In a tubal ligation, also known as “having your tubes tied,” your fallopian tubes are cut or blocked. Fertilization happens in the fallopian tube, so a tubal ligation prevents pregnancy by keeping the sperm and egg from meeting.

Some women who have had a tubal ligation might choose to have it reversed. A tubal ligation reversal reconnects the blocked or cut segments of the fallopian tube. This allows a woman who had previously had her tubes tied to become pregnant naturally. This procedure is also known as a tubal reanastomosis, tubal reversal, or tubal sterilization reversal.

Approximately 1 percent of tubal ligations are reversed.

Factors that can make a tubal ligation reversal more likely to be successful include:

  • The type of tubal sterilization. Some types of tubal sterilization, including Essure, are not reversible.
  • How much of the fallopian tube is left undamaged. Reversal surgery is more successful when there’s a lot of healthy fallopian tube left.
  • Age. Reversal is more successful in younger women.
  • Body mass index. Reversal may be less successful if you’re obese or overweight.
  • Other health conditions. Other health conditions, such as autoimmune diseases, can affect pregnancy. If you have one of these conditions, your doctor might take that into account when deciding if a tubal ligation reversal is right for you.
  • General fertility. Having general fertility problems makes tubal ligation reversal less successful. Prior to surgery, your doctor will probably test both you and your partner to learn more about your sperm and egg health. Your doctor might also take images to make sure your uterus can support a pregnancy.

The average cost of a tubal ligation reversal in the United States is $8,685. However, depending on factors such as where you live and what tests you need beforehand, the costs range from $5,000 to $21,000. Insurance doesn’t usually cover the cost of the surgery, but your doctor’s office may offer a payment plan.

First, your doctor will look at your fallopian tubes using a laparoscopic camera. This is a small camera put into your abdomen through a tiny slit. If your doctor sees that you have enough fallopian tube left to reverse your tubal ligation, and everything else looks healthy, they’ll perform the surgery.

Most tubal ligation reversals are done with laparoscopic surgery. This means the surgeon will make several small slits in your abdomen (the largest being approximately ½-inch long), then put in a camera and small instruments to do the surgery. They’ll control these from outside your abdomen. This takes approximately two to three hours, and you’ll need general anesthesia.

Your doctor will remove any damaged sections of your fallopian tubes and any devices from the tubal ligation, such as clips or rings. They’ll then use very small stitches to reattach the undamaged ends of your fallopian tubes. Once the tubes are reconnected, the surgeon will inject a dye into one end of each tube. If no dye leaks out, that means the tubes have been reattached successfully.

In some cases, your surgeon might use a procedure called a minilaparotomy. Your surgeon will make an incision in your abdomen, usually about 2 inches. They’ll then take the ends of the fallopian tube out of your abdomen through the slit. The surgeon will remove damaged parts of the fallopian tube and reconnect the healthy sections while the tubes are outside your body.

If all goes well, you’ll usually be able to go home about three hours after surgery. Recovery for laparoscopic surgery takes about a week. Recovery for a minilaparotomy takes approximately two weeks.

In that time, you’ll probably have pain and tenderness around the incision. Your doctor might prescribe you pain medication, or you can use over-the-counter medication. For a few days after your surgery, you might have shoulder pain from the gas used to help your doctor see more of your abdomen during surgery. Lying down can help relieve that pain.

You’ll have to wait 48 hours to bathe after surgery. Don’t rub your incision — pat it gently instead. You should avoid any heavy lifting or sexual activity. Your doctor will tell you how long to avoid these activities. Otherwise, you won’t have any activity or dietary restrictions.

You should see your doctor for a checkup one week after surgery.

In general, 50 to 80 percent of women who have tubal ligation reversal go on to have successful pregnancies.

Factors that impact the success include:

  • Your partner’s sperm count and quality. Pregnancy is more likely to be successful if neither you nor your partner have any fertility issues.
  • The amount of healthy fallopian tube left. If less damage was done to your fallopian tubes when you had tubal ligation, you’re more likely to get pregnant.
  • Presence of pelvic scar tissue. Scar tissue from previous pelvic surgeries may affect your chances of getting pregnant.
  • Type of sterilization. Women who had ring/clip sterilization are more likely to get pregnant after reversal.
  • Age. Pregnancy success after tubal reversal is most likely in women under 35 and least likely in women over 40. The pregnancy success rate for women under 35 is 70 to 80 percent, while the rate for women over 40 is 30 to 40 percent.

Like with any surgery, tubal ligation reversal can lead to complications from anesthesia, bleeding, or infections. These are rare and your doctor will go over these risks with you before your procedure.

It also increases your risk of ectopic pregnancy, which is when a fertilized egg implants outside your uterus. This most often happens in the fallopian tube. In general, ectopic pregnancies account for up to 2 percent of pregnancies. For women who have had a tubal ligation reversal, the rate of ectopic pregnancy is 3 to 8 percent.

An ectopic pregnancy is a serious complication. Without treatment, it can cause life-threatening bleeding. An ectopic pregnancy can’t continue as a normal pregnancy and is considered a medical emergency.

If you’ve had a tubal ligation, in vitro fertilization (IVF) is your other option for getting pregnant. In IVF, your eggs are mixed with your partner’s sperm in a lab. Fertilized eggs are then implanted directly into your uterus and pregnancy can proceed as usual from there if the procedure is successful.

The choice to have a tubal ligation reversal or undergo IVF is different for every woman. However, there is evidence that IVF might be a better choice than tubal ligation reversal for women over 40, while the opposite is true for women under 40.

One concern is cost. For women under 40, reversal is often less expensive, including the costs of pregnancy afterward. IVF is usually less expensive for women over 40.

Another factor to consider is the likelihood of pregnancy after each procedure. For example, the pregnancy rate for women over 40 who have a tubal reversal is half the rate of those who have IVF. For women under 35, pregnancy after a reversal is almost twice as likely than from IVF. For women ages 35 to 40, pregnancy is also almost twice as likely with tubal reversal than with IVF.

It’s possible to reverse a tubal ligation and have a successful pregnancy. However, there are many factors to consider when deciding if a reversal is right for you, including cost, your age, and your general health and fertility. Talk with your doctor about your options for future pregnancy.