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Tubal Reversal or IVF?

A 38-year old patient asked PREG the following question:

“Would you recommend a tubal reversal, or should I proceed directly to IVF?”

Our expert embryologist, Heather Collins, replies:

“At 38 years old I would recommend moving straight to IVF for numerous reasons. By definition, a tubal ligation is designed to damage or “tie” the tube to prevent the oocyte being able to travel down the tube for fertilization and subsequent pregnancy. Dependent upon the type of ligation performed, a reversal may not even be possible due to the irreversible damage. Unfortunately, the state of the tube is not known until the tubes can be examined internally; sadly, in many cases, patients undergo the expense and pain of surgery, as well as the extensive recovery, only to be disappointed by the news that the condition of their tubes simply weren’t fixable. In many other cases, if the reversal can be done, the patient will have extensive scaring making it very difficult for the sperm and egg to ever connect prolonging the precious time and the number of monthly cycles it would take to conceive. Time is of the essence, especially if the patients desire multiple children.

Typically, when moving straight to IVF, a cycle can be planned, eggs retrieved and fertilized, embryos transferred, and have an outcome within 60 days. Oocytes are collected directly from the ovary so having a tubal ligation is of no consequence. While an oocyte retrieval is a “surgery” it is much less invasive with NO incisions, minimal discomfort, and very little down time. At 38, patients electing to move straight for IVF can benefit from pregnancy rates as high as 50%. As a huge bonus, cryopreservation of remaining embryos for further family expansion use can alleviate the pressure of the maternal ticking clock. The embryos are genetically frozen at 38 years of age, regardless if they are not implanted until 48.

One last point to mention when considering tubal reversal verses IVF: some insurances will NOT pay for the reversal, while they may offer some sort of infertility coverage. I would recommend checking specific insurance plans prior to either procedure. The financial counselors here at PREG can certainly help you navigate the many questions you may have regarding your insurance and benefits. For all these reasons, I would certainly recommend IVF over a reversal to any patients on the fence between the two procedures.”