tubal ligation reversal or do ivf instead?

So you think you may want to reverse your tubal ligation?   There are many issues to consider before making a decision to go forward with reversal surgery or to undergo in vitro fertilization (IVF) instead. This discussion will give you the information you need to make an informed decision regarding surgery versus IVF.  

  •  Reversibility:  Many tubal ligations are reversible, but only if one area of the fallopian tube is occluded or destroyed by clip or burn techniques. If multiple areas have been treated, tubal ligation reversal is not a surgical option. 
  •  Type of tubal ligation:  It is very important for you to get the operative report to see which type of surgery was performed and the extent of tubal damage. For example, Fallope ring or Pomeroy tubal ligations can often be reversed if only one area of the tube has been treated. 
  •  Insurance:  Even if you have an insurance policy that “covers infertility”, the vast majority will not cover tubal ligation reversal. However, if you have the surgery and it fails, after one year you may often have insurance coverage for in vitro fertilization. 
  •  Costs:  IVF with Dr Laurence Jacobs at Fertility Centers of Illinois (both Chicago area IVF centers - Highland Park & River North) is approximately $10,000. However, several IVF centers charge as much as $12,000-$20,000 per attempt.   Laparotomy (regular incision) will cost approximately $25,000-$30,000 because it includes 2-3 days of hospitalization as well as the surgical and anesthesia bills. Laparoscopic tubal ligation reversal, which can be accomplished by a handful of skilled surgeons, generally will run $10,000-$13,000 since it can be performed as an out-patient procedure. 
  • Age of the female patient:   Women under 35 (usually with good egg/oocyte quality) can do either tubal ligation reversal surgery or in vitro fertilization (IVF) and expect a good outcome. However, women over 35 (with fair to poor egg/oocyte quality) may do better with IVF so that the best appearing and healthiest eggs can be chosen. The “ovarian reserve” of eggs can easily be assessed at any of our Fertility Centers of Illinois Chicago area fertility offices by doing a single blood test and an ultrasound on day 2, 3 or 4 of the menstrual cycle. (see the ‘ovarian reserve’ article on Dr. Laurence Jacobs’ website).http://www.infertilitydoc.net/pdf/OvarianReserveExplained.pdf
  •  Male factor:  A thorough semen analysis (SA) including ‘strict morphology’ should be done before a decision is made regarding surgery reversal versus IVF. If there is any significant male factor problem, IVF is the best choice since the best sperm can be utilized with IVF/ICSI (intracytoplasmic sperm injection) at both of our fertility IVF centers in Illinois in order to overcome male factor. (see the ‘strict morphology’ article on Dr. Laurence Jacobs’ website) http://www.infertilitydoc.net/html/male.html#function 
  • Surgical treatment:  Most true infertility specialists (reproductive endocrinologists) in the Chicago area will do an exploratory laparotomy with a large incision to do reversal surgery. This  involves  three to four hours of surgery and two to three days of hospitalization.   A few Chicago area reproductive endocrinologists can do tubal ligation reversal surgery by laparoscopy as an out-patient, usually costing far less and taking less time. 
  •  Will you need fertility therapy after a tubal ligation reversal?  If you are young and there is no male factor problem, trying on your own for six months to a year is reasonable. If, however, you are over 35, or there is mild male factor, ovulation induction with IUI may still be necessary in order to get pregnant.            (see article on ‘Clomid and IUI’ on Dr. Laurence Jacobs’ website)  http://www.infertilitydoc.net/pdf/CLOMID_IUI.pdf