Pregnancy after tubal ligation

The type of tubal ligation performed may determine whether tubal reconstructive surgery is feasible. In general if cautery, i.e., tube burning has been performed tubal reconstructive surgery is not an option because of the extent of tissue damage. If tubal sterilization was performed by amputating the distal segment or implanting the distal segment into the uterus, tubal reconstructive surgery is not appropriate. If the operative report indicates tubal interruption was performed at multiple levels, tubal reconstructive surgery would not be appropriate. In all these cases in vitro fertilization would be the preferable option. If a patient has had multiple prior surgeries and is likely to have extensive pelvic adhesion/scarring tubal reconstructive surgery is not indicated. Tubal reconstructive surgery is most successful when a relatively small mid tube segment has been removed or ligated without use of cautery, a technique known as a Pomeroy tubal ligation. Other factors determining whether surgery or IVF is most appropriate includes maternal age and whether there is a significant male factor. With advanced maternal age, i.e., often the supply of good quality of eggs is low making in vitro fertilization the better option because of the potential significant delay to fertilization with reconstructive surgery. Likewise, if there is a significant male factor IVF gets around this issue almost entirely. 

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