Next to marriage, most couples I know look to having kids in their near (or distant) future. Many of them say that having kids in the equation gives them more purpose and their union, a more profound meaning (one of the goals of marriage, according to the Bible, is procreation).
However, becoming a mother is a privilege not everyone can enjoy. Some women who wish to have children are unable to for various reasons and have to go through lengths to conceive — tapping science, even, in hopes of getting pregnant.
On the other end of the spectrum, there are also women (couples) who are blessed with a hyperactive reproductive system that they have to resort to contraception, whether natural (abstinence) or artificial (oral/injectable contraceptives, condoms) to plan the family.
A common solution for couples who wish to space their children apart is oral contraceptives, while those who no longer want to have children often resort to sterilization, a more permanent method of contraception. The surgical procedures — vasectomy for men and tubal ligation for women — are highly effective.
What happens, though, if you suddenly decide to have more kids after having a ligation? Is it safe? Is it even possible?
SmartParenting.com.ph interviewed Dr. Sybil Bravo, section chief of OB-Gyn Infectious Diseases, Department of OB-Gyn at the Philippine General Hospital (PGH), to shed light on the matter.
Pregnancy after a tubal ligation
SP: Is ligation a permanent procedure? Is it safe?
Dr. Bravo: Bilateral tubal ligation is a permanent surgical form of female sterilization. It is usually performed after childbirth, although it can also be done at any time long after delivery. In general, tubal ligation is a very safe procedure if performed by a trained physician.
SP: What happens during ligation?
Dr. Bravo: During a tubal ligation, the surgeon or obstetrician-gynecologist cuts a portion of both fallopian tubes and ties them off to prevent an egg from entering the uterus.
SP: If the woman changes her mind, is pregnancy still possible after ligation?
Dr. Bravo: Yes, it is still possible [for a woman] to get pregnant after the procedure, though it is rare at less than 1%, especially among younger women who underwent ligation. Spontaneous tubal recanalization may occur over time, and the risk is higher among younger women who underwent [other methods of ligation]. There is bipolar coagulation [where the fallopian tube is grasped between two poles and electrical current is passed through them], and there's clip application [where a clipping device is used to block the fallopian tubes], compared to the usual cutting and tying a portion of the fallopian tube.
When the woman and her family decide later that they want another pregnancy, she should consult an obstetrician-gynecologist.
SP: What procedures can a woman have to get pregnant after ligation?
Dr. Bravo: Her options would be to have a tubal reversal procedure or get pregnant through in vitro fertilization (IVF).
A tubal reversal procedure is difficult technically, and pregnancy success rates may be less. Getting pregnant [naturally] involves being in good health condition for both the woman and her husband/partner. They may try to get pregnant spontaneously at least on the second monthly period after the reversal surgery. For some cases after tubal ligation reversal, the obstetrician-gynecologist may need to induce ovulation or perform other forms of assisted reproduction technology (ART) procedures.
If through IVF, there is no need for tubal reversal.
SP: What are the risks associated with pregnancy after tubal ligation?
Dr. Bravo: Women who get pregnant after ligation are at risk of having an ectopic pregnancy (the rate is about 1 in 15,000). An ectopic pregnancy is one where the fertilized egg has implanted outside the uterus and remained inside the fallopian tube.
Signs and symptoms of an ectopic pregnancy include severe and persistent pelvic pains [similar to] dysmenorrhea, nausea, abdominal tenderness, fatigue, vaginal spotting, and missed menstrual cycles. She should consult the doctor as soon as possible if she exhibits these symptoms.
SP: What is the success rate of pregnancy through IVF after tubal ligation?
Dr. Bravo: Each IVF cycle can have more than 50% success for women younger than 35 years old. With four treatment cycles, there can be about 90% success rate.
SP: Are there safety issues to consider when one gets pregnant through IVF after ligation? Is there special care required?
Dr. Bravo: For the mom, getting pregnant by IVF may cause ovarian hyperstimulation syndrome due to the medications used to stimulate development of several eggs. This is rare though, as it occurs at a rate of 1% to 2%. Your cycle is closely monitored by your doctor to decrease the chances of this complication from happening. The risk of the fetus having congenital anomaly is the same as that of the general population.