When you had your vasectomy or tubal ligation, you may have thought your family was complete or that you never wanted children. But then life happened. Now the pitter patter of tiny little feet in your home is what you desire.
More than half a million American men have vasectomies and nearly 700,000 American women have tubal ligations each year. While most remain permanent, there are a small percentage of men and women who change their minds. If you’ve been snipped or tied, you may worry about conceiving naturally, but the good news is that you’ve got options.
“Most men think that it’s game over, but that’s not true,” said urologist Rahul Mehan, MD. “Vasectomy reversal is a viable option. Where there is a will, there’s a way.”
“A reversal is possible for women too,” said Pooja Shah, MD, an OBGYN at Banner Health Center in Chandler, AZ. “There are various techniques for tubal ligation, all with different success rates.”
If you’re considering a vasectomy or tubal ligation reversal you can have a go at conceiving, here are five things to know.
1. The decision shouldn’t be taken lightly
Don’t make any “snip” decisions like Michael Scott did in the TV comedy, “The Office.” Michael snip, snapped three times for his partner Jan. “You have no idea the physical toll three vasectomies have on a person,” he said. All kidding aside, having a reversal shouldn’t be taken lightly for either partner. Although these are safe procedures, it’s important to discuss with your OBGYN or urologist beforehand.
“As a general OBGYN, I would want to understand the factors that led to my patient’s original tubal ligation as well as the reason for her requesting a reversal,” Dr. Shah said. “These will help me counsel the patient appropriately and provide realistic expectations for her.”
2. What surgery will entail
Unlike a vasectomy, a vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists. Major advances have been made in the technique and instrumentation. Surgeons use surgical microscopes that can magnify up to 25x and apply six to eight stitches that are finer than human hair to reconnect the vas deferens.
“It’s a safe procedure, with risks of bleeding and infection less than 1%,” Dr. Mehan said. “You’ll need to take it easy for about a week and abstain from sex for 3 weeks for healing—or longer—depending on the repair.”
Tubal reversal surgery involves identifying the healthy sections of the fallopian tubes and undergoing microsurgery under general anesthesia to reconnect them. Surgery should be performed by a skilled subspecialty surgeon, generally a gynecologist who is specially trained in infertility and microsurgery.
Like the vasectomy reversal, tubal reversals can be more invasive than the tubal ligation. Recovery from the surgery is dependent on the surgical approach. “Small incisions via a laparoscopy may have less down time than an abdominal incision via a laparotomy,” Dr. Shah said. “Several months after surgery, patients will undergo an imaging test (like a hysterosalpingogram) to ensure the fallopian tubes are open all the way through. Then pregnancy can be attempted.”
3. Understand the success rates of each
Overall, pregnancy rates after a vasectomy reversal can be as high as 95% whereas they are between 40% and 85% after a tubal ligation.
For men, success is dependent on the amount of time that has elapsed since the vasectomy. “We’re seeing success as high as 95% if it's performed in the last 10 years, but a significant decline if it’s been over 15 years,” Dr. Mehan said.
For women, success is dependent on a number of things, including the type of ligation performed, a woman’s age, medical issues and the skill of the surgeon.
“Tubal ligations that were performed with a clip or ring have the most viable or healthy fallopian tube tissue to use for a reversal, and hence have higher success rates,” Dr. Shah said. “Tubal ligations that have left minimal fallopian tube tissue or have caused scarring inside the tube may not even be candidates for tubal reversal surgery at all.”
4. Check on your fertility
The health of your partner and their fertility are important things to consider before a reversal procedure.
“Before either couple considers a reversal, they should meet with a fertility expert to evaluate the viability of getting pregnant,” Dr. Shah said. “This will include looking at their operative and pathology reports for their surgeries done in the past, medical histories and testing for factors that will affect pregnancy, like a woman’s ovarian reserve and a man’s semen analysis.”
Based on this information, the fertility doctor can help walk you through all your options to find what will work best for you and your family.
5. What if a natural pregnancy isn’t in the cards?
But, if one or both partners aren’t good candidates for reversals, then other avenues of expanding their family should be explored, such as in vitro fertilization or adoption.
“In some couples, we opt for a sperm retrieval procedure to enable in vitro fertilization, especially when time is a factor,” Dr. Mehan said. “These methods are a more efficient way to achieve pregnancy than natural methods.”
Next Steps
The decision to grow your family is exciting, but you want to put your best feet forward in the process. If you and your partner are considering reversals, contact your health care provider or reach out to a fertility specialist for guidance. To find a Banner Health specialist, visit bannerhealth.com.
