Tubal vs. IVF Treatment
Pros/Cons of Tubal Reversal and IVF Treatment
- Tubal Reversal vs IVF Definitions
- How to choose Tubal vs IVF
- Advantages & Disadvantages
- Tubal vs IVF Consultation
One of the frequently asked questions in fertility care is whether a woman who desires pregnancy after a tubal ligation, should have a tubal reversal surgery or should go straight into in vitro fertilization (IVF). While there is no uniform, and simple, answer to this question, the trend in recent years has been away from surgery and towards IVF. And the reasons for this trend are medical as well as economic.
Tubal Reversal vs IVF
A Tubal Ligation, in principle, involves the surgical interruption of both fallopian tubes. Since intact tubes are essential for egg and sperm to meet, and for fertilization to occur, their surgical interruption prevents pregnancy.
Tubal Ligations can be performed in two ways: either a portion of the tube is coagulated (i.e., burned), or a portion of the tube is simply excised. Which technique was utilized is important because the success of tubal reversal surgery greatly depends on how much healthy tube was left after the initial Tubal Ligation. If not enough was left, good surgeons will not even attempt a reversal, since it will not succeed in leading to pregnancy.
Unfortunately, it is not always even possible prior to surgery to determine whether enough healthy tube is left for a successful surgery and it, therefore, is not uncommon that patients go into surgery under assumption of having a tubal reversal surgery done, only to wake up from anesthesia to be told that there wasn’t enough tube left to even try.
But length of remaining tube is not the only decisive factor; quality counts, as well, And here the kind of Tubal Ligation that was performed once again comes into play. If the tubes were “burned,” heat damage to tubal tissues can be very extensive and reach far beyond visually visible areas. Tubal Ligations by coagulation are, therefore, only rarely good candidates for reversal surgery.
Additional forms of tubal sterilization are so-called distal salpingectomy or fimbriectomy and complete salpingectomy. In these two forms of tubal sterilization either the distal portion of the tube (the fimbriae) or the entire tube are removed. These two sterilization procedures never lend themselves to reversal.
We encourage anyone, before they make a decision, to consult with us. Currently, we are offering a Free Tubal vs IVF E-Mail Consultation.
How to choose?
Much of what we discussed above will already determine the choice between reversal surgery or IVF. Clearly, if your TL was done by coagulation, or if you had either a fimbriectomy or salpingectomy, the choice of IVF will be very obvious. What, however, if your TL was done by straight forward knife (scalpel) excision?
Under such a circumstance, the medical decision can go either way, provided you can be certain that the surgeon left enough length tube to allow for a proper reversal surgery. How can you be certain? Your (and your physician) really never can be absolutely certain until the surgeon holds the two ends of the tube in his/her hands at time of surgery; However, one can make an educated guess: First, it is important to review the operative report from the Tubal Ligation surgery. Properly executed reports should indicate how much tubal length was left after the surgery was completed. In addition, a so-called hysterosalpingogram (HSG) can be performed. This is an x-ray, in which the proximal part of the remaining fallopian tubes (i.e., the part closer to the uterus, and before the surgical interruption) can be outlined. Confirming that this part is of adequate length does not guarantee that the distal part (the part after the interruption) is adequate, but makes it more likely.
Assuming, the judgment is that your tubal remnants, with great likelihood are adequate, a tubal reversal surgery may be pursued. An absolutely final judgment, whether such a surgery is technically feasible will, however, not be possible until surgery, when the surgeon directly visualizes your tubes. By that time you will, however, very likely already be under anesthesia.
Advantages and Disadvantages
The first step to determine which is better for you is to register for a Free Tubal vs IVF E-Mail Consultationand complete the Pre-IVF E-Mail Consultation Form.
Going the tubal reversal surgery route has one overwhelming advantage and that advantage is that, if successful, tubal reversal surgery does not require any follow up treatments. You and your partner return to the standard way of having babies, and, hopefully, also have a lot of fun doing so.
Tubal reversal surgery has, however, also a number of risks and disadvantages over the alternative of IVF: The first we already discussed; the surgery may simply turn out to be technically unfeasible. A very important second disadvantage is that, even if the surgery is performed well, on the average only approximately 50-75% (depending which reports you believe) of fallopian tubes remain open and reported pregnancy rates usually are only in approximately the 50% range.
And, finally, surgery is always expensive because it usually involves operating rooms in hospitals (or surgicenters), in addition to physician fees, and both of those are usually quite costly. Moreover medical insurances usually do not cover voluntary sterilization reversals.
Tubal vs IVF Consultation
What is then, after all, the right way to go, you may ask. The answer is that there is no absolute right way. What is the right decision for one person may be the wrong one for the next individual. All we can suggest is that you choose the right physician and follow his/her advise.
Who then is the right physician for you? It should be a fertility specialist who offers both, tubal reversal surgery and IVF. Only physicians who offer both of these services do not have a self-serving economic interest to direct you towards one or the other choice.
Contact us for a tubal vs ivf consultation.
Dr. David Barad discusses CHR's unique IVF program.
Last Updated: October 24, 2011
