Tubal Reversal Surgery

Comparison of Tubal Reversal to IVF

The table below shows a detailed comparison of the advantages of IVF vs. traditional tubal reversal surgery vs. robotic assisted tubal reversal. Also, review tubal reversal outcomes by the type of ligation. In women where tubal blockage is the only cause of infertility, IVF success rates are typically high.

Fertility after Tubal Ligation: Comparison of IVF, Robotic Assisted Laparoscopy Tubal Reversal Surgery vs Mini-Laparotomy Tubal Reversal Surgery

The following table summarizes some potential pros and cons of the various procedures.

Factors

IVF


Robotic Assisted Laparoscopic Tubal Reversal

Tubal Reversal via Mini-Laparotomy

Age <35, adequate tubal length, normal uterus, normal egg quality testing, normal semen analysis

>50-60% delivered pregnancy rate per treatment cycle (1 month). >90% cumulative chance for delivery with 4 fresh IVF cycles.

5-15% delivered pregnancy rate per natural cycle after tubal reversal surgery, >50-60% cumulative chance for conception within 2 years

5-15% delivered pregnancy rate per natural cycle after tubal reversal surgery, >50-60% cumulative chance for conception within 2 years

Age 40, otherwise same as above

20-30% delivered pregnancy rate per treatment cycle, >60% cumulative chance for delivery with 4 fresh IVF cycles.

1-5% delivered pregnancy rate per natural cycle after tubal reversal surgery, >30-40% cumulative chance for conception in 2 years

1-5% delivered pregnancy rate per natural cycle after tubal reversal surgery, >30-40% cumulative chance for conception in 2 years

Age 44, otherwise same as above (most women have abnormal egg quality test results at this age)

2% delivered pregnancy rate per treatment cycle (not recommended). The use of donor egg should be considered.

<1% delivered pregnancy rate per natural cycle after surgery. Surgery is not recommended. The use of donor egg should be considered.

<1% delivered pregnancy rate per natural cycle after surgery. Surgery is not recommended. The use of donor egg should be considered.

Short tubal length or fimbriectomy (distal tube removed)

Same as above

Lower pregnancy rate and higher ectopic rate. Surgery is not recommended.

Lower pregnancy rate and higher ectopic rate. Surgery is not recommended.

Abnormal semen parameters (expected low fertilization rates)

Same as above

Lower pregnancy rate. Surgery is not recommended unless the use of donor sperm is planned.

Lower pregnancy rate. Surgery is not recommended unless the use of donor sperm is planned.

Marginal egg quality

Lower pregnancy rate but possibly a better option given the higher monthly conception rate

Lower pregnancy rate but possibly less expensive as multiple monthly attempts can be made at no additional cost

Lower pregnancy rate but possibly less expensive as multiple monthly attempts can be made at no additional cost

Poor egg quality (low egg retrieval score, high FSH)

Not recommended. Couple should consider the use of donor egg.

Not recommended. Couple should consider the use of donor egg.

Not recommended. Couple should consider the use of donor egg.

History of significant pelvic infection(s), pelvic adhesions, advanced endometriosis or prior ectopic pregnancy

No change in pregnancy rate.

Not recommended.

Not recommended.

Days off work for treatment cycle or surgery and recovery

2-6 office visits (30 minutes) over 10 days, 1 day for egg retrieval, 1 day for embryo transfer, feeling of pelvic bloating may last 1-3 weeks.

1 day for tubal reversal surgery, possible overnight in the hospital, possible 1-3 days at home for recovery, preoperative and postoperative office visit

1 day for tubal reversal surgery, possible 1-2 days in the hospital, 3-10 days at home for recovery, 6 weeks for “complete” recovery, preoperative and postoperative office visit

Time to conception

Usually within 6-12 months

Up to 1-2 years

Up to 1-2 years

Size of incision

No incisions needed, needle aspiration of eggs performed

3-4 small (<1 cm) abdominal incisions

One 5-6 cm lower abdominal incision

Risk for ectopic pregnancy (potentially life threatening)

1-2%

5-20% - dependent on tubal length, tubal opening size match, and associated adhesions

5-20% - dependent on tubal length, tubal opening size match, and associated adhesions

2 or more children desired

20-30% twin rate with transfer of 2 good day 5 embryos (more than 2 not recommended)

1-2% chance for twins in a natural cycle, if pregnancy is successful, no additional costs for attempting more pregnancies

1-2% chance for twins in a natural cycle, if pregnancy is successful, no additional costs for attempting more pregnancies

Need for contraception after delivery

Tubal ligation is still effective

Yes

Yes

Cost (prepaid cash prices)

$7,000 - $13,000 per treatment cycle

<$6,000 if done at Ogden Regional Medical Center

$10,000-$15,000 in Utah, <$7,000 in some tubal reversal surgery centers outside of Utah

Money Back Guarantee option available if no delivery

Yes, 100% of fees paid to RCC, certain restrictions apply, no refund for medication or anesthesia costs

No

No