Is A Tubal Reversal A Good Option For Me?

QUESTION:

I am a 33 year old mother of two. My children are 11 and nearly 10 years old.  After the birth of my second child in 2003 I had surgery to prevent further pregnancies. (I was in an unhappy marriage and only 23, and couldn't see myself ever getting out with 2 children.) The doctor was reluctant, because I was so young, but he decided to go ahead and perform the sterilization surgery. My tubes are not cut or clipped or burnt, they just have little clips on them to prevent the egg from passing through.  But just as many people predicted, now I regret the decision.  

I am divorced, my children are growing up, and I am in a wonderful relationship with a man who has no children of his own but would very much like to have one.  Barring infertility issues on his part, is there much hope of us being able to reverse my tubal and conceive a child of our own?  I don't have any other medical issues. I am healthy and active, average healthy weight, non-smoking, non-drinking...same for him. He is 39 and I'll be 34 this year, so we feel like the clock is ticking on any opportunity for another child.  Can this surgery be done, what are the odds of conception afterwards, what factors do I need to consider, how long do you need to wait after the surgery before trying to conceive.  And what is the average cost??  I appreciate any answers you can give me on the matter.

Thank-you! K. from Kentucky

ANSWER:

Hello K. from the U.S. (Kentucky),

The type of tubal ligation that you have is the best to reverse because the majority of the tube is kept intact and there is minimal damage to adjacent tubes.  Also, considering you are young still, a tubal reversal would be a good option in your case. A good and experienced gynecologist or reproductive specialist can do the reversal either by laparoscopy (using a scope and little incisions) or by a mini-laparotomy (a small incision above the pubic bone. You would want to find a surgeon who is well experienced in this and does them a lot to get the best chances for success.  

I have had a patient who went to North Carolina to have hers done by a doc who only does reversals. The risks for this procedure are the same risks as for any surgery (infection, bleeding, general anesthesia, injury to adjacent structures, failure) but this is not considered a major surgery, but rather should be an outpatient (same day) surgery.  In terms of success, those rates can vary widely so I can't give you an exact number.  A good surgeon will have an 80% success rate in patients under 35 years old after 1 year of trying.  If a pregnancy does not occur within 1 year, then the procedure probably has failed.  

Basically, with a tubal reversal, all you are doing is attempting to restore your natural fertility rate. This rate is very age dependent.  Your chances of natural pregnancy at 25 years old was 85% per year whereas at 35 it will be 30% per year because your eggs have aged.  So, keep these statistics in mind. The alternative to a tubal reversal, and with a higher likelihood of success is In Vitro Fertilization, but the down side is you would have to do this every time you wanted a child from this point on.  With a reversal, you could continue to have children by natural means if you wanted more than one.  Cost wise, tubal reversal will vary depending on the doctor, the clinic and whether or not it is done in an outpatient surgery center or hospital.  The cheapest I have seen is about $6000 and is done in an outpatient surgery center.  Hospital performed reversals will be $15,000-18,000.  I hope that gives you the information you needed.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

Comment: Thank you so much, once again. Armed with the information you provided, we can now move forward! I feel like I got lucky having my question go to such a knowledgeable and open volunteer!