Tubal Reversal surgery vs. In Vitro Fertilization (IVF)

An alternative to tubal reversal is in-vitro fertilization (IVF).

Which method is better for regaining fertility?

Whether or not IVF or tubal reversal is better must be based on individual factors and workup.

IVF is a nonconventional method and involves the daily administration of fertility injections.  The patient’s response is checked over a 2-4 week period, together with frequent visits for further management.  At the appropriate time, the eggs are harvested from the woman by placing a needle through the vagina and into the ovary.  This procedure drains follicular fluid from the ovaries.  On the day of egg salvage, the husband’s sperm is combined with the patient’s eggs and the embryos are produced.  The succession of the fertilized eggs (now an embryo) is monitored over a phase of several days.  The embryos are transferred back into the patient’s uterine cavity by insertion of a small tube through the cervix and into the uterus.

Some reasons making IVF a less desirable choice than Tubal Reversal include:

  • In general, one to four embryos are transferred, depending on the patient’s age.  The success rate of pregnancy is quite variable and may lead to multiple attempts. When couples are unproductive, they must want the process again, which is costly
  • IVF has a much greater risk for multiple gestations than Tubal Reversal
  • Some couples may not have the time nor wish to make multiple visits to the clinic, which are obligatory for IVF, and nt for Tubal Reversal
  • Many of the steps for IVF are uncomfortable. Many people must convince themselves that the procedure may work ‘this time,’ unlike Tubal Reversal which involves just one procedure
  • Risks of over-stimulating the ovaries are much greater than for Tubal Reversal, and can be very serious (Ovarian Hyperstimulation Syndrome – OHSS).

Tubal reversal is preferable for people who want to conceive naturally with a conventional procedure.

What are the disadvantages of having a Tubal Reversal rather than IVF?

  • Tubal Reversal allows the possibility to conceive more pregnancies. This is a disadvantage for those who just want to have single child . This requires future contraception.
  • Any pregnancy after Tubal Reversal needs to be monitored early due to an increased risk for ectopic pregnancy

Success rate comparison between IVF and Tubal Reversal:

  • It is found 20-35% success rate via IVF.
  • It is found 66% pregnancy rate over time via tubal reversal.

IVF is the best option for patients for whom tubal reversal is not possible, or in patients who are poor candidates for a tubal reversal. Many patients will have additional infertility factors presence, such as diminished ovarian reserve (can be evidenced by a rising follicle stimulating hormone (FSH) value), blocked fallopian tubes, advanced age, other medical conditions, or severe sperm abnormalities that make tubal reversal a less optimal procedure that IVF. Additionally, some tubal ligations remove too much of the fallopian tube to reanastomosis, and therefore a tubal reversal is less likely to be successful.

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