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Infertility/Fertility/Pregancy after ablation and tubal

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Question
I am 37 soon to be 38 years old, a divorced mother of three. I had the ablation and tubal surgery back in 2005, which at first I did not have a period, over the years the pain and more bleeding has been substantial. Now that I have met my soul mate... I know it's so cliche, but really would like to consider having that one bond together that a child brings. Can I have a tubal reversal and what would the odds be to get pregnant and sustain the pregancy since the ablation was completed years ago, and now with each passing month my periods are actually periods with cramps?

Answer
Hello Christine from the U.S. (Iowa),

The usually answer to your question would be NO, but I think there might be a possibility in your case.  There are several factors to consider, however and you need to bear these in mind as you make your decision.

1. You are 38 years old.  This means that your chances for natural pregnancy is significantly lower than before.  If we assume that (1) the tubes can be successfully fixed and (2) that the endometrium still forms and allows implantation, then your "natural" chance of pregnancy is 5% per month or 13% per year of trying.  For comparison purposes, your chances at this age using IVF would be 50% per month attempt.

2.  A tubal ligation is a procedure where a portion of the tubes is destroyed by either burning, cutting and tying, clipping or banding.  The tubes then need to be microsurgically cut back to normal tube then reattached by very fine sutures.  The procedure, even if accomplished, does not always lead to functioning tubes.  The tube is more than just a pipe and has several different muscle layers.  If it does not have each of these layers, then it will not function correctly.  Also, if the tubal ligation has been over 10 years, it is unlikely that the tubes are still healthy inside and therefore, have a higher chance of failure.

3.  Endometrial ablation is where the uterine lining is destroyed by burning or freezing.  This then leaves scar tissue and since the lining layer has been removed, the uterus cannot form an endometrial lining and so bleeding stops.  Based on the fact that you continue to have periods, that means that your ablation was probably inadequate or incomplete and there is endometrial lining developing.  Therefore, there is hope that implantation can occur, but if there is extensive scar tissue, this will prevent implantation by whatever means you choose to try for pregnancy.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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