Choosing the right fertility treatment option can be a challenging decision for individuals or couples who are considering expanding their family. For women who have previously undergone tubal sterilisation, the options are in-vitro fertilization (IVF) and tubal sterilisation reversal.
Whilst both methods aim to help individuals conceive, they differ significantly in their approach, cost, success rates and risks. In this blog post, we will explore the pros and cons of IVF and tubal sterilisation reversal, providing valuable insights to aid in making an informed decision.
IVF: Pros and Cons
IVF involves the fertilisation of eggs and sperm outside the body in a laboratory, after which the resulting embryos (fertilised eggs) are transferred to the uterus. Eggs are collected from the ovaries following ‘ovarian stimulation’ with injectable hormones that encourage the ovaries to grow multiple eggs. Sperm is usually collected by masturbation. Here are the pros and cons of IVF:
Success rates: One cycle of IVF (one round of ovarian stimulation/ egg collection and fertilisation of eggs to make embryos) offers a 32% chance of pregnancy on average.
Overcoming infertility obstacles: IVF bypasses various causes of infertility by directly introducing embryos into the uterus, allowing individuals with complex fertility issues to have a chance at conception. Examples are for couples who have been trying naturally without success for over 6-12 months who have other causes of infertility such as a very low sperm count, blocked fallopian tubes or unexplained infertility.
Genetic screening options: IVF enables, whilst costly, preimplantation genetic testing, allowing for the selection of embryos free from certain genetic disorders.
Donor options: In cases where one partner cannot produce viable eggs or sperm, IVF provides the opportunity to use donor eggs, sperm, or embryos.
Costly procedure: IVF is often an expensive treatment option, involving multiple cycles of medications, making it financially challenging for some individuals or couples. It takes on average 3 cycles of IVF to have a successful pregnancy and live birth. A cycle of IVF can cost on average between £4500 and £7000+ (depending on treatment options and clinic attended).
Physical and emotional toll: The IVF process can be physically and emotionally demanding, with frequent doctor visits, hormone injections, invasive procedures and the potential for multiple failed attempts, leading to stress and emotional strain.
Risks: IVF carries a small risk of complications such as multiple pregnancies (1 in 15), ovarian hyperstimulation syndrome (OHSS, 1 in 20), injury to pelvic organs during egg collection (1 in 1000), not getting any eggs (1 in 400) and potential side effects from fertility medications (significant side effects uncommon).
Tubal Sterilization Reversal: Pros and Cons
Tubal sterilisation reversal (tubal ligation reversal) is a surgical procedure that aims to reconnect the fallopian tubes after separation during a previous sterilisation procedure. This surgery last between 1 and 2 hours, requiring a skilled surgeon experienced in the use of microsurgical instruments and techniques. It can be performed as open surgery through an old caesarean scar or alternatively as keyhole surgery through 2-3 small (<1cm) cuts on the tummy wall and in the tummy button.
Natural conception: By reconnecting the fallopian tubes, tubal sterilisation reversal allows for the possibility of natural conception, eliminating the need for assisted reproductive technologies such as IVF.
Lower cost: Compared to IVF, tubal sterilisation reversal is often a more cost-effective option, requiring a one-time surgical procedure without the need for ongoing medications or multiple cycles of treatment.
Emotional benefits: For individuals or couples seeking a more natural approach to conception, tubal sterilisation reversal may provide a sense of emotional well-being and fulfilment.
Success rates: Depending on the surgeons experience and skill, pregnancy success rates following reversal can be as high as 75%. Several factors impact success rates such as type of previous sterilisation (clips/ cut & tie) and the patients age, however success rates are consistently higher than with IVF and provide a more cost effective option for the majority of patients who have been sterilised.
Ovulation induction: For women who have irregular cycles/ are not regularly ovulating, tubal reversal can be combined with ovulation induction treatment to achieve pregnancy without the need for IVF.
Age is not as much of an issue: As a reversal allows a chance of pregnancy every month following surgery, as opposed to IVF which only captures a patients eggs in one month, patients who are older and have been sterilised will have an overall higher and more cost effective chance of conception after reversal over a 1-2 year period than with IVF.
Treatment of PTLS symptoms
Limited options for other fertility issues: Tubal sterilisation reversal only addresses the issue of blocked fallopian tubes. If there are other underlying fertility concerns, such as male factor infertility (no sperm or inability to ejaculate or maintain an erection) additional fertility treatments may still be necessary, and IVF may be best.
Surgical risks: Like any surgical procedure, tubal sterilisation reversal carries potential risks such as infection, bleeding, and damage to surrounding organs (click here for our webpage on risks of surgery). Recovery time can vary between 2-6 weeks depending on if the surgery is open or key hole.
Reversal of Sterilisation
32% / cycle
No need for surgery if male factor
Can use donor eggs/sperm
Option for several pregnancies
Higher success rates
Reduced risk of twins
Treatment of PTLS
OHSS – 5-10%
No eggs – 0.3%
Injury to pelvic organs – 0.1%
Ectopic pregnancy – <5%
Twins – 8-12%
Cycle cancellation – 0.3%
No pregnancy – 68%
Infection (sepsis) – 0%
Treatment for wound infection – <2%
Bleeding (post op) – 0%
Return to theatre – 0%
Damage to organs in tummy – 0%
Ectopic pregnancy – <5%
Twins – <2%
Failure to repair 1 or both tubes – 3%
No pregnancy – 30%
(Female Sterilisation Reversal Clinic Data 2023)
When deciding between IVF and tubal sterilisation reversal, it is important to consider individual circumstances, preferences, and medical advice. IVF offers good success rates for couples who would struggle to conceive even with open tubes, genetic screening options, and donor options but can be financially and emotionally taxing. On the other hand, tubal sterilisation reversal provides a more natural approach and can often be a more cost-effective option for expanding your family.
Consulting with a fertility specialist who performs both IVF and tubal reversal surgery will help you to weigh up the relevant pros and cons and decide on the best course of action.
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