Tubal Reversal
A tubal reversal is microsurgery to rejoin the fallopian tubes after sterilisation. The surgeon removes the blocked section and stitches the healthy ends back together with sutures finer than a hair, so eggs and sperm can meet again. If it works, you can try for a baby naturally every month, without IVF.
That is its great strength. One operation can lead to more than one pregnancy, with no egg collection and no laboratory. If you were sterilised years ago, in a different chapter of your life, it is a way back to trying the way most couples do.
The decision between reversal and IVF comes down to four things: your age, how you were sterilised, how much healthy tube is left, and your partner's semen. Clips and rings reverse best, while burned or removed segments reverse worst. Getting those four right is what makes this a confident choice rather than a gamble.
At a glance
- Also known as
- Tubal ligation reversal, sterilisation reversal, tubal reanastomosis, tubal reconnection, tubal anastomosis
- Appointment time
- 1.5–3 hours
- Anaesthesia
- General
- Time in clinic
- Day case to 2 nights, depending on the approach
- Back to normal
- 1–2 weeks after keyhole surgery; 2–3 weeks after a mini-laparotomy
- Whole process
- 4–6 weeks
- Scar
- Small keyhole cuts, or a short bikini-line incision of a few centimetres
- Typical cost
- $6,000–$15,000 (United States, self-pay)
- Usually preceded by
- Ovarian Reserve Testing, Semen Analysis
Figures reviewed .
On this page
Who it’s for
The best candidates were sterilised with clips or rings, which crush a short section and leave plenty of healthy tube. They are under about forty, ovulate regularly, have a reasonable ovarian reserve, and their partner has a normal semen analysis. For these women, reversal can be an excellent option.
The odds fall when the sterilisation was done by burning a long section of tube, or when segments were cut out. Very little healthy tube may remain, and a short rejoined tube works less well. If the tubes were removed completely, reversal is not possible at all.
Others are better served by going straight to IVF. That includes women in their forties, couples where the semen analysis shows a significant problem, and women with other tubal damage or endometriosis.
Your old operation note is valuable here. See eligibility for the general requirements.
Before your first consultation
Request the operation note from your sterilisation. It says which method was used and where, and it gives the surgeon a far better idea of your chances before anyone operates.
How it’s done
You are asleep under general anaesthetic. The surgeon reaches the tubes either by keyhole surgery, sometimes robot-assisted, or through a mini-laparotomy, a short cut of a few centimetres along the bikini line.
Each tube is examined first to see how much healthy length remains on either side of the blockage. The scarred or clipped section is cut away, a fine splint may be passed to hold the channel open, and the two ends are stitched together in layers using an operating microscope or high magnification. Dye is then passed through the cervix to check that it flows through each repaired tube.
If one tube is too short or damaged to repair, the surgeon may rejoin only the other. One good tube is enough for pregnancy.
At the consultation
Ask what the surgeon will do if one tube turns out to be too short on the day. Knowing the plan in advance helps you understand your odds before you wake up.
After tubal reversal
After keyhole surgery you are home the same day or the next, with sore small wounds and shoulder-tip pain from the gas for a day or two. After a mini-laparotomy, expect one or two nights in hospital and a slower first week.
Most people are back at a desk within one to three weeks. Heavy lifting waits until about six weeks.
You can usually start trying after your next period, once you feel comfortable. Some surgeons arrange a dye test a few months later to check the tubes are open.
| Weeks before | Old operation note obtained, ovarian reserve and ovulation checked, partner's semen analysis done. |
|---|---|
| Day 0 | Surgery under general anaesthetic. Home the same day or after one or two nights. |
| Days 1–7 | Sore wounds and gas pain. Short walks and plenty of rest. |
| Weeks 1–3 | Back to a desk. Wounds healed and most daily activities back to normal. |
| After the next period | Trying to conceive can usually begin. |
| Months 3–4 | A dye test if your surgeon recommends one, to confirm the tubes are open. |
| Months 12–18 | Most pregnancies after a successful reversal have happened by now. If not, it is time to review the plan. |
In the first month
Agree with your partner how long you will try before reviewing the plan, and put the date in the diary. Having a clear point to reassess keeps the months that follow hopeful rather than open-ended.
Tubal reversal scars
Keyhole surgery leaves three or four small cuts, each about a centimetre, one usually in the navel. A mini-laparotomy leaves a short horizontal scar low on the abdomen, often along the line of an earlier caesarean if you have one.
Both fade to fine pale lines over a year.
Risks and complications
The early risks are those of any pelvic operation: bleeding, infection, the usual anaesthetic risks and, rarely, injury to nearby organs.
The specific risk afterwards is ectopic pregnancy, where an embryo implants in the tube instead of the uterus. A repaired tube carries a higher chance of this than a normal one, and an ectopic can be serious if it is missed. Every pregnancy after reversal needs an early blood test and a scan at around six weeks to confirm it is in the uterus.
The tubes can also scar shut again over time, or fail to work well despite being open. That is the reason for having a plan with a time limit, rather than trying indefinitely.
Tubal reversal results
After a clip or ring sterilisation, in women under about thirty-five, published series put the chance of pregnancy within a year or two at well over half. Odds remain good into the late thirties and fall steeply after forty, when egg quality becomes the limiting factor.
After burning or long segment removal the odds are clearly lower, and they depend on how much tube was left to rejoin. The rejoined length is what matters most.
What makes reversal shine is the chance of more than one baby from a single operation. What tends to disappoint is the wait. Natural conception takes months, and I always encourage the couples I meet to give it a fair run before deciding anything.
Alternatives to tubal reversal
IVF is the main alternative, and the comparison is genuinely close for many couples. IVF bypasses the tubes entirely, is not affected by the sterilisation method, and gives a quicker answer. Each cycle costs money, though, and each additional child usually means another cycle.
Reversal tends to win for younger women with clips and a normal semen analysis, who would like more than one child. IVF tends to win past about forty, after burned or removed tubes, or where the partner's semen is poor.
If a reversal does not lead to pregnancy within the time you agreed, IVF is still available afterwards.
IVF
Conventional IVF, where the ovaries are stimulated to produce a batch of eggs, the eggs are collected under sedation and mixed with sperm in the laboratory, and one embryo is transferred. The core treatment that the other pages in this group are variations on.
Best for: anyone whose tubes, sperm or time make natural conception unlikely, and who wants the treatment with the best odds per attempt
Combining tubal reversal with other treatment
A tubal reversal can be combined with a hysteroscopy to check the uterus, or with treatment of mild endometriosis or adhesions found during the operation.
Bangkok is a strong destination for this pairing. Private hospitals there often have gynaecological microsurgeons and IVF clinics under one roof, so a reversal and a back-up IVF plan can be discussed in the same visit.
Tubal reversal cost
Reversal is usually priced as a single package, and that one fee is the whole treatment if it works. IVF costs are per cycle, so the fair comparison is a reversal against the number of IVF cycles you would likely need for the family you want.
Ask whether the quote covers surgeon, anaesthetist, theatre, the nights in hospital and the follow-up dye test. Ask too what happens if only one tube can be repaired.
Thailand is a strong choice for reversal. Package prices in Bangkok are typically a fraction of US self-pay, and the recovery is short enough for a two-week trip.
| Country | Self-pay | Public / insurance |
|---|---|---|
| United States Outpatient microsurgical centres at the lower end; hospital-based and robotic reversal at the top | $6,000–$15,000 | Rarely covered by insurance; self-pay is the norm |
| United Kingdom Private packages usually include the hospital stay | £3,000–£6,500 | Not routinely funded on the NHS |
| Thailand All-in packages at private Bangkok hospitals; confirm a post-operative dye test is included | $3,000–$6,500 | Self-pay for international patients |
Read more: Fertility Surgery
Choosing a clinic for tubal reversal
Tubal reversal is microsurgery, and results depend heavily on the surgeon's experience. You want someone who does reversals regularly, not occasionally, and who uses magnification for every stitch.
Ask how many reversals they perform a year, and what pregnancy rate they see for women of your age with your type of sterilisation. A good surgeon knows both, and tells you plainly when IVF is the better route.
The question that reveals the most is what tube length they need to proceed. A clear answer shows they plan around the anatomy rather than simply booking the operation. I would want to hear it before the date is set.
When you consent
Ask the surgeon to record how long each repaired tube is in your discharge letter. That number helps any future doctor judge your odds and decide when to suggest IVF.
Frequently asked questions
Can every sterilisation be reversed?
No. Clips and rings reverse best; burned or removed segments much less well, and removed tubes not at all. See who it's for.
Is reversal better than IVF?
It depends on age, sterilisation method, tube length and the partner's semen. See alternatives.
What is the risk of ectopic pregnancy?
Higher than with normal tubes, which is why every pregnancy needs an early scan. See risks.
How soon can I try to conceive?
Usually after your next period, once you feel comfortable. See afterwards.