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Your Conception Game Plan: Tubal Reversal or IVF

February 18, 2013

Women who have had a tubal ligation may find themselves wanting to build their family years later either with the same partner or in a new relationship. She might be a candidate for in vitro fertilization (IVF) or tubal ligation reversal depending on how many children she would like to have, and the presence of other female or male factor infertility conditions.

Are You A Candidate for Tubal Ligation Reversal or IVF?

Preliminary fertility testing is an important step in deciding which procedure you will pursue. Patients should undergo a complete fertility workup to determine if any other fertility conditions are present that would be best addressed with IVF. Your fertility doctor will also want to check your partner’s sperm count and quality, as significant male factor infertility is best addressed using IVF with intracytoplasmic sperm injection (ICSI).

Amos Madanes, M.D., of Midwest Fertility Center in Chicago, Illinois, says the primary indicators of tubal ligation reversal success are normal semen analysis results, good uterine integrity (no presence of fibroids, scar tissue, etc.), and a substantial amount of remaining fallopian tube to reconnect. “Before surgery, we want to find out the probability of success with tubal ligation reversal. We can either do the procedure, or recommend a procedure that is medically better for the patient, like IVF. Some of the most important criteria are the availability of sperm and the availability of tube to perform the reversal. If the patient is a candidate for both procedures, they are free to choose,” he states. In the instance that both partners are healthy and have optimal fertility, tubal reversal is a viable option.

Should You Choose IVF or Tubal Ligation Reversal?

There are several factors that would influence a fertility patient to pursue one treatment over the other. If a patient is looking to preserve the contraception that tubal ligation reversal offers or is only looking to have one child, IVF may be the better treatment option. “If you do IVF, you preserve your contraceptive method of having your tubes tied. If you are looking to have one child with a second family, IVF is a good option,” Madanes says.

The method of tubal ligation reversal varies by clinic, with some clinics using laparoscopic surgical techniques rather than abdominal surgery. Laparoscopic surgery requires minimal recovery time and there is less preparation on the patient’s part. “Medically, IVF is more involved: two weeks of shots and risk of Ovarian Hyperstimulation Syndrome (OHSS)." Madanes continues, "From the medical point of view, tubal reversal is an easier procedure."

Another factor to consider is cost. Though tubal reversal costs are similar to the costs of one IVF cycle, it is a single-cost event (presuming the patient is able to conceive without fertility treatment after the reversal), rather than the cost of multiple fertility treatment cycles.

Dr. Madanes says it is important for a fertility patient weighing their options of tubal ligation reversal or IVF to work with a clinic that has extensive experience in both procedures so the treatment options can be presented without bias. Tubal reversal ligation is a good option for patients who do not have the funds to do multiple IVF cycles, are looking to have more than one child, and do not have any other female or male factor infertility condition. IVF is a better option for patients looking to maintain the contraceptive aspect of a tubal ligation, those who are not candidates for tubal reversal, and those looking to have just one child.

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Comments (2)

Actually, I am wondering to have more babies, both the ivf and tubal reversal procedure are out there, but not able select one of them. I am 35 years of age and mom of two growing children. Can you please suggest the right procedure?

Hello Lilita, I am not a doctor, nor do I have any medical training however, I do know that depending on what type of tubal ligation you had (cut/cauterized, tied, clipped) you have to qualify for a tubal ligation. In some cases such as when the tubes were cut sometimes doctors are unable to reconnect them. When a woman has a tubal ligation there is scar tissue on the fallopian tubes. If a woman has a tubal reversal she is at risk of experiencing an ectopic pregnancy because of the scar tissue on the fallopian tubes. There have been quite a few instances where a woman has a tubal reversal and has to move forward with IVF anyways. The older the woman is at the time of a tubal reversal the higher the risk of experiencing an ectopic pregnancy. If you have insurance it will most likely not cover a tubal reversal or IVF. Insurance companies consider a tubal ligation an "elective" procedure. Most clinics do not offer payment plans for tubal reversals/IVF. However, if you would like to discuss your options with a trained medical professional such as a Reproductive Endocrinologist I am happy to help you find one in your area. You can email me directly at Julie@fertilityauthority.com