Two routes, and they work differently

Female sterilisation, often called tubal ligation or having your tubes tied, closes or blocks the fallopian tubes so that egg and sperm cannot meet. Ovulation continues as before, and so do periods. Nothing about your egg supply has changed.

That leaves two ways forward if you want to conceive. Either the tubes are surgically repaired so that natural conception becomes possible again, or the tubes are bypassed altogether by IVF, in which eggs are collected directly from the ovaries and the resulting embryo is transferred into the uterus. These are not two versions of the same treatment, and the better choice depends on details that are specific to you.

Reversal: what it involves and what it depends on

The HFEA describes the situation where reversal is realistic: if there is only slight scarring or a potentially reversible blockage — for example where you have previously had a sterilisation procedure — and the clinic has the expertise, surgery may be offered. Where clips were used to close the tubes, it may be possible to reverse this, usually through an open abdominal operation in which the clips are removed and the tubes carefully repaired using an operating microscope.

Two conditions in that description do a lot of work. The first is the method used at your original operation: clips generally damage a shorter segment of tube than methods that cut or remove a length of it, which affects whether there is enough healthy tube left to rejoin. If you do not know which method was used, your operation record will, and it is worth obtaining before any consultation.

The second is expertise. This is microsurgery and it is not available everywhere. NICE makes the same point about tubal surgery generally, recommending that it be considered for mild tubal disease in centres where appropriate expertise is available.

The advantage of a successful reversal is that conception can then happen at home, repeatedly, without further treatment. The disadvantages are that it is abdominal surgery, the result is uncertain, and it costs months before you know.

IVF: bypassing the tubes

IVF does not require the tubes to work at all, which is exactly why it is offered here. NICE defines a full cycle as one episode of ovarian stimulation and the transfer of any resulting fresh and frozen embryos, so a single stimulation may give more than one attempt.

The factors that matter most for IVF are age and ovarian reserve rather than tubal anatomy. NICE recommends taking ovarian reserve into account when discussing IVF, and using AMH measurement or antral follicle count as predictors of ovarian response to inform counselling about the likelihood of live birth after assisted conception. It separately advises against using AMH to predict the chance of conceiving naturally, and against using FSH as a predictor of ovarian response — a distinction worth holding on to if you are offered a private hormone panel.

One situation makes IVF clearly preferable: if a tube is blocked at its outer end and distended with fluid, NICE recommends offering laparoscopic salpingectomy or tubal occlusion before IVF, because leaving it in place reduces the chance of success.

What should decide it

Your age and ovarian reserve. Reversal spends time; IVF spends money. If time is the scarcer resource, that points one way.
The sterilisation method and how much healthy tube remains.
Whether there are other fertility factors. A semen analysis for a male partner is a single non-invasive test that can change the entire plan, and NICE Clinical Knowledge Summaries put male factors at around 30% of couples.
How many children you hope for. A working tube can be used repeatedly.
Access and funding. Discussed below, and it is often the deciding factor in practice.

Ectopic pregnancy: the risk to plan for

A repaired tube does not work quite as it did. The HFEA advises that people with tubal damage try naturally for up to six months after surgery, that there is a higher risk of ectopic pregnancy, and that a scan at around six weeks is needed if you conceive, to confirm the pregnancy is correctly sited in the uterus.

Arrange that in advance rather than at the time. If you conceive after tubal surgery and develop severe one-sided tummy pain, pain at the tip of the shoulder, or bleeding with faintness or dizziness, seek emergency help immediately — the NHS advises calling 999 for these combinations in early pregnancy.

Funding, and an exclusion that surprises people

Previous sterilisation is a common exclusion from publicly funded fertility treatment. Ireland's HSE states it directly in its access criteria for free IUI, IVF and ICSI: you must never have had a sterilisation procedure to prevent pregnancy, including blocking or sealing the fallopian tubes, or a vasectomy.

In England, funding decisions are made locally by Integrated Care Boards, with NICE recommendations acting as guidance rather than entitlement, and previous sterilisation is frequently excluded in local policies. Reversal surgery is generally not NHS-funded. Ask for the written policy where you live before building a plan around either option.

A note on how this is often framed

Changing your mind about sterilisation is common, and it is not a character flaw. Circumstances change — new relationships, bereavement, or simply a different life than the one you were planning for. You may encounter clinicians or funding policies that treat the earlier decision as disqualifying. That is a rationing position, not a clinical fact, and it says nothing about whether treatment would work for you.

Getting Pregnant After Tubal Ligation: Reversal or IVF