IVF vs. Tubal Reversal: Which Is Better?

A lot of women have their tubes tied when they decide they don’t want children, or that they have had enough children. In fact, approximately one million women have their tubes tied each year. Many of these women remain happy with their decision for years; but some later change their minds.

For the women who change their minds, there are two options for getting pregnant after tubal ligation surgery: getting a tubal reversal surgery or undergoing in vitro fertilization (IVF).

What is Tubal Reversal?

As the name suggests, a tubal reversal involves undoing, or reversing, the tubal ligation. The success of the reversal procedure depends on the type of tubal ligation that was performed.

The Pomeroy Technique is the most common type of tubal ligation. With this method a doctor actually ties a loop in the center of the fallopian tubes, and then surgically removes the knotted portion. The ends of the tubes are then sealed to prevent an egg from traveling to the uterus. Roughly two-thirds of women are able to get pregnant after reversal of a Pomeroy surgery.

Tubal Rings/Clips use a device to crimp or close the tube. Eventually, the part of the tube that is crimped forms scar tissue that prevents an egg from passing to the uterus. Roughly two-thirds of women get pregnant after reversal of a ring or clip reversal.

Tubal Ligation and Resection involves tying off 1-2 centimeters of the fallopian tube, then cutting out the portion of tube between the two ligatures. This type of tubal ligation is usually done immediately after childbirth. The pregnancy success rate for a reversal of this type of tubal ligation is roughly 60-70 percent.

Tubal Coagulation uses electricity to cause blood to coagulate in the fallopian tube, which creates a barrier to prevent eggs from passing through. The success rate for a tubal coagulation reversal is roughly 40-60 percent, depending on the type of tubal coagulation.

Fimbriectomy is a procedure where the surgeon removes the frilly or fuzzy part of the fallopian tubes that are right next to the ovaries and catch the eggs as they pass out of the ovaries. This method is not used as frequently as many of the others, and the success rates after reversal are approximately 30-40 percent.

What is IVF?

IVF is an assisted reproductive technology (ART) procedure where a doctor manually collects the eggs, fertilizes them in a lab, and then surgically implants one or more eggs into the uterus. You can also freeze the fertilized eggs for implantation at a later time.

A woman may use her own eggs or donor eggs depending on a variety of factors; and it is possible for a doctor to collect eggs from a woman even after she has had a tubal ligation.

The biggest factors that will determine whether or not you will use your own or donor eggs are: your age, and the quality of your own eggs. After age 40, the quality of your eggs tends to decline, making fertilization more difficult. Additionally, if you previously had issues with the quality of your eggs, you might be better off using a donor, especially if you have also had a tubal ligation.

The success rates for IVF vary depending on your age, your underlying health and fertility issues, whether or not you use donor eggs, and the clinic where you receive the treatment. The average success rate is between 6.5 percent and 46.3 percent for women using their own eggs, depending on age; and roughly 35 percent across the board for women of all ages using donor eggs.

Tubal Ligation vs. IVF

Cost

With a tubal reversal, you only have to pay for the cost of the reversal.

With IVF you have the cost of fertility drugs, as well as the costs of collecting the eggs and/or semen, fertilizing the eggs, implantation, and after care. If you decide to freeze your eggs, you also have to pay storage fees.

Invasiveness

A tubal reversal is considered invasive. The doctor will need to put you under with anesthesia and either make an incision, or do a laparoscopic procedure to undo the tubal ligation.

IVF fertilization is considered less invasive. A doctor can collect the eggs and implant the fertilized eggs into the uterus as an outpatient procedure, using only local anesthesia.

Success

If you are healthy and you are reversing a type of tubal ligation that generally has a high success rate, such as the Pomeroy or clip ligation, you might be able to get pregnant without any assistance. However, even with a high projected success rate, it is still possible to experience complications, such as scar tissue, that can interfere with fertility. Also, having your tubes tied for a long time could reduce your chances of success.

The success rates for IVF are similar to and, in some cases, lower than those for reversal.

Some Final Thoughts about IVF vs. Tubal Reversal

If you are under the age of 40, healthy, and you have not previously had fertility issues, you might consider going with a tubal reversal first, and see how that works out. You might find that it’s all you need to become pregnant again. If you find that you are unable to get pregnant within two years of having the reversal, you can then explore IVF as an option. On the other hand, if you are over 40 and have concerns about your fertility, you might consider foregoing the tubal reversal and going straight to IVF.

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