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    pink loader
    in vitro fertilisation (ivf)

    How to treat infertility after Tubectomy operation - Tubal Ligation Reversal VS IVF

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    Tubal Ligation Reversal is a procedure used to restore a woman's fertility after tubal ligation process. IVF is a process of fertilization where an egg is fertilized with a sperm in a lab. Tubal Ligation Reversal and IVF are the two methods to treat infertility after Tubectomy procedure.

    One of the most frequently asked questions associated with infertility care is whether a woman who wants to conceive after a tubal ligation procedure should have a tubal reversal surgery or should directly go straight for In Vitro Fertilization (IVF) procedure. While there is no uniform, and simple, answer to this question, the trend has been away from surgery and towards IVF procedure. A tubal ligation process involves the surgical interruption of both fallopian tubes. After completing the surgical interruption, it is necessary to intact tubes for egg and sperm fertilization to occur which results in positive pregnancy. Tubal ligations can be performed in two ways: either a portion of the tube is burned, or a portion of the tube is simply cut to remove the blocked portion from the fallopian tubes. It is important to use a good technique because the success of tubal reversal surgery greatly depends on how much part of the healthy tube was left after the initial tubal ligation procedure. If in case not enough was left then the surgeons will not even attempt a reversal as in such cases a tubal reversal surgery will not lead to a successful pregnancy. (1)

    In this article, you will get to know about:

    1. Tubal Ligation Reversal:

    A tubal ligation reversal is a procedure to reverse a tubal ligation when the fallopian tubes are cut or blocked to make a woman prevent pregnancy successfully. During a tubal ligation reversal, the doctor removes the obstructed area of the fallopian tubes. After that, the doctor attaches the fallopian tubes to allow pregnancy in a woman. (2) In most instances, the medical technique is a short-stay procedure using a small abdominal incision and microsurgical techniques to restore the connection between the obstructed tubal segments. As there are multiple risks involved such as infection, poor tissue healing, other damage to the fallopian tubes, uterus or ovaries. Each patient who is going or is about to go under Tubal ligation reversal must determine all these risks with their surgeons based on their individual medical case. Tubal ligation can be performed in multiple ways but the result is always the same i.e. an interruption of the fallopian tubes that prevents pregnancy. The most common method of tubal ligation is the surgical removal of the middle section of the tubes. This is because the main goal in a tubal reversal surgery is to reconnect the tubes to make them open for having a positive pregnancy. (3) The surgical method for performing a tubal reversal surgery requires only one day for the procedure and further, the doctor suggests seven days of light bed rest to the patient. After three months of surgery, the patients have to go through a Hysterosalpingogram (HSG) test to check the status of the fallopian tubes. This test is a diagnostic test performed using x-ray technology to show the flow of special radio-opaque contrast material dye through the uterus and fallopian tubes into the uterine cavity. HSG proves that there are no blockages remaining in the tubes that might prevent pregnancy.
    The recovery time after tubal ligation reversal depends on the expertise of embryologist and current health status of the patient. Tubal reversal is a major abdominal surgery that is more difficult. It takes a longer time to complete the original tube-tying operation. In some cases, women may need to stay in the hospital for 1 to 3 days. But nowadays, tubal reversal surgery is most often done using "microsurgical" techniques. An overnight hospital stay may not be needed. Women who have undergone microsurgical method usually go home the same day, typically within 2 to 4 hours after the surgery is complete. The doctor will prescribe painkillers to help the patient manage any discomfort after the completion of the procedure. After the surgery is completed, most of the women go back to their regular routine within 2 weeks.

    Tubal Ligation Reversal

    2. Tubal Ligation Reversal Procedure:

    Before starting the Tubal Ligation procedure the patient is given anesthesia. The surgeon places a laparoscope, through your belly button and into the pelvis area. This step lets the surgeon look at the fallopian tubes and decide if reversal surgery is possible. If the surgery is required then the surgeon makes a small surgical cut i.e. "bikini cut" near the pubic hairline of the patient. The surgeon then removes the clips or rings that were used to block the fallopian tubes of the patients. After removing the blockage the surgeon reconnects ends of the tubes to the uterus, using small stitches. (4)

    Tubal Ligation Reversal Procedure

    3. Pros of Tubal Ligation Reversal:

    Tubal Ligation Reversal is a medical process in which a small incision is made near the pubic hairline. A laparoscope or thin tube which is connected to microscopic instruments is inserted and used to remove the clips or rings used to reconnect the tubes to the uterus. The pros of Tubal Ligation Reversal are:

    • High success rate: The chances of having a successful pregnancy is higher in case of tubal ligation reversal. As according to a study, the pregnancy rates after tubal reversal surgery were 81% for women under 30 age, 75% successful for the women aging between 30-34, 65%  successful pregnancy for those whose age limit between 35-39 and 34% successful for the women 40 years of age and older at the time of their tubal reversal procedures. (5) The chances of pregnancy after tubal ligation reversal reaches as high as 80%.
    • Affordable cost: It is a cost-effective procedure. As the cost of tubal ligation reversal may vary from city to city and clinic to clinic. The cost also depends on the facilities and technology used by the center or the doctor. Every patient can afford the treatment and can fulfill their dream of parenthood successfully. 
    • Chances of having Natural Pregnancy: After performing tubal ligation reversal surgery there are high chances that the pregnancy can happen naturally. This makes tubal ligation reversal procedure a prominent solution for patients who have undergone the procedure of Tubectomy. (6)
    • Fewer chances of having ovarian cancer: It is proven in research that the tubal ligation greatly lowers a chance of having ovarian cancer in women.  

    4. Cons of Tubal Ligation Reversal:

    The cons of tubal ligation reversal are mentioned below:

    • Sterilization is permanent: Sterilization procedure is meant to be permanent after the tubal ligation reversal procedure. Getting sterilization reversed is a really expensive one and challenging for most of the patients. At times, it becomes very complicated. The success rates of sterilization reversal are not very high. There is a possibility that the fertility levels in the woman are affected in the long term. (7)
    • Doesn’t protect against STDs: There will be a need for certain protective methods to prevent any kind of sexually transmitted diseases, including HIV. (8) Tubal Ligation Reversal does not protect an individual against STDs. STDs means sexually transmitted diseases. This means they are most often but not exclusively spread by sexual intercourse like Chlamydia, genital herpes, genital warts, gonorrhea, some forms of hepatitis, syphilis, and trichomoniasis are some types of STDs. STDs are also called Venereal Diseases (VD).
    • Lead to Ectopic pregnancy: There is a high chance of having an ectopic pregnancy due to tubal ligation reversal procedure. This type of pregnancy occurs when the fetus grows in one of the fallopian tubes instead of the uterus. Ectopic pregnancy is a pregnancy in which the fetus develops outside the uterus, typically in a fallopian tube.

    5. Risks associated with Tubal ligation Reversal procedure: 

    There are certain risks associated with a tubal ligation reversal which include:

    • An insufficiency to get pregnant after the procedure: Pregnancy rates following tubal ligation reversal vary depending on a woman's age and other factors.
    • Infection: There is a risk of getting infected after the tubal ligation reversal is completed. A patient can consult her doctor in such cases.
    • Bleeding: Some patients can experience bleeding as well. If the bleeding is excessive, then it is suggested to consult the doctor immediately.
    • Scarring of the fallopian tubes: The surgery can leave some scars or marks on the patient's body. 
    • Injury to nearby organs: In some complicated cases, there are considerable chances that the nearby organs can get affected while performing the surgery.
    • Ectopic pregnancy: In some cases, an ectopic pregnancy can also occur where the embryo implants outside the uterus, usually in a fallopian tube.

    Risks associated with Tubal ligation Reversal procedure

    6. Tubal Ligation Reversal Success Rates:

    Success rates after a Tubal Ligation Reversal can vary widely, depending on various factors such as maternal age and the type of tubal ligation procedure that was performed in the patient. It's difficult to predict the results of pregnancy after a tubal ligation reversal procedure. But the younger women particularly those who age 35 and under tend to have much better success rates than the older woman. In most of the cases where tubal ligation reversal isn't successful, In Vitro Fertilization (IVF) may be an alternative option to assist you in becoming pregnant. If the remaining fallopian tubes are healthy and patient and her partner don't have any other infertility issues then they have a good chance of having their own child successfully after tubal reversal. Age plays an important role in whether a woman can get pregnant after a tubal ligation reversal procedure. Older women are much less likely to have a successful pregnancy than a younger woman. In general, pregnancy success rates varies from 40% to 85%. (9)

    Live birth rates following microsurgical tubal reversal have been stated to a range between 55 to 81 percent. These success rates are most strongly influenced by the age of the patient at the time of Tubal Ligation Reversal.  However, among younger women of 35 years with no other cause of infertility may result in up to a cumulative pregnancy rate of approximately 70 percent. While as per the perspective of cost-per-cycle tubal reversal is relatively efficient. 

    7. In Vitro Fertilization (IVF):

    In Vitro Fertilization is one of the best Assisted Reproductive Technology (ART). IVF has become the dominant technique for achieving successful pregnancy in women with abnormal or blocked fallopian tubes. IVF is a process which helps an egg to be fertilized with a sperm in the medical laboratory. After fertilization, an embryo is formed then is transferred to a woman’s uterus. This allows pregnancy to occur by completely bypassing the fallopian tubes. Since, the introduction of IVF treatment in the late 1970s, the success rate of this treatment has been improved dramatically. IVF is now applied to many additional fertility related problems like severe male factor or any unexplained infertility. The technique includes the hyper-stimulation of ovaries inserting a needle-aspiration and obtaining the oocytes and combining them with the sperm in a medical laboratory. After the formation of embryos, a healthy embryo is then transferred to the uterus of the woman. This procedure is less invasive than surgery and related post-procedure rest-time is less i.e. a patient can go to her daily lifestyle within a short span of time after IVF procedure. The greatest risks of IVF treatment are ovarian hyperstimulation syndrome (occurring in 1-5% of patients) and multiple gestations. As with any medical process, it is extremely necessary to choose an IVF clinic which believes in providing high-quality care. The outcomes for each clinic vary widely based upon the patient reviews and population attending the clinic as well as the experience and techniques employed by the IVF physicians and embryologists. Other than the techniques the cost of IVF treatment varies widely by region and clinic. Likewise, insurance coverage is prominently variable and differ widely depending on the individual policies, employers and insurance companies. (10)

    In Vitro Fertilization

    IVF treatment is also high in demand due to its recent advances and latest techniques which are enabling to achieve high success rates. The latest advances and new technologies minimize the chances of occurrence of multiple pregnancies and birth defects. However, according to a journal the refinements are being done in every step of IVF procedure i.e., ovarian stimulation, sperm collection, fertilization of eggs, embryo development in laboratory and embryo implantation into the uterus.

    8. IVF Procedure:

    IVF procedure includes further steps such as:

    Step 1: Stimulation: Stimulation is performed so that the surgeon can collect the eggs from the ovaries.
    Step 2: Retrieval of eggs from the ovaries: The eggs are collected through a minor surgical procedure called "follicular aspiration." A very thin needle is inserted through the vagina into an ovary, which sucks the eggs out. This process is repeated for each ovary.
    Step 3: Retrieval of sperms from the male partner or using donor sperm: The surgeon then collect sperms from the male partner which are later used to fertilize the egg.
    Step 4: Fertilization of eggs with sperms: First, the sperm and the eggs are collected from both the partners. The eggs are then fertilized with the sperm.
    Step 5: Embryo Formation: After fertilization, the embryo is formed which will be implanted to the uterus of a woman. A patient can get a chance to choose the healthiest embryo between multiple formed embryos. The patient can even tell embryologists to transfer more than one embryo to the uterus for increasing the chance of having a successful pregnancy.
    Step 6: Implantation of embryo into the uterus: At last, a healthy embryo is selected and is transferred to the uterus of a woman. (11) After two weeks, the pregnancy test is taken and if it results positive it indicates that the woman has successfully conceived.

    9. Advantages of the IVF procedure:

    IVF helps multiple infertile patients to have their baby with infertility treatments. The ultimate advantage of IVF procedure is achieving a successful pregnancy and a healthy baby without the usage of complicated procedures and surgery. IVF procedure makes this a reality for couples who would be unable to have a baby otherwise:

    • Blocked Fallopian Tubes: For women with blocked or damaged fallopian tubes, IVF treatment provides the best opportunity of having a child using their own eggs or sperms.
    • Patients with a low ovarian reserve: IVF treatment can be used to maximize the chance of pregnancy in older patients. In most of the medical cases, the embryologists opt Natural IVF cycle to focus on the quality of eggs, rather than quantity.
    • Male infertility: Couples with a male infertility problem will have a much higher chance of conceiving successfully with the utilization of IVF treatment than conceiving naturally.
    • Unexplained infertility: IVF can help in resulting in a successful pregnancy in a couple with unexplained infertility. IVF is one of the first solutions which are recommended for couples who are unable to receive a proper diagnosis of the cause of their infertility issues. 
    • PCOS: Polycystic Ovary Syndrome (PCOS) is a common condition in which a hormone imbalance leads to irregular menstrual cycles. IVF has resulted in a successful pregnancy for patients diagnosed with PCOS condition. 
    • Endometriosis: Endometriosis is a condition where certain parts of the womb lining grow outside the womb. These patients may go for IVF treatment, as it is proved itself as best and successful treatment. 
    • Premature ovarian failure: Women with premature ovarian failure can opt for IVF treatment using donor eggs, which generally has high success rates for patients opting for the procedure. (12)

    10. Disadvantages of IVF:

    There are some disadvantages of IVF treatment:

    • Ovarian Hyper-Stimulation Syndrome (OHSS): It is a risk that is only associated with IVF treatment where the ovaries are stimulated through the use of medications, to make multiple eggs. (13)
    • Multiple pregnancies: At times, IVF pregnancies result in multiple pregnancies. It is because 2-3 embryos are transferred to the uterus of a woman to increase the success rate.
    • IVF treatment can be expensive: IVF treatment is not cheap compared to other treatments. It is good to have a clear idea of the costs involved before starting a treatment. 
    • Higher chance of Ectopic pregnancy: IVF treatment includes the high risk of having an ectopic pregnancy i.e. up to 1-3%. There are high chances of having an ectopic pregnancy particularly in women with damaged fallopian tubes.

    11. Why is IVF Treatment Required?

    IVF treatment is required for treating various cases of infertility. It often offers hope where other methods have failed especially for those women who have been unsuccessful with other different fertility treatments, including fertility medications and Intrauterine insemination (IUI) and people suffering from most types of infertility, including Reduced fertility, Polycystic Ovarian Syndrome (PCOS), male factor infertility such as low sperm count, damaged or blocked fallopian tubes, women with uterine fibroids, reduced ovarian function, endometriosis, genetic disorder, and unexplained infertility.

    12. IVF Success Rates:

    IVF success rates vary based on the medical case and the age of the woman being treated, the underlying cause of infertility and sometimes according to the country as well as the clinic in which the treatment is performed. However, the estimate average success rates of IVF treatment varies between 29% and 43% for women under 35. For the woman who ages between 38 to 40, the IVF success rate varies between 15% and 27%.

    IVF Success Rates

    13. Factors that may affect IVF Success Rates:

    There are multiple factors that affect IVF success rate. Some of them are mentioned below:

    • Age factor: The age of the patient is one of the important IVF success factors to consider while undergoing IVF procedure. While younger women have higher chances of having their IVF successful, an older woman with fewer eggs and the lower quality of an older woman’s eggs decreases the chance of having an IVF treatment successful. In fact, the live birth rate of IVF success rate for women under 35 is 40 percent and women over age 42 have a 4 percent success rate.
    • Past pregnancies: More IVF success factors include past pregnancy details. If the patient got pregnant earlier with the same partner that’s currently undergoing IVF treatment, there is a greater probability of IVF success in this case. However, factors such as a history of recurrent miscarriage or complications may reduce the chances of IVF success.
    • Cause of infertility: Some of the female infertility problems do impact IVF success rate like uterine abnormalities, exposure to DES or fibroid. The factors of success of IVF treatment are based on ovulation. Ovarian dysfunction, like high FSH levels which indicate a low ovarian reserve, may decrease the chances of having a successful IVF treatment.
    • Lifestyle habits: A woman should stop smoking if she wants to increase her chance of having her baby successfully. In fact, many times a woman is required to stop smoking at least 3 months before starting her IVF treatment. As smokers require higher dosages of fertility drugs to stimulate their ovaries. They have lower implantation rates than non-smokers. Women who smoke require almost twice as many IVF attempts. A woman can increase the chance of her IVF success by reducing excess weight and maintaining a good weight. Overweight women also have reduced success rates with infertility treatments than women with normal weight. Underweight women are also at greater risk of having success with IVF procedure. 
    • Use of donor eggs: Factors such as egg quality and age of donor are an important factor in the success of an IVF treatment. Using donor eggs from younger women may increase the chances of pregnancy for women over 40 percent. (14)

    Tubal Ligation Reversal and IVF both the treatment help patients in fulfilling their parenthood dream. Each treatment has its advantages and disadvantages which must be compared at the time of finalizing the procedure. One can compare all the positive as well as the negative aspects of this article and can choose her perfect suitable treatment for pregnancy. Elawoman helps its patients to get an appointment with the best infertility centers and best infertility specialists. You can get your appointment fixed by visiting elawoman.com or else you can call us on  +918929020600.
     

    SOURCES AND REFERENCES:

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    5 Comments

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    Gargi Mishra

    After tubal reversal as I didn't have any other infertility problem, I was able to conceive naturally. I am now gifted with a baby boy and enjoying my life to the fullest.

    May 18, 2018, 3:52 p.m. 4.5

    user_img

    Anju Kaur

    I opted for tubal reversal as I had some problem with my fallopian tubes. After this, I was able to get pregnant without any further operation.

    Dec. 28, 2017, 1:04 p.m. 4.5

    user_img

    Sakshi Panwar

    My sister went through tubal reversal but couldn't conceive naturally. Then she opted IVF and now she has a 3 year old boy.

    Aug. 24, 2017, 5:04 p.m. 4.5

    user_img

    Phinni Manalo

    Infertility treatment like IVF or In-vitro fertilization is opted by many couples who choose to get the tubes tied and later on face challenges in conceiving. Test tube baby can also be a option after tubal ligation.

    Aug. 24, 2017, 5:02 p.m. 4.5

    user_img

    Mahesh Kumar

    I'm 33 so my doctor asked me to go for tubal reversal rather than opting for IVF. I don't understand why I have been recommended tubal reversal. I think I need to change my doctor.

    Aug. 24, 2017, 4:07 p.m. 5.0

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