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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.

Have more Questions? Contact us today!

33 Comments

  1. Kimberly Boehm

    September 8, 2018 - 7:51 pm
    Reply

    So I’m 36. I have 3 children. My oldest is 20, she is in the army, and I have 2 boys 17,& 13. I really miss having a baby around. I’m wondering what I have to do to qualify for the Ivf? Me and my boyfriend have been together for 12 years and we really want a baby. We come from poor family’s. Anyway I was just wondering what the chances are for a couple who doesn’t have much but has lots of love for children. Thanks

    • Shady Grove Fertility

      September 24, 2018 - 4:04 pm
      Reply

      Hi Kim, your age still makes you a candidate for ivf. We accept many insurances and have different financial programs. If you would like to learn more, please call 1-888-761-1967.

  2. Mary

    August 16, 2018 - 3:48 pm
    Reply

    I have been married for 14 years. I have two children and had my tubes removed in 2008. I am now wanting another child, but my husband is not 100% on board yet. Can this process be started without him?

    • Shady Grove Fertility

      September 24, 2018 - 4:31 pm
      Reply

      Hi Mary, you can start the process of consulting with physicians on what your treatment plan would be, but you husband would have to consent to his sperm or donor sperm to be used later on down the road. If you have any other questions or are looking for more information on tubal reversal, please call 1-888-761-1967.

  3. Shaleena

    August 3, 2018 - 4:50 pm
    Reply

    Hi my name is shaleena I and 25 almost 26. My girlfriend and I would like to have a child but my tubes have been tied for a year, what steps can I Take to getting pregnant?

    • Shady Grove Fertility

      August 6, 2018 - 1:36 pm
      Reply

      Hi Shaleena, we offer different treatment options for you and your girlfriend to start a family. Read more about them here or call 1-888-761-1967 for more information about our different LGBTQ treatment options.

    • Melanie Ioramo

      October 18, 2018 - 11:40 am
      Reply

      Hi! My name is Melanie, I am 40 years old, I have 5 children. My eldest daughter is 21 and my youngest is 12 years old. I had my first 2 given birth naturally and my other 3 kids c-section.When I had my 3rd c-section I also had my tubes tied,that was back in 2006. But I remarried and my husband and I really want a baby of our own.Is there any chance at all for us?

      • Shady Grove Fertility

        October 24, 2018 - 3:31 pm
        Reply

        Hi Melanie,
        You are still able to get pregnant with fertility treatment. If you would like to learn more about how, please call 1-888-761-1967.

  4. Jerry

    July 9, 2018 - 9:18 pm
    Reply

    I have had a vasectomy and my fiance has tubes tied from prior marriages. We want a baby together is it possible

    • Shady Grove Fertility

      August 3, 2018 - 8:28 pm
      Reply

      Hi Jerry, this is possible with many different factors that would decide your best treatment option. Call 1-888-761-1967 for more information.

  5. tomas wilson

    July 2, 2018 - 7:39 am
    Reply

    mmh true

  6. Tyiesha Mitchell

    June 29, 2018 - 12:51 am
    Reply

    Hello my name is Tyiesha, I’m 40 I have 4 children. Me and my husband want another child. But I’ve had my tubes tied for 16 years. Is it possible for me to have a reversal after so long?

    • Shady Grove Fertility

      June 29, 2018 - 2:00 pm
      Reply

      Hi Tyiesha, it is possible, but there is no guarantee that you will be able to conceive after the procedure. I would recommend speaking to one of our specialists, they will offer the best medical advice for your situation. For more information please feel free to call 888-761-1967.

  7. Anita Williams

    March 22, 2018 - 1:21 am
    Reply

    My tubes are tied and want to have another. I wanna know how much it cost it have an IVF done

    • Shady Grove Fertility

      March 30, 2018 - 7:14 pm
      Reply

      Hi Anita, please call our new patient center at 888-761-1967 to schedule a consult.

  8. Jayme Kelley

    January 13, 2018 - 4:38 pm
    Reply

    My fianceé has two boys and a girl, and I have two boys and a girl, but I had a tibal ligation after I had my youngest child. I finally found a man that treats me like a princess, doesnt cheat, doesnt lie, has a good job that hes had for years, and he treats my children well, which has been a recurring problem over the course of trying to have relationships since my two sons were born. I know that we both trust each other enough to consider having another baby, as we have both already seen how each other act with the children in a relationship that was terminated: his kids mothers have kept his kids from him out of spite, and my kids fathers have done the same to me, but neither of us have ever done this to them, and I feel like it would be safe to have a baby with him. But we are torn, as we have six children total already, and the procedures listed above are expensive. Although I am sure my fiancee would say the cost is of no consequence, I worry that it is too much money, and that I may never become pregnant again. I wish I could do this.

  9. Daria

    December 7, 2017 - 9:21 pm
    Reply

    I’m 43. Downs Syndrome is a real risk at my age. Is there genetic testing of the embryos done prior to transfer?

  10. anesha johnson

    July 30, 2017 - 5:31 pm
    Reply

    Well I’m 34 and I have 4 kids with my husband but we have boys and we want a girl… My oldest is a girl but is from a previous relationship. I wanted to do a tubal but just saw that ivf would be a better route. Any thoughts or suggestions I am also type 2

  11. 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

  12. 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

  13. zodwa

    April 25, 2017 - 9:09 am
    Reply

    I want another baby but my tube are tied please help

  14. Jessica

    March 27, 2017 - 2:01 am
    Reply

    Ivf how much is it?

  15. 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.

      • Tamara

        March 12, 2018 - 12:00 am
        Reply

        What insurance did u have

  16. 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!

  17. 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.

  18. 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

  19. 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.

  20. 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

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