Pregnancy After Tubal Ligation and Ablation

What is Tubal Ligation?

Tubal ligation is a popular form of female sterilization that severs the fallopian tubes so that eggs can no longer pass through them to get ready for an attempt at fertilization. The Centers for Disease Control and Prevention reports sterilization is the second most common form of birth control among women who use such in America. When the tubes are cut, the pieces are then often burned on the ends to help make the procedure more permanent. The burning just adds to the protection that the pieces couldn’t fuse together again should they come untied — which can happen.

What is an Ablation?

An endometrial ablation is a procedure that cauterizes and removes the inner lining of the uterus. Women often elect to have this procedure if they suffer from heavy periods, cramping during their menstrual cycle, polyps, fibroids, or cysts. The procedure can cut down on those issues by removing the endometrium, which serves as the foundation for many of those growths to form upon. Other women may have irregular bleeding and the cause cannot be determined. In these cases, it’s often assumed that women need an ablation because their lining is so thick that breakthrough bleeding is occurring. However, this should always be documented by ultrasound measurements before moving forward with the procedure. The American Society for Reproductive Medicine notes that a small percentage of women will still have menstrual bleeding after an ablation, but most will no longer have periods. This can prove to be risky since pregnancy is still slightly possible and women wouldn’t have the warning of a late period to let them know something is off if they did conceive.

Can You Get Pregnant After a Tubal Ligation and Ablation?

Short of getting a complete hysterectomy, there is no way to avoid pregnancy by 100 percent odds. The likelihood of falling pregnant after a tubal ligation and an ablation is very small. Around 13 women will become pregnant in the five years following tubal ligation for every 1,000 who have it done, per WebMD. Combining this with ablation, one could assume that the chance of pregnancy is small, but it exists.

For pregnancy to take place, the tubes would first have to come untied. After untying, those two pieces of fallopian tube must find their way to one another and reattach. This might seem like it’s impossible, but the human body is able to heal injuries inside of it just as easily as it can injuries on its surface. For example, when someone gets a cut on their skin, the two halves of skin separated by the cut are still able to fuse back together and reattach. Sure, this isn’t exactly like being severed, but even a severing of a part can be healed back together in some cases.

Nonetheless, even if a tubal ligation surgery managed to undo itself and the tubes fused back together, this isn’t a given that pregnancy would be able to occur. The ablation has severely thinned the inner lining of the uterus. Usually, the point of the procedure isn’t to impact fertility, but rather to treat other issues, such as uterine polyps and fibroids or heavy periods caused by an endometrium that is too thick. The ablation removes that lining and makes it highly unlikely that a future pregnancy will occur. Even if an embryo was able to be fertilized due to the breakdown of the tubal ligation, that embryo would have very slim chances at being able to implant in the uterus.

However, that embryo could implant elsewhere or be trapped in the tube. The risk of ectopic pregnancy is already greater for women who undergo tubal ligations. Those who have reversals are still at risk, too. Then add to that the risk that the pregnancy would be looking for a place to implant and couldn’t find a hospitable womb to do it in. The risk of ectopic pregnancy may actually be even more likely for women who have had both tubal ligations and ablations if their tubal is somehow reversed. Women should keep this in mind when consenting to undergo both procedures, either separately or together.

There is also the potential that an ablation could fail. This may seem less likely to anyone who understands how the procedure works. How could a procedure fail to produce the lining that doctors are going in after in the first place? That’s not where it fails. The point of the procedure isn’t just to remove that endometrial lining, but to remove all of it. Sometimes pieces get left behind that can lead to continued problems and leaving those areas exposed in utero allows for space for an embryo to implant. In addition, there is the potential for more lining to grow if even small pieces of it are left behind to fester.