How do I choose between tubal reversal and IVF?

Tubal sterilization is the most common means of birth control used in the US. This permanent form of contraception will not allow you to subsequently attempt pregnancy unless you undergo another surgical procedure (tubal reversal or microsurgical reanastomosis) or have an in vitro fertilization (IVF) procedure.

The success of tubal reversal surgery is dependent upon the amount of fallopian tube remaining after the sterilization, and whether the surgery involved the use of cautery or burning the fallopian tube. Other factors include the quality of the male partner's sperm, female age, and egg quality and quantity.

If the male partner has poor sperm quality (low sperm count or motility), chances for pregnancy are reduced. However, IVF with ICSI can overcome this problem. Pelvic conditions such as endometriosis or any scar tissue in the area of the tubes or ovaries would also reduce the chances for success after tubal reversal surgery. However, IVF pregnancy rates are generally not affected by these conditions, so IVF is a better option in women with significant endometriosis or pelvic scar tissue.

Because the quality and quantity of eggs decline in some women at a relatively young age, testing the "ovarian reserve" is recommended before proceeding with either tubal reversal or IVF. Maternal age is the most influential factor and a major consideration in the decision process. Fertility steadily declines each year after age 34, and dramatically declines after age 38. IVF significantly improves pregnancy rates in older women.

When considering pregnancy after tubal reversal, the majority of women choose IVF over tubal reversal surgery. However, each patient is unique and an informed decision should be made only after a comprehensive physician consultation and thorough review of your medical history.

 

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