Achieving a pregnancy naturally is not possible after a tubal ligation because the blocked tubes prevent sperm from meeting and fertilizing an egg. If a tubal reversal is not desired or possible, another way of allowing sperm to fertilize an egg is in the embryology laboratory through an assisted reproductive technology (ART) technique called in vitro fertilization (IVF). In IVF patients first undergo a treatment called controlled ovarian hyperstimulation (COH), where daily injections are administered to a woman in order to stimulate the growth of multiple eggs in each ovary. After a period of 7-10 days of injections, the eggs are aspirated (harvested) from each ovary in a minor surgical procedure called transvaginal egg retrieval. Sperm is obtained from the male partner via ejaculation, and the sperm is mixed with, or injected into (intracytoplasmic sperm injection=ICSI), the eggs, to achieve fertilization.
Fertilized eggs are next cultured into embryos in the laboratory for 3-5 days before several of the embryos are transferred into the woman’s uterus for implantation. In IVF, the laboratory replaces the fallopian tubes as the site where fertilization takes place; in vitro = out of the body.
Certain clinical situations/conditions may be contraindications to performing a tubal reversal, making IVF or other ART techniques better options for achieving pregnancy:
Non-reversible tubal ligation – patients who have undergone a type of tubal ligation which is not reversible (i.e. salpingectomy, or removal of the tubes) must undergo IVF
Severely damaged tubes – patients who have undergone a tubal ligation which damaged a significant portion of the tube (yielding a final tubal length of less than 5 cm), or critical portions of the tube (such as the very beginning/proximal or end/distal portions of the tube), are advised to undergo IVF
Severe male factor – patients who’s male partner was diagnosed with a severe abnormality on semen analysis (severely decreased count/concentration, motility, and/or morphology), cannot rely on the ability of sperm to fertilize an egg unassisted, and must undergo ART with ICSI (the injection of a single spermatozoa into an egg in the laboratory in order to achieve fertilization)
Diminished ovarian reserve – patients who’s ovarian function is significantly reduced (advanced reproductive age, abnormal ovarian reserve testing, prematurely menopausal…) are strongly advised to undergo ART with IVF or egg donation
Poor surgical candidate – patients who are determined to be at high-risk for surgery (extensive prior pelvic surgery/scarring, extensive pelvic scarring from prior pelvic infection or endometriosis, diminished cardiovascular function, major systemic medical illness…) must first undergo preconception screening to determine the safety of pregnancy, after which they may be advised to undergo ART with IVF
The California Center for Reproductive Health recognizes your desire to undergo a tubal ligation reversal. Our physicians will make every effort to approve your eligibility for the procedure while ensuring your safety and providing you with a reasonable likelihood for a successful and healthy pregnancy.
If you are eligible to undergo a tubal reversal or IVF, and you are uncertain which procedure will be most appropriate for you, the following comparison may be useful in making a decision:
Tubal Reversal
In Vitro Fertilization (IVF)
Cost
$6,000-$7,000 onetime
$10,000+ per cycle
Cost effectiveness*
Very cost effective
Less cost effective
Success rate
70%
30-50% per cycle
Multiple gestation (twins, triplets)
Extremely low chance
About 30%
Ectopic pregnancy**
Possible
Possible
Ovarian hyperstimulation syndrome***
No
Possible
Length of time to completion
1-2 hours
Several weeks
Stress/anxiety level
Very low
Very high
*Cost effectiveness refers to the likelihood of success (pregnancy) per amount of money spent. Because the cost of a tubal reversal is low and is a onetime expense which allows couples to try to conceive as many times as they wish and have additional children with no additional future costs, it is in general a very cost effective treatment. IVF, on the other hand, requires a large expense to achieve a lower success rate which may need to be repeated if more children are desired in the future.
**Ectopic pregnancy refers to a pregnancy which implants outside of the uterus, typically in the fallopian tube. An ectopic pregnancy is not a normal pregnancy and cannot be saved, requiring medical or surgical intervention (if not recognized early). The risk of an ectopic pregnancy following a tubal reversal is 5-7%, while the risk following IVF has been reported as high as 3%.
***Ovarian hyperstimulation syndrome (OHSS) refers to an exaggerated response of the ovaries to injected medications given during ovarian stimulation in an IVF cycle. OHSS may result in severe abdominal pain, nausea, vomiting, bloating shortness of breath and discomfort for days to weeks, which may require hospitalization and serial procedures to drain fluid which accumulates in the abdominal cavity. Because women who undergo a tubal reversal do not require any hormone injections to achieve pregnancy, OHSS is not encountered after a tubal reversal.
