Approximately 5% of women undergoing tubal sterilization procedure
regret their decision because of change in their marital status, loss of a child or wanting more children.
What are the options?
Women regretting their tubal sterilization procedure have 2 options:
Am I good candidate for reversal of sterilization?
1.5% of women who have undergone tubal ligation decide to have surgery to reverse the procedure. Depending on the method of
sterilization utilized, successful pregnancies following reversal of tubal ligation occur in 60-80% of cases within the first
12 months after surgery.
You are not a candidate for reversal of sterilization if:
- Your sterilization procedure involved complete removal of the fallopian tubes (salpingectomy).
- You had multiple point tubal coagulation (burning) technique. Burning the tube in 2 or three different sites causes extensive
tubal damage. Very short tubal stumps are available for the reanastomosis, resulting in shorter tubal length after reattachment.
This is unlikely to result in a functioning tube or a successful pregnancy.
- The end of the tube (fimbriae) is damaged as result of your tubal ligation procedure. So, even if the tubes are successfully
reattached, the tube may not be capable of capturing the egg from the ovary and transporting it into the tube.
- Your husband has a low sperm count (male factor). With low sperm count not enough sperm reaches the egg in the fallopian
tube, decreasing the likelihood of successful fertilization of the egg. In such cases,
In Vitro Fertilization (IVF) is a better option.
- You are
over the age of 40 you may consider IVF because of the rapid deterioration
in the quality of your eggs.
- You have high day 3 FSH level. With poor quality eggs neither reversal of sterilization or IVF will solve your problem.
In such cases IVF with donor eggs (donor egg IVF) is usually advised.
How is the tubal reversal performed?
 
Reversal of sterilization traditionally involved a 2-3 hour major abdominal surgery utilizing an operating microscope to reattach the closed tubal segments. The most significant factors influencing success rate with reversal procedures are the level of expertise of the surgeon and length of tube remaining after sterilization. Success rates are highest when the length of the tube is estimated to be more than 2 inches.
More recently, tubal reversal is increasingly being performed by an outpatient minimally invasive robotic laparoscopic technique, involving 4-5 small ½ inch abdominal incisions. The advantage of this surgery is that the recovery period from the operation is several days as compared with the 4-6 weeks after traditional major abdominal tubal reversal procedures.
IVF as an Alternative
 Today,
In Vitro Fertilization (IVF)
offers an alternative to surgical reversal of tubal ligation. With IVF, the woman's eggs are removed directly from the ovaries,
fertilized in a laboratory Petri dish, and the resultant embryos placed into the uterus. Thus, the tubes are simply bypassed
in the process.
In considering IVF versus surgery, there are advantages and disadvantages to both:
What are the advantages of IVF?
- Reversal of tubal ligation until recently was a major surgical operation, with significant post- operative pain and up to four to six weeks of recuperation.
- The risk of
ectopic (tubal) pregnancy following reversal of sterilization is about 5-10% compared with 1% after IVF.
- A woman younger than 35, undergoing two
IVF attempts at a clinic with good success rates has a better chance of having a baby compared with surgical reversal of sterilization.
- There is no need to repeat the tubal ligation or utilize other methods of birth control after one`s family is completed.
- IVF with Intracytoplasmic Sperm
Injection (ICSI) is the treatment of choice when male factor is present, because there may not
be enough sperm to fertilize the egg naturally in the tube even if the reversal procedure has been successful.
What are the advantages of surgery?
- Reversal of sterilization can now be accomplished by outpatient
robotic laparoscopic surgery, a procedure
comparing more favorably with
IVF treatment.
- IVF treatment is costly and may need to be repeated several times before it is successful.
- IVF is time consuming and involves daily
gonadotropin hormone injections, blood tests and several ultrasounds.
- Two or more attempts at
IVF may be more costly than surgical reversal of sterilization.
-
IVF carries a risk of multiple births.
- If the couple wants more than one child, and there are no frozen embryos available, they would need to repeat the entire IVF process.
What are the success rates with IVF and reversal of sterilization?
- With sterilization reversal procedure - cumulative pregnancy rates 1 year after surgery are 60-80% if you are young with minimal tubal damage after sterilization.
- With IVF, pregnancy rates vary with your age. The table below summarizes BocaFertility’s IVF success rates between 2001 and Dec 2008:
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