IVF vs. Tubal Ligation Reversal
Women who want more children after tubal ligation must decide between two treatment options: In-vitro fertilization (IVF) and tubal ligation reversal.
In-Vitro Fertilization (IVF)
This medical treatment involves controlling the woman’s natural cycle with hormone injections that stimulate the ovaries to produce a large number of eggs. The eggs are retrieved from the ovaries, combined with sperm in a laboratory and the fertilized eggs are placed inside the uterus. A single course or cycle of treatment takes three to eight weeks. The success rates are variable and depend on the reasons for infertility. In general, success rates per cycle are 10 to 30 percent.
Most IVF specialists advise patients to start the process by planning to undergo at least three cycles. The average cost of a cycle in the US is approximately $10,000 to $12,000, and can be as high as $20,000. Recently CNN and the NY Times have reported on the costs of in-vitro fertilization.
The most serious risk of IVF is ovarian hyperstimulation syndrome (OHSS). Ovarian hyperstimulation syndrome may be classified as mild, moderate or severe. The worst cases are associated with pregnancy since HCG (the pregnancy hormone) continues to stimulate the ovaries. Severe OHSS is a life threatening complication.  Despite careful monitoring, up to 33 percent of IVF treatments has been reported to be associated with mild forms of OHSS. Severe OHSS has been reported in three to eight percent of IVF cycles. Other risks of IVF are multiple gestations (30-50 percent) and ectopic pregnancy (three percent).
Tubal Ligation Reversal
This surgical treatment involves reattaching fallopian tubes that have previously undergone surgical separation (tubal occlusion or tubal ligation). The surgery time can range from one to five hours, and the average costs in the US can be $8,000 to $9,000, but can be as high as $25,000. Approximately 70 percent of patients who undergo tubal ligation reversal will become pregnant. Pregnancy rates for reversal depend on the patient’s age and the method of tubal ligation, and can range from 20 to 80 percent. The main risk of tubal ligation reversal is an increased risk of ectopic pregnancy (10 percent).
When to Choose IVF versus Tubal Reversal
IVF is a good treatment for couples who have unexplained infertility, severe sperm disorders and for women with severely damaged fallopian tubes from pelvic inflammatory disease (PID).
Tubal ligation reversal is a better treatment for women who have previously had a tubal ligation and who do not have any of the above indications for IVF.
Ligation Reversal Misinformation
Misinformation regarding tubal ligation reversal exists on the Internet. Most of this misinformation centers on the success of ligation reversal when compared to IVF, the cost and the risks of the surgical procedure.
Success Rates
The success rates of ligation reversal are related to the type of sterilization procedure a patient has undergone. At Chapel Hill Tubal Reversal Center, 69 percent of patients become pregnant after reversal of ligation and resection sterilizations. Clip and band sterilization procedures have excellent reversal results with 76 percent of patients becoming pregnant.
For IVF the success rates depend on the reason for infertility and can range from 10 to 50 percent. The average success of a single cycle is approximately 30 percent. The success rates of IVF decrease with maternal age over 35 years of age. After 40 to 42 years of age, IVF specialists will advise the use of donor eggs (eggs from another woman) to increase the chances of success. Many IVF specialists will attempt to increase the pregnancy rate of IVF by transferring several embryos into the uterus. This increases the chance of multiple gestations. Sometimes high order multiple gestations (triplets or more) will occur and these pregnancies can be very high-risk pregnancies.
Tubal ligation reversal has a higher chance of success when compared to a cycle of IVF by providing the couple with multiple opportunities to become pregnant and the ability to have more than one pregnancy without the need for hormonal control of the cycle.
Chapel Hill Tubal Reversal Center has success rates that are better than the 30 percent average success rates associated with an individual cycle of IVF.
Cost
Many sources quote tubal ligation reversal as high as $25,000. This is true if reversal ligation surgery is done in a hospital-based ambulatory care center or a hospital with an overnight stay. If a patient has a laparoscopic tubal ligation reversal or robotic assisted tubal ligation reversal, then they will pay much higher costs for surgery.
When performed as an outpatient procedure through a small abdominal incision and using microsurgical technique, ligation reversal surgery can be very affordable. Many patients are mislead to believe modern technology results in better success of ligation reversal; however, current medical literature does not support increased success rates for tubal ligation reversal when these surgeries are done laparoscopically or with robotic assistance. Success rates are similar with the use of these modern technologies when compared with abdominal incisions and microsurgical operative techniques. What is very clear is the use of these modern technologies dramatically increase the cost of reversal surgery.
The medical director of Chapel Hill Tubal Reversal Center, Dr. Gary Berger, has perfected a mini-laparotomy approach (mini-abdominal incision). He has continually refined this technique over the last twenty years. It allows easy access to the fallopian tubes and a quick operation. This minimizes the amount of time a patient spends under anesthesia. The decreased anesthetic time results in faster postoperative recovery and reduces the cost and risk of being under an anesthetic. Many hospitals charge patients for anesthesia by the minute and the longer a surgery, the higher the cost. This is true even if the surgery is done in a hospital ambulatory care center. The longer a patient is exposed to anesthesia, the more difficult and longer it takes to recover from the medication effects.
Chapel Hill Tubal Reversal Center is a free standing health care facility that is licensed by the State of North Carolina as a surgical center and has been accredited by the Joint Commission on Hospital Accreditation. Our free standing center is dedicated only to ligation reversal. We do not have to charge for anesthesia by the minute to help subsidize the services of other patients. To help patients who have ligation reversal at our center have a good postoperative period, patients stay at a local hotel and are seen the day after surgery by one of our tubal reversal nurses. Mini-laparotomy surgery is extremely safe with minimal postoperative discomfort and therefore, does not require an unnecessary, overnight hospital stay. A hotel stay is far cheaper than a hospital admission. As a result, we are able to offer ligation reversal for $5,900.
Risk of Tubal Reversal Surgery
Tubal reversal surgery is extremely safe in the appropriate patient. Patients who are not morbidly obese and who do not have severe heart, lung or vascular disease are excellent candidates for outpatient reversal surgery. There is a 10 percent risk of ectopic surgery after ligation reversal; however, with close follow-up of an early pregnancy, this risk can be appropriately managed to avoid the complication of tubal rupture.
We have had excellent operative results with few adverse outcomes in our reversal patients. We advise close follow-up care of our patients. Most suspected ectopic pregnancies are diagnosed early and treated with medical management to prevent complications.
Our Goal
At Chapel Hill Tubal Reversal Center, we are tubal ligation reversal experts dedicated to providing safe and low cost tubal ligation reversal. By keeping the cost low and focusing only on tubal ligation reversal, we make reversing a tubal ligation available to women who would be unable to afford the high cost of in-vitro fertilization or tubal reversal in the hospital setting.
June 27th, 2009 at 8:59 pm
TERRI – We have had several couples where both tubal reversals and vasectomy reversals were performed who now have children together. At age 33, the chances should be good.
June 27th, 2009 at 8:26 pm
I’m 33 years old and have three children. They were easy healthy pregnancies, labors (all 3 induced), and deliveries. I’ve had my tubes tied for almost 8 years. My new husband has two children and he had a vasectomy 5 years ago. We have children that belong to each of us, but we want to have a child between us (kinda like a your, mine, and ours thing). What are the chances of getting pregnant if we both get untied?
June 24th, 2009 at 7:49 pm
JACQUELINE – As long as you are having regular menstrual cycles and ovulating, it is feasible to have a tubal reversal. You can get specific information by calling a tubal reversal nurse at (919) 968-4656.
June 24th, 2009 at 7:33 pm
I just turned 41 and had my tubes tied for about 11 years. I don’t know what procedure was done. I have had 4 pregnancies; the 1st was a miscarriage. The 2nd I had to take progesterone. All babies were very big and required c-sections. I am overweight but otherwise healthy. I became pregnant very easily. What is the feasibility of tubal reversal?
May 29th, 2009 at 6:41 pm
Maureen
Contact our office and send us your medical records. I have some specific questions about your medical situation. After we evaluate your records and answer some basic questions about the nature of your medical situation and reasons behind your infertility then we may be able to offer some help.
May 29th, 2009 at 3:53 pm
I have had a couple cycles of IVF done in the past. I am 27 yrs old and got pregnant with IVF but miscarried shortly after. Doctors have told me IVF is the best option for me because they think scar tissue is blocking my tubes, plus they are afraid about clearing my tubes because they think I may have scar tissue throughout my insides. I had surgery when I was a baby and had all my large intestine and part of my small intestine taken out, so they think scar tissue built up in my tubes and everywhere else. I am out of options and am running out of money to try to have a baby. I would greatly appreciate some info, thank you. I do live in North Carolina.
April 8th, 2009 at 3:11 am
SARAH – The information that you have been told is not correct. It does not matter how long the tubes have been tied. The only effect this has on becoming pregnant is the difference in your age since fertility and pregnancy are related to a woman’s age. You can see the pregnancy rates after tubal ligation reversal for women in different age categories here.
April 7th, 2009 at 11:14 pm
I have had my tubes tied for 9 years and from what I read it is the best way to have had them done for sucess in the reversal. I have been told though after having your tubes tied for that long it will be impossible to concieve. Is this true I am planning on getting a reversal next year but afraid that what I have been told I will never get pregnant again
March 14th, 2009 at 11:01 am
Although possible, at age 49 the chances of having more children are very slight because of the natural decline in fertility as women age. At your age, donor egg IVF is the best treatment option.
March 14th, 2009 at 10:57 am
I am 49 I have tubal ligation 18 years ago I have a partner in my life for 16 years that don’t have any childrens he wants to have childrens would that be possible at my age to have tubal reversal and get pregnant.or is that too risky.
February 23rd, 2009 at 9:57 pm
[...] reverse tied tubes. This series can be educational, however, for all woman trying to decide between tubal ligation reversal or in vitro fertilizaiton (IVF). This article discusses Issues and Risks of [...]
February 19th, 2009 at 9:03 am
Jane
In general, tubal ligation reversal is more successful in obtaining pregnancy than IVF. You should send us your records and we can give you a more precise answer.
February 18th, 2009 at 11:49 pm
hi,im jane a 33 years old filipina.i had 5 kids from my previous marriage and had tubal ligation at the age of 25…now im with a new partner and planning to have a kid of our own next year,is there a possibility for me to undergo reverse tuballigation and get pregnant?about my lifestyle i not smoke and drink,i do always go mountain hiking and do exercise,im 5 ft tall and 50 kilos.hope someone can say a good advice ….
December 31st, 2008 at 7:20 pm
[...] There are several reasons why tubal ligation reversal is a better alternative to IVF to restore fertility after tubal ligation. [...]
November 9th, 2008 at 9:02 am
I had IVF on Oct. 20 2008 it failed. now I wish I had tubal reversal. I was thinking at my young age “42″ IVF would be the way to go. I went to Jordan because the cost was around $2,500.00 here in the states it’s $12,500.00. but my trip to Jordan after tickets, room, food and IVF I didn’t end up saving anything. now I’m out of a lot of money and thinking to try tubal reversal. please someone with a clear mine help me decide. V
November 4th, 2008 at 1:14 pm
Monica
You would be a candidate for tubal reversal. To be sure, send us your operative report from your surgery and your HSG. If your tubes do have some pre-existing damage this would possibly increase your chances of having an ectopic pregnancy after ligation reversal but you would have a chance to become pregnant naturally that you do not have now.
Can you give me a timeline of what happened and in what order? Pregnancies, ectopic, surgery, HSG, tubal ligation and IVF?
November 4th, 2008 at 12:57 pm
I have two children from a previous marriage. I also had two ectopic pregnancies. I had the metho shot for the first and then surgery for the second. When the Dr. did the surgery, he said I was very lucky to have the child I had and that he didn’t think I could conceive naturally again.
I had 3 pregnancies in the uterus. (One resulted in m/c). The 3 pregnancies were the month immediately following an Hysterosalpingogram…
I had my tubes tied after my second child, but have since remarried. Had one unsuccessful try at IVF.
Would I be a candidate for tubal reversal?
September 11th, 2008 at 8:05 am
AUGUST 28, 2008 I HAD MY SUGERY. TODAY I FEEL LIKE A NEW WOMEN THANK YOU. DR. MONTEITH
September 11th, 2008 at 6:26 am
It is possible to become pregnant after reversal at age 41. Your partner would have to have a vasectomy reversal and you would have to have a tubal reversal. You can see our statistics on our web page. Your situation is unique. You should email me for more advice.
September 10th, 2008 at 4:41 pm
At 41 I would have never thought about having another child but now I’m in that situation. My new spouse and I would like to have a baby and I’ve been reading on what would be best the IVF or The Tubal Reversal – I’m like Brigite in MO – is it even possible for me to become pregnant at my age after having my tubes tied 10 years ago? Also, to add to the complications my new spouse has had a vasextomy so what are our chances if any at all?
September 5th, 2008 at 9:12 am
Ok I’m very scared because I’m getting confused about which one to have done the IVF or Tubal Reversal.
I’m 42 years old I have different doctors telling me different things.All I want is the truth,is it even possible at my age?The tubal reversal is more what I was looking to have done,but again doctors tell me at my age the IVF is better.
I have this one doctor here in Missouri that wants to do a egg check should I?
All my test and husbands test have came back normal.
So please help if anyone really knows the answer.
Thank You;
August 12th, 2008 at 11:44 am
Information is such an important tool, especially when making an important decision like preparing one’s body to be pregnant again. Thank you, Dr. Monteith, for your comparative article.
June 19th, 2008 at 5:34 pm
I have thought about this alot ova the years….Dr. Berger will u still be around in 2011?
June 10th, 2008 at 7:11 am
If you want more children after having a tubal ligation there are two choices-IVF or tubal reversal surgery. Many patients tell us their local doctors try to push them toward IVF. As pointed out, IVF is more expensive and is a one shot deal. We encourage women to research both options and ask questions about cost, chances of pregnancy and what the procedures entail. I think most women would agree that tubal reversal surgery is the better option.
June 9th, 2008 at 1:24 pm
Tubal ligation reversal is definitely the better option for most couples looking to get pregnant again. Dr. Berger has made tubal ligation reversal even more effiective and and less traumatic through his 20 years of perfecting his technique and devoting himself to bettering this surgery.
June 9th, 2008 at 7:44 am
This is an excellent discussion of tubal reversal and comparison with IVF. Women looking for answers regarding childbirth following tubal ligation will be grateful for the clear explanation. Thanks to Dr. Monteith.
June 9th, 2008 at 6:46 am
This is a great topic, thanks Dr Monteith.
I hear this discussed by our patients so frequently when telling their story of how they arrived at the Chapel Hill Tubal Reversal Center. It is clear that they have weighed the IVF option and have decided that tubal reversal was the BEST choice for them.
June 8th, 2008 at 7:52 pm
Anyone who is serious about conceiving a child after tubal ligation must educate themselves about tubal reversal and IVF. The facts speak for themselves. Most women prefer to become pregnant naturally rather than undergo the alternative of in vitro fertilization (IVF). Tubal reversal performed by Dr. Berger is simpler, less expensive, and has higher pregnancy and birth rates than IVF.
June 8th, 2008 at 4:35 pm
I think that this information will help women see that tubal reversal surgery is a great option for women who wish to conceive a child on their own more than just once. So many times women are told that their best chances for pregnancy is to undergo IVF but as one can see, tubal reversal surgery is the better option for most women.