Pregnancy After Tubal Ligation

Vilma Ruddock
couple talking with doctor

The chance of getting pregnant after a tubal ligation is low because it is one of the most effective method of birth control. If you are one of the few who get pregnant, you have a risk that it is an ectopic pregnancy (outside the uterus), which can have serious consequences. Discuss the risks with your doctor before your tubal ligation procedure.

Chance of Pregnancy

A tubal ligation rarely fails, so you have less than one percent chance of getting pregnant after the procedure, according to the United States Centers for Disease Control (CDC). Compare this to a failure rate of six percent for the birth control pill.

Symptoms of Pregnancy

Because a tubal ligation is a safe and effective form of birth control, you don't have to live in fear of an unexpected pregnancy. However, don't ignore any symptoms you have that suggest that you might be pregnant. The earliest symptoms of pregnancy include implantation bleeding, fatigue, breast tenderness, and nausea or vomiting.

What to Do

See your doctor as soon as possible if you have any of these symptoms after tying your tubes. Your biggest concern is to make sure you don't have an ectopic pregnancy because a delay in diagnosis can lead to severe complications.

Ectopic Pregnancy

According to a review in the Journal of Postgraduate Medicine, of the small number of pregnancies after a tubal ligation, only about 15-20% of them will implant outside the uterus, most frequently in a fallopian tube.

The remaining 80-85% of the pregnancies will reach the uterus, and the chance of continuing on to deliver a baby will be the same as any uterine pregnancy.

Complications

Though the chance of having an ectopic pregnancy is small, the risks are great, and ectopic pregnancies are the leading cause of maternal death in the first trimester. The greatest risk is bleeding from or rupture of the fallopian tube or other organs, such as ovary or bowel, where an embryo may attach. This can lead to severe hemorrhage and death.

Symptoms of an Ectopic Pregnancy

The longer an ectopic pregnancy goes unrecognized the greater the risk, so early diagnosis is essential. In addition to the usual early symptoms of pregnancy, pay close attention to the following symptoms that might suggest an ectopic pregnancy:

  • Irregular vaginal bleeding, which often may be just spotting
  • Persistent or increasing abdominal or pelvic pain, especially on one side
  • One-sided shoulder pain, suggesting blood in the belly from a bleeding or a ruptured ectopic
  • Light-headedness and dizziness suggesting significant blood loss

Don't delay in consulting your doctor as soon as possible if you have any of these symptoms.

Who is at Risk

In a 1997 New England Journal of Medicine (NEJM) article, researchers published the results of a long-term, multi-center study of pregnancy after tubal ligation. They found that there were 47 ectopic pregnancies out of 10,685 women who had had a tubal ligation. Of these, the chance of an ectopic pregnancy varied by age and method used and was greater for:

  • Women age 30 and younger
  • Women whose tubes were burned compared to those who had their tubes cut soon after delivery of a baby

The risk of an ectopic pregnancy was greater at two or more years after a ligation procedure and was present even 10 years after tubal ligation.

How Tubal Ligation Fails

Tubal ligation methods, which include burning, tying, cutting, or blocking the fallopian tubes, prevent pregnancy by blocking egg and sperm from traveling and meeting in the tubes. A ligation can fail and allow sperm to meet an egg and fertilize it because of two main reasons:

  1. Early failure: There is a small chance that the ligation procedure failed to block the tubes completely at the time it was done, and they remain open to the passage of egg and sperm.
  2. Delayed failure: Occasionally, months or years later, the two blocked portions of the tubes re-join or reopen and allow sperm and egg to meet.

Occasionally, an unrecognized early pregnancy was present before the procedure was performed. You can reduce this risk by having the procedure done within a few days after your period ends and before you have ovulated.

Options For a Pregnancy After Tubal Ligation

You should consider a tubal ligation a permanent procedure, but if you decide you want to have a pregnancy after you tied your tubes, your options are:

  • Tubal ligation reversal (TLR), which also has a risk of ectopic pregnancy after the procedure
  • In vitro fertilization (IVF)
  • Using a surrogate to carry your pregnancy

Consult Your Doctor

Before you have your tubes tied, discuss the chance and risks of pregnancy with your doctor. Though the risk of pregnancy is low, your biggest concern if you do get pregnant is an ectopic pregnancy. Don't hesitate to consult your doctor if you suspect you might be pregnant after tubal ligation, even if you had the procedure years ago.

Pregnancy After Tubal Ligation