This is a question I get quite often. In my opinion, a more useful question is: “Which is more efficient?” Let me first say that there is a relatively high birth rate following tubal ligation reversal (reanastomosis) when viewing a long term time horizon. In successful surgeries, the birth rate within 3 years of the procedure is approximately 50%. By comparison, when IVF performed in a center of excellence, the birth rate is comparable following a single attempt and is far less invasive than surgery. And unlike tubal reversal, IVF does not require hospitalization or an extended recovery period. Moreover, by doing IVF and leaving the tubal ligation undisturbed, the woman retains subsequent control over family planning without having to resort to using some other form of contraception.

Another point to be considered is the high incidence of tubal or ectopic pregnancy following the performance of tubal reversal (about 20%). Major surgery also requires a few days of hospitalization and subsequently a few weeks of convalescence. There is also a risk of post-operative complications, increased cost, time away from work, incapacitation, and significantly greater discomfort. The cost of a full cycle of IVF is, in fact, comparable to that of tubal reversal surgery.

In my opinion, provided that IVF is performed in a program with high success rates, tubal surgery for fixing damaged or blocked Fallopian tubes, with few exceptions, can no longer be justified financially or ethically.