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PREGNANCY AFTER TUBAL LIGATION (TL)

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INTRODUCTION

Tubal ligation, also known as getting your “tubes tied,” is an option for women who no longer wish to have children. This outpatient surgical procedure involves either blocking or cutting the fallopian tubes. This has the effect of preventing an egg that’s released from your ovary from traveling to your uterus. There, it could potentially meet with a sperm.

While tubal ligation is (for the most part) effective in preventing pregnancy, it isn’t an absolute. An estimated 1 out of every 200 women will become pregnant after tubal ligation. Tubal ligation can increase your risk for an ectopic pregnancy. This is where a fertilized egg implants in the fallopian tubes instead of traveling to the uterus.

Tubal ligation is the most common and most effective method of family planning. Pregnancy after tubal ligation is possible, and this may be due to unintentional errors like an ectopic pregnancy or surgical reversal of the procedure, if desired.

Some women worry about pregnancy even after a tubal ligation. On the other hand, some women find themselves wanting to get pregnant again after previously deciding to have the surgery. Is it possible to have a pregnancy after tubal ligation? We will discuss this topic to address these issues.

TUBAL LIGATION

Ligation of the tubes is a surgical procedure where each fallopian tube is permanently blocked by means of surgery. The fallopian tube is a long, narrow tube that connects the ovary to the womb or uterus. It carries the egg towards the uterus and also carries the sperm towards the ovaries. Tubal ligation therefore mechanically blocks the fallopian tubes to prevent the sperm from fertilizing the egg so that a woman becomes ‘sterile’ and cannot get pregnant.

Tubal ligation is the most commonly used method of family planning worldwide and one of the safest surgical procedures. It can be done in the hospital or in a clinic at anytime, usually after a woman gives birth. The fallopian tubes are permanently blocked by tying them together, clipping or banding, cutting or burning (cauterized) them shut. Tubal ligation is also referred to as female sterilization, tubal occlusion, tube tying, or tying the tubes.

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CHANCES OF FAILED TUBAL LIGATION

Tubal ligation is one of the most effective contraceptive methods if performed correctly. The risk of being pregnant after tubal ligation is lower than the risk in the use of other methods of contraception. Failure of tubal ligation occurs when a woman becomes pregnant after the surgery is done.

Causes of Failed Tubal Ligation. There are several causes of failed tubal ligation. It can be classified as failure before or after tubal ligation. Failure before tubal ligation occurs when pregnancy, called luteal-phase pregnancy, was not detected before the procedure is done. Failure after tubal ligation represents technical errors done in performing the surgery. This is called true failure of tubal ligation.

The causes of true failure of tubal ligation are incomplete or inadequate closure of the tube, misidentifying a different structure for a fallopian tube, development of a fistula or recanalization, and a misplaced device used in occlusion the fallopian tube.

Failure to identify the fallopian tube maybe due to poor lighting or presence of scarring (adhesions). Scarring results when a patient has had conditions that required surgery in the abdomen, for example, endometriosis or pelvic inflammatory disease. A fistula or an abnormal opening called tuboperitoneal fistula develops between the abdominal (peritoneal) space due to incomplete healing of the ligated end of the fallopian tube. Recanalization occurs when the ends of the fallopian tube regenerates and form slit-like spaces and pouches or the ends of the tubes meet and re-establish the patency of the tube.

Scientific Proof. A study, the U.S. Collaborative Review of Sterilization or CREST, is the largest study done to find out the risk of pregnancy after tubal ligation with use of different methods. This was a study conducted up to 14 years on more than 10,000 women. In this study, the 10-year cumulative rate of failure of tubal ligation was 1.85% for all types of ligation methods.

The rates were highest with the use of Hulka clips (36.5 per 1,000 procedures), followed by silicone bands or rings (17.1 per 1,000), partial salpingectomy and unipolar coagulation (7.5 per 1,000). Partial salpingectomy involves cutting a piece of the fallopian tube, which is done on both tubes. Coagulation involves applying electrical current to cauterize or burn a segment of the fallopian tubes. The study also reported that the 10-year pregnancy rate was higher among younger women aged 28 years and younger.

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TUBAL PREGNANCY.

Generally, the risk of pregnancy after tubal ligation is low. The risk of pregnancy in women who had tubal ligation is much lower than women who did not have tubal ligation. If pregnancy occurs following tubal ligation, the pregnancy will most likely be ectopic. When an egg is fertilized and gets implanted anywhere but the uterus, an ectopic pregnancy is said to occur. In many cases, the egg implants in one fallopian tube, called a tubal pregnancy. Other locations are the ovary, cervix, or abdominal cavity.

In the CREST study, the 10-year cumulative risk of ectopic pregnancy from all methods of tubal ligation was less than 1%, that is, 7.3 ectopic pregnancies per 1,000 procedures. The highest rate of pregnancy occurred among women who had bipolar electrocoagulation, 17.1 ectopic pregnancies per 1,000 procedures, while the lowest was among women who had partial salpingectomy, 1.5 per 1,000. It was also found that women, 30 years of age and younger were more at risk for ectopic pregnancy and that ectopic pregnancy may occur even at 10 years or more after tubal ligation.

A woman who becomes pregnant after tubal ligation needs to see a doctor immediately. Ectopic pregnancy will not proceed to full-term and is a life-threatening condition. In tubal pregnancy, the fetus grows inside the fallopian tube, which may cause the tube to expand and eventually rupture. Rupture will lead to significant bleeding and lead to shock, which is a surgical emergency.

Tubal ligation is a permanent procedure but women may often feel regret at having been sterilized. Regret is most commonly because of divorce, remarriage, death of a child, or the desire to have more children. According to the CREST study, this occurs more commonly among younger women who have remarried or wanted another child.

WHAT ARE THE RISKS OF PREGNANCY AFTER TUBAL LIGATION?

When a surgeon performs a tubal ligation, the fallopian tubes are banded, cut, sealed, or tied. Tubal ligation can result in pregnancy if the fallopian tubes grow back together after this process.

A woman is at greater risk of this occurring the younger she is when she has a tubal ligation.

According to the University of Pittsburgh Medical Center, the rates of pregnancy after tubal ligation are:

  • 5 percent in women younger than age 28
  • 2 percent in women between ages 28 and 33
  • 1 percent in women older than age 34

A woman may also discover she’s pregnant after her tubal ligation procedure. This is because a fertilized egg may have already implanted in her uterus before her procedure. For this reason, many women opt for tubal ligation after giving birth or after a menstrual period, when the risk of pregnancy is lower.

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SYMPTOMS OF PREGNANCY

If your fallopian tube has grown back together after tubal ligation, it’s possible you could have a full-term pregnancy. Some women also opt to have a tubal ligation reversal, where a doctor puts the fallopian tubes back together. This isn’t always effective for women wanting to get pregnant. But it can be.

Symptoms associated with pregnancy include:

breast tenderness

  • food cravings or feeling sick when thinking about certain foods
  • missing a period
  • nausea, especially in the morning
  • unexplained fatigue
  • urinating more frequently

If you suspect you may be pregnant, you can take an at-home pregnancy test. These tests aren’t 100 percent reliable, especially early in your pregnancy. Your doctor can also perform a blood test and/or ultrasound to identify if you’re pregnant.

NEXT STEPS

While tubal ligation is a very effective contraception method, it doesn’t protect against pregnancy 100 percent. It’s important to remember as well that the procedure doesn’t protect against sexually transmitted infections. If you and your partner aren’t monogamous, it’s important to use a condom each time you have sex.

Talk to your doctor if you’re concerned your tubal ligation won’t be effective. If you had your procedure at a young age, or it’s been more than a decade since you had your procedure, you could be at a small but increased risk for pregnancy. You can pursue other contraception options to reduce the risks. This could include a vasectomy (male sterilization) or asking your partner to wear a condom during sex.

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