Many women consult a reproductive endocrinologist on how to get pregnant after tying or blocking their fallopian tubes.
Tubal sterilization is one of the most common methods of contraception-prevention of pregnancy in the US and world wide.
It generally entails blocking the fallopian tubes to prevent meeting of the egg with sperm.
Blocking the fallopian tubes can be accomplished using one of two methods 1.
Interruption of the tubes from outside where each tube is tied and a piece of each tube is excised.
This is done about one inch away from the uterus through laparoscopy or open abdominal procedure or 2.
Interruption of the tubes from inside where a device is placed in the lumen of the tube.
The device will induce scarring that will block the tube.
The device is placed at the junction of the uterus and the fallopian tube via a hysteroscope introduced into the uterus through the vagina with no incisions.
The most common complication after tubal sterilization is regret.
Many women seek pregnancy after interruption of the fallopian tubes, usually after starting a relationship with a new partner.
Irrespective of the interruption method a reproductive endocrinologist would need to figure out the following clinical information

1. Ovarian reserve-estimate of the number of egg remaining in the ovaries.
   Women desiring pregnancy after sterilization are commonly older and may have good or low ovarian reserve.
   This is explored through blood tests as cycle day 3 FSH, LH and estradiol and another tests called AMH.
   Moreover, a vaginal ultrasound can visualize the ovary to determine the number of small follicles within the ovary-antral follicle count.
   
2. Male factor.
   A semen analysis is ordered to determine the volume of ejaculate and the number, movement and shape of sperm.
   
3. Status of the fallopian tube.
   This is ascertained from the prior operative report.
   Sometimes a dye test of the fallopian tube and the uterus-HSG, can visualize the length of the proximal part of the tubes or the position of the device used to interrupt them.
   
4. The uterus.
   The cavity of the uterus can be visualized during the dye test or through injection of a small amount of fluid inside the uterus during vaginal ultrasound-saline sonography.
   
5. Pre-conception tests for both partners to determine the safety of pregnancy

When all these information are available, the status of couple fertility can be identified and further treatment options can be recommended.
How to get pregnant after tubal sterilization? The method used to block the fallopian tubes as well as other fertility factors will determine the best path to fertility treatment and pregnancy.
Women who had their tubes tied.
Two options are available; either tubal anastomosis-connecting the two cut ends of the tube or bypassing the tubes through IVF- in vitro fertilization.
Not all tubes are suitable for re-connecting.
Anastomosis is possible in women that have adequate length remaining and when the initial interruption was done close to the uterus rather than far out.
Its also more successful if the tubes were not burnt.
Even after surgery the tubes my re-obstruct few months later or may remain patent but narrower, increasing the chance for ectopic pregnancy.
In women with other infertility factors as lower ovarian reserve, male factor infertility, or when the tubes are not suitable for anatomosis, IVF carries a much higher chance for conceiving.
On the other hand, younger women with no other infertility factors with tubes judged to be suitable for anastomosis can consider this surgical procedure and may achieve a pregnancy rate of approximately 60% in the two years after the procedure.
These women should expect a pregnancy 40 to 50% after each IVF cycle depending on their age, while keeping their tubes tied for long term contraception.
One more issue to consider is that anastomosis requires surgery, mainly through open incision.
Few surgeons can connect the fallopian tube using laparoscopy or minimally access surgery.
Women who had their tubes blocked from inside using a device.
These devices where approved by FDA and intended for permanent sterilization.
The device is placed at the junction of the uterus and the tubes.
Removal of the device is difficult as it cannot be pulled out due to scarring.
Removal requires surgical excision of the device and part of the wall of the uterus with reconnecting the tubes to the uterus.
All that is very unlikely to succeed in achieving a pregnancy.
Thus the available practical option to leave the devices in place and perform IVF.
There is a concern that the tail end of the device that protrudes into the uterine cavity after placement may affect IVF success of my affect the pregnancy sac.
Few case reports of IVF with the device in place showed that the device is unlikely to affect the success of IVF or cause problems for the developing pregnancy sac.
Women desiring pregnancy after tubal sterilization require evaluation of both the status of both fallopian tubes as well as other fertility factors so that the correct recommendation regarding future fertility are made.
Women with normal ovarian reserve and no other fertility factors can consider reversal of sterilization if the tubes are anatomically suitable.
Women who had a tubal device placed should not consider surgery and are advised by reproductive endocrinologists to proceed to IVF.