fertilization of the ovum, which occurs in this region naturally. Usually the section of a fragment of tube and a ligature with re-absorbable suture is performed, so that the ends separate and thus increases the contraceptive efficacy of the procedure. The problem arises when you want to recover its former function.
Although re-permeabilization is technically possible, there are multiple disadvantages to performing it, ranging from the extent of the area that was surgically removed to the existence of adhesions, among other factors.
Even a flawless surgical technique does not guarantee the effectiveness of the repair, as it depends on many factors (you have to recover both the permeability and motility of the tube). However, there are cases in which this technique is especially recommended, as is the case of very young women considering more than one pregnancy in the future.
Therefore, in vitro fertilization is, at present, a popular choice for women with tubal ligation, as it allows for a short term gestation without the need to wait for the outcome of a surgical technique. However, the age of the woman is a decisive factor in the success of this technique, since the chances of pregnancy decrease with increasing age. For this reason, once the decision has been taken, it is not advisable to postpone its implementation.
Tubal ligation is often used as a definitive method of birth control, so it is normal that the woman has had children before (in other words, she is initially fertile). This circumstance, of course, simplifies the necessary study.
- It is important to perform a blood test to check that there are no hormonal alterations. The basal hormonal test (FSH, LH and Estradiol) enables you to know the ability of the ovaries to produce eggs.
- The man undergoes a seminogram test. This is a simple analysis which makes it possible to study the fertilizing capability of the semen.
- With the results in hand, the process of diagnosis and recommendation of the most appropriate treatment is started.
If it is confirmed that the ability of the ovaries to produce eggs is preserved and there is no pathology in the male nor with the endometrium, the indication would be to perform IVF, since in the absence of Fallopian tubes, it is not possible to carry out artificial insemination. In Vitro Fertilisation can be performed with intracytoplasmic sperm injection (ICSI) or without.
In the event of a diagnosis involving an endometrial polyp or fibroid, you can schedule a hysteroscopy for confirmation. The hysteroscopy is an exploration of the interior of the uterine cavity, which is usually done without the need for anaesthesia. It enables us to make a diagnosis of certain pathologies and even perform treatment on certain occasions (you can remove polyps or fibroids, for example). In this case the technique to be performed is also in vitro fertilization.