Tubal sterilization, commonly known as getting one’s tubes tied, is a highly effective procedure intended to be a permanent form of birth control. The surgery is designed to block the passage of the egg from the ovary to the uterus, thereby preventing fertilization by sperm. Many people who choose this option are concerned about the absolute permanence of the method, especially when they hear the tubes are “cut and burned.” The idea that a severed structure could spontaneously rejoin warrants a clear explanation of the procedure’s mechanics and the rare possibility of its failure.
Understanding Sterilization by Cutting and Cauterization
The procedure referred to as “cutting and burning” creates a physical barrier in the fallopian tubes, the conduits for the egg. One common method involving both cutting and cauterization is the Pomeroy technique, often performed after childbirth. In this variation, a loop of the fallopian tube is lifted, tied off with a suture, and the small segment within the loop is surgically removed.
The ends of the severed tube are sometimes treated with heat, or electrocautery, to destroy the tissue and create additional scarring. The primary goal of this deliberate tissue destruction is to ensure the complete separation of the two remaining tubal segments. This wide separation and the formation of scar tissue permanently block the channel, making the union of sperm and egg physically impossible.
Another method, bipolar coagulation, uses an electrical current to burn a small section of the tube, turning it into a non-functional, scarred tissue segment. While this technique may not involve a physical cut, the result is the same: a permanent interruption of the tube’s pathway. Both methods rely on separating the tube’s lumen, or inner channel, and promoting scar formation to secure the permanent blockage.
The Mechanism and Rarity of Tubal Recanalization
Despite the intent of permanent blockage, a biological phenomenon known as tubal recanalization can, in rare instances, allow the tubes to rejoin or form a new passage. This natural process occurs when the body’s healing mechanisms attempt to repair the surgical trauma, essentially bridging the gap created by the sterilization. The failure rate for all types of tubal sterilization is low, with approximately 13 out of 1,000 women experiencing a pregnancy within five years of the procedure.
The spontaneous rejoining occurs most often through the regrowth of the epithelial lining, the specialized tissue that lines the inside of the fallopian tube. This lining can proliferate and attempt to cover the exposed, severed ends of the tube. In some situations, this regeneration creates a microscopic passageway or fistula that connects the two previously separated segments.
The risk of recanalization is higher when a short segment of the tube was removed or when the cauterization was not extensive enough to create a significant gap between the ends. If the severed ends of the tube retract and approximate each other closely, the chance for the epithelial tissue to bridge the distance increases. This bridging creates a new, albeit narrow, channel through which sperm may pass, allowing for fertilization to occur.
Pregnancy Risks After Sterilization Failure
The most significant consequence of tubal recanalization is the possibility of pregnancy. When sterilization fails, the anatomy of the fallopian tube is often compromised, dramatically increasing the risk of an ectopic pregnancy. This occurs because the newly formed channel, while allowing sperm to reach the egg, is frequently too narrow or scarred for the fertilized egg to pass back to the uterus. This traps the developing embryo in the tube, leading to an ectopic pregnancy.
Ectopic pregnancies are a medical emergency because the growing embryo can cause the fallopian tube to rupture, leading to severe internal bleeding. Women who have had a sterilization procedure need to be aware of symptoms that could indicate a failed procedure and an ectopic pregnancy, even years after the surgery. These warning signs include severe abdominal or pelvic pain, especially if it is sharp or one-sided, and any abnormal vaginal bleeding. Immediate medical attention is necessary if these symptoms appear, as early diagnosis of an ectopic pregnancy is essential for patient safety.