Tubal Reversal – A Waste of Time and Money?
Tubal Reversal – A Waste of Time and Money?
Here are a list of points I recommend that patients consider when contemplating tubal ligation reversal.
- One should be wary of what the proclaimed “success rates” are for tubal reversal; “success” should be measured in terms of live birth not just patency of the tube after surgery. The tubes may be open but not functionally normal; there is no way to test for tubal function.
- Tubal reversal is a major surgery that requires in most circumstances an incision in the lower abdomen several inches long. There is a hospitalization following the procedure for at least one night, possibly longer.
- The procedure and the following hospitalization is not paid for by insurance, there is no guarantee that it will “work” to establish tubal patency, and there is certainly no guarantee that pregnancy will result.
- A Hysterosalpingogram is necessary 6-8 weeks after the procedure to make sure that the tubes are open; this may or may not be covered by insurance.
- The couple must take into consideration other factors that may reduce the potential for pregnancy after tubal surgery. Thus, even though the surgery is successful in opening the tubes, there are other factors that affect the chance of pregnancy. Endometriosis, low sperm count, female age related factors, abnormal blood tests in the female, uterine abnormalities, hormonal problems, and ovulation problems will all adversely affect the “success” of the tubal surgery, usually lowering it quite significantly.
- After the tubal reversal, if the tubes are open on hysterosalpingogram, the couple will not have reliable birth control, whether they achieve pregnancy naturally thereafter or not.
- Thorough evaluation for other existing infertility issues (as one should do prior to IVF anyway) must be done prior to performing a tubal reversal. This is necessary to make sure that there are no other factors that may reduce the potential for pregnancy after the surgery. The female partner must make sure that there is no endometriosis (this requires laparoscopic surgery before the tubal reversal), that there are no ovulation problems, that there are no hormonal issues (done with blood tests), and that there are no uterine abnormalities (evaluated with fluid ultrasonography or office hysteroscopy). The male must have a semen analysis also.
- The age of the female is of crucial importance. If the female is over the age of 35, one can expect that the chance of pregnancy may be reduced based upon this alone, whether the tubes are open or not. Opening the tubes may take care of the tubal factor to a degree, but it will not address the age factor.
- If the couple does not achieve pregnancy, as frequently happens after a tubal reversal, IVF will be necessary anyway. With very careful selection and screening, we can choose some individuals that may benefit from tubal reversal surgery, but the vast majority will not. They are better served by pursuing IVF from the beginning.
The cost of IVF treatment is comparable to having tubal reversal surgery, however, the problems involved with the surgery (outlined above) are avoided. We often see couples that have had tubal ligation reversal or vasectomy reversal (all of the same issues apply for this, except, of course, it is the male that has the surgery) that have spent the time, effort and money on such procedures and end up coming for IVF anyway.
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