Thursday, January 7, 2010

Tubal Reversal Vs. In Vitro Fertilization


I was diagnosed with PCOS 6 years ago. I had one treatment of Clomid and became pregnant soon after with healthy twin boys. At the time I had decided to get a tubal ligation soon after delivery but now I am regretting the decision I made. Now after so many years I am finally having a very regular menstrual cycle.

My question is, what would be the better option for me: IVF or a reversal of my tubal ligation?


Hello, Here are the pros and cons for both options that I usually share with my patients:

*Tubal reversal or reanastamosis

It is a surgical procedure. Some surgeons do it as a large open incision and some as a small incision. Tubal reanastamosis is not covered by private insurance. The large incision will be very expensive ($20,000-$35,000) with a 6-8 week recovery. The small incision can be done as outpatient surgery but will cost $8 - $12,000. Recover will be 4 weeks. The latter surgery is skill-based and should be done by a physician comfortable with a mini-lap procedure to insure success.

The pros are that if the procedure works, you can get pregnant over and over by natural means.

The cons are that it is a surgery, and that success depends on the surgeon, the length of the tube after repair, and the type of tubal ligation that was done. There is an increased risk of a tubal pregnancy (surgical life threatening emergency). Pregnancy rate will vary by age and will be less than the equivalent rate in the normal population. You will need contraception again if you don't want more than one more child. You have to at least try for one year following surgery to get pregnant and determine if the reversal worked. If it hasn't, then the only option left is IVF for an additional cost.

*IVF or in vitro fertilization

IVF is a non-surgical procedure and will cost approximately $15,000 per attempt (which includes the IVF, medications and lab tests). It is sometimes covered by private insurance.

The pro is that it is not surgery, that you will get pregnant with minimal waiting, it is great for those who want one or two more children and that it has a much higher pregnancy rate than trying naturally, especially if you are older. Sometimes you will have enough eggs fertilize that some can be frozen and used for a later frozen embryo transfer, giving you the leisure of deciding to have another child when the time is right. It is not painful to have the eggs retrieved or transferred into the uterus and it is performed as an outpatient procedure.

The con is that it is expensive (as described above), that you have to take injections on a daily basis for a short period of time (although they are not too bad) and that you may have to do it again and again if you want to have more children. It is not a "natural" process since in vitro fertilization is done in an embryology lab.

In closing, nowadays, because IVF pregnancy rates are so much higher, we recommend IVF over tubal reanastamosis. However, the doctors that don't do IVF tend to recommend tubal reversal. The doctors that do both, as I do, tend to recommend IVF because it is better. It is more of a sure thing than the surgery. However, if you are still under the age of 35 and know that you will want to have more children, then the reanastamosis might be the best way to go, assuming that it works. The costs will be about the same, but if it doesn't work, then you have to do IVF. Most of my patients will choose IVF since it has a better chance of success for the money.

Good luck with your decision and whatever you do decide, I wish you success.


Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.

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