Tubal Ligation Reversal vs. In Vitro Fertilization (IVF)
In patients with a prior tubal ligation the decision regarding whether to undergo surgery for reversal of the tubal ligation (‘reconnecting the fallopian tubes ends’) or undergo IVF (where fertilization occurs in an incubator and the embryos are then placed directly into the uterus), should take into consideration the pros and cons of each treatment option for that individual couple.
Open abdominal surgery
Traditionally, the procedure for tubal ligation reversal has been done by open abdominal surgery which requires general anesthesia and a hospital admission overnight, although in some cases can be done as an outpatient procedure.
When considering the reversal procedure, the most important factor to estimate the chances of success in achieving a live birth after the reversal is the age of the patient. Because age remains the most important factor that predicts a live birth, highest success rates are expected in women younger than 37. After that age, success rates are similar after tubal reversal or after IVF.
In addition, the success of tubal reversal depends on the length of the remaining fallopian tube (which often can only be established at the time of the surgical procedure), on the technique that was initially used for the tubal ligation, and the scar tissue that is found at the time of the attempted repair. It is important to assess other factors of infertility, such as the semen analysis, because having fathered pregnancies in the past is not necessarily a guarantee that the quantity and quality of the sperm is appropriate for spontaneous conception at the present time. As an example, if the sperm count is too low, IVF with ICSI will likely be necessary.
Risks of having an ectopic pregnancy (pregnancy implanted in the fallopian tube) are usually considered higher after tubal ligation reversal than after IVF (2-10% after tubal reversal vs 2% after IVF). This is because despite a successful reversal of the tubal ligation, scar tissue might affect tubal function.
Advantages of IVF
Advantages of IVF include that it does not require surgery and, depending on ovarian response, it usually allows for the cryopreservation of surplus embryos for multiple attempts if desired.
Advantages of Tubal Reversal
Advantages of tubal reversal are that if successful, it is a one-time procedure and the couple can attempt to conceive on their own multiple times.
Financial considerations vary for every case, as insurance benefits vary according to the patient’s individual plan. Couples should discuss with their doctor the pros and cons of each procedure to make sure they decide what is right for them.
Role of tubal surgery in the era of assisted reproductive technology, Practice Committee of the American Society of Reproductive Medicine (ASRM)