tubal reversal surgery vs. IVF: Which is the best option

Should I Do Tubal Reversal Surgery or IVF?

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There are a number of excellent reasons a woman with a previous tubal ligation may desire a tubal reversal surgery rather than undergoing IVF.  In the case of a patient desiring more than one child, tubal reversal is often more cost-effective (review our tubal reversal surgery money back guarantee). 

Another common reason is many patients prefer to conceive “naturally” rather than requiring the increased cost and complexity of IVF.  Increased incidence of multiple births (twins, etc.) is easily avoided by choosing tubal reversal.  There are also consent forms for IVF detailing the potential risks involved with medications and procedures involved.

A key issue for high-quality patient care is to counsel patients appropriately about who is a good candidate for tubal reversal surgery, as compared to IVF, and be able to give informed recommendations.  Keep in mind the saying, “If all you have is a hammer every problem looks like a nail.”  If your practitioner only offers tubal reversal surgery then you may not get the most informed and objective perspective.  In some cases IVF would be more likely to result in pregnancy.

Most tubal reversal surgeries performed at The East Coast Tubal Reversal Center result in the opening of both fallopian tubes.  So why don’t nearly all women with tubal reversal surgery become pregnant?  Several things relating to the original tubal ligation procedure affect the chance for pregnancy after reversal of sterilization. 

In most cases we need your BMI to be below the “obese” range- which is less than 30. Please use the BMI calculator link to put in your height and weight to determine your BMI. If your BMI is above 30 you usually need to lose weight before you are a candidate for our minilaparotomy outpatient surgery approach for tubal ligation reversal. There are circumstances where a woman distributes her fat mostly in hips, thighs or chest and not in the belly. If you have a BMI above 30 but don’t have a significant fat in your belly we’ll ask you email us a picture in a bathing suit or bra and underwear from front and side so we can get a better idea if you are a candidate prior to weight loss.

You can calculate your BMI using this BMI calculator.

The most important factor predicting success is the remaining length of the fallopian tubes.  The fallopian tubes are normally 4-5 inches in length.  If the tubal ligation procedure shortens the tubes to less than approximately 2 inches (4 cm) the chance for pregnancy is very low.  The pathology report from your tubal ligation would properly inform us of the amount of tube that was removed.  We can usually predict the length of remaining fallopian tube from the surgical description of the tubal ligation operation-the "operative note" in cases where a portion of the tube was not removed. 

There are at least a dozen ways to “tie tubes.”  Most do not damage the tubes to an extent that cannot be repaired.  Some methods such as an “interrupted 3-burn technique” do not leave enough tube for repair.  Another method call a fimbriectomy is a very poor candidate for repair and it would be more cost effective to do IVF instead. 

Another factor affecting success is length of time since the tubal ligation was performed.  If more than 10 years has passed the chance for pregnancy is reduced. Finally, if the tubal ligation was performed using the hysteroscopic technique called “Essure” then tubal reversal is probably not possible.  The Essure coils become embedded deep in the tube and generally cannot be removed.  Although resection of the tube containing the Essure coil is possible, the success is much lower than usual and IVF is recommended.

Maternal age is also an important influence on fertility.  We perform blood tests and an ultrasound to estimate a woman’s fertility potential if she is over 35 years old.  Lastly, fertility of the male partner is also obviously very important and a preoperative semen analysis is strongly recommended.  If your partner’s sperm count is quite low (and cannot be improved) then IVF will be a much better choice. 

Tubal reversal surgery has a higher risk of ectopic pregnancy (pregnancy in the tube instead of the uterus), occurring about 1 in 10 times.  Keep in mind also that tubal patency after surgery (the tubes being open after surgery) does not mean you can become pregnant.  The fallopian tubes are complex organs with a muscular layer and an inner mucosal layer lined with cilia.  The muscular contractions and coordinated movements of the cilia are required for a fertilized egg to be pushed down the tube to implant in the uterus.  Because a segment of tube was damaged during the tubal ligation the tube may not have completely normal function despite being reopened with tubal reversal surgery.

In most cases, intrauterine pregnancy rate after tubal reanastomosis is 50-75%.  The fallopian tubes heal quickly following reversal of sterilization and pregnancy may occur within two or three months.  If there is a conception there is a 10-15% chance of a tubal pregnancy.  As long as an ectopic pregnancy is caught early by ultrasound and/or blood testing the risk for serious consequences is low.