Tubal Ligation

IVF after Permanent Contraception

One of the most common surgical procedures for permanent contraception in the United States is tubal ligation. More recently other, less invasive options for permanent birth control have emerged, including Essure® and Adiana®. However, many women who have a tubal ligation or other permanent contraceptive procedure later change their minds and desire a pregnancy. This is not uncommon when someone remarries and decides to build a family.

Generally, women who have undergone a procedure for permanent contraception have two basic options: a tubal ligation reversal, or IVF. In instances where the woman has utilized the Essure® or Adiana® methods of contraception, reversal is not possible, and the only option that remains is In Vitro Fertilization.

There are many factors to consider when deciding between undergoing a tubal reversal and IVF.

• The woman's age
• The method by which the tubes were ligated (tied)
• The general health of the ovaries, and
• The quality and quantity of the male partner's sperm.

Each of the above factors should be considered when weighing the two options. One should also consider the efficacy of the tubal reversal procedure. When the tubes are successfully placed back together, the expected pregnancy rate over the next three (3) years is reported to be between 50 – 70%. While there have been no direct head-to-head comparisons between IVF and tubal reversal, IVF confers a significantly shorter expected time to pregnancy with higher cumulative pregnancy rates. In general, patients opting for a tubal reversal tend to be young (less than 35 years old) with plans for multiple future pregnancies. Women older than 35 face a rapidly diminishing pregnancy rate, and should carefully consider all options available.

Ultimately, a woman who has had a tubal ligation and now desires to achieve pregnancy will need to carefully weigh the risks and benefits of both IVF and tubal reversal. The cost of each of the procedures can be similar. However, we suggest that the In Vitro Fertilization process will likely achieve pregnancy in a much shorter period for relatively the same cost of a tubal reversal. We encourage you to speak with your gynecologists and a qualified reproductive endocrinologist to better understand your options and the financial implications of each.