Sometimes women who have opted for a permanent method of contraception, such as tubal ligation, change their minds. Doctors advise that patients are 100% sure they don’t want to get pregnant in the future before getting tubal ligation. But life happens —situations, relationships, and goals change.
So, what are your options if you’ve had tubal ligation, but now want to get pregnant?
There are generally two options: tubal reversal surgery and in vitro fertilization (IVF). Tubal reversal entails reopening or reconnecting the fallopian tubes to the uterus. IVF involves retrieving eggs from your body, fertilizing them in a laboratory, and transferring the embryo back into the uterus, bypassing the fallopian tubes altogether.
How do you decide which option is right for you?
Below are some factors to consider:
1) How is your partner’s sperm quality?
If your partner’s sperm quality is good, you can consider both both options. However, if sperm quality is poor, IVF may be the better option. If sperm count or motility is low, it will be harder to get pregnant naturally after a tubal ligation reversal. But with IVF, since fertilization takes place outside the body, poor sperm quality can be overcome.
2) How old are you?
Starting from your mid to late thirties, the chances of getting pregnant in general decline. By age 43, most women have trouble getting pregnant with both IVF and tubal ligation reversal approach. If you are in your mid to late thirties, your chances of getting pregnant after a tubal reversal are reduced, and IVF may be a better option. If you are in your forties, you may not want to go with either option and instead, pursue egg donation.
On a similar note, some women experience a decline in either egg quantity or quality earlier in life. Regardless of your age, you should test your “ovarian reserve” to see whether you have adequate egg supply. If not, you may not want to go with either procedure, and consider egg donation.
3) How healthy are your fallopian tube segments?
If your remaining fallopian tube segments are not healthy or are very short, it may not be possible for you to get a tubal reversal. In that case, IVF would be a better fit.
4) Do you have pelvic scar tissue?
If you have scar tissue around your tubes or ovaries, your chances of getting pregnant after tubal reversal is lower. However, success rates of IVF are generally not affected by pelvic scar tissue. If your doctor tells you you do have pelvic scar tissue, IVF might be a better option.
Here are additional points of consideration for each procedure:
Tubal Reversal Surgery
- After surgery, you ideally won’t need any medical intervention like medications, drugs or procedures in order to get pregnant
- Low risk of multiple pregnancies with natural conception
- You have to go through the preparation and recovery of a surgical procedure
- If you are unable to conceive naturally, you may eventually have to pursue IVF anyway
- After having a child, you will need to go back to using contraception or having your tubes re-tied
- Avoid the preparation and recovery of a surgical procedure
- The outcome is known with a pregnancy test, which can be taken 10 days after the first cycle of the procedure. With tube reversal, it can take up to a year to know whether you can successfully get pregnant.
- You will need to take medication to stimulate egg development
- There is an increased risk of multiple pregnancies
- If the first attempt does not work, you will have to go through the process again
How do the success rates compare?
Overall, success rates of pregnancy are between 55-80% for tubal reversal. For IVF, success rates range between 20-35% per cycle. These rates are influenced by a number of factors, the biggest being your age.
Which costs more?
Both procedures can be expensive, especially because insurance rarely covers the costs. The cost of tubal reversal varies depending on the surgeon, hospital, and geographic region. In some areas, tubal reversal is more expensive than IVF, but in other areas, surgeons have high volume outpatient surgery clinics where costs of reversal surgery are lower.
There’s no right answer in choosing between these two options. In general, tubal reversal has higher requirements for being a good candidate, and if it fails, IVF is still an option. Your best bet is to weigh the pros and cons of each with your doctor or a fertility specialist to make the best decision for your particular situation.