Assistance with Conception - Reversal of Female Sterilization

Changes in circumstances may cause a woman who has previously undergone a "sterilizing" procedure to think about having it re­versed so that she can attempt to become pregnant.

Sterilization of women and men is always done with the caution that it must be regarded as irreversible. In women sterilization is quite major surgery, requiring both general anesthesia and access to the inside of the abdomen. These days, the Fallopian tubes are most often closed off with clips (Filshie clips), which look like tiny clothes pins, or with rings of metal or plastic. Whichever method is used, the aim is to prevent the passage of eggs down the tubes from the ovaries and the progression of sperm up the tubes, so that "never the twain shall meet." Before a decision is made for steril­ization, most doctors and family planning clinics discuss the pro­cedure very fully with their patients, emphasizing its finality. And most women deciding for it believe that they will not change their minds about wanting more children no matter what. But circumstances like, but are not limited to, divorce, losing their partner or an existing child to illness or accident some are bound to change their decisions.

 But, how we will feel under changed circumstances is not always predictable. Partners do sometimes move on, or die, and relation­ships break down and are replaced by new ones. It is impossible truly to predict how one will feel in such a situation. Some women who have lost a child find, after the initial grief and disbelief has passed, that they want to get pregnant again. This is not to replace the dead child but, as some women have expressed it to us, more like a tree or vine that has lost a branch but puts out new shoots. Simply because it takes time to have a first family, to go through the trauma of loss, and then to decide on trying to bear another child, many women in this position are likely to be in their later reproductive years. The following case stories illustrate issues that should be considered before reversing sterilization.

 Mary was 32 when she agreed with her husband Sam that she should have sterilization. Maybe Sam had been a bit keener than she was, but she had two healthy sons. Two years later, Sam announced that he was divorcing her and moving in with another woman. Four emotion­ally turbulent years later, at age 38, Mary met Tony and began to expe­rience the love and support she deserved. Tony had never had children, and he came from an ethnic background that favors large families.

Mary went for a chat with her gynecologist, who had carried out the laparoscopic application of clips for her. Mary was having regular cycles and was otherwise healthy. Her GYN recommended testing for ovulation; her day 21 progesterone level was fine. Tony had a seminal analysis done, and it was pronounced perfectly normal. So Mary un­derwent open-abdominal surgery, a laparotomy in which a bikini cut was made low on her abdomen, and a microsurgical reanastomosis (reconnection) was performed. Each clip was carefully cut out, along with the underlying segment of tube. Then the two ends of the tube were joined with stitches as fine as spider's web, so that the canal of the tube was restored. She was advised by her surgeon to wait for two months before trying to conceive. When she did try, she became pregnant right away. She has since gone on to have three sons with Tony, brothers to her two older boys.

 To do the reanastomosis, Mary chose a surgeon with a good rep­utation who frequently performs this particular operation. She was lucky to have gone into the procedure with healthy tubes and to be wry fertile. In good hands and with fortunate conditions, the figures for successful pregnancy after reanastomosis when clips have been used are around 95 percent. The figures are not so good if there are adhesions (scarring) from previous surgery or if there has been any kind of infection.

 Cecelia's daughter died when she was just two years old, from a rare childhood cancer. Cecelia had twice given birth by C-section and had sterilization done during the second surgical delivery. Rather than applying clips to her Fallopian tubes, the surgeon had cut away a por­tion of each tube. Cecelia underwent a reanastomosis, but her surgeon warned her that the resulting length of tube was shorter than normal. Cecelia did become pregnant, but it was an ectopic pregnancy—a recognized possibility after reversal surgeries. The whole tube had to be removed in an urgent open-abdominal operation. After much con­sideration Cecelia decided to follow her doctor's recommendation to try ART, and after two cycles of treatment she was pregnant. A very anxious eight months followed until another daughter was born, a little early but well, by a third C-section.