Reversal of female sterilisation at North Staffordshire Hospital

What is reversal of female sterilisation?

Reversal of female sterilisation is an operation that reconnects your fallopian tubes after they were cut, sealed or blocked during an earlier sterilisation, with the aim of letting you conceive naturally again. It is a more complex operation than the original sterilisation and there is no guarantee it will restore your fertility.

Why might you want a reversal?

Sterilisation is meant to be permanent, but circumstances change. Around 5 to 10 in every 100 women who have been sterilised later decide they would like it reversed, often because they have a new partner or want more children than they originally planned for.

On the NHS, funding for reversal is tightly restricted and only granted in exceptional circumstances, for example where a woman's only child has died and she wishes to try for another. Outside cases like this, reversal is usually only available privately.

What are the benefits of reversal of female sterilisation?

If successful, the main benefit is being able to conceive naturally, without needing techniques such as IVF. Other benefits include:

• a lower chance of a multiple pregnancy compared with natural conception after IVF
• avoiding the high doses of hormones used during IVF treatment
• the chance to keep trying naturally each month, rather than around a single treatment cycle
• often costing less overall than a course of IVF.

Are there different types or surgical approaches?

Yes. The operation can be done as open surgery, through a single low cut across your abdomen, or as keyhole surgery using several smaller cuts. Some clinics also offer a robotic-assisted version of the keyhole technique. Your surgeon will recommend the approach best suited to your circumstances and your original sterilisation method.

How successful reversal is likely to be also depends on how your tubes were originally sterilised. Reversal tends to work best if clips or rings were used and is far less successful if your tubes were sealed by burning (diathermy) or removed completely, in which case reversal is not possible at all.

What happens before the operation?

Before your surgery, you can expect:

• a detailed consultation covering your original sterilisation, general health, and any previous pregnancies or gynaecological surgery
• blood tests and a scan of your womb and ovaries, and possibly a test called a hysterosalpingogram to check the length and condition of your remaining tubes
• a semen test for your partner, to rule out any fertility issues on their side
• a review of your current medicines, since blood-thinning drugs in particular may need pausing beforehand
• if you smoke, aim to quit around two months ahead, cut back on alcohol for a short stretch either side of surgery, and generally eat well and stay active beforehand
• fasting from the night before, so nothing to eat or drink once midnight has passed on the day itself.

What happens during the procedure?

1. A general anaesthetic puts you to sleep for the whole procedure.
2. For open surgery, your surgeon makes a low cut across your lower abdomen. For keyhole surgery, several smaller cuts are used instead.
3. Any clips or rings from your original sterilisation are removed.
4. The damaged ends of each fallopian tube are trimmed away.
5. The healthy sections of tube are reconnected with fine stitches.
6. A dye is passed through the reconnected tubes to check they are open.
7. The cuts are closed and a dressing applied. An open operation usually lasts one to two hours in total.

What does recovery look like?

Straight after surgery, you are monitored closely in a recovery area as the anaesthetic wears off, before being taken to a hospital room. Most people stay in hospital for one to two nights, with regular painkillers available, and you will need someone else to drive you home.

At home, plan on resting for the first week, taking paracetamol or ibuprofen if needed, and avoiding heavy lifting or sex until your consultant confirms it is safe. Work is usually best left for a week or two, longer if your job is physical, and it is worth waiting to drive again until you could comfortably manage an emergency stop, which for most people is roughly seven days on.

Keyhole surgery tends to have people back on their feet sooner, often within a fortnight, while a full return to normal activities after open surgery can take closer to a month.

What are the risks and complications?

As with any operation, reversal of female sterilisation carries some risk, including:

• bleeding, infection, or blood clots
• an unwelcome reaction to the anaesthetic
• a higher chance of ectopic pregnancy, where a fertilised egg implants outside the womb, if you do conceive afterwards
• damage to nearby organs during surgery
• scar tissue forming after the operation, which can re-block the fallopian tube it affects.