Life is funny, isn’t it?
You thought you were finished having children, so you had tubal ligation surgery – also known as 'having your tubes tied' and moved on with your life. But things changed. Maybe you and your partner want to have another child, or maybe you’re in a new relationship and want to get pregnant again. Or maybe you never wanted children, had your tubes tied, but, years later, are ready for a baby.
Whatever the reason, you want to conceive and now need to decide how to do it. Your research has revealed there are two options – either keep your tubes tied and have In Vitro Fertilization (IVF), which bypasses your fallopian tubes entirely, or undergo tubal reversal surgery and attempt to conceive naturally.
Which should you choose? The decision is very personal and depends on many factors, including your age, safety risks, the number of children you want to have, cost and whether your initial tubal surgery is even reversible.
An option to consider is minimal-stimulation IVF. Mini IVF uses less medication than traditional IVF to produce eggs inside a woman's ovaries, resulting in fewer (but higher quality) eggs in which to make embryos.
This lower hormonal protocol has a much less taxing effect on the woman’s body, reproductive system, and emotional health than traditional IVF. Often called “natural IVF,” mini-stim is growing in popularity with patients who value a more holistic fertility approach that works with the native rhythms of a woman's body to produce eggs.
So, whether IVF or tubal reversal is a better choice depends on:
Whether you and your partner are fertile:
This might seem obvious, but if you have a fertility problem, such as Polycystic Ovary Syndrome (PCOS), Endometriosis, or Diminished Ovarian Reserve (DOR), you may need help getting pregnant through IVF even if you undergo a tubal reversal, making the reversal unnecessary.
The other thing you’ll want to do is make sure your partner has a normal Total Motile Sperm Count (TMSC) so that if you do undergo tubal reversal surgery, your chances of getting pregnant are not compromised by a low sperm count.
Because a woman’s fertility declines with age (starting in her mid to late 20s and accelerating when she is 35 years old, with a steeper drop by the time she is 37), the older a woman is by the time she is ready to have children, the lower her chances of conception.
For this reason, time is of the essence for women trying to conceive at older ages. Because recovery following tubal reversal surgery – during which doctors make a small abdominal incision to restore the connection of fallopian tube segments – can be prolonged.
Time to pregnancy for patients with tubal reversal can take many months (18 months, one review found.) Women 35 years and older may benefit from IVF, which has a shorter time to pregnancy (as little as four months) over the tubal reversal.
In addition, several studies looked at the cost between IVF and tubal reversal and found that for women 37 and over, IVF was a better decision because of its price to success rate ratio.
How many children you want to have:
Because pregnancy takes time and a woman continues to lose viable eggs throughout her pregnancy (and during breastfeeding) without ovulating, knowing how many children you want – and when you want to have them – is an important factor when considering IVF or tubal reversal.
While tubal reversal may be a good option for a woman in her mid to late 20s who only wants one child, it might not be a good choice for a woman who is 34 and wants two more children.
In traditional IVF, a woman can often make two normal embryos in one cycle. In mini-stim IVF, it may take two or three cycles since a softer approach is taken that doesn’t feel overwhelming to repeat several times.
Since IVF cycles only take a few weeks and embryos can be frozen for later use, a woman who undergoes a cycle on her 34th birthday can give birth to two children by the time she turns 37, even if she waits one year to have her second embryo transfer after her first IVF birth. That’s definitely a benefit to IVF – the timing is much more in your control.
The type of tubal ligation surgery you had:
It may surprise you to read this, but there are many different types of tubal ligation surgery.
Women can have their tubes banded together (bent and secured so nothing can pass), cut and tied, just cut, or removed entirely, which is called a salpingectomy.
Doctors cannot reverse a salpingectomy, so for this reason, you must talk to your surgeon about the type of surgery they will be performing on you beforehand so you know whether reversal is possible down the road.
However, if you’re wondering if your tubal ligation will be reversible, it may be better to consider long-acting reversible contraception, such as an IUD to maintain your options.
The most important thing you can do once you’ve had a tubal ligation is to get and keep a copy of the Operative Report. This describes exactly what the surgeon did and will be essential in determining if tubal reversal is an option.
Safety risks, including ectopic pregnancy:
Since both IVF and tubal reversal are medical procedures, there are risks to both. While some of the risks are the same (anesthesia risk, for example), there are two risks associated with a reversal that does not exist with IVF, traditional or mini-stim.
First, a woman’s fallopian tubes may be damaged during reversal surgery (or the initial ligation surgery, for that matter), compromising her ability to get pregnant and requiring IVF to conceive.
Second, reversal surgery puts a woman at increased risk for ectopic pregnancy, a very serious condition in which the pregnancy implants in the fallopian tube, and requires emergency care. There is also a risk with IVF that doesn’t exist with tubal reversal surgery, and that’s the rare, but not impossible, risk of Ovarian Hyperstimulation Syndrome (OHSS), where a woman’s ovaries are exposed to too much hormonal medication.
The good news is that mini-stim IVF does not carry this risk. In mini-stim IVF, we utilize a gentler medication protocol that doesn't push your body as hard to produce eggs and therefore doesn’t result in OHSS.
Cost vs. success rates:
Financial considerations are always one of the most critical pieces of the puzzle, and when compared with traditional IVF, tubal reversal is more affordable.
Typically, the reversal surgery cost is between $5,000 and $8,000, whereas one IVF cycle can cost, out of pocket, upwards of $20,000. However, you’ll want to consider success rates, too. One study showed a 70% pregnancy success rate for women who underwent reversal surgery – but they were younger than 35 years old, and it took some women up to 18 months to conceive.
When you look at those figures through the ‘success-per-cycle’ lens, you see pregnancy rates following tubal reversal are less than 5%.
With traditional IVF, the national success rate in 2018 for women under 35 was 50% per cycle, according to the Society for Assisted Reproductive Technology (SART). So, while tubal reversal is less expensive than traditional IVF, you might be more successful with IVF, depending on your age.
With mini-stim IVF, however, the cost is closer to that of tubal reversal.
Because fewer medications are used, and patients undergo a more natural treatment protocol, mini-stim IVF costs $12-15,000 out of pocket, all in. And while success rates are lower than traditional IVF per cycle, the gentler approach – which some preliminary research shows may be working with your body to develop higher-quality eggs– allows patients to do it several times to achieve pregnancy.
Should I do tubal reversal surgery or IVF?
So which should you do, then, IVF or tubal reversal?
We wish there were an easy answer, but it depends on all the factors outlined above. If you're young and money is limited, tubal reversal might make sense for you. But if you're in your early to mid-30s, value safety, affordability and want a more natural approach to IVF, minimal stimulation IVF could be exactly what you're looking for.
No matter what you decide, make sure you carefully consider the decision and know that your (renewed) family-building dreams are within reach thanks to advances in science and technology.