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.