Question 28. If I had my tubes tied, can I have them untied?

This has been a busy couple of days here at Dominion as DrD is off for a well-deserved bit of R&R. Trying to do the work of 2 doctors is kind of like clapping with one hand...but so it goes. Today I was asked again about what to do in cases of previous tubal ligation. This clinical scenario comes up fairly frequently and so it is certainly a valid question to discuss. I have not done a tubal reversal surgery in many years and usually refer all interested parties to Dr. Gary Berger in Chapel Hill, NC. In spite of Dr. Berger's office being on the Carolina blue side of the Duke blue/Carolina blue divide, he is a skilled and caring MD with an office based surgery center. His price for a tubal reversal is very reasonable and for those patients sure about going down this path I think that he is an excellent choice and well worth the trip to NC.

However, not all patients are good candidates for tubal reversal and many end up considering Natural Cycle IVF or Stimulated Cycle IVF as better choices. Plus after having an IVF baby there are no concerns about birth control as your tubes are still tied!

So here is today's Question of the Day....


28. If I had my tubes tied, can I have them untied?


Fertile women who have had their “tubes tied” (tubal ligation) may do very well and achieve pregnancy with tubal reanastomosis surgery. Pregnancy rates of 70% to 80% are noted in women who undergo a tubal reversal procedure, depending on their age, the type of tubal ligation procedure performed, and the presence (or absence) of other infertility factors.

Most often, this repair (tubal reanastamosis) requires a laparotomy, which involves a bikini-line incision of the lower abdomen. This major surgery requires 2 to 4 weeks for recovery, and most insurers do not cover it. Some physicians have reported good success with laparoscopic tubal reanastamosis, but this approach can be more technically challenging. As a consequence, most women choose to undergo a nonsurgical IVF procedure instead. Studies have shown that IVF is usually more cost-effective than surgical reanastomosis of the fallopian tubes. Specifically, if the surgery fails to establish a pregnancy, then IVF may be necessary anyway. Patients with a previous tubal ligation are usually excellent candidates for IVF, including Natural Cycle or unstimulated IVF, given their previous fertility.

However, patients who are shown to have diminished ovarian reserve with a history of a previous tubal ligation should be carefully advised of the potential for a poor response to fertility medications. In such cases, tubal reanastamosis or Natural Cycle IVF may represent more appropriate options.