Where does the term reversed come from?

Refertilization of women

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

By the time a woman chooses to have sterilization, she usually has her family planning done. Most women who undergo sterilization already have two or more children. Nevertheless, later, for example in a new partnership, the desire to have children can arise again. With an operation, fertility can in principle be restored (refertilization). However, whether the woman will actually become pregnant after this depends, among other things, on her age and the fertility of her partner.

Course of the operation

During sterilization, both fallopian tubes, through which the egg cells get from the ovary to the uterus, are severed or partially electrically obliterated. During re-fertilization, the separated ends of the fallopian tubes are reconnected. If the procedure is successful, the fallopian tubes are open again.

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

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

Refertilization is a relatively complicated operation. It is only performed in special centers by surgeons who have extensive experience with the operation.

Possible complications

Like any surgery, re-fertilization involves certain risks. These include infections, disorders of wound healing, injuries to other organs or thrombosis. General anesthesia puts you at risk of cardiovascular problems. If you have certain problems, such as bleeding, you may need to have another operation. The procedure can cause adhesions and scars to form in the abdomen. Compared to women without surgery on the fallopian tube, women have a significantly higher risk of an ectopic pregnancy after refertilization.

Costs are usually not covered

Sterilization used to be a fairly common method of contraception. This has changed since the health insurance companies only cover the costs for the procedure in exceptional cases. Refertilization after sterilization also generally has to be paid for privately. Depending on the method, the procedure costs 2,000 to 4,500 euros. The amount not only includes the costs for the operation itself, but also for the consultation, anesthesia, hospitalization and medical follow-up care.

There are also travel costs if there is no clinic near your home that specializes in the procedure. Pregnancy counseling centers, for example, know where to find a suitable hospital.

The statutory health insurance companies only cover the costs of re-fertilization under certain conditions: for example, if sterilization was classified as medically necessary at the time (e.g. because of a hereditary disease), but there are better treatment options today. The health insurance companies also pay for the procedure if the cause of the impermeable fallopian tube is not sterilization but, for example, inflammation or an adhesion caused by endometriosis.

Chances of success

The information on how many women become pregnant after an undone sterilization varies between 30 and 70 percent. The abdominal incision with microsurgery seems to be a little more promising than a laparoscopy. Whether and how quickly an operated woman becomes pregnant does not only depend on whether her fallopian tubes are permeable again. It therefore makes sense that both partners have their fertility checked before the operation.

Alternative: artificial insemination

A sterilized woman can also become pregnant through artificial insemination. In this process, previously removed egg cells from the woman outside the body are brought together with the sperm cells of her partner in the laboratory. One or two fertilized egg cells are then inserted into the uterus.

There are no meaningful studies on whether re-fertilization is more successful than artificial insemination. Both methods have advantages and disadvantages. After a successful operation, several pregnancies are possible naturally. However, if the fertility of one or both partners is disturbed for other reasons, artificial insemination is more successful than re-fertilization. On the other hand, artificial insemination is very expensive. If it does not succeed, it can become a great physical and emotional burden.

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