Getting pregnant after a tubal ligation

Q: I had a tubal ligation performed in 1994. I’m contemplating reversing the procedure. What is entailed in doing so and what are my chances of conceiving? I’m 38 years old but don’t plan on becoming pregnant again ’til maybe early 40’s. I’d like to hear your opinion. Thanks.

A: Congratulations on thinking of pregnancy. But before becoming too hopeful, even with the wonders of modern science, we need to be realistic. Basically, the chance of a tubal ligation being successfully reversed is about 50%. For that reason alone, some reproductive endocrinologists, who are the experts involved, recommend just going to in vitro fertilization – which bypasses the tubes altogether, and saves you a surgical procedure. You also need to remember that about 10% of women who conceive after tubal surgery end up with an ectopic pregnancy, requiring yet another operation.

However, my major concern here is your age. Unfortunately, for reasons not totally known to us, fertility does diminish with age. The eggs we conceive with have been there since our birth – remember, sperm are constantly being newly manufactured. And older eggs just do not fertilize and mature as well as young eggs. Unfortunately we must also think about risk of genetic abnormalities, which also increase with age. Your chance of delivering a child with Down’s syndrome at age 40 is about 1 in 100, but your chance at age 44 is 1 in 25.

So my advice at this point would be that if you have definitely decided to go for another pregnancy, do it as soon as possible. You will also need to consider the sperm count of your partner, and exactly what your insurance will cover — in vitro vs. tubes being operated on — needs to be discussed with a good reproductive endocrinologist. Best wishes.