Tubo-tubal Anastomosis (Tubal Ligation Reversal)

By RRM Academy Reviewed by Dr. Naomi Whittaker, MD, Board-Certified OBGYN, MIGS, NFPMC, FCI Updated July 27, 2026

Tubal ligation reversal (tubo-tubal anastomosis) is a microsurgical procedure that reconnects the segments of the fallopian tube separated or occluded during prior sterilization, restoring natural tubal patency and allowing natural conception to resume. The surgery involves precise re-anastomosis of the two tubal ends under magnification, with meticulous attention to lumen alignment and mucosa-to-mucosa apposition. It can be performed laparoscopically, robotically, or via mini-laparotomy.

Pregnancy rates after microsurgical reversal range from 57% to 84% across published series, with outcomes strongly associated with the woman's age at time of reversal and the length of remaining tube available for reconstruction.¹² The type of original sterilization also matters: one large series found pregnancy rates of 76% after ring or clip ligation, compared with 68% after ligation and resection and 67% after coagulation (P < .001).¹ Pregnancy and birth rates decline steadily as age at reversal increases: one large series found an 88% pregnancy rate and a 62% live birth rate among women under 30 at the time of ring or clip reversal.¹

Tubal ligation reversal is a restorative procedure: it addresses the anatomical barrier directly, restoring the reproductive tract to normal function. This is distinct from in vitro fertilization, which bypasses the fallopian tube entirely and removes fertilization from its natural environment. For women under 40 without additional fertility factors, published data support tubal reversal as an effective pathway to pregnancy.¹²

Assessment before reversal includes evaluation of remaining tubal length, the partner's semen analysis, and the woman's ovarian reserve. Both partners contribute to the outcome, and the pre-surgical evaluation reflects that. Age at reversal is the single strongest predictor of success, and timing relative to that factor is a central part of the clinical conversation.

This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.