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).
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.
Tubal ligation is a surgical procedure that blocks the fallopian tubes to prevent pregnancy. Many people commonly refer to tubal sterilization as having their ‘tubes tied’. The more correct medical term is tubal occlusion (occluding or closing the tube), because not every fallopian tube is ligated or tied when it is closed. There are many different ways to perform a tubal ligation, but all the procedures cause some destruction of the fallopian tubes. There are many ways to perform a tubal ligation: tying and cutting, cauterizing (burning) and clipping or banding the fallopian tubes are the most common techniques.
There are many different ways to block the fallopian tubes for tubal sterilization: 
Many patients seem to imagine the fallopian tube is like a shoe lace which is tied up like a bow to prevent pregnancy. As tubal ligation reversal specialists, we wish it were that easy- then untying tied tubes would be easier!
The Filshie clip causes bilateral tubal occlusion by squeezing a very small portion of the tube. The squeezed portion is deprived of its blood supply and eventually undergoes avascular necrosis (dies and is absorbed by the body). This causes the fallopian tube to be divided in half and the two ends to close up. The Filshie clip is held in place (in between the two divided ends) by a small amount of scar tissue which forms over the clip.
At first, the dye will fill the uterine cavity. It is essential that the dye actually enter the fallopian tubes up to the point where the anastomosis was performed. Often, this does not occur due to spasm of the sphincter between the uterus and tubes (shown by the arrows) or from mucus or calcium deposits in the proximal tubal segments.
If the dye passes through the anastomosis sites, the fallopian tubes are open. Most radiologists do not consider the x-ray to show tubal patency (openness) unless dye spills into the abdominal cavity. When this happens, the diagnosis of tubal patency is conclusive.
We often see x-rays where dye has passed through the tubal anastomosis site, but has not yet spilled into the abdominal cavity. This is due to an insufficient amount of dye being injected into the tubes. The radiologist may mistakenly believe the tube is blocked when in reality it is open.
