Reversal of Sterilisation after Endometrial Ablation

One question we are often asked by women who have undergone both a tubal sterilisation and an endometrial ablation is ‘can I still undergo a tubal sterilisation reversal to get pregnant?’.

Unfortunately, whilst tubal ligation can be reversed, if a woman has also had an endometrial ablation, this can have significant consequences on not just the ability to fall pregnant after reversal, but also on the safety of any future pregnancies. To explain why this is, you first need to know what an endometrial ablation is.

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Endometrial Ablation Explained

An endometrial ablation is a short procedure, usually performed in the outpatient setting (no overnight stay) by a gynaecologist. It involves heating the lining of the womb, either with water or electrical currents, to cauterise and destroy the blood vessels in the lining of the womb (endometrium). This leads to scarring and a reduction in endometrial tissue and therefore lighter menstrual flow (periods). Because of this, it is a commonly used treatment for heavy periods.

Because the lining of the womb is (in most cases) irreversibly damaged by this procedure, endometrial ablation is not recommended for women who want to keep the option of having children in the future.

In addition to this, because of the scarring within the womb caused by the procedure, women who undergo endometrial ablation are asked to continue using birth control or to have a more permanent form of birth control, such as sterilisation. This is because any pregnancies that do occur carry high risks of adverse pregnancy outcomes such as miscarriage, preterm labour, abnormal placental implantation, and ectopic pregnancies.

Can Endometrial Ablation be Reversed?

The medical procedure used to perform ablation of the womb lining is intended to reduce the lining of the womb and eliminate heavy or prolonged periods. For this reason, the damage done to the womb lining should be considered permanent and irreversible. However, an endometrial ablation doesn’t always remove all the uterine lining and many women do report that they resumed normal menstrual bleeding within five years after having the procedure.

Sterilisation Reversal after ablation

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The most common method of female sterilisation is tubal ligation or ‘having your tubes tied’. It is possible to reverse this form of sterilisation following an ablation, but the risks and success rates need to be carefully considered.

If you wish to have your tubal ligation reversed after ablation, to try for a pregnancy, there are a few factors which will be considered before going ahead. These include:

· How long ago your sterilisation was done

· The method of sterilisation which was used

· Your age and general health

· Whether you are having regular periods (pregnancy following ablation is extremely unlikely in women who are not having regular periods).

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· Your pregnancy history.

· The results of any investigations you may have had, such as trans vaginal ultrasound for endometrial thickness and hysteroscopy (a camera in the lining of the womb to check for scarring and womb cavity size).

· Any other gynaecological you have

The success of a sterilisation reversal and possible pregnancy after ablation very much depends on whether you are still having periods following your endometrial ablation, and how regular they are.

If you are having normal, regular periods after endometrial ablation then the chances are there may be sufficient womb lining still present, to allow a pregnancy to implant. However, whilst the presence of functional womb lining is important, the size of the womb cavity and presence of adhesions is also important. As such, your gynaecologists may recommend undergoing a hysteroscopy to assess the endometrial cavity prior to a tubal reversal.

Unfortunately, if you are not having regular periods, then you may be advised that sterilisation reversal surgery is not be the best option for you if you want to have another child. If however, your reason for reversal is for the treatment of post tubal ligation syndrome and not pregnancy, then please discuss this with your specialist.

As with any medical procedure there are always different options, risks, success rates and potential future complications to consider. It is advisable that you seek advice and guidance from a gynaecologist who specialises in fertility & tubal reversal surgery, such as Sam Dobson, before you consider going ahead.

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