The tubal ligation reversal process begins with a comprehensive evaluation to determine if a woman is a good candidate for the procedure. This evaluation includes a review of the woman's medical history, details of the original tubal ligation procedure (if records are available), and an assessment of her current fertility through blood tests (such as FSH and AMH levels) and a pelvic exam. In some cases, a hysterosalpingogram (HSG) may be performed to assess the length and health of the remaining segments of the fallopian tubes.

The tubal ligation reversal surgery can be performed using different techniques, including open surgery or minimally invasive surgery (laparoscopy or robotic surgery). The technique used depends on the surgeon's expertise and preference, as well as individual factors such as the extent of the tubal ligation and the condition of the tubes.

In open surgery, a larger incision is made in the abdomen to access the fallopian tubes. The surgeon identifies the blocked or damaged portions of the tubes, removes them, and then reconnects the remaining ends using fine surgical sutures.

In minimally invasive surgery, several small incisions are made in the abdomen. A laparoscope (a thin tube with a camera) and small surgical instruments are inserted through these incisions. The surgeon ¹ uses the video screen to guide the instruments and perform the same process of reconnecting the tubes as in open surgery. Minimally invasive surgery often results in a shorter recovery period, less pain, and less scarring. 

After the tubes are reconnected, they are often tested during the surgery by injecting a blue dye into the uterus and observing its passage through the tubes to ensure the connection is patent (open) and there are no blockages.

The chances of pregnancy after a tubal ligation reversal depend on several factors, including the length of the remaining fallopian tubes after reconnection, whether there is any damage to the tubes from the original surgery or other factors, the woman's age (as natural fertility declines with age), and other fertility factors in both the woman and her partner.

Some women who undergo tubal ligation reversal and have other risk factors for infertility or who do not conceive within a certain timeframe after surgery may be advised to consider other fertility treatment options such as in vitro fertilization (IVF). IVF bypasses the fallopian tubes by fertilizing eggs with sperm outside the body and then transferring the resulting embryos directly into the uterus.