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Tubal Reversal vs. IVF?

Many women who have had a tubal ligation, commonly referred to as “having your tubes tied,” find themselves wanting another child due to life changes. But can a woman get pregnant if she’s had a procedure that is considered a permanent form of birth control? Yes, and talking to a reproductive endocrinologist is the first step in determining all of the options.

Dr. Jason Bromer, of Shady Grove Fertility’s Frederick office, says, “women with tubal ligations are some of our most successful patients because we know that they have been fertile before. There are two ways pregnancy can be achieved after tubal ligation. Traditionally, the only option for patients was through a surgery called a tubal reversal. However, there is now another option for women with In Vitro Fertilization, or IVF.”

In almost every case, IVF is the better option because it gives patients the highest chance of pregnancy in the shortest amount of time, and avoids a significant surgical procedure.

Tubal Reversal Surgery

Tubal ligation can be performed in a number of different ways but the result is always the same – an interruption of thefallopian tubes that prevents pregnancy. “The most common method of tubal ligation is the surgical removal of the middle section of the tubes,” says Dr. Bromer. “So the goal in a tubal reversal surgery is to reconnect the tubes to make them open all the way through.”

The latest methods for performing a tubal reversal surgery require only one day for the procedure and seven days of light bed-rest following it. About three months after the surgery, patients have a Hysterosalpingogram (HSG) to check the status of the tubes. An HSG is a diagnostic test using x-ray technology to show the flow of dye through the uterus and fallopian tubes into the uterine cavity. It shows if there are any blockages remaining in the tubes that might prevent pregnancy.

Tubal Reversal Success and Increased Risks

Whether or not tubal reversal surgery can be successfully performed depends on two factors. “Is there enough healthy tissue on each end of the tube to be reconnected,” explains Dr. Bromer, “and is the reconnected tube long enough to function properly? Unfortunately, not all patients have tubes that can be reconnected.”

“Sometimes even when reattaching the tubes is successful, there can be scarring of the tissue that interrupts the flow of the tube,” says Dr. Bromer. “This happens in about 20% of the cases.” If, however, the HSG confirms that the tubes are open, then the patient can begin trying to get pregnant on her next cycle.

There is also an increased risk for ectopic pregnancy after tubal reversal surgery.
“One risk with tubal reversals is that there is a 10-20% chance of having an ectopic pregnancy after tubal reversal surgery,” says Dr. Bromer. Ectopic pregnancy occurs when a fertilized egg gets stuck in the fallopian tubes and implants there. Ectopic pregnancies must be terminated with medications or surgery to avoid a rupture of the fallopian tube, which can be life-threatening.

Since the tubes cannot always be reconnected, the success rate for achieving pregnancy after a tubal reversal is around 40% for women under 37.

IVF and Success Rates

Another popular option for women trying to get pregnant after a tubal ligation is In Vitro Fertilization or IVF. IVF is a process by which an egg is fertilized in the lab and then transferred to a woman’s uterus. This allows for pregnancy to occur by completely bypassing the fallopian tubes.

Any woman who has a good ovarian reserve or has previously attempted a tubal reversal unsuccessfully would be a good candidate for IVF treatment. Dr. Bromer adds, “Even couples with fertility challenges other than the tubal ligation, such as advanced age or male factor infertility, can be helped by IVF.”

An IVF cycle takes about two months to complete. After the evaluation and hormone suppression phase of the cycle, patients are prescribed injectable hormones that stimulate egg maturation. During this 10-12 day stimulation period, the patient is seen frequently for ultrasound and bloodwork to monitor the growth of egg containing follicles and the levels of hormones.

At the end of this period, an egg retrieval procedure is performed. The eggs are fertilized with the partner’s sperm and grown to three or five day embryos. Then, one or more embryos are transferred to the woman’s uterus. Two weeks later, a blood pregnancy test reveals the results.

The success rate for achieving pregnancy with IVF frequently exceeds that of a tubal ligation. At Shady Grove Fertility, IVF has a 50-60% success rate for women under 38, even when only one embryo is transferred.

View Shady Grove Fertility’s IVF Success Rates

Time to Pregnancy

It takes about three months after a tubal reversal surgery to confirm that the surgery was a success. Once the tubes are shown to be clear by the HSG test, the average time to pregnancy, from start to finish, is two years.

“The fact that it can take up to two years to become pregnant after tubal reversal surgery is really off-putting to a lot of my patients,” says Dr. Bromer. “Most of them are anxious to get pregnant sooner, often because they are older when they start the process.”

“One of the best things about IVF is that the time to pregnancy is so much shorter,” says Dr. Bromer. A cycle of IVF takes only about two months to complete. Some women require multiple rounds of IVF to achieve pregnancy, but even with difficult cases, treatment is usually completed within a year.

Age

Age is a key factor in the decision between IVF and tubal reversal surgery. As a woman ages, the number and quality of her eggs decline, making it harder to get pregnant. As early as 30 years old, a woman’s chances of getting pregnant each month start to go down.

Since many women who want to get pregnant after tubal ligation are in their thirties, there is a chance that even with a successful tubal reversal surgery, they won’t become pregnant, as the 2 year time to achieve pregnancy becomes even more significant. In this case, it is likely that IVF would be recommended. To avoid having to do surgery and IVF, it is recommended that these women choose IVF as the first line of treatment.

“For women over 37, I wouldn’t even consider tubal reversal surgery,” says Dr. Bromer. “In this age group, where declining fertility is coupled with a higher risk of ectopic pregnancy, IVF is clearly a safer option with better chances of success.”

Cost

Tubal reversal surgery and one cycle of IVF cost about the same amount, between ten and fifteen thousand dollars. Tubal reversal surgery is almost never covered by insurance.

Shady Grove Fertility has several innovative financial programs that reduce the cost and financial risk associated with treatment. These programs include a Shared Risk 100% Refund Plan, Multi-Cycle Discount Program, Shared Help Fertility Treatment Discount Program and options for grants and loans for fertility treatment.

The most popular program is the Shared Risk 100% Refund Plan. This plan entitles the patient to up to six rounds of IVF and the related frozen embryo cycles. If the patient does not take a baby home, 100% of the fee is refunded.

“With the Shared Risk program and the success rates being so high at Shady Grove Fertility,” says Dr. Bromer, “IVF is almost always the more cost-effective option.”

Male Partner’s Fertility

One more factor that can tip the scales is the male side of the equation. Having a sperm analysis completed for the male partner is a critical step in making the decision about whether to use IVF or tubal reversal surgery. “If the male partner of the couple has a low sperm count for example,” explains Dr. Bromer, “then even a successful tubal reversal surgery is not likely to result in pregnancy.”

IVF, however, can be performed with special techniques that work around the male factor issues. ICSI, for example, is a process in which a single healthy sperm is injected into the center of each egg resulting in normal rates of fertilization even in men with severely abnormal sperm counts.

The Prognosis is Good

Dr. Bromer says the key to this decision is a thorough evaluation and a discussion of the patient’s goals. “I suggest that couples come in and bring all the paperwork about their tubal ligation surgery,” he says. “We will do some basic fertility testing on both partners and go from there – but the first step is making an appointment.”

For some women, the answer will be tubal reversal surgery. “The ideal candidate for tubal reversal surgery is a woman under 35, who wants multiple additional children and who had a well-performed tubal ligation.” Dr. Bromer says.

“The majority of my patients, however, have had multiple children, but later divorced and remarried. They are usually over 35 by the time they come in and want to have only one more child with their new spouse. For these women, IVF is nearly always a much better option.”

Either way, the prognosis is good. With a little expert guidance, women with tubal ligations can be back to changing diapers in no time.

 

For more information or to schedule an appointment with one of our physicians, please speak with one of our friendly New Patient Liaisons by calling 888-761-1967.

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14 Comments

  1. Keya Jackson

    January 22, 2016 - 1:05 am
    Reply

    Four years ago my husband and I had our third daughter by CSection and subsequently had my tubes tied. We would now like to consider IVF to add a baby boy to our family. I am 38 and my husband is 41.

    • lucy

      February 5, 2016 - 5:39 pm
      Reply

      I would love to have a baby boy now two but im 40 and my husband is 34 and he is asking me to have a baby for about 2 years now

  2. Alejandra Helmer

    March 2, 2016 - 7:47 am
    Reply

    I had my tubes cut 2 inches after having my 4 child. After 14 years of marriage I’m divorce and have someone new in my life he treats my children like his own. But would love to have another child reverse tubal is to much for me but ivf I was wondering if that would work for us and how much it would cost.

  3. chenelle jemison

    June 27, 2016 - 9:19 pm
    Reply

    Wanted to know how much it cost to have this surger. I had my tubes tied in 2004 and now I want another child. It cost so much to get my tubes untied

  4. Ashley Morgam

    August 17, 2016 - 8:41 am
    Reply

    The costs of getting tubal ligation reversed with the help of this surgery range between $5000 to $8000 I guess. It is good that we are learning the benefits of the tubal reversal surgery and additionally, the success rate is also encouraging. I still remember, at one stage doctors only used to suggest IVF as the only option.

  5. Crystal Kuechenmeister

    September 12, 2016 - 1:59 am
    Reply

    I am on my second marriage have had a tubal ligation almost 11 years ago, I am in my mid 30’s and wondering which option would be best for me!

  6. Crystal Wells

    October 26, 2016 - 8:46 am
    Reply

    I am in a relationship with a man I plan to marry. He has no children to my six.. I love him and would love to give him a child of his very own. Most concerned about price.

    • Brenda

      February 9, 2017 - 5:58 am
      Reply

      Check to see if your insurance would cover it mine did even after having insurance we still paid $2000 out of pocket to meet my insurance out of pocket exspense on top of the $15,000 My insurance covered it’s very expensive especially if you don’t have insurance… it is well worth it and I’m glad I done it & don’t have to worry about getting pregnant again after I deliver,Great experience and worth every dime to be able to share a child with someone you love.

      • Mary

        April 2, 2017 - 9:27 pm
        Reply

        Where did you get it done?

      • Victoria

        April 6, 2017 - 3:18 am
        Reply

        What type of insurance did you have that paid? I’m 37/38 and my dr. Tied my tubes right before a twin c-section surrogacy. She didn’t believe in it and within minutes of the surgery she had me sign this paper and I woke with a tubal ligation.

  7. Jessica

    March 27, 2017 - 2:01 am
    Reply

    Ivf how much is it?

  8. zodwa

    April 25, 2017 - 9:09 am
    Reply

    I want another baby but my tube are tied please help

  9. Joanna

    May 22, 2017 - 2:47 am
    Reply

    I am 40 I have 3 kids An had my tubes tied now remarried to a wonderful man who is a great father to my 3 kids An he has no children of his own an I would love to add just one more given him the greatest gift what is the cost of I’ve

  10. Shelley Lombrano

    June 16, 2017 - 4:42 am
    Reply

    Thinking of a boy strongly after tubal ligation but over 41 and hubs is 49 with two older. We have two girls 2 &. 5

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