You had the surgery. You checked it off the list. For most people, getting your tubes tied—medically known as tubal ligation—is the "one and done" solution to birth control. It feels final. It feels like a closed door. But bodies are weirdly resilient, and sometimes they don't follow the plan. Can you get pregnant with tubal ligation? Yes. It’s rare, but it happens. Honestly, the stats might surprise you because we often talk about sterilization as if it’s 100% foolproof. It isn’t.
Life doesn't always play by the rules of medical textbooks.
While the failure rate is low, it’s not zero. We’re talking about a procedure where a surgeon cuts, ties, seals, or clips the fallopian tubes to prevent the egg and sperm from ever meeting. It's a mechanical roadblock. But human biology is aggressive about reproduction. Sometimes the body finds a way to bypass the roadblock, or the roadblock itself wasn't built quite right.
Why the "Permanent" Fix Isn't Always Permanent
Most people think of tubal ligation failure as a mistake made in the operating room. That's usually not the case. Surgeons are generally very good at what they do. Instead, the failure often comes down to the way the body heals. Over time, the fallopian tubes can undergo something called recanalization.
Basically, the two severed ends of the tube grow back together. It sounds like a sci-fi movie, but your body is programmed to repair itself. If a tiny microscopic channel forms between those two ends, sperm can swim through. You’ve now got a path for pregnancy despite the surgery.
Then there’s the "luteal pregnancy" factor. This is a bit of a fluke of timing. If you were already pregnant—literally by a few days—when you went in for the surgery, the procedure won't stop that pregnancy. The egg has already passed the point where the tube was tied.
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The CREST Study and the Hard Numbers
If you want the real data, look at the U.S. Collaborative Review of Sterilization (CREST) study. It’s the gold standard for this stuff. They followed thousands of women over a decade. What they found was that the risk of pregnancy after tubal ligation varies wildly depending on how the tubes were blocked and how old the patient was at the time of the procedure.
For instance, women sterilized at a younger age (under 30) actually had a higher cumulative failure rate compared to older women. Over 10 years, the failure rate for some methods was as high as 1.8% to 1.9%. That’s nearly 2 out of every 100 people. It’s not a huge number, but if you’re one of those two people, it’s 100% of a surprise.
The method matters too:
- Bipolar coagulation (using electric current to sear the tubes) had different success rates depending on how much of the tube was damaged.
- Spring clips (like the Hulka clip) had a slightly higher failure rate in some studies because they rely on mechanical pressure that can occasionally shift or not fully occlude the lumen.
- Postpartum partial salpingectomy (taking a piece of the tube out right after giving birth) is often considered one of the more reliable versions.
The Ectopic Risk: A Serious Warning
When we talk about the possibility of can you get pregnant with tubal ligation, we have to talk about ectopic pregnancies. This is the scary part.
Normally, an egg is fertilized in the tube and travels to the uterus. If your tubes are tied and you still manage to get pregnant, there is a very high chance the embryo gets stuck in the scarred or partially blocked tube. This is an ectopic pregnancy. It cannot survive outside the uterus, and more importantly, it can cause the fallopian tube to burst.
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Internal bleeding. Shock. Life-threatening stuff.
If you have had a tubal ligation and you suddenly feel sharp, stabbing pelvic pain or have weird spotting, you cannot ignore it. You might think, "Oh, it's just a cyst" or "I can't be pregnant, my tubes are tied." That line of thinking is dangerous. Doctors will tell you that a positive pregnancy test after sterilization is an absolute medical emergency until proven otherwise by an ultrasound.
Spotting the Signs When You Think You’re "Safe"
Most people who've had their tubes tied stop tracking their cycles. They stop worrying about late periods. But if you’re wondering about the symptoms of pregnancy after the procedure, they’re pretty much the same as a standard pregnancy, at least initially.
- The missed period. Simple, yet easy to dismiss as stress or "early menopause" depending on your age.
- Nausea. That morning sickness vibe doesn't care if your tubes are tied.
- Breast tenderness. Your hormones are reacting to the HCG (human chorionic gonadotropin) regardless of the surgical barrier.
- Unusual fatigue. If you’re feeling these things, go buy a cheap drugstore test. It’s better to know. Honestly, the mental load of wondering is worse than the $10 for a plastic stick.
Can the Procedure Just... Fail Immediately?
Not usually. "Technical failure" happens, sure. Maybe the surgeon clipped a ligament by mistake instead of the tube. It’s rare, but humans make mistakes. However, most failures happen years later. The tissue thins out, a fistula (a tiny hole) forms, or the clips migrate.
It’s also worth noting that some modern surgeons are moving away from "tying" and toward bilateral salpingectomy. This is the total removal of the fallopian tubes. You can’t grow back a tube that isn't there. If you’re currently weighing your options, asking for a full removal instead of a ligation is often more effective and has the added benefit of significantly reducing ovarian cancer risk, since many of those cancers actually start in the tubes.
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What Happens if the Test is Positive?
First, breathe. Second, call your OB/GYN immediately. You need an ultrasound.
If the pregnancy is viable and in the uterus—which does happen—you have the same choices anyone else has. Some people choose to continue the pregnancy. Others choose termination. It’s a deeply personal crossroad, made more complicated by the fact that you already took permanent steps to avoid this exact scenario.
If it’s ectopic, you’ll likely need medication like methotrexate to dissolve the pregnancy or surgery to remove the affected tube.
Actionable Steps for Peace of Mind
If you are reading this because you’re worried you might be the exception to the rule, here is what you should actually do:
- Take a pregnancy test now. Don't wait for "better symptoms." If you have enough HCG to cause symptoms, you have enough to turn a test positive.
- Check your surgical records. If you can, find out exactly which method was used. Was it clips? Banding? Cauterization? Knowing this helps your doctor understand your specific risk profile.
- Monitor for unilateral pain. If you have pain specifically on one side of your lower abdomen, that is a massive red flag for an ectopic pregnancy.
- Consider a "belt and suspenders" approach. If you are absolutely, 100% terrified of pregnancy and you haven't had the surgery yet, talk to your partner about a vasectomy. A vasectomy plus a tubal ligation makes the odds of pregnancy almost statistically impossible.
- Discuss Salpingectomy. If you are scheduled for a tubal ligation soon, ask your surgeon if they perform bilateral salpingectomy (full removal) instead of just "tying" them. It is the gold standard for modern sterilization.
The reality is that tubal ligation is incredibly effective. It's more effective than the pill, the patch, or condoms. But it is a medical procedure performed on a living, healing, changing body. Understanding that "permanent" has a tiny asterisk next to it is just part of being an informed patient. Stay aware of your body, don't ignore weird pains, and remember that even the best surgical barriers sometimes fall to the sheer persistence of biology.