Reversing a tubal ligation – getting pregnant after

Q: I am a 41-year-old mother of three. I recently became involved with a man who has no children. I had a tubal ligation at age 21, and because of my youth the doctor said that he only clipped my tubes but did not cut or cauterize them. What are my changes of a reversal at this point in my life? Another doctor has suggested in vitro fertilization, which I don’t want to do. I know we have waited a little late in the baby game here but we really want to have a child together. Any suggestions?

A: In general, the reversal rate for a tubal ligation is about 50%. That means that if a woman who has had a tubal ligation has her tubes put back together, there is about a 50% chance she will conceive. One problem to remember is that when tubes are put back together (the fancy word is reanastomosed), if a woman conceives there is about a 10% chance that she will have an ectopic, or tubal, pregnancy, requiring yet another surgery.

My major concern in your situation is the age factor. Fertility does diminish with age, somewhat around age 35, but more substantially at 40. We know that woman do ovulate less well the older we get, and we do have medications that can help with ovulation. But even if we get good ovulations, we may not get pregnant.

Your physician did bring up correctly the possibility of in vitro fertilization. This would obviously avoid the problem of tied tubes. However, to be honest, looking at take-home baby rates per cycle of in vitro fertilization across the country, for women over 40 the rate is 7-8% per cycle, whereas for women under 40 the rates are 17-18% per cycle.

One other possibility to consider is that of donor eggs. Many in vitro programs can provide eggs from younger women if the eggs from an older patient do not result in a successful pregnancy. They take your husband’s sperm to fertilize the donor eggs in test tube, and then implant the eggs into your uterus, and you would carry the baby. Success rates from donor egg programs are usually quite good, usually about 30% success for take-home baby rates per cycle.

It does sound quite clinical to hear all these numbers, but unfortunately to make these difficult decisions you need to have hard and fast numbers. But then on top of the numbers you need to make the human decisions, to really decide which way to go. Good luck.