Female refertilization

If the life situation of a sterilized woman changes and she still wishes to have a child, sterilization can be reversed. However, the operation cannot guarantee that the woman will become pregnant again.

© Jeff Greenough/Blend Images/Strandperle

When a woman decides to have a sterilization, she has usually completed her family planning. Most women who undergo sterilization already have two or more children. Nevertheless, a desire to have children can arise again later, for example in a new partnership. In principle, fertility can be restored with surgery (refertilization). Whether the woman actually becomes pregnant afterward, however, depends on her age and her partner’s fertility, among other factors.

Operation procedure

During sterilization, both fallopian tubes through which the eggs pass from the ovary to the uterus are cut or partially electrically sclerosed. During refertilization, the separated ends of the fallopian tubes are reconnected. If the procedure is successful, the fallopian tubes can be reopened afterwards.

The operation is performed about two days after the last menstrual period. It takes one to three hours and requires general anesthesia. As a rule, a two-day stay in the clinic is necessary. Two surgical procedures are possible: an incision in the abdominal wall (microsurgical procedure) or an abdominal endoscopy (laparoscopic procedure).

In both procedures, the scarred ends of the fallopian tubes are removed first. During an abdominal incision, the ends are sutured in layers using a special surgical microscope and especially fine instruments. In a laparoscopy ("buttonhole surgery"), the abdominal wall remains intact except for one or two small incisions for inserting the endoscope, through which the surgeon looks into the abdomen and also inserts the instruments.

Refertilization is a relatively complicated operation. It is only carried out in special centers by surgeons who have a lot of experience with the procedure.

Possible complications

As with any operation, refertilization is associated with certain risks. This includes infections, disorders of wound healing, injury to other organs or thrombosis. General anesthesia poses a risk for cardiovascular problems. In the event of certain problems, such as secondary bleeding, a new operation may be necessary. They can cause adhesions and scars in the abdominal cavity. Compared to women without tubal surgery, women after refertilization have a significantly increased risk of ectopic pregnancy.

Costs are usually not covered

In the past, sterilization was a fairly common method of contraception. This has changed since health insurance companies only cover the costs of the procedure in exceptional cases. Refertilization after sterilization must also generally be paid for privately. Depending on the method, the procedure costs 2000 to 4500 euros. The amount includes not only the cost of the operation itself, but also the cost of the consultation, anesthesia, hospital stay and medical aftercare.

In addition, there are travel costs if there is no clinic close to home that specializes in the procedure. Pregnancy advice centers, for example, know where to find a suitable hospital.

Statutory health insurance companies only cover the costs of a refertilization under certain conditions: for example, if the sterilization was considered medically necessary at the time (for example, because of a hereditary disease), but better treatment options exist today. The insurance companies also pay for the operation if the cause of the impermeable fallopian tubes is not sterilization but, for example, inflammation or an adhesion due to endometriosis.

Chances of success

Data on how many women become pregnant after a reversed sterilization varies between 30 and 70 percent. Abdominal incision with microsurgery seems to be a little more promising than laparoscopy. Whether and how quickly a woman who has undergone surgery becomes pregnant depends not only on whether her fallopian tubes are permeable again. It therefore makes sense for both partners to have their fertility tested before the operation.

Alternative: artificial insemination

A sterilized woman can also get pregnant through artificial insemination. In this process, previously retrieved oocytes of the woman are brought together with the sperm cells of her partner outside the body in the laboratory. One to two fertilized eggs are then placed in the uterus.

There are no conclusive studies on whether refertilization is more successful than artificial insemination. Both methods have advantages and disadvantages. Thus, after a successful operation, several pregnancies are also possible in a natural way. However, if the fertility of one or both partners is impaired for other reasons, artificial insemination promises more success than refertilization. On the other hand, artificial insemination is very costly. If it is not successful, it can become a great physical and psychological burden.

A consultation in a doctor’s office or pregnancy counseling center can help to consider all aspects and find out which method is most suitable.

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