Tubal ligation (tubes tied) is the commonest form of contraception. Occasionally, a woman regrets being having her tubes tied and desires to get pregnant. There are two options available to get pregnant after tubal ligation, tubal reversal or in vitro fertilization (IVF).
For most women, IVF represents the fastest way to pregnancy. This may be important to older women whose fertility is declining with age. The success rates of IVF may exceed 20% per cycle. Despite its expense, it may be the best option for patients over the age of 35. For many, however, IVF is prohibitably expensive. A single-cycle of IVF cost $9,000 to $12,000 for a 20% chance of conception. Three IVF cycles has a 50% success rate but will run as much as $50,000.
The alternative is surgery to reconstruct one or both fallopian tubes in a procedure called tubal anastomosis. This surgery may be performed through an abdominal incision or robotically. The procedures begins with placing a small video camera through the belly button (laparoscopy). The tubes are examined and if the tubes are amenable to repair, the scarred portion of the fallopian tubes are removed, and each portion of the tubes spliced back together with very small stitches. If performed robotically, it is performed as an outpatient.
There are several issue that influence the decision to proceed with surgery:
- Age – As already has been mentioned, women face a decline in fertility with age. There is a measureable decrease in fertility at age 32 and a meaningful decline at age 35. After age 38, there is a measurable decline in fertility every 6 months. When time is of the essence, IVF is the fastest path to pregnancy and should be consider in preference to surgery
- Male Infertility – When the male partner has a low sperm count, a couple may struggle to get pregnant despite a successful surgery. In such cases, IVF would maximize the success of pregnancy with the sperm that are available. It is recommended that patients have their partner undergo semen analysis before having surgery.
- Tubal Status – Depending on the technique used for tubal ligation, the condition of the fallopian tubes may be beyond repair. If too little tube is left behind, if the tubes were tied too close to the uterus or if the tubes are distorted by scarring, the tubes cannot be repaired. The condition of the tubes may not be known until the time of surgery, but an xray of the fallopian tubes (hysterosalpingogram) is performed before surgery to help identify evidence that the surgery would be ineffective. Finally, at the time of surgery, the procedure begins with laparoscopy to evaluate the condition of the tubes. The surgery may be abandoned at this point if the tubes are beyond repair.
- Co-Existing Infertility Factors – Even if the procedure is performed successfully, other factors that influence fertility will alter the effectiveness of the surgery. Conditions such as endometriosis or polycystic ovarian syndrome (PCOS) will limit fertility.
If the above factors are not a problem, tubal reversal surgery can be very effective. In women under the age of 35, 40-70% of patients will get pregnant over a two year period.