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As a center specializing in infertility care and treatment, we receive many calls from couples in which the woman has previously undergone a tubal sterilization procedure. Many of these couples are interested in undergoing a tubal reversal procedure in which the tubes are surgically reanastomosed, or put back together, with the intention of attempting to become pregnant. This is indeed an excellent option for many couples in this situation. However, it is not the only option available to help you get pregnant. In-vitro fertilization (IVF) is another procedure that is highly successful at helping couples conceive a pregnancy. IVF is a fertility treatment in which a woman’s ovaries are stimulated with medication to maximize the number of eggs produced per cycle; these eggs are then extracted through a minor surgical procedure, fertilized with sperm in the laboratory, and these embryos (usually no more than 2-3) are transferred into the woman’s uterus. The fallopian tubes are bypassed in this process and the previous issue of the tubal sterilization is avoided.  In fact, undergoing IVF sometimes makes more sense than undergoing a tubal reversal surgery. Other times, IVF is truly the only option as not all tubal sterilization procedures are reversible.

 We are proud to offer both the tubal reversal procedure and IVF as options for treatment for those who have chosen to previously tie their tubes.  While there are many factors that go into the decision of which treatment is best for you, the physicians at Advanced Fertility Care pledge to help you make the right decision about which treatment option is best for you in your individual circumstance.  In his many years of practice, Dr. Larsen has performed many successful tubal reversal surgeries, both open and laparoscopic.  In addition, he was on the teaching staff at the National Institutes of Health Reproductive Endocrinology and Infertility Fellowship for five years where he taught others how to perform this delicate procedure.

If you have had a tubal sterilization procedure done and are interested in discussing your options with our physicians, please click below to schedule an appointment.

So what is the right decision? There are a number of factors that need to be considered in choosing the best option for you:

1. Type of Tubal Sterilization Procedure

In general, the less damage done to your tubes when they were “tied” the more likely a reversal procedure will be successful. Pregnancy outcomes after tubal ligation by clips/rings or those done at the time of childbirth showed the highest ongoing pregnancy rates while the pregnancy rates for other forms of sterilization, particularly fulgaration/electrocautery (burning) are significantly lower. Certain types of tubal sterilization procedures are not reversible. For example, if the fimbriae, or the ends of the your tubes, have been removed, it is not surgically possible to reverse your tubal. Likewise, if you have undergone the Essure or Adiana procedure (where the tubes have been blocked in a procedure done through the cervix, without incisions) IVF is your only option for pregnancy. Therefore, one of the first things we will need to do is to review the operative report from your sterilization surgery. Obtaining a copy of this report from your doctor and bringing it with you to your initial appointment is critical for our physicians to provide you with the best counseling.;

 

2. Male Factor

One of the first things we need to assess before deciding whether a tubal reversal or IVF is your best option, is your partner’s sperm count, even if he has had children with another woman (or with you). If there is a significant decrease in normal sperm number, function or quality, the recommended and necessary treatment would likely be IVF with ICSI (intracytoplasmic sperm injection). In couples where the woman has open tubes and the male partner has a significant issue, IVF is the treatment of choice and very successful.It is not prudent medical practice to have the woman undergo tubal reversal, a potentially risky and expensive surgery, since it will not fix the male issue contributing to the infertility.

 

3. Age and Reproductive Status of the Woman

With advancing age, there is a significant decrease in pregnancy success rate with either IVF or tubal reversal treatment, and an increase in both the infertility and miscarriage rates due to factors such as decreased egg quality and decreased stimulation ability of the ovaries (commonly known as “ovarian reserve”). In general, some of these changes can occur as early as 5-10 years prior to menopause and in less common cases, beginning as early as the late 20’s or early 30’s. A very important part of the initial evaluation will be to assess your ovarian reserve with blood tests and an ultrasound, both of which will need to be done while you are on your period (cycle days 2, 3, or 4). If we find that your ovarian reserve is declining (indicating a decreased chance of successful pregnancy), we usually would recommend that you undergo more aggressive treatment with IVF since it has been shown to give you the shortest time to pregnancy and best chance for success.

Since natural conception can take some time, even with a very successful tubal reversal, we also would usually recommend that women over age 38 undergo IVF as the treatment of choice and discourage any woman over age 40 from considering tubal reversal surgery. At this age, the longer time spent waiting for surgical recovery and natural conception can cause a significant decrease in a woman’s ovarian reserve and further decrease the odds of becoming pregnant. Occasionally, when we do ovarian reserve testing we discover results that would suggest that regardless of the treatment choice, the chances for successful pregnancy would be less than 5%. In those circumstances we would recommend against either treatment and recommend donor egg IVF versus adoption as having the most realistic chances of conception.

 

4. Medical Factors

With our years of experience, we have found that women who are overweight have lower success rates with any types of fertility treatment including attempts at tubal reversal. The procedure itself is microsurgical and very delicate in nature. Women who are more than 25% over their ideal body weight often have weight distribution that makes a traditional tubal reversal very difficult. Weight issues may also significantly impact IVF success and increase risks as well. As a result, IVF is only offered to women with a body mass index (BMI) of 32 or less. Therefore, in some cases, we may recommend significant weight loss prior to offering any fertility treatment. Additionally, there are certain gynecologic and/or medical conditions that would make tubal reversal surgery less advisable. As a result, prior to offering either treatment, you will be required to undergo a medical screening process in an effort to identify any issues that may complicate pregnancy or make it more dangerous to get pregnant. If we identify such issues, you may also be required to consult with a high risk OB specialist for preconceptual counseling to ensure that all steps are taken to optimize pregnancy outcome. Rarely, we will recommend against either treatment because of medical issues that make pregnancy or surgery inadvisable.

 

5. Surgical and Anesthesia Risks

Several risks are associated with any surgical procedure, whether it be tubal reversal surgery or the IVF retrieval.

For tubal reversal surgery, one of the main risks is that the surgery is not successful and the tubes remain blocked. This can occur immediately after surgery during the healing time or any period of time after surgery. There appears to be approximately a 2% risk for one tube and 0.5% risk for both tubes to become scarred over and closed. A second risk is that from surgery itself. In most circumstances, the surgery usually takes 2-4 hours and involves an open procedure where a 4-6 inch incision is made near the pubic hairline. In some cases, this surgery can be performed through a telescope through the belly button which reduces the time of surgical recovery. In general, the recommended recovery time after surgery ranges from 3 days to 2 weeks. In addition, the waiting time prior to trying to conceive averages 2 to 3 weeks. If pregnancy is not achieved within 6 months after the reversal, it is then recommended that you undergo an X-ray test (Hysterosalpingogram) to confirm that the tubes have remained open. Potential, risks from either open or laparoscopic surgery include scar formation, bleeding, bladder or bowel injury, and infection. Furthermore, general intubated (ventilator) anesthesia is used during these types of cases, increasing the risks of anesthesia related complications over lesser types of anesthetics such as those used during the course of the IVF egg harvesting (eg. intravenous sedation).

During the IVF procedure, the woman undergoes an IVF egg harvesting, a minor surgical procedure in the office setting in which an ultrasound guided needle is passed through the vaginal wall into the ovaries in order to withdraw the eggs from the ovaries. Risks to this procedure are extremely rare and may include injury to bladder, bowel, bleeding, and infection. The procedure itself lasts approximately fifteen minutes and recovery time ranges from 30 minutes to 1 hour post procedure, after which the patient is sent home. Most women can return to normal activity the very next day. In contrast to general anesthesia used in tubal reversals, intravenous sedation is used and the woman continuously breathes on her own during the entire procedure without the assistance of a ventilator. Foregoing the use of general inhaled anesthetics greatly reduces anesthesia complication risks.

 

6. Family Planning

We have to consider your current and future plans in our recommendation for the optimal treatment for you. The ideal candidate for a tubal reversal would be a younger woman who wants more than one additional child, as a tubal reversal will allow you to retain your fertility after the delivery of your next child. Once your childbearing is completed however, you will be again forced to decide whether you want yet another surgery to perform a tubal sterilization procedure, or whether another form of contraception is preferable. In contrast, when undergoing IVF, the tubes remain blocked, so there is no additional contraception needed.

Another consideration for couples that may already have children is a potential desire to have another child of a particular gender in order to create a balance of genders within the family. This process is called family balancing or gender selection and can be successfully accomplished through the use ofIVF with additional testing termed Pre-implantation Genetic Screening. Utilizing this process, one can virtually guarantee having a child of the preferred gender assuming they are successful with the IVF process.

 

7. Tubal Reversal Fees

Unfortunately, because a tubal sterilization procedure is entirely elective, insurance companies almost never cover the costs associated with helping you get pregnant after you’ve had your “tubes tied”, whether it be with surgery or with IVF (and that’s even if your insurance plan does have infertility or IVF coverage). Therefore, you usually have to pay for either of the procedures out of pocket. We realize this and are committed to trying to keep your costs at a minimum. The cost of a tubal reversal surgery itself will be range between $7,500.00 (if we are able to be perform the procedure  at our ambulatory surgery center) up to an estimated $20,000.00 if we need to do the surgery at another facility (this higher range is because we do not have control over another location’s facility fees).  This does not include the initial consultation or diagnostic workup that helps us determine which procedure to recommend.

The fee for an initial consultation for tubal reversal surgery is $300.00 (which includes a $50.00 scheduling deposit paid at the time of booking). However, the $300.00 initial consultation fee will be deducted from your overall surgery cost when you schedule your procedure.

In comparison, IVF costs can range anywhere from $10,000-$25,000 and include options for multiple cycle package plans, and in some circumstances, money-back guarantees. In many cases, after an initial fresh IVF cycle, there may be enough embryos for a woman to freeze, which would then allow for additional attempts at IVF for greatly reduced costs ($4000-$5000 per attempt) if the initial attempt is unsuccessful or if a couple wishes to have more than one child.

 

8.  Success Rates

One of the most critical factors affecting success rates with tubal reversals is the method of tubal sterilization used, as mentioned above. Data from institutions that perform many tubal reversals annually reveal that pregnancy outcomes after tubal ligation by clip/ring showed the highest ongoing pregnancy rate of 60%, while most of the pregnancy rates for other forms of sterilization such as fulgaration / electrocautery (burning), tying, or cutting only had ongoing birth rates between 44%-49% with miscarriage rates in the 31%-36% and ectopic pregnancy rates ranging between 9% for clip/ring and as high as 19% for those who had initially had their tubes burned.

The success of reversal surgery also depends on the length of remaining tube after tubal sterilization procedure and where the tubal interruption was originally performed (at the beginning versus the end of the tubes). Much of the medical literature supports that a minimum remaining tubal length after the reversal greater than 3.5 cm is necessary in order to achieve and sustain a pregnancy. For reference, the tube is ordinarily about 8-10 cm in length. Longer tubes after reversal were associated with better pregnancy outcomes than shorter tubes and miscarriage rates/ectopic rates increased with shorter tubal lengths. In a large study of over 2500 patients conducted by one of the larger surgical centers, tubal lengths less than 4.9 only resulted in a 32% ongoing pregnancy rate. This is why more destructive tubal ligations are associated with lower chances of success with the tubal reversal options in comparison to undergoing IVF.

We are proud to boast one of the highest IVF success rates in the state as well as the country. Our clinical pregnancy rates per embryo transfer vary by age group, but our own internal IVF pregnancy success rates between 2007 and 2010 range between 60% to as high as 77%. (Please see Success Rates section of website for detailed information). Therefore, if you choose to undergo IVF instead of a tubal reversal with us, know that you will be receiving world class care and will have as good a chance of conceiving there is.

 

Summary Overview

As with any medical procedure, IVF and tubal reversals both have pros and cons, or risks and benefits that need to be considered (this is not an exhaustive discussion of the risks and benefits of each, just an overview).

 

Tubal Reversal

Pros: Tubal reversals afford couples multiple opportunities to get pregnant. There are no increased risks of having a multiple pregnancy (twins or more). For many couples, this feels like a more “natural” approach to conception.

Cons: The risk of having a tubal or ectopic pregnancy after tubal surgery is as high as 15-20%. This will likely result in the need for yet another surgery and can be a potentially life-threatening situation. The tubal reversal itself is longer and associated with a higher incidence of complications than IVF. Occasionally, you will undergo the surgery only to have us find at the time of surgery that it is not possible to reverse one or both tubes. In addition, you may end up needing to do IVF anyway if tubes re-occlude after surgery or if you experience infertility even if your tubes remain open.

 

In Vitro Fertilization

Pros: IVF is the best treatment available for couples who are infertile, and the time to successful pregnancy is often faster. The surgical procedure to harvest the eggs is done under IV sedation instead of general anesthesia. There is no need for contraception decisions once childbearing is completed.

Cons: IVF is an involved procedure that takes several weeks from start to finish. Depending on the number of embryos transferred, the risk of having multiples ranges from 3-4% to as high as 35% for twins. Multiple pregnancies have higher risks such as preterm labor and delivery, pregnancy complications, cesarean section, pregnancy loss, etc.

Tubal Reversal done at Arizona Advanced Surgery Center

Includes:

Reversal procedure via mini Laparotomy
AASC Surgery Center-Facility Fees
Surgeon’s Professional Fees
Anesthesia
Total: $7,500.00

Financial Details:

** The initial consultation requires a $50.00 scheduling deposit at the time of booking (refundable if 48 hours notice is provided for cancellation).

** $300.00 initial consultation fee will be deducted from the Tubal Reveral Surgical Cost at the time payment is made for the procedure.

Payment is due in full at the time surgery is scheduled.

Accepted forms of payment are: VISA, Mastercard, Discover, or Cashier’s Check

Cancellation Penalties:

Tubal Reversal Procedures cancelled with more than 7 business days notice will receive a refund of their surgical fee less a $1,000.00 cancellation penalty.

Tubal Reversal Procedures cancelled with less than 7 business days notice will be refunded 50% of their surgical fees.

 

Fees Not Included (Approximate):

Initial Consultation**$300
Diagnostic Testing (required)$1,200
Semen Analysis (required)$240
Follow Up Consult$200
Surgeon's Professional Fees -
(if surgery is done at a facility other than AASC)
Quote based on outside surgery center utilized
Laparoscopic or Robotic ProceduresQuote based on outside surgery center utilized
Observation Unit StayQuote based on outside surgery center utilized

There is hope. Are you ready to make your miracle happen?