By: Vinita Alexander, MD / aid of ChatGPT
The answers depend on many factors, including the type of original surgery performed at the time of original sterilization and remaining tubal length post-surgery, age of the female, and comorbidities in the female (For example, cases in which significant scarring of the tube may be present, like endometriosis or a history of pelvic inflammatory disease, or multiple prior abdominal surgeries, can be an indication of a worse prognosis for success of tubal reversal). Tubal reversals can be performed laparoscopically, via laparotomy, or robotically.
Tubal re-anastomosis – colloquially known as tubal reversal – and in vitro fertilization (IVF) are two different methods used to achieve pregnancy in cases where there are issues with the fallopian tubes. Each approach has its own advantages and disadvantages, which are reviewed below.
Advantages of IVF:
1. Overcomes Various Infertility Factors: IVF is a very successful fertility treatment that can be used to overcome a wide range of infertility factors, including tubal blockage or damage, male factor infertility, ovulation disorders, and unexplained infertility. It provides options for couples with multiple infertility factors and a high success rate (generally > 50% per embryo transfer if female is under age 35).
2. Higher success rate: IVF offers higher conception rates compared to a tubal reversal, especially in cases where there are other fertility issues (in addition to tubal factor) present. Because it often entails direct insemination of sperm into eggs (guaranteeing a sperm will meet an egg) and allows for the selection of the highest quality embryo for transfer, an embryo transfer increases the chances of successful implantation and pregnancy over spontaneous conception chances alone after tubal reversal.
3. Flexibility: IVF can offer greater flexibility in terms of timing of pregnancy and also allow the possibility of genetic testing prior to embryo transfer. The chances of pregnancy generally depend on the age of oocyte source at time of embryo creation.
Disadvantages of IVF:
1. Emotional and physical demands of IVF: IVF can be emotionally and physically demanding for couples, and sometimes more than one embryo transfer is needed to attain pregnancy. The emotional stress of IVF, including the uncertainty of success can be challenging.
2. There can also be certain risks with IVF treatment, including ovarian hyperstimulation syndrome (OHSS), although the risk is very low.
Advantages of Tubal Reversal or Tubal Reanastomosis:
- Spontaneous conception: A successful tubal reversal allows for spontaneous conception, as it can restore normal fallopian tube function in the appropriately selected patient (i.e. in a patient without substantial tubal scarring caused by prior pelvic infection or endometriosis).
Disadvantages of Tubal Reversal:
- Cost: According to Healthline.com (April 10, 2023), the average cost of a tubal reversal is $8,685 in the United States.
- Success rates vary: The success rates of tubal reversal vary greatly according to several factors, such as the type of tubal ligation procedure performed initially, the length and health of the remaining fallopian tube segments, and the women’s age. Success rates tend to decrease rapidly when female age is over 35. Generally, the patients with the best prognosis for successful conception after tubal reversal are those who: are less than 35 at the time of reversal, underwent ring or clip application as the method of initial tubal ligation, and have at least 4 cm of remaining fallopian tube length in situ (per tube). There is also a risk of failure or increased risks of ectopic pregnancies (pregnancies outside the uterus) after a tubal reversal.
- Surgical risks: The risks associated with the surgical procedure for tubal reversal (whether completed via laparotomy, robotically, or laparoscopically) include bleeding, infection, and injury to surrounding structures, and risks of general anesthesia.
Ultimately, the choice between tubal reversal and IVF depends on multiple factors, including specific fertility issues, the individual’s age, personal preferences, and financial considerations. It is very important to consult with a fertility specialist, who can provide personalized guidance based on scientific evidence and the individual circumstances.
References:
- Tulandi, T. Female infertility: Reproductive surgery. In: UptoDate. Falcone T (ed) and Eckler K (Ed), UpToDate, Waltham, MA. (Accessed on May 17, 2023)
- ChatGPT, personal communication ,May 24, 2023
- Hersh, E., April 10, 2023, Healthline website, accessed May 31, 2023, https://www.healthline.com/health/pregnancy/tubal-ligation-reversal