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22 April 2020

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Tubal Ligation Reversal vs IVF – Options & Success Rates

Dr Alice Huang

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Dr Alice Huang

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Tubal ligation reversal versus IVF: What are the options if you want to have another baby? 

Tubal ligation is a procedure women undergo to have their fallopian tubes permanently blocked, either by clipping, cutting, or burning.  It is one of the most effective forms of permanent contraception.  However, what happens if you change your mind and decide you’d like to have another baby?

Having a baby after tubal ligation

There are two options for women who wish to fall pregnant after they’ve had a tubal ligation -  a woman can either undergo tubal reversal surgery or bypass the fallopian tubes altogether by undertaking IVF treatment.
There is no right answer - every woman must choose the right option for their particular situation. Consulting with a fertility specialist is one of the best ways to weigh up the pros and cons of each situation in order to make the best decision.  

What influences the chance of having a baby after tubal ligation?

The most important factor in determining the chance of falling pregnant after tubal reversal surgery is the woman’s age.  The younger a woman is, the higher the chances of conceiving after tubal reversal surgery.  
Other important factors that can influence whether to proceed with tubal ligation reversal include:

  • The quality of  male sperm
  • The type of tubal ligation the woman had in the first place
  • How easy it was for the woman or couple to conceive previously, before the tubal ligation (for example, was fertility treatment needed?)
  • Other pelvic conditions such as fibroidsendometriosis, pelvic inflammatory disease (PID) or scarring from previous surgeries

If there are no other health issues with the female or male partner that may hinder fertility, the chances of conceiving naturally after tubal ligation reversal surgery are generally good, especially for younger women.

The likelihood of falling pregnant can range between 40-80%, depending on the pelvic environment, sperm quality etc. However, if the woman is older than 40 years old, chances of pregnancy will be significantly lower, even if both tubes were successfully unblocked during surgery.  

What’s involved in tubal ligation reversal?

The tubal ligation reversal procedure usually involves a laparotomy (10-15cm cut on the lower abdomen) where the fallopian tubes are reconnected with tiny stitches under a microscope. This is done under general anaesthetic and could be a day procedure or involve a 1 to 2 night hospital stay. Some fertility specialists have performed this treatment through keyhole surgery, but it is unknown if the success rates are equal to the open approach. 

Why should women choose to have tubal reversal surgery?

The key reason for tubal reversal surgery is to allow for natural conception. For younger women whose partner’s sperm is not very abnormal, the chances are good.  What’s more, after the initial cost of the procedure, couples can continue to try for natural conception without ongoing costs.

What are the risks of tubal reversal surgery?

The procedure to reverse tubal ligation carries operative and anaesthesia risks. Additionally, pregnancy after tubal surgery carries an increased risk of tubal ectopic pregnancy.   Another factor to consider is that after reversal surgery, natural conception may not be achieved and therefore IVF may need to be considered. If so, IVF may be considered from the outset to avoid undergoing an unnecessary reversal operation (as unblocked tubes are not needed for IVF).

What are the benefits of IVF over tubal ligation reversal?

Some women may have a higher chance of conceiving through IVF, rather than reversing a tubal ligation. This is especially true for older women, or if the male partner’s sperm is abnormal. 
Also if only one more child is wanted, having IVF means that you maintain reliable contraception afterwards, and IVF does not involve a major operation that will require hospital overnight stays.  
However, there can be ongoing costs for IVF treatment, if multiple IVF cycles are required to fall pregnant. Additionally, there are some minor risks associated with IVF medication and the egg retrieval procedure or increased risks with multiple pregnancies if more than one embryo is transferred.

Where to from here

It would be easy to make the decision about tubal ligation reversal versus IVF treatment if we had a crystal ball to tell us whether conception was possible after tubal reversal surgery or IVF.  Since we don’t, the important thing to remember is that there are options to achieve pregnancy and a fertility specialist is best placed to help you make an informed decision.
Find out more:Fertility Specialists in QLDFertility Specialists in NSWFertility Specialists in VICFertility Specialists in TAS, and Fertility Specialists in Singapore

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