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Tubal Reversal Surgery or IVF?
by Leigh Ann Woodruff, July 13, 2016
There are many women who have had their "tubes tied" (tubal ligation) and then decide they do, in fact, want another child. In the tubal ligation surgery, a woman's fallopian tubes are separated in a surgical manner to prevent eggs from reaching the uterus for fertilization.
If you have had tubal ligation surgery and then decide you want another child, in vitro fertilization (IVF) is one option. With IVF, the eggs are retrieved from a woman's body, fertilized in the lab and then transferred back into the uterus — bypassing the fallopian tubes altogether. Another option, however, may be tubal ligation reversal, a surgical procedure to reconnect or reopen the fallopian tubes.
So how do you know if you should consider tubal reversal before proceeding to IVF?
"Depending on the age of the patient and type of tubal ligation, if the patient is younger than age 39 and has adequate tubal length for reversal, surgery is a viable alternative to IVF," says Donald C. Young, D.O., FACOG, medical director of Mid-Iowa Fertility. "It is very helpful for the tubal reversal surgeon to have the sterilization operation reports and/or pathology report from the surgery to give appropriate recommendations for a reversal versus IVF."
What Type of Tubal Ligation Did You Have?
Tubal ligation basically means that each of the fallopian tubes is separated into two segments using a ring, clip, stitch or electric current.
The most common type of tubal ligation is the "Pomeroy Procedure," in which part of the fallopian tube is lifted to create a loop, a ligature is tied around the base of the elevated portion, and the segment is removed. This procedure does leave two healthy segments of fallopian tube that could be rejoined through reversal surgery later. Another method of tubal ligation with a Falope ring or Hulka clip also damages just a small length of the tubes and may be ideal for reversal.
If you have had the Essure method of tubal ligation in which a synthetic material is placed in the tube to create a blockage, most clinicians do not recommend tubal reversal surgery. "Virtually all fertility specialists would recommend IVF for those patients," Dr. Young says.
What Is Tubal Reversal?
With tubal reversal surgery, also known as tubal reanastamosis, is a surgery to rejoin the separated segments of the fallopian tube. The surgery may be done as an open procedure, laparoscopically, or with robotic surgery.
Most of the time, the preferred method for tubal reversal is a microsurgical repair through an open "bikini-cut" incision. "I perform tubal reversal surgery through a small, 2-inch incision, which allows same-day surgery and discharge home," Dr. Young says. "Women may return to work after approximately 10 days."
Patients may try for pregnancy very soon, often within the first month, after the procedure. Many become pregnant within the first year to 18 months.
Tubal Reversal Success
The patient's age, as well as the length of her tube after tubal reversal are factors that help determine whether a tubal reversal will be successful. According to Dr. Young, pregnancy rates correlate with the final length of the tube after the procedure, and the highest pregnancy rates are noted when lengths are greater than 4 cm.
"If the patient is over age 38 or has short tubal length from a sterilization such as cauterization (burning), then IVF would be a better treatment choice for successful conception and delivery," Dr. Young explains.
Another thing to consider is whether there is any male factor infertility involved when the couple is trying to conceive. If there is, IVF is probably the better choice.
"Approximately 90 percent of fallopian tubes are open after the surgery, and 70 percent of women will become pregnant," says Dr. Young. "With proper selection, pregnancy rates may equal IVF pregnancy rates over time."